Patient behavior that ticks you off

jnette, ASN, EMT-I · Mar 1, 2005

Only two things that I can honestly think of, Zebra.

The first (and most important) is total noncompliance with fluid and potassium/phos. restriction.. and by that I don't mean those who allow themselves occasional treats (as i know I surely would!) or who try, but seem to have a difficult time. No, I mean the few who truly ignore everything you try so hard to do to encourage them to help themselves in this area. Where it goes in one ear and out the other.. totally. The ones who CONSISTENTLY come in with 6-8 kg. of fluid..and not over a weekend, either ! (and then complain of cramps, etc., when you try to remove at least MOST of it as you know you'll never get it ALL.)

The other (more trivial, but yet annoying) behavior is the impatience re "is it time for me to comce off yet"?

While we all certainly understand how difficult it must be to sit in that chair for 3-4 hours, they KNOW (after how many years now?) :chuckle the sound of the "time to come off alarm".. then there's the impatience when they are through holding their sites and you are tied up with a bleeder or some other incident, and they start getting grumbly. etc. Granted we DON'T have many of these, but occasionally, this does rear its ugly head.

But the worst seems to be those who are in the waitng room, waiting to start their tx. on 2nd shift. Granted, they have set appt. times.. BUT... depending on what occurs on the FIRST shift, there is no guarantee that they will get on exactly at that set time. The chair they are assigned might still be occupied by the previous patient who can't get their B/P back up.. or could be having serious bleeding and will have to hold longer.. there are patients who might have been brought in LATE by their taxi or other transportation (happens a LOT).. and therefore started later.. and will also come OFF later. All these things some patients just don't seem to understand.. or want to (?)

And it is not like we haven't explained NICELY over and over and over again.. it's like "it's all about me" and don't try to explain, I WANT to be impatient and complain.

What happens is that this puts a tremendous amount of pressure on the staff, and believe me, we are under enough pressure as it is, from all that has been occuring onthe morning shift already..(tearing down the machines, cleaning them, and getting them all set up again, testing... while getting patients off, and ready, and out the door.)

Just SO MUCH is going on during turnover, that the stress levels are already through the roof. To then have a patient start peeping through the door or behind the drawn curtain (in our case) and pacing around.. or worse, start getting everyone in the waiting room going... this is more than we can handle at times. Our patient KNOW the routine... they them SELVES have been the one to hold another up on occasion through no fault of their own.. so it boggles our mind at times when they just don't seem to "get" it.

We can't run any faster, we can only work with one patient at a time..

I can't be at two or four different places at one time. I can't get the next person on until the first one is DONE. Shew !!!

Truly, that's about the worst frustration I can think of. The "impatience" aspect. And how it stresses us out even more.. and stress can cause a dang good nurse to make errors. And we sure do not want THAT !

I do appreciate you asking. As I said, we have a pretty darn good group of patients, and other than what I mentioned above, can't really think of much else. :)

imperial · Mar 1, 2005

Please do not take this the wrong way as it is not meant to be.... and, I realize the nurses/techs here at this board, are well trained and caring staff.

I think it would be helpful for elderly patients to know what irritates staff in order to make it a more pleasant experience. However, on the other hand, after working with elderly patients for quite some time, as well as consulting with long term care facilities, I have found that often, staff, do not understand the emotional aspects of what an elderly (versus younger) patient might be experiencing. Geriatrics is a unique area and the numbers of geriatric patients is rising every day. I would be curious to see what the staff in your unit have to say in response to your question, as well as those posting on this board.

In my observations I have found that staff become annoyed when elderly patients do not follow certain aspects of their care, or call out/yell when they need assistance. Now, do these patients have a call bell to contact staff when they need something? Why do these elderly patients not follow aspects of their care?

jnette, ASN, EMT-I · Mar 1, 2005

Please do not take this the wrong way as it is not meant to be.... and, I realize the nurses/techs here at this board, are well trained and caring staff.
I think it would be helpful for elderly patients to know what irritates staff in order to make it a more pleasant experience. However, on the other hand, after working with elderly patients for quite some time, as well as consulting with long term care facilities, I have found that often, staff, do not understand the emotional aspects of what an elderly (versus younger) patient might be experiencing. Geriatrics is a unique area and the numbers of geriatric patients is rising every day. I would be curious to see what the staff in your unit have to say in response to your question, as well as those posting on this board.
In my observations I have found that staff become annoyed when elderly patients do not follow certain aspects of their care, or call out/yell when they need assistance. Now, do these patients have a call bell to contact staff when they need something? Why do these elderly patients not follow aspects of their care?

imperial.. I'm not sure I understand your question as it relates to a dialysis unit.. or did you mean geriatrics in "general" ? (as in LTC)

Dialysis units do not have call bells, as the staff are ALWAYS in the room with the patients at ALL times. The room itself is small, and we are present at all times, so there would be no need for a callbell.

If any of our patients were to cry out, we would immediately respond to see just what the problem is, as this happens rarely, and would be a real concern.

As for informing our patients about what irritates staff, our clinical mgr. has often sent out letters explaining things. re appointment times, what to expect and not expect, she has gone above and beyond when it comes to being open and keeping our patients well informed about everything. As I stated earlier, this tends to be an issue with just a small handful of our patients, and it is more a "personality" thing, really.

Also, by no means is dialysis a geraitric condition.. our patients are all ages. :)

RRN · Mar 1, 2005

Many dialysis units DO have call bells. In many states it's madatory and the unit will get cited during an inspection if the call bell is not where the patient can reach it. A unit with 38 stations such as the one I worked in Cali is by no means "small".

Also in another post you made a statement that is not true. The DON or CM in some units DOES NOT need to have a BSN .. If that were true many units wouldn't have a DON/CM. It is true though that in order to have CNN behind a nurse's name that nurse does have to have a BSN.

And I believe the OP asked specifically about elderly patients.

Thanks

imperial · Mar 1, 2005

Yes, the dialysis populations is NOT just geriatrics, but more and more geriatric patients are in need of dialysis and the numbers are growing. I think the call bell issue is one that needs to be looked at. An example might be when staff are busy and a patient is feeling feint and can't call out. Having a mechanism in place might be helpful. Also, I see this as a tremendous part of the emotional aspects of dialysis treatment. Upon entering a unit, one might ask the staff, how do I get the nurse if I need someone and the reply is 'we are nearby all the time'.. However, having a means to contact staff is reassuring, esp when one can't yell.

I know in California, Georgia and Louisiana there is not one regulation that states one must have a call bell.

I wish that patients could play 'nurse for a day' and nurse/tech can play patient for a day',...... then there might be a better understanding....

RRN · Mar 2, 2005

In Maine there is a requirement for the patient to have a call bell within reach.

And I always tell my patients "You don't have to know my name to ask for help. Just say I don't feel good or I'm sick" I also tell them some of the feelings they might experience . Such as lightheadness or nausea. And I try hard to keep an eye on those yawning patients or the one's with a far off look in their eyes.

nosonew, BSN, RN · Mar 2, 2005

My issues are mostly identical to Jnette... the patient who refuses to be patient even when it is explained to them the prior patient had a medical issue.

And the few that gain huge amounts of weight and don't take their quinine before treatment...and cramp and cramp (very, very painful I know). However, we can only teach them and keep encouraging them to comply with doctors orders...we are not a babysitting service.

Or that one that feels the dry weight is incorrect, and wants his EDW increased, even though his chest xray shows fluid in his lungs... that is irritating to listen to and deal with day after day after day.

Regarding geriatric issues and call bells...

We do not have call lights except in the restroom and the isolation station, and I tell my patients at admission and off and on during their time with us that if they need our attention, they can do ANYTHING to get it...IF it is an emergency or they are concerned about something. That includes throwing their remote control on the floor...anything to get noticed during the frenzy of turn-over.

The main issues I discuss with new teammates regarding our elderly population is 1. Don't ever talk to them like they are babies and 2. Don't yell at them, most DON'T have a hearing deficit and those that do, wear hearing aids! Oh, and don't be disrespectful by saying, "honey", "sugar", "baby", etc... most adults don't appreciate that.

It is also interesting about how things are so different depending on where your unit is located. We are small-town mid-west. Most of clients are middle-class white farmer-types. They generally all have insurance of some type, have had good health-care, are generally compliant, and we have NO no-show people. This obviously makes our job easier.

Very interesting...

Nesher, BSN, RN · Mar 2, 2005

While I think it is noble of you ( Medicalzebra) and your fellow patients to want to change your behavior to suit the nurses - you have it wrong! The nurses should change themselves to suit the patients! You shouldn't need to be in that role.

In fact this leads me to a pet peeve I have about some nurses I work with. They complain about patients who are independent, want to make their own choices and don't want to do what the nurse wants when the nurse wants it. They are real people who don't want to be manipulated. The could be the core reason why the nurses get pissed at eldery people. Plus they probably don't move fast enough to please them. Nurses love control, and if they don't have it...watch out.

Opps just realized you were asking in particular about HD folks - my comments aren't related to that population, but in general may still apply.

JVanRN · Mar 2, 2005

oops

imperial · Mar 2, 2005

My first question would be -- Why is the patient wanting their EDW increased? Why is the patient drinking too much fluid? Why is the patient being non compliant with treatment? After these questions are answered, then there is a better avenue for communicating between patients and staff. AND>> "Can you (patient) tell me what is happening when you have to wait in lobby as we are busy that makes you impatient?" Asking thepatient what is happening with them or why they are reacting and trying to find out the reason often will lead to resolving the problem Perhaps, this is where the social worker can enter into thje picture.

jnette, ASN, EMT-I · Mar 2, 2005

Many dialysis units DO have call bells. In many states it's madatory and the unit will get cited during an inspection if the call bell is not where the patient can reach it. A unit with 38 stations such as the one I worked in Cali is by no means "small".
Also in another post you made a statement that is not true. The DON or CM in some units DOES NOT need to have a BSN .. If that were true many units wouldn't have a DON/CM. It is true though that in order to have CNN behind a nurse's name that nurse does have to have a BSN.
And I believe the OP asked specifically about elderly patients.
Thanks

Interesting.. beacause our unit is so small, I guess call bells aren't even considered... I can see that the big units would have them, although I don't know that they do in our area.. will have to inquire.

As for the BSn, the last I heard (several years ago) was that to qualify for DON/Clinincal Mgr. one MUST have their BSN. Our DON didn't have hers, either, but has been working on it for the past couple years in order to comply. She's about done now. I don't know if this is a STATE requirement, or national, but in our case, it IS true. I know they are allowing hte current DONs time to get theirs while keeping their current position, but they have to show that they are enrolled and actively working on getting their BSN. :)