I work on a med-surg unit with plenty of diabetic patients. Most are noncompliant with high A1Cs and are always demanding cookies.
I try to find a balance. Last week I had a 400 pound patient demanding multiple snacks outside of his diet. He had a wound that wasn't healing and I explained to him that high blood sugar levels could interfere with the healing process. He still demanded that I give him whatever he wanted. I managed to convince him to meet me in the middle and have one of what he wanted instead of two of everything and covered his carbs and blood sugar.
So question: when a diabetic patient demands sweets, has high blood sugars and isn't NPO or clear liquids for a procedure, do you just continue to give them all the snacks they want? Or do you insist that if they want to be noncompliant with the hospital diet that they must get their own treats?
I used to work on a vascular surgery floor, with a ton of non-compliant diabetics coming in for amputation after amputation (half a toe...the whole toe...half the foot...the whole foot...BKA...AKA). You really can't change people who don't want to change, but I wouldn't enable their destructive behaviors.
I would never last on a floor where the manager didn't have my back. Writing nurses up for not getting a diabetic a soda? No way.
I educate and encourage compliance, but if they know what they're doing and they don't care, they get the snacks and I keep my sanity. These people don't just ask and accept "no" for an answer. They call over and over, beg, cry, follow staff around the hallway, etc. It takes time away from other patients who actually want to get better.
I do report their behavior to the MD and occasionally ask for an extra accucheck with SS coverage to keep them from getting critically high overnight.
It's their right to slowly kill themselves! Sucks, but I'm willing to bet that your hospital wants you to run and get whatever they're requesting---customer satisfaction survey's and all dontcha know!
Hospitals may be different. At the "transitional care center" where I work (SNF) we just document non compliance. And document patient education. I agree with you. We can't take food away from them if family brings it, etc. *eye roll* We will take away alcohol from ETOH patients.
Your patients' glucose become critically high from having some peanut butter crackers?
I wouldn't be funneling M&M's all day but just what kind of snacks do you guys carry on your units?
We carry juice, a few types of crackers, jello, pudding, etc. The critical highs don't come from one snack, but from many. We have patients who will eat all the food on the unit if we let them. They'll also order food for delivery, eat off their roommate's trays and usually have surplus candy in their nightstand drawers ...just in case.
Nope, I tell them I will give them what is allowable on their diet. If they want more, they have to ask family to bring it.
This is what I do also. In my opinion they're adults and can do as they please providing they've been properly educated, but I try not to facilitate the behavior. I had a 31week pregnant patient last week admitted for seriously uncontrolled DM who was demanding a Pepsi. I tried to be kind about it but told her all I could bring was diet soda. The baby was delivered a few hours later for crappy NST/BPP. I wouldn't have been able to sleep knowing I'd had even a portion of a part in that. If she hadn't been pregnant with repetitively crappy strips I'd probably eventually just let her have what she wanted, like PP said I can't undo years of bad habits in one admission.
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
I used to work on a vascular surgery floor, with a ton of non-compliant diabetics coming in for amputation after amputation (half a toe...the whole toe...half the foot...the whole foot...BKA...AKA). You really can't change people who don't want to change, but I wouldn't enable their destructive behaviors.
I would never last on a floor where the manager didn't have my back. Writing nurses up for not getting a diabetic a soda? No way.