sticknurse

Hello everyone, I am working with a challenging young man who suffered a spinal cord injury. He is 27 and preferes to sit up in his wheelchair for hours at a time despite our admonishments. I am looking for advice because he's refusing interventions and education attempts we've made so far. I am trying to find a way to impress upon him the risks he's taking and help him understand his risk. We also suspect ( I work in the home with another nurse) that he may be abusing his prescription valium as well. He is a recovering addict by his own admission and sometimes apprears to be "under the influence" of something when he is assessed. He also refuses vitals and asks us "don't write that I refused vitals." A nurse who works with him told me recently he threatened to fire her if she reported a new area of pressure she noted to the doctor. He basically told her if she called the doctor she need not return. What do you do with a patient like this? There's virtually no family support in place, his own mom stated "I don't want to be his back-up caregiver anymore, I've had it with his verbal abuse and manipulative behavior." (Mom is a social worker!) What would a prudent nurse do?

My sister was working in long term care (alzheimer's unit) and a patient of hers had bitten her tongue and it began to bleed. The poor lady had Parkinson's as well, and was shaking like a leaf. Well, my sister decided she would do well to give her an ativan and calm her down some, but when she returned with the pill, the poor woman got confused and instead of picking up her water for a drink with the med, she accidently grabbed a dog biscuit that she'd been feeding her little dog...(hubby was visiting from independent living area and brought the dog) my sister, in horror, said, OH NO Honey, spit that out! Well, the little lady spit it onto the floor as asked, and the dog ate the expectorated biscuit off the floor, but he also ate the ativan....poor dog, he did survive though. Anyone else got one? sticknurse

Hey just taking this to the people. What's your opinion? Are nurturing types like us often attracted to the wrong types? Do you do "everything for everyone" at home as well as at work? How do you cope with the situation? Where do you draw the line? Any advice?

There's just something in nurses I guess. We keep our eyes on others, like it or not! Once I went to my neighbor's house and since the weather was warm they had the screen door only closed...anyway I knocked on the door but no one answered, ( I didn't know this lady very well, just casually) Anyway, these legs were visible from the door, and they were not moving at all, no matter the knocking I was doing. Just two legs lying across the hallway, I freaked out and entered the house to help the fallen one and it was my neighbor's teenage daughter who apparently didn't realized she'd scared me half to death and thought no one in their right mind would just enter their house anyway! She screamed and it's a miracle they didn't call the police to take me away! Still amuses me after all this time.

I agree with the above poster, the best bet is to remove any reward she may be receiving as a result of the behavior. Good luck.

Thanks everyone for your input. I am an independent nurse and he is a medicaid client. The case manager is an RN and well aware of the situation, however since he "fired" (he thinks) her the last time she tried to remind him of his responsibility she is not too happy with him either. His own mom is a social worker and she is fed up with him as well, even though she is listed as the back up caregiver, she has stated that she doesn't want to be his go to person because of ongoing abuse she has experienced. He is difficult on a good day. The doctor is aware of his noncompliance, yet it goes on. I am pretty sure I just need to get myself off this case. Thanks for the input and advice again.

I am trying to care for a young man in him home. He is considered to be his own responsible party. The problem I'm having is he is not good about taking any initiative with his own health needs. For instance, he constantly refuses assessment, "no one takes my vitals", also, he has fired other nurses for calling the doctor with legitimate concerns. He fails to maintain the supplies necessary to adequately care for him ie. gloves, catheters, etc. There is almost no family support, only a mom who we may or may not be able to get hold of. He denied her existence at first, then another nurse told me about her. I thought he had no back up caregiver at all. He has sort of a reputation and only one nursing agency is even willing to send staff in to see him, he has also been known to send a nursing assistant away or tell her her services won't be needed, then turns around and expects his homecare nurse to perform the aides job, which wouldn't be so bad except we are only authorized to spend an hour with him and only allowed to provide a specific NURSING service, not everyone's duties. Further problems arise when he surprises us with these requests and we must choose to make him happy or keep other client's visits on time. He has become a problem also due to his failure to be honest with us (the nurses) about new orders and refusing to answer legitimate nursing questions as in "Have you been eating?" Or 'How is your pain?" This client's attitude ranges from ignoring the question altogether to outright hostile responses. I am at my wits end. Any suggestions? Sorry so long.

I was an "Electronic Warfare Signals Analyst" and that's all I can tell you!!

I went to the local library and asked about memory related videos (at that time there were still videos, geez) anyway, I checked out one on Memory Enhancement, can't remember the title exactly, but it taught techniques to remember things visually and believe me it works. It has something to do with the brain and visualizing what you want to remember. I remember drawing little sketches of "ribosome man" and had him doing things in little cartoons I drew for myself, and I made the dean's list while cutting my study time down about half. I also made pre-tests of the material and then I had to "take" my tests. It was boring but it did work. Here's an example of the first technique, I bet you will remember it tomorrow if you hear it today... you're leaving for work in the morning and the dh says, Oh by the way honey, can you pick up some milk, lettuce, tomatoes, ketchup, mustard and napkins on your way home tonight? Well, you don't need a post-it, you just go out and get in your car and imagine a big head of lettuce bouncing up and down on the hood of the car, with the tomatoes orbiting around it like planets, but the lettuce is splashing mustard and ketchup all over the hood when it bounces, and someone is pouring milk down the windshield, ooh no, there's even napkins stuck in the mess all over the hood. The more emotional the reaction to the visual, the better you will remember it so it's good to incorporate something that will give you a strong reaction. when i read the above, I get mad cause I love my car and hate to imagine it that way. That reaction will also help me remember!! Humor also works very well. Make super heros out of your biology notes!! Good luck. Remember we don't use our minds to their fullest potential, mostly because we don't understand how the neurons get connected the quickest. There are techniques that work and they will save you time if you check them out. Good luck!!

Thanks to all for your informative responses. I am "covering mine" with education and lots of charting! I also try to let the new nurses (he goes through them like cheerios) what they will be facing. I don't work for an agency so there's no policy i can use to get out from under this. I work for myself, and as a "prudent nurse" I try to do what I can to make him aware of any possible consequences he may face if he continues to refuse care. As far as a lawsuit claiming staff didn't assist him, well, he has a long history of this type of behavior from what I gather. He's been in and out of rehab, mom is fed up, dad is in prison, and friends that I've met are questionable as far as intervention potential....thanks for the advice. I will keep trying to convince him to change, but I fear to no avail.

I am providing him with educational material which will explain his risks, and charting all the responses I get when I attempt to enlighten him. He's very intelligent, but stubborn as well. We are concerned that one of his wounds is infected now and he's refusing to go to the doctor so far. I've never taken care of a more challenging patient....thanks for the advice!

I congratulate you on furthering your education!! So someone got the wrong impression. I remember getting flack when I thought I was just doing my job, (my first job as a nurse, I was a cna too) and all I did was review some of the issues I found while making rounds...well you'd think I hollared and carried on like a drill sgt. That's not even my nature. I tried to let the ladies I worked with know that I meant no harm, I only wanted what was best. I apoligized. Well, it took some time, but they finally accepted me when they realized I would answer lights, and help out whenever I could. It just takes time. One of my favorite mentors at that job was a nurse I absolutely hated the first 6 months. I'd ask her a question and she wouldn't even respond...it turned out she was practically deaf. I felt like an idiot for being mad at her for so long when i finally found out...just never know. We're still friends today 12 years later.. P.s. Don't be so hard on yourself, k? It causes wrinkles and stuff.

Call me paranoid, but I don't think I'd want that. Just think about the "confidential" stuff people let slip already....no way, not me.

Her behaviour was unacceptable. She's an adult. We have a responsibility to protect the vulnerable ones. We don't need nurses with abusive attitudes. I wouldn't feel bad about her departure. Too many times we enable these people. Wouldn't that "we feel bad we didn't include you" possibly reinforce to her that she was not that bad, and therefore wouldn't feel it necessary to change her behavior in the future? Don't prevent someone from feeling the natural consequences of their actions!!! How will she learn? Honesty Honesty Honesty!! she's a stinker.

Check with local better business bureau. Check the facility itself in person. Look for residents who are actively engaged in activities, and "interview" these folks if they're willing to speak with you. There will be other family members around, ask them about the facility. Are they happy with the place? Look on the internet for healthcare surveys which are conducted periodically by an independent entitiy. These surveys show information about problems the facility has been asked to address. Don't judge a facility based on the beautiful decor whatever you do, judge it based on the safety of its clients, and their overall well being. If you know a nurse, ask her or him to come with you and "check it out" you don't want to take "the tour" that the facility will offer, you want to investigate on your own. As a businessman, you realize I'm sure that they will be on their best behavior when they know you're coming...I've worked in several nursing homes and wasn't terribly impressed I'll admit. There are good ones out there too, but they're in my opinion, hard to find. Another consideration, would it be possible to let them stay home with nurses/aids doing visits? Some states allow clients to remain in their homes and recieve visiting staff. It saves the state money, and most people stay healthier when they stay at home. Less risk of facility acquired infection for instance, and more personalized care. I highly recommend that you ask about that if it's feasible. In Ohio medicare will pay for the homecare and so do some of the private insurance companys. I work as an independent nurse myself, and my boss IS the client, they can hire and fire their own staff. This allows the client to be in control and they love it. In a nursing home, on the other hand, mom and dad get whoever's on that day. It may be an agency nurse, (unfamiliar with the facility itself, never mind your parents) or a recent grad who has little experience and no support in her first job. You could get lucky with a nursing home, but in my opinion your loved ones would be happier and better off in their own home. Good luck and pm with any questions if you like. If you want to check availablity of home care in your situation, talk with a social worker or the doctor and see if you can find out about it. Hope this helps. Good luck.

I now have a very sweet and supportive husband. He owns his own business and understands the demands my business places on me. I recently started my own business and it can be a difficult thing at times. The reason I wanted to start this discussion is out of concern for anyone who may not have fallen in the proverbial hole yet. Let's help them recognize they are at risk at least. When I met the guy who ruined me for awhile, I noted that he had a college education (business major) and a very good job....but then he'd quit and be unemployed (playing golf all day) for 6 months at a time....waiting on the "right opportunity" he was a true con artist, and good salesmen. He knew the book "how to win friends and influence people" by heart and it was very effective. I don't assume that all the intelligent white collar guys are angels please. Knowledge in and of itself does not a good spouse make....thanks again for the advice. Btw, I took a class about boundaries in the midst of my divorce and surprise!! It was chock full of therapists, nurses, and other helping types....interesting....someone posted that she is happier being single and I agree, it's much nicer to be "alone" and happy than married and miserable. I've encouraged more than one coworker when they've decided to leave their abusive spouse, one that comes to mind had been beaten up and called a "fat cow" several times by her husband. she would come to work with the bruises, and crying alot...well, another nurse and I ended up going to court with her when she finally got a restraining order. This poor woman had no idea what her rights were, she thought she'd be destitute (they'd been married 14 years) if she left him. She's now happily remarried to a good man. I just hate to see some of the nicest people (nurses) get crapped on, it burns me up. we should help each other when we can. Thanks to all.

Thank you for your input. I am inquiring because I feel like I've learned the hard way personally, how to look out for myself. I used to allow my ex to cause me all kinds of problems. I finally let him go. I would have advised a client to get out, but I stayed and put up with it for a long time. I finally took a class about boundaries, where I learned to stand up and protect what was good about myself. I didn't have to be understanding when others abused me at home. I didn't have to make excuses for them ie. well, he's had a rough time, and he's emotionally compromised due to his childhood etc. There's no way I would go down that path again, but I did. Here I thought I was smarter than that!! Met alot of nurses along the way who had similar situations. Just wondered how you all have coped...keep em coming!!

I've been reading this thread for only 15 minutes or so, and I'm a bit disturbed with some of the views expressed by my virtual peers. It's sad that we are so quick to throw a stereotype label upon others without considering the individual. I take care of a young man who has two hard working parents, whose care is funded through medicaid. They are nice people who are constantly apoligizing for utilizing the funds our government and taxpayers have paid into. Recently I told them he needed to have his doctor look into some high bp readings, and there was hesitation because they didn't want to "use" the system. How much responsibility are we willing to bear when it comes to the clients who fail to seek medical help because they don't wish to be labeled? I lived on ramen noodles and peanut butter when I went to school, because my family did not approve of "charity" and I was discouraged from getting assistance. I was living with two small kids, recieving no food stamps, no educational assistance, and living off the little bit of money from my gi bill. I had an ex husband who was refusing to support his kids as well. The point is, some people who really could use the help, to heal, to be there for their kids, the people who don't abuse drugs, who are trying to get a hand, to become better, are penalized and looked down upon too. Btw, I made it thru by my d#*n self!!!!! I have no problem with medicaid, there will be abuse, but if there was no program, then who would you lean on when it all falls apart???

Nurses are hot and ready to party!!!!!(Bob and Tom show)

You sleepily ask your child if they've "charted it" when awakened with a request, then give them the ok to go when they confidently answer "yes, of course." You've responded with information about bladder capacity when asked about a bathroom stop while traveling...(esp. if you JUST stopped and know it's going to be a candy stop...) You've answered your home phone with "Goodmorning, south hall, this is (insert name) can i help you?

Took care of a "diva" once in the home setting. She had a habit of complaining about every thing and constantly tried to manipulate her caregivers, family included. I finally just sat down and had a truthful chat with her, told her I felt as if she'd forgotten that others had feelings too. while we're caring for the patient, it's ok to be honest, sometimes the truth can make things better. It can be delivered quite kindly too. Hey I'm really trying to help you, but you're (behaviors etc) is going to affect my ability to deliver what you need and possibly make people you need avoid you. I know that's not what you need...let's try another way. It works for families too, they often don't see they're alienating the ones who can help them.

Wow that's crazy I can't understand how i missed them!! Cool trick.

I was hospitalized in 1971 with Reyes syndrome. My mother tells me I had been impossible to arouse for a day or so before I was taken to the hospital. The interesting part is, I still remember a nurse coming in to check my temp. (rectally which I DID NOT APPRECIATE) and I remember my grandpa coming in with a mask and gown. I would hide under is gown to stay away from the nurses. Mom also told me after the situation was under control and I was recovering, I described my ambulance ride to the hospital (I'd been in a coma for at least a day by that time). I was 2 years old. Here's to all of you, for taking care of the little ones. God bless you.

Sounds like an interesting idea. It would be nice to see more of us pursuring just treatment on a wide scale. There's got to be some way to unite us. I would love to see a grass roots effort, to effect change. Good for you! Nurses so often "settle" for abusive work environments, because they no longer believe there's any better place, how many times have we said "they're all the same, may as well accept it"? Good luck to you. I think you've found a niche.

I am an independent provider. I enjoy working for me! if you have questions i'd be happy to try to help. Good luck!