"Spoiling" patients?

rkitty198, BSN, RN · Aug 18, 2009

According to the Nursing Practice Act where I live, Nurses are supposed to:

prevent complications, intervene if complications arise, and take steps to stabilize a patient if complications cannot be avoided.

Now, even though giving the patient a burger and fries may not, at that time, create diabetes related complications, but overtime it can.

I know you want this patient to have confidence in you and allow you to perform care for her. However you cannot do this by being an enabler of her bad choices. Now if she wanted to go and buy that candy bar herself, then that was her decision.

What you are doing is creating an environment where this patient may not let the other staff care for her. This can be very damaging to the patient (where if there was a time of crisis) and to the other staff who are trying to create a care plan.

I know as a Nurse we want the patients to trust us and like us so that we can provide the best care, but not at the expense of the patients health.

Pepper The Cat, BSN, RN · Aug 18, 2009

Your intentions may be good but you are creating problems.

if you continue to buy this resident special treats, she will begin to expect it of you. She will refuse to eat her meals because she knows you will bring her a special treat just to get her to eat.

And what about the other residents? Did you bring them burgers and fries too? Because maybe they don't really like the food offered either.

**canoehead, BSN, RN** · Aug 18, 2009

Are you willing to do that for her every day you work? She'll need sugars and coverage every day, and if you are setting up a barter of food for insulin/glucose checks it will be easy for her to ask for more and more. It worked for one day but you'll probably agree it isn't feasible over the long term, or for every patient that wants it.

The other nurse may be a bit crusty about how she expresses herself, but perhaps she has been around long enough to forsee what a PIA this will create in the long run.

morte, LPN, LVN · Aug 18, 2009

1) would you bring in opiates for a heroin addict?

2) would you bring in alcohol for an alcoholic?

NurseLoveJoy88, ASN, RN · Aug 18, 2009

or rather, residents. (i work in ltc) a fellow nurse accused me of "spoiling" my residents, and we had a spirited debate about it. she is an excellent nurse, but very much "by the book". the residents do not like her, and they let her know. what started the discussion was when one of the residents compared her to me, and said, "why can't you be more like that other nurse?", and she got a bit miffed, and said they only like me because i spoil them.
well, maybe i do, but i find that it makes everything go much more smoothly. for example, one resident is a very non-compliant diabetic, refuses fingersticks, insulin, won't eat the food, etc, so her sugars are always off, that is, when you can get the sugars at all. their answer is to force her to go to the dining room for meals, so they can monitor her. but she hates eating there, so she just makes snarky comments about the "jailhouse food", then goes back to her room and eats the crap she got out of the vending machine. lord only knows what this does to her blood sugar, because she won't let the other nurses do her fingerstick to find out.
well, i was heading out to a fast food place for my dinner, and brought her a burger and fries, which she scarfed down like she hadn't eaten in days, which she probably hadn't. of course it sent her sugar up, but since she was in a good mood because i had gotten her what she considered a decent meal, she allowed me to do the fingerstick, and give her the coverage.
miss "book nurse" said i shouldn't have gotten her the fast food, that she needed to eat her proper meal. perhaps she is right, but i felt i got better results by doing what i did. after all, she did eat, and she did allow me to stick and cover her afterwards, which is a lot more than book nurse was ever able to do. this resident is never going to be a compliant patient, and all the forcing does is **** her off and make her even more non-compliant.
in my opinion, sometimes you need to put the "book" away and deal with these folks on a more personal level, but they don't teach you that in nursing school.actually, in nursing school they did teach us this. i went through the very same situation as you accept i was that " book nursing student" my patient was a diabetic that was very out of control and she refused to eat the food that okay for her to eat. so my instructor told me that i needed to call down to dietary to order the patient a cheese burger and fries since thats what she wanted. because the patient was on a diabectic diet there was no way dietary would allow me to do this.so i had to go to the doctor and get an order for a nutritional consult just so this patient can get her cheese burger and fries. my instructor was not pleased until i had went through all lengths to get the patient her cheese burger.

never the less, i was unable to meet her request in time and her husband bought her in the cheese burger and fries. even to this day i would not feel comfortable giving a diabetic patient with high numbers a cheese burger and fries. the only thing i'm worried about with your patient is if she is going to expect a cheese burger and fries often and if not will she be even more non-compliant to the nurse that won't buy her fast food.

Ruby Vee, BSN · Aug 18, 2009

how many burgers and how many orders of fries to you want to spend your own personal money on for residents of your ltc facility? are you willing to swing by the pizza parlor and pick up a pizza for joe, because that's all he wants to eat? and by the way, mary wants a starbuck's mocha and mildred wants . . . . you catch my drift.

i suspect that crusty old "by the book nurse" is by the book for a reason.

you may be very popular with the residents now -- and you seem to feel very superior about that -- but your setting yourself and your colleagues up for some real problems down the road. i'd advise you to rethink your approach.

WalkieTalkie, RN · Aug 18, 2009

For some reason this reminds me of when I was in college and someone put regular dish soap into our industrial dishwasher. The e-mail we got said "While the intentions may have been good, the results were not..." Sure, it seemed like a good idea at the time, but in the end, it is harming the patient.

You're feeding into this patient's manipulative behaviors and you're not helping your co-workers develop realtionships with her. Have you spoken with dietary about maybe getting her other food choices? While it is certainly within the patient's "rights" to kill herself with food and poor choices, you shouldn't aid her in the process.

leslie :-D · Aug 18, 2009

In my opinion, sometimes you need to put the "book" away and deal with these folks on a more personal level, but they don't teach you that in nursing school.

would you really expect a school of nsg, to teach bribery and/or enabling of undesirable behaviors?

that is precisely what you are doing.

listen, there is nothing wrong with making your pts feel special.

but what you do for one, you do for all.

otherwise you could be accused of favoritism.

but what you are doing, is actually, rather manipulative.

you have a 'plan' with ulterior motives, that will result in getting needed tasks done.

to truly "spoil" a pt, you make them feel as if they are an exceptional person.

w/one pt, it may be as simple as squeezing their shoulder as you scurry by them.

for another, it may be complimenting/noticing their new slippers, or getting their hair done.

but it should never entail poor nsg judgment, or acts that can negatively affect the pt.

nurses (esp in ltc) need to present a united front.

while your heart is in the right place, you have much to learn.

a pt will almost always do what you want them to, if you have developed a trusting relationship.

you, a nurse, providing her with a fatty meal, is more damaging than the pt grabbing something from the vending machine.

chances are, you could stand to learn a thing or two from the more experienced nurses.

your colleagues (and pts) will thank you. :nurse:

leslie

ayla2004, ASN, RN · Aug 18, 2009

It is difficult to manage patient who are non complaint, sometimes you can get them to comprise of occasiool treats as part of the plan with taking meds as required.

Can't patient order requests from the kitchens?. could this be built into her care plan so often a week with medical approval and she may be more complaint if she has that control. so she can't play staff off against each other and decline care.

I have spoilt residents in the past because i liked them and while thye were good for me they weren'y for others

NotFlo · Aug 18, 2009

I think this is a bad idea. Sure, it "worked" for one shift, but are you going to be purchasing a burger and fries for her every time you work? Is she going to be as willing to cooperate with you when you work with her again without the bribe of junk food attached?

What about the nurses that work with her when you're not there, is every nurse supposed to run out for fast food every time they work with her so that she'll let them do an accucheck and provide insulin coverage?

I think you just made an already tough situation that much tougher for all your coworkers.

lisamc1RN, LPN · Aug 19, 2009

This may be one of the oldest tricks in the book. Resident sets nurse against nurse. Lifts one nurse up as the best nurse in the whole world because you will do what I want you to do. As your reward, I'll give you my finger and let you stick me. That mean nurse doesn't cave into me at all.

Then the kicker comes. You have to do everything she wants you to do. Believe me, she will forget your former kindnesses the minute you draw a line on what you will do to keep her happy and compliant. At some point, you are going to want to stop bribing her and get her to comply because it's the healthy thing for her to do. Once you do it, you are going to be moved into the "mean" nurse category, and another "nice" nurse is going to take your place for a while. It's pure manipulation and as long as it works, she'll continue to do it.