Say it ain't so...........

Davey Do · Mar 25, 2019

2 hours ago, AutumnApple said:
Do you truly think people check into hospitals just for social stimulation? Or are we jaded?

What a great topic, AutumnApple! I have wondered this myself.

Case in point: We have Frequent Flyer on the geriatric psych unit who shows up in ER saying they're suicidal. Suicidal because they couldn't buy the grown daughters' Christmas presents. Suicidal because the SSI check was late. You know what I mean.

Now, this is a low-maintenance patient that has never been a behavior problem and doesn't suck the energy from us. I can even kid with this patient, give them a hard time, as I often do, and this patient will smile and kid back. Even during the admission.

We all like this patient and would like to have a unit filled with this type of patient. As one nurse said years ago, "(This patient) is the nicest drug addict I've ever known".

But I thought, as you have AutumnApple, does this patient check in for social stimulation?

Ew.

That's sad.

For social stimulation, I'd rather go to Chuck E Cheese's during a birthday party for a bunch of ADHD kids.

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You're right. Then I'd be suicidal.

RatherBHiking, BSN, RN · Mar 25, 2019

I think some people just have more trouble dealing with life, loneliness, pain, etc in general than other higher functioning adults. They are psychosomatic. . It's hard to be non-judgmental when you feel like you see them more than your own extended family and there's never anything majorly wrong but to them they really feel there is something wrong and are worried about it. Also, sometimes there IS something wrong and no one can find the problem.

For example, any little change in my body I feel before any tests show anything. I had so many symptoms related to my hypothyroidism even though I was on thyroid med. I can feel when my levels are out of whack before the tests show it. I had whole body muscle and joint aches so bad in my 30's I was afraid I would have to go on disability. Then I was having a lot of heart palpitations. I started having anxiety symptoms. I was put through heart tests, MRI's, physical therapy and still had pain so bad I couldn't sleep. I did have arthritis and degenerative disk disease but I just knew my symptoms were bigger than that. It took me three doctor's who would listen to me and treat my symptoms and not my lab work. One dr got mad at me for "allowing" myself to develop a huge goiter. I said I told you my thyroid meds were too low. I've since found a wonderful doctor who listens to me and was willing to work with me to find me a thyroid medication that makes me feel like I'm no longer 80. My heart palpitations are gone. My joint pain is gone. My dr keeps my levels on the low end of the range to keep me asymptomatic. I was getting depressed because no one was listening and I felt horrible. I try to remember that when I have to deal with patients I don't understand because I know what it's like to feel awful and no one believe me because my tests don't show anything.

Ruby Vee, BSN · Mar 25, 2019

Years ago when I was relatively young and completely NOT jaded, I had a patient whose major concern was that the staff mix her cocktail correctly at bedtime. She had a couple of bottles of booze that we kept in the narcotics drawer, and each shift we had to count how many fluid ounces remained in the bottle. She had an order for the cocktail, and the pharmacy knew all about it. We signed it out on the MAR if we were working 3-11. (That's how long ago it was.)

I asked one of the older, experienced nurses about the patient. "Oh," she said. "They are very wealthy, and her husband doesn't pay much attention to her. My mother-in-law (wife of a physician on staff who was also a member of the patient's country club) says that whenever he takes a new mistress, she checks into the hospital for some TLC. We work her up for something, and her husband takes time out of his busy day to check on her. We've never found anything wrong with her before, but now her liver function tests are wonky . . . "

**CalicoKitty, BSN, MSN, RN** · Mar 25, 2019

I've known many patients that were glad to be back in the hospital vs. their nursing home, rehab or home. They are often sad to be discharged again. They mention how they don't get the same level of care/attention. Some even mention the quality of food. Some people have such a terrible time at one place they want to be discharged to another. Even a guy that wanted nursing home vs home with family "care". People come in for vague symptoms repeatedly.

People that come in screaming how they don't want to come to this hospital again (xth time this week/month), and yet don't want to go elsewhere.

There are the patients that want everything "just so", and oddly can't figure out how to move their arms to move the pitcher of ice/water to the perfect location on their tray table.

On the flip side, I spent about 10 days twice in hospitals. I was incredibly lonely since it was over an hour from my new home and I had just moved out of state. Few visitors. The TV was not very stimulating. And the roommates could be hit or miss.

Long Term Care Columnist / Guide · Mar 26, 2019

I've always thought that maybe they feel safe there. A hospital admission takes them away from whatever problems they may be having "on the outside" and gives them a breather. I've met this kind of patient many, many times, and I feel so sorry for them that they need to come to the hospital for attention and care.

Davey Do · Mar 26, 2019

6 minutes ago, VivaLasViejas said:
I've always thought that maybe they feel safe there.

Agreed.

There was a big de-institutionalization of state psych patients back in the '90's and some would do what they needed to do in order to be admitted to the hospital.

Then again, sometimes it's the old "Three hots and a cot" thing.

allnurses Guide · Mar 27, 2019

Yes, there are definitely people who want to be in the hospital for psychosocial reasons, which has always moved me to pity. There is a person I know right now who is being "cared for" by their adult child. The adult child is severely disorganized and leaves the house a shocking mess, has a prescription drug problem, does not work, rarely cooks and struggles mightily to cope with life post divorce with what I suspect is bipolar disorder, but known diagnosis of anxiety and depression. The adult child has trouble functioning in life even without a parent who is post CVA and not all there. The parent claims to rarely be bathed, to be hungry all the time because nobody provides them with food and the two of them fight. A lot. The adult child claims the parent exaggerates and isn't remembering the way things really are and is shopping for sympathy.

The parent definitely is having cognitive decline and there is a lot of tension in the home and tension in the family/community as a whole, as nobody is sure what is really true besides the facts that neither one is really very able to care for even themselves with any real quality of life, let alone another person and that everyone is unhappy, unless confronted directly - then suddenly they get defensive on behalf of the other. Its confusing. There is no money to hire someone to help out. Friends and family get tapped out quickly due to the level of need, the mess in the home and the sense of not knowing what is true, what isn't, whether abuse is present or isn't and just....how to help when "help" is so inadequate. Lots of good intentions, but lots of moral distress on the part of anyone who looks at the situation for very long.

When the parent has days available again for rehab through Medicare, they asks their family doctor to get them into inpatient rehab, where they pretty obviously feels more secure. Of course, admission of the parent to rehab makes the adult child both relieved and yet squirrely, because adult child is possibly used to the parent's pain meds being readily available, so drama starts there with adult child accusing staff of stealing and withholding the parent's meds along with just a suspicious nature toward anyone caring for the parent - heavy on criticism and low in coping skills.

The parent has zero chance really of recovering further function, but the parent themselves don't realize that, so to them, the admission both gets them clean, fed, looked after as well as physical therapy daily, which they hope will lead them back to being able to drive and live independently. It also gets them out of a stressful, toxic, depressing environment. So while the "psychosomatic" problems are a little frustrating to deal with, to the parent, this is very valid. The parent is anxious and feels ill cared for at home at times and is above all likely very fearful of further decline. Admission probably makes the parent feel like at least they isn't going backwards and gives the sense someone cares if they eat or are clean. Quality of life at home is so very poor, a combination of the realities of the level of debility and that subsequent depression, needing to deal with being cared for and finding little reason for hope.... and on the part of the adult child the difficulty of coping with caring for a debilitated and aging parent when you have your own problems to worry about, very little help and a whole lot of people critiquing you on things they are not themselves willing to take on.

Its a mess.

It is difficult to care for patients who we perceive as "not sick enough" to be taking up a bed. Often they are anxious, demanding and/or persnickety. I see them as a side effect of the American culture placing little to no value on the elderly and the disabled and offering very few resources to help those caught up in the space between affordable quality care and the cost of getting it as well as the unending hole of despair when there is no real help for the endless need of someone disabled and needing care 24/7.

kbrn2002, ADN, RN · Mar 27, 2019

On 3/25/2019 at 8:51 PM, Davey Do said:
Agreed.
There was a big de-institutionalization of state psych patients back in the '90's and some would do what they needed to do in order to be admitted to the hospital.
Then again, sometimes it's the old "Three hots and a cot" thing.

The three hots and a cot can be an issue I suppose. Reminded me of my student days psych rotation. The patient I was working with was not deemed dangerous to staff but had been admitted following escalating symptoms including threatening to kill the president. Turns out while doing a deep dive into his history this gentleman lived in a small camper with limited resources and was habitually admitted every winter for something that would be guaranteed to be relatively long term. I still have deep suspicions that he was working the system for a warm place to stay when the temperatures dropped too low for him to be safe in his normal environment.

allnurses Guide · Mar 27, 2019

It definitely happens. I work for a safety net hospital. It is well known we have more people come to the ER when it gets cold. When weather is very, very cold rumor has it we have found admitted patients charging a fee to allow another homeless individual pose as their family member and sleep on the provided pull out sofa in their room.

Emergent, RN · Mar 27, 2019

We have a gal who obviously puts herself into DKA so she can get hospitalized and get Dilaudid for abdominal pain. Last time she missed the mark and only got her blood sugar really high. The PA told her she wasn't going to get pain medicine for high blood sugar. She is quite a pest about her need for Dilaudid. Her story about how her blood sugar got so high is always very reheorificed. ?

FolksBtrippin, BSN, RN · Mar 28, 2019

On 3/25/2019 at 3:35 AM, AutumnApple said:
Just a for fun topic.
We as nurses see a lot of things during our careers. I know I am considered that person at social gatherings who always has a great story to tell that'll get the chatterbox juices flowing for everyone else.
Having seen so many things, and seeing people at their worst, can make us jaded though.
Yeah. I said it. Jaded. That buzz word used much too often to describe nurses who are fed up with................well, whatever.
But there are instances where it is true.
So, I want to pick apart a statement I find myself saying to myself (and yes, I of course have heard it stated openly by others too) that might be considered jaded. Or is it?
Consider for a moment when that patient appears in the ER once again and you just know they're going to be admitted. Probably to your unit, again. It's their second visit to the hospital this month, and the last time they were an inpatient was no more remarkable than the ten (eleven, twelve, thirteen.............) times before that they were there.
The frequent flyer is about to become YOUR patient again.
When this happens, often we say:
"Oh, they're just bored, coming in for someone to pamper them a bit again."
Or we say something to the like of that. In short, we accuse them of just being there for social reasons. They're lonely, bored, poorly adjusted or whatever else and have no idea where else to take their problems.
Do you truly think people check into hospitals just for social stimulation? Or are we jaded?

I think if a patient is checking into the hospital for social stimulation, that problem needs to be addressed. Not necessarily by nursing, maybe by social work. But the aftercare plan should include a referral to some kind of service that provides social interaction.

It doesn't mean you're jaded if you are noticing this problem. It does mean that something is wrong.

Need for social interaction is sometimes the problem, but not always. People with borderline personality disorder can have a constant underlying feeling that something is gravely wrong with them which can lead to a cascade of symptoms that can end up in a hospitalization. Sometimes they know they are exaggerating, and sometimes they really don't know.

Even in community psych, it can be hard to tease out the patients who fake illness for medical attention (they know they are lying) and the ones who have a delusion that they are chronically ill (somatoform disorder).