Non compliance? - page 2

I'm just curious what you all think... I have a colleague who insists that when a patient is noncompliant regarding their diet, (diabetic CHF etc.) even when we document and alert the provider... Read More

  1. by   K+MgSO4
    I work with liver failure patients. We have them assessed by neuropsych if they are competent we will patch them up when they are ascitic, non compliant with low salt diet, still drinking etc. I always say we can fix many things....stupid not one of them.
  2. by   T-Bird78
    Pt has the right to refuse. You can educate pt and document, but also try talking to the familiy about it. My sister's MIL was on a low sodium diet and she'd eat their meals, but also beg my sister and BIL to bring her french fries. They didn't because they knew why she couldn't have it. I had a LTC pt in my clinicals who refused her meds every day, so after a set number of days the facility would contact her family so they knew she was refusing again and talk to the pt about it.

    What does your coworker suggest, sitting on people with a spoon and making airplane noises? LOL.
  3. by   hppygr8ful
    Quote from kbrn2002
    I work with a nurse that has a similar mindset. It's a SNF and many residents are there for the remainder of their lives, she will go as far as removing sweets from a residents room because they are diabetic and "can't have that." I am shocked she hasn't ever been in trouble for this, removing personal items from a resident is such a huge no-no. If the resident wants to be diet non compliant that's their choice, even if they don't have the mental capacity to make informed decisions for themselves.
    My mom who recently passed was in two different memory care facilities in the course of two years. The first was not so great. Smelled like piss all the time (though the staff and admin didn't seem to notice). My sister who lives several hours away sent her a 2 pound box of chocolates from her (mom's) favorite chocolatier. When we went to visit we asked about the chocolate and were told she was on a low fat, high fiber diet and could only have 1 piece a day. My older sister who was her POA asked why we had not been informed of this diet. She also stated the obvious which is that my mother was dying and if she wanted to eat nothing but chocolate cake and ice cream she should be able to do that. The facility said we had to sign a diet waiver which we did.


    In the mental health facility where I work patients are often placed on therapeutic diets. If they don't like it we have them sign a diet waiver. That way we have covered our bases as far as education goes and the patient gets what they want.


    Hppy
  4. by   kbrn2002
    Quote from hppygr8ful
    My mom who recently passed was in two different memory care facilities in the course of two years. The first was not so great. Smelled like piss all the time (though the staff and admin didn't seem to notice). My sister who lives several hours away sent her a 2 pound box of chocolates from her (mom's) favorite chocolatier. When we went to visit we asked about the chocolate and were told she was on a low fat, high fiber diet and could only have 1 piece a day. My older sister who was her POA asked why we had not been informed of this diet. She also stated the obvious which is that my mother was dying and if she wanted to eat nothing but chocolate cake and ice cream she should be able to do that. The facility said we had to sign a diet waiver which we did.


    In the mental health facility where I work patients are often placed on therapeutic diets. If they don't like it we have them sign a diet waiver. That way we have covered our bases as far as education goes and the patient gets what they want.


    Hppy
    We do something similar. It's a risk vs. benefits form that the resident or POA if applicable signs. Considering the population I work with I am all for this. At their later life stage it really becomes a quality vs quantity of life issue. At 80+ years old if a diabetic wants sweets they've certainly earned the right to make that choice
  5. by   Chisca
    After more than one dialysis patient argued with me that ice was not water I've decided you can have a 55 gallon drum of water if you want. And a salt lick.
  6. by   llg
    Quote from hppygr8ful
    My older sister who was her POA asked why we had not been informed of this diet. She also stated the obvious which is that my mother was dying and if she wanted to eat nothing but chocolate cake and ice cream she should be able to do that. The facility said we had to sign a diet waiver which we did.
    Hppy
    That story reminds me of my grandmother. She had dementia -- and was not a pleasant person to be around during the final years of her life. She was in a very nice LTC with a great staff. My parents couldn't see any reason try to force her to live a health lifestyle to prolong her life a few months. So they got an order written that she could have all the chocolates that she wanted -- and a glass of Irish Whiskey every evening. The goal was simply to keep her happy.
  7. by   Here.I.Stand
    The way I've always taken the "diet order" isn't necessarily to make sure we police their intake, but 1) to ensure that the kitchen delivers the right food, 2) to ensure we know what is ideal for the pt as part of their plan of care, and 3) so we know what ideal-world info to teach the pt.

    I personally wouldn't provide food not in their diet order... unless the pt is receiving comfort care or other situation where the pt shouldn't HAVE a diet order. If the pt is a 40 yr old with DM II and a giant non-healing butt wound with BGs in the 400s, heck no I'm not making a Snickers run.

    But if their doting wifey brings a Snickers, taking it away is called "theft."
  8. by   marable
    I did my patient teaching and felt like my responsibility ended with my last sentence to them....I even told a few of them that my responsibility ended with my instructions , they could benefit from my education and experience or choose not to , their call....Sounds cruel but what else can a nurse do ? It is up to the patient ....

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