Are patients allowed to order food from outside places and have it delivered to their rooms if they are on anything but a regular diet?
Right now we have a morbidly obese pt. who is a raging diabetic. He's on a diabetic diet. He can not even move himself around in the bed independently. All of us have been stressing our backs lifting his legs, pannus, arms, etc. so that he can turn and reposition. Getting him to sitting position on the edge of the bed is a real back buster. Don't even get me started on the two hour long dressing changes.
Just about every night he orders large amounts of food from the local fast food delivery places.
I understand that food is an addiction and free will and all of that but he is not complying w/ his prescribed diet which is affecting his ability to heal.
We had a another situation w/ a diabetic dialysis pt. who the doctors allowed to be on a regular diet. He needed to have his gallbladder taken out but refused. He would order burgers and fries and nibble on them all night while at the same time getting Phenergan q6hr and Dilaudid q3hr for his nausea and stomach pain. He'd refuse his Carafate, Reglan and Pepcid. And dialysis for days at a time.
Both of these pt.s could be verbally abusive and demanding to the staff. It is so frustrating that the doctors don't put their foot down and tell them that they cannot have a regular diet. Why can't the docs discharge them for non-compliance? We are basically just boarding these folks
b/c they refuse everything that will make them better.
I've been a nurse for a long time and I know the answer...customer satisfaction. But it feels good to vent.
I'm still curious about the ordering food from outside places, though. And, do you all see any docs that will stand up to these pt.s and not allow them things that are hindering their healing? Or will discharge them if they are refusing all tx. that will make them better?
I myself am non-compliant (yes I will use that word) in many ways, BUT I do NOT expect anyone else to fix it! I am overweight, but very active. My friends had commented at one time on my failure to do everything I should (do not get enough rest, do not usually take care of myself, etc) but as I told them, I take responsibility for my actions, and don't expect anyone to "fix me in spite of myself." And THAT is the difference!
Uh, people expect to be fixed for their imperfect lifestyle choices all the time. They may not all be breaking the backs of others, yet. Just how much must one weigh before their dead weight affects the backs of healthcare workers?
Yeah, the oozing over eating morbidly obese are not pleasant to take care of but considering the majority of our country can't or won't eat/move for a healthy weight, I see it as hypocritical to righteously set the bar just above one's own weight as the measure of non compliance.
Uh, people expect to be fixed for their imperfect lifestyle choices all the time. They may not all be breaking the backs of others, yet. Just how much must one weigh before their dead weight affects the backs of healthcare workers?
Yeah, the oozing over eating morbidly obese are not pleasant to take care of but considering the majority of our country can't or won't eat/move for a healthy weight, I see it as hypocritical to righteously set the bar just above one's own weight as the measure of non compliance.
I don't think the bar is set just above some other non-compliant person's weight. I think the bar is set at being unable to care for yourself. I think that is the point that most people become frustrated that you scream about your rights but then you can't even take care of yourself and someone else have to do it for you. That is the point that your decision infringes on someone else.
I once had a diabetic patient refuse certain quantities of insulin because "I know my body, I've been a diabetic for 30 years." Well, sir, judging by the fact that you're here for DKA and happen to be missing a foot, I tend to disagree.
I once had a diabetic patient refuse certain quantities of insulin because "I know my body, I've been a diabetic for 30 years." Well, sir, judging by the fact that you're here for DKA and happen to be missing a foot, I tend to disagree.
To the OP and all others using the term, noncompliance,†PLEASE STOP! This is a slur against patients and harkens to the archaic paternalistic system of medicine that has lead healthcare to its current sad, state. Continuing to use this term is indicative of the problems of why patients are ordering in food and of most problems in our system. (Reference: Handbook of Community Psychiatry)
First there is the issue that hospital food generally sucks. This is mostly due to cost cutting measures. If we can't have enough nurses on a floor, what makes one think that the food will be any better than MREs?
Next is an issue that medicine has historically (and continues to) overlook; that is the psychology. Do you think that diabetics don't know what 2 liter bottles of soda do to them? Why do they continue to drink them?
For those people, that may be the ONLY enjoyment that they have in life. Sad , but true. How many of us get to cuddle up to our spouse/partner/significant other? We have family and friends who offer us support when we face difficult situations. We have our pets that reduce stress and depression (Looking Into Dog's Eyes Triggers Release Of Love Hormone Oxytocin). Despite all the obstacles healthcare providers face at work, at the end of the day, their lives are much better than those of their difficult,†complex, or non adherent patients.
This, there is the issue that what the physician believes is the patient's goals are NOT necessarily so:
My grandfather (in his 90's) went to the hospital almost once every 6 weeks during his last 2 years of life for his sugar levels (diabetes). Against the advice of his doctors, he continued to smoke and drink soda until the end. As a family, we did not intervene other than paying for his healthcare. At that point, the 3 things that gave him the most pleasure in life were smoking, eating, and his cat (which I promised him I would take if anything happened to him).
How could we deny him these in the face of the hard life that he endured? This is the exact same situation as the person with lung cancer refusing a 5th round of chemo. If life were all about health and safety, we would have no firefighters, no explorers, no martyrs, and no heroes. The Buddhist monks seek enlightenment, even at the cost of their own lives. (See: Sokushinbutsu)
We all want what is best for others, but who gets to define what is best? Some issues of equal opportunity†stem from this. The issue of "women in combat†is not so much about women not being able to do the job as much as a gentleman would never subject a woman to such a degradation. This comes from the rules of combat when armies marched on to a field to face each other in a massive duel. (See: Gentlemans' War)
It was not from a degradation of women but from holding them in esteem. Yet, it has been argued in our enlightened society that denying women that opportunity (if they so choose) is wrong. It is time to apply this thinking to the patient encounter.
The most recent issue related to this comes from mammograms and colonoscopies for people in their 80s. (See: NY Times, "Too Many Colonoscopies in the Elderly") Would one label someone in their 80s refusing these tests nonadherant? Yet, people in their 80s are pushed for these tests.
Remember, when ever you point a finger to blame someone, 3 fingers point back at YOU! [\QUOTE]
My reply:
I am the OP. Thank you for your well written and thorough reply. That said, it was very condescending. You don't need to tell me to stop doing something IN ALL CAPS. I completely understand the role of food in comforting oneself and I understand that food can be just as powerful an addiction as any drug. I also understand that I am not always perfect in my lifestyle choices so I don't have the right to criticize others.
I may have given the impression that I am some kind of judging, Nazi nurse with a hatred for the obese. This could not be further from the truth. I am very very kind to all of my patients, almost to a fault. This pt. was verbally abusive at times but I never raised my voice or gave him any kind of attitude. I did his dressing change EXACTLY the way he wanted it done even though he was nit picky and it took me over an hour. I also spent a lot of time chatting w/ him about his life and trying to get to know him as a person because I wanted him to feel comfortable, liked and not judged. (And b/c I like people and like to get to know them.). I had a lot of compassion for his situation. I know that no one gets that morbidly obese because they love themselves and have had a perfect life.
It was not my intent to vilify the patients that I wrote about. My original post more than anything had to do with why the doctors were contributing to the patient's noncompliance (yes, I used that word) by intentionally prescribing a diet that was making the pt. ill. In essence, taking up a hospital bed while very little was being done to promote healing.
I merely wanted to know what other nurses thought of situation and how they would handle it.
The definition of autonomy by Merriam-Webster is: : the state of existing or acting separately from others.
By this definition, the diabetic in your example who exerts autonomy by drinking 2L of soda is in fact not really being autonomous at all when this act of autonomy lands him in an ER because his sugars are in the 600's. Once your autonomy requires 24 hour care by others in a hospital you have given up said autonomy.
When a person's autonomous choices land them in the hospital repeatedly, I have the right to voice some frustration over it on an anonymous nursing forum.
To the OP and all others using the term, noncompliance,†PLEASE STOP! This is a slur against patients and harkens to the archaic paternalistic system of medicine that has lead healthcare to its current sad, state. Continuing to use this term is indicative of the problems of why patients are ordering in food and of most problems in our system. (Reference: Handbook of Community Psychiatry)
Despite all the obstacles healthcare providers face at work, at the end of the day, their lives are much better than those of their difficult,†complex, or non adherent patients.
We're supposed to believe that "non adherent" is vastly superior to "non compliant?"
And to "Banterings": How do you have the right to judge that my life is superior to those of our "non-adherent" (non-compliant) patients? Perhaps I would prefer to be in the hospital (at least for a little while) getting all my needs met while getting attention and not needing to cook, clean, work two jobs plus live on a working farm with all attendant chores, pay all the bills, etc.? And yes, I self-medicate with food and caffeine, but I manage. And I am NOT judgmental, I have many bariatric patients who like me because I am NOT judgmental. I just see reality and don't sugar coat it. I discuss proper diet and continue to (gently) encourage better choices, often (usually) without success.
Sorry, sometimes I get rebellious when someone makes demands. Even if they preface it with "please," when they bold it and put it in all caps, it's still a demand and rubs me wrong.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
There is a nursing facility where they help people lose weight. They couldn't prevent people from ordering food. Had to do with patient rights.
I've seen this on TV shows about weight-loss facilities where a patient will keep on ordering huge quantities of food and shoveling it down. They never tell you who is paying the cost of the hospitalization. Inquiring minds want to know.
I don't give a crap anymore. Maybe I am jaded, but I have learned that the patients are going to do what they want to do and we (the nursing staff) can't change it; all we can do is educate and DOCUMENT.
The inmates run the asylum...I just wish the doctors would discharge them!
LadysSolo
411 Posts
I myself am non-compliant (yes I will use that word) in many ways, BUT I do NOT expect anyone else to fix it! I am overweight, but very active. My friends had commented at one time on my failure to do everything I should (do not get enough rest, do not usually take care of myself, etc) but as I told them, I take responsibility for my actions, and don't expect anyone to "fix me in spite of myself." And THAT is the difference!