Non compliance?

I work with liver failure patients. We have them assessed by neuropsych if they are competent we will patch them up when they are ascitic, non compliant with low salt diet, still drinking etc. I always say we can fix many things....stupid not one of them.

Pt has the right to refuse. You can educate pt and document, but also try talking to the familiy about it. My sister's MIL was on a low sodium diet and she'd eat their meals, but also beg my sister and BIL to bring her french fries. They didn't because they knew why she couldn't have it. I had a LTC pt in my clinicals who refused her meds every day, so after a set number of days the facility would contact her family so they knew she was refusing again and talk to the pt about it.

What does your coworker suggest, sitting on people with a spoon and making airplane noises? LOL.

My mom who recently passed was in two different memory care facilities in the course of two years. The first was not so great. Smelled like piss all the time (though the staff and admin didn't seem to notice). My sister who lives several hours away sent her a 2 pound box of chocolates from her (mom's) favorite chocolatier. When we went to visit we asked about the chocolate and were told she was on a low fat, high fiber diet and could only have 1 piece a day. My older sister who was her POA asked why we had not been informed of this diet. She also stated the obvious which is that my mother was dying and if she wanted to eat nothing but chocolate cake and ice cream she should be able to do that. The facility said we had to sign a diet waiver which we did.

In the mental health facility where I work patients are often placed on therapeutic diets. If they don't like it we have them sign a diet waiver. That way we have covered our bases as far as education goes and the patient gets what they want.

Hppy

We do something similar. It's a risk vs. benefits form that the resident or POA if applicable signs. Considering the population I work with I am all for this. At their later life stage it really becomes a quality vs quantity of life issue. At 80+ years old if a diabetic wants sweets they've certainly earned the right to make that choice

After more than one dialysis patient argued with me that ice was not water I've decided you can have a 55 gallon drum of water if you want. And a salt lick.

The way I've always taken the "diet order" isn't necessarily to make sure we police their intake, but 1) to ensure that the kitchen delivers the right food, 2) to ensure we know what is ideal for the pt as part of their plan of care, and 3) so we know what ideal-world info to teach the pt.

I personally wouldn't provide food not in their diet order... unless the pt is receiving comfort care or other situation where the pt shouldn't HAVE a diet order. If the pt is a 40 yr old with DM II and a giant non-healing butt wound with BGs in the 400s, heck no I'm not making a Snickers run.

But if their doting wifey brings a Snickers, taking it away is called "theft."

I did my patient teaching and felt like my responsibility ended with my last sentence to them....I even told a few of them that my responsibility ended with my instructions , they could benefit from my education and experience or choose not to , their call....Sounds cruel but what else can a nurse do ? It is up to the patient ....

I'm just curious what you all think...

I have a colleague who insists that when a patient is noncompliant regarding their diet, (diabetic CHF etc.) even when we document and alert the provider they are not adhearing to it, that we can ultimately be held liable?

Im in a sub acute rehab setting.

I feel like the patients have the right to do what they want and as long as we educate and document, the rest is out of our hands.

My colleague says the reason they have a diet ordered is to ensure they adhere to it. I just don't see how if I do everything in my power to keep the patient in compliance but they still choose to eat whatever they want, I've done all I can do.

What at do y'all think? What can I do differently?

No. Absolutely not.

If that was true nobody would go into oncology because of all the lung cancer patients that won't stop smoking their two packs per day.

Don't know why a nurse would try to be these patients' mothers. Grown adults have the right to do whatever they want with their bodies, and we are essentially just doing damage control and keeping them alive during their brief hospital stay (long-term care facilities notwithstanding). If a patient wants to shoot up heroin in the bathroom with a used needle, so be it; that's their choice. I'm not going to attempt to control their actions because I don't want or need that power in my life. I'll give them narcan when they OD and call the doctor for a fluid bolus order if their BP goes low. As long as we're keeping non-DNR patients alive, following orders, giving good advice and documenting everything, that's all that matters. Pediatric patients might benefit from a more active authoritative hand, because all kids (and many adults) need guidance. But any patient education should be limited to "I highly recommend doing X/not doing X because of such and such reasons." If they choose to accept the advice or not is their own choice.

The real question is to what extent should we enable self-harm before intervening. It's really subjective and depends on the extent of self-harm. It's disturbing to see any amount of harm done, but all you can really do is attempt to persuade someone to make some sort of lifestyle change to attempt to avoid harm. Life is just a series of harm and suffering with brief intermissions in between, and even active attempts to avoid it will fail eventually.

"Bro you probably shouldn't eat that twinkie"

On 5/19/2018 at 1:33 PM, Glycerine82 said:

I'm just curious what you all think...

I have a colleague who insists that when a patient is noncompliant regarding their diet, (diabetic CHF etc.) even when we document and alert the provider they are not adhearing to it, that we can ultimately be held liable?

Im in a sub acute rehab setting.

I feel like the patients have the right to do what they want and as long as we educate and document, the rest is out of our hands.

My colleague says the reason they have a diet ordered is to ensure they adhere to it. I just don't see how if I do everything in my power to keep the patient in compliance but they still choose to eat whatever they want, I've done all I can do.

What at do y'all think? What can I do differently?

I think I'm glad I wake up being me and not your colleague. I can't imagine how much stress he or she must be under thinking they are responsible for delivering outcomes over which they have zero control. Your colleague fails to understand that the only real discipline is self discipline anyway, and that all her or his efforts to play diet police will come to nothing as soon as the patient is out of sight.

There was a thread a bit ago about something similar, implying patient education is out, and nurses are now obliged to do successful health coaching. Though I'm not sure if it's what your colleague was referring to, the whole health coaching thing is yet another way the third party payers are trying to pressure the nursing staff to deliver better (read cheaper for the insurance companies) outcomes. Every time nurses silently accept a new obligation pushed on them they are complicit in their own undoing. Just saying.