Patients who refuse to cooperate with medical/nursing treatment....

[deespoohbear]

I have just about had it with patients who think the hospital is a joke. I took care of a patient recently who basically refused to cooperate with the medical/nursing treatment and plan....This patient is morbidly obese (and no I am not exaggerating), one of the worst cases of cellulitis that I have ever seen in his lower extrimities....receiving antibiotics Q4....goes outside to smoke at least every 2 hours....then gripes at the nursing staff because his meds are late....(I, for one will NOT chase a pt down in a smoking area to give medication)...stated his PICC was infected and demanded it pulled (no S/S of infection, no redness, no edema)...(we pulled it)....requested to go to another department to see child who was being treated (an adult child with a minor problem according to the patient)....refuses to keep his legs elevated....never content with his food....multiple requests for coffee, blankets, etc....I just wanted to go in and say "Look here, buster...I can't help you until you are willing to help yourself...and I cannot heal your legs in 12 hours.....and if you don't like it we have this little procedure called leaving AMA, and would you like to try it? I will be more than happy to fill out the forms.....

People like this just make me livid....I wanted slap the s*it out of him, but I figured the mess would be too huge for me to clean up......This pt is probably going to end reporting me and the nurse before me, but I really don't give a crap....I refuse to bow down to non-compliant, arrogant, I can't wipe my own nose patients.....I have drawn my line in the sand....

[wolfie]

Working as an ED nurse I came across this alot and it's very frustrating. To relieve myself from all the frustration I first had to not take it so personally which was hard. Second I just adopted the attitude that this is the United States and they have the right to be stupid. It helped alot with my anger level.:chuckle

[sjoe]

Just remember to document all patient education and refusals in these cases. "The land of the free" even entitles age 6 inpatient children to refuse psych meds, so there is not much to be done on that score.

Just document and let it go.

[bossynurse]

Sometimes you just pray for an AMA!!!! Had a guy once that had a hx of heart and kidney transplant. Was admitted for "frequent falls". 1st I do not work on neuro unit I work on surgical unit but apparenty we had the only private room available. This guy was seen getting out of a car after a 1 hour disappearance from floor. He sent me down to security with a large sum of money to hold. AT 5pm I had done accucheck and given him some regular and longer lasting insulin(dont remember type and dose) Anyhoo at 1830 he isisted on another accucheck and told tech he would take his own insulin. He had apparently brought some from home and refuse to give it up. who knows what other meds he had hidden in room. I tried to tell him not to take it and why not to and he started cussing at me telling me to stay the f out of his room. Threatened to have his g/f meet me after my shift over. I recorded everything informed doc that pt may have taken own insulin but refused to tell me how much. He did same thing two night earlier. I heard the next day that night shift found him non responsive and had to inject dextrose. DUH! Next day tox screen drawn since he had left hospital day before. Positive for canibas. dcd home. the other night I found out he was found dead at home--too much insulin ! And to think that someone died waiting for a heart and someone had to die to give this idiot one.

[zudy]

I also work in ED, and I try not to let it make me crazier than I already am. Had a 20 yr old male come in a few weekends ago, c/o STD. Said,"I can't believe I've got the clap! I have ELEVEN kids, so you know I've been w/ a lot of women and this has never happened to me!" The dr told him where to go to have a free AIDS test done, pt demanded to have it done in ED. ( No insurance or job,natch.) Iwanted to ask him how he could afford 11 kids when it's all I can do to support 2 kids and work 2 jobs, but I'm tired of getting written up for my smart mouth.

[Q.]

When I hear of these patients, I always think of the line my husband always says:

Life's tough when you're stupid.

[deespoohbear]

Originally posted by sjoe

Just remember to document all patient education and refusals in these cases. "The land of the free" even entitles age 6 inpatient children to refuse psych meds, so there is not much to be done on that score.

Just document and let it go.

Oh, believe me I covered my butt pretty well as did the nurse before me you had this patient....my documentation has saved my butt from the frying pan several times in my career....

CYA is my motto!!!

Susy K-love your husband's saying. Priceless.... I will have to add that to my collection.....

[EmeraldNYL, BSN, RN]

Deespoobear, I feel your pain. Unfortunately these patients are all over the hospital, not just in the ER. You just have to do the best to help the ones you can (and who are willing to listen). It is sooo frusturating though.

[hoolahan, ASN, RN]

They aren't any better when they are at home, let me tell ya from the HH perspective. But fortunately, I just tell them like it is, in the language they understand, and then we can discharge them for non-compliance. They get re-referred back, but after a few episodes of non-compliance documented, our agency won't take them back anymore.

I like that diagnosis, TSTL, I may use that!

[deespoohbear]

I bet it is worse in the home because you are on their turf.... At least in the hospital I feel like that is "my" turf...and gives a little bit of an advantage....(sometimes).

[Stargazer]

Originally posted by Susy K

When I hear of these patients, I always think of the line my husband always says:

Life's tough when you're stupid.

Okay, that made me laugh out loud, but I actually think the opposite. Life must be relatively easy when you're too damn dumb to even know how dumb you are.

And ERNurse, the complete version of that saying is, "Too stupid to live, too annoying to die."

[Tweety, BSN, RN]

I know you're just venting and I feel you pain. They come to the ER and say "fix me". The come to the floor and it's a completely different story.

[K O'Malley]

We had a patient the other day with severe arterial blockages and way too young to be having these problems. She also happened to be a very heavy smoker. When we told her and explained how smoking can cause blockages she just said "that is the most ridiculous thing I have ever heard!" OK, lady, keep on smoking yourself to death and let everyone else pick up the tab for all your medical procedures.