Had another ETOH withdrawal patient yesterday, he was also a mental health patient in real life, chronically unemployed, and had been readmitted after being discharged post knee-replacement surgery (thank you U.S. taxpayer!), meth positive and in full blown ETOH withdrawal.
High-dose protocol, IV Ativan q 1/2 hour, 1:1 sitter in room + wrist restraints. Any time the patient awoke he launched into loud abusive profanity and tried to grab the crotch of the sitter.
I guess one positive in all this is job security for healthcare professionals, including myself. But, I must admit, this type of patient disillusions me...
I ask you, how does a person such as this afford a 1/5 of whiskey a day, plus methamphetimine???
I truly understand the OP's need to vent her frustration. I may only have 1 1/2 years of experience, but on my telemetry unit, I see pts daily who are drug addicts and alcoholics, as well as a variety of other mental illnesses like schizophrenia, bipolar disorder, etc. Just because the pt is there for a medical reason does not mean they do not have other problems.
Yes, I have those pts who are obviously drug seeking. Usually these pts know to the minute when they are due for pain meds, and also know that if they say they are nauseous they get phenergan or zofram. They also know what mg strength the narc is. You can set your watch to them because they will ALWAYS call when it's due. Yet, they are doing things that are atypical of a pt who legitimately has severe (8-10) pain, like walking to the cafeteria, going for a smoke, walking (with their IV pump (I swear it's true!!!)) to the grocery store two blocks down to panhandle money.
I have had a pt all this week who based on her history has all the signs of a drug seeker. She is a heroin addict (20+ years), and a prostitute. But she is also married and has several great kids that I have gotten to know over the last few days. She is intelligent, nice, and educated. Lots of the nurses who work with me hear "Addict" and immediately go to "Drug Seeker" I tell you that this is not so. She presented for chest pain that turned out to be related to pneumonia, and she has a history of septic emboli. She is on methadone for the heroin withdrawal, and can get either dilaudid or nubain PRN. She rarely calls, is a quiet patient, and I have to ask her if she is having pain. Her pain is quite severe after a coughing attack, or exertion, but she will try to sit it out rather than ask for meds.
After talking to her a little, I realized that she had had a bad experience with a previous hospital stay where she was treated like a drug seeker, rather than a pt with a legit medical problem..
Yes she is an addict, yes her problems are likely due in part to her drug abuse, but her problem and her pain are legitimate.
Addicts do not often seek help voluntarily without intervention. It is our job as nurses not to judge, but to take the time to acknowledge them as human, not question if they are drug seeking or truly have pain, and most importantly to educate them as to what their addiction can lead to and to provide resources for help whether they want them or not. You never know, you may be the first person who has provided them with the help they want/need.
The difference between the amateurs and the pros is that a professional is able to render competent care regardless of her/his personal feelings/reactions.
Amen. I work with Medicaid patients. Many of them are disabled due to chronic disease, but at least half have some sort of mental health or abuse issue. Some are a product of their enviornment, those who are the third or fourth generation of families who have been "discouraged" from sucess by an enabling government infrastructure. But many have led productive lives at one point, and have come to their current status as a result of some sort of traumatic event or onset of mental illness. My greatest concern is the growing number of patients who have been turned into abusers as a result of providers who have "overindulged" them with painkillers because it is easier to write a prescription than plan rehab.
Not that you had to have compassion for your patient or feel sorry for them. That's your issue.
Excuse me, but I don't see where compassion is equal to feeling sorry for someone. I do think it's a shame that these people suffer. And I do not deny or argue that they are NOT suffering. I'm sorry that their lives are horrid, and I feel for them in that respect. But when we say someone is a victim, we are saying that someone has had a situation thrust upon them that they had no control over. An addict had control at one point in time, and made the CHOICE to give the control to the substance by using the substance.
Both of my parents were/are alcoholics. I have made the CHOICE not to do drugs or to drink alcohol. If I ever choose to take a substance and become addicted as a result, then I am not a victim, I just have made a bad choice as I already know that I stand a really good chance of becoming addicted due to genetics.
Those of you who are addicts and are working your tails off to stay clean and sober have my utmost respect and admiration. I know how difficult it is to get there, as I witnessed my own mother try her darndest to get sober and stay that way. But I truly don't see how the attitude "Poor them, they are victims" helps these people find their way out of the cycle of addiction.
As far as substance abuse being a disease, yes it does become a disease state, I agree. But, that does not write off the fact that it is a disease that results from the choices that human, spiritual beings make who are given free will by God.
I don't buy into the modern idea that we are just a bunch of chemical reactions and impulses, enslaved by our DNA. We are spiritual beings living in, yes, an imperfect world, and we are influenced by many things. There is good and evil and, no, the world is not black and white, and humans are complex. Yet, there is a spiritual component to what we do in this world.
I think that the main point of this was the pt's who treat us like doormats. Yes, each individual and circumstance is different. That is not the issue. The issue is we are human and as such have our own breaking point. I am not a nurse to be someones focus of anger at the world/themselves/disease/whatever. These addicts only think of themselves and as such do not realize that I have other pt's who deserve my time just as much as they do. Because of constant ranting, light pushing... they put me under an enormous amount of stress, that as much as I try to hide, my other pt's sense.
Actually, Earle, it is the 1st step that states, "We admitted we were powerless over alcohol and our lives have become unmanageable." The 2nd step is, "Came to believe that a power greater than ourselves could restore us to sanity."
This pertains to drugs as well. With attending meetings, working the steps, and talking with my sponsor, I will hopefully stay on the path to sobriety. At first, this program is about not drinking or using, but then it is about how to live. A fellow AA member/friend has a saying....."Go ahead and go back to drinking and drugging.....we will refund all your misery."
There's a reason why 2 of the early steps in 12-step programs involve taking a "moral inventory" and making amends where possible. (I don't remember the actual order of the steps ... I'm sorry)
That means that true recovery involves taking responsibility for one's choices, acknowledging the harm one has done while actively using and trying to heal that where possible.
There's nothing we can do to make an addict turn that internal corner that leads to recovery ... it's dangerous to think that we can rescue them.
As someone pointed out above, sometimes we're lucky enough to be the right person in the right place at the right time to validate a change that's ready to happen. When that happens, the angels sing.
When it doesn't, we're faced with the behaviors we all describe as drug-seeking ... and it makes us crazy. Al-Anon exists to help people involved with active addicts deal with those behaviors. Nurses don't have that kind of support ... and we need it. I think that was the point of the OP.
Assessing and treating pain in the active substance abuser is a tough, tough nut to crack.
Just to complicate things, there's the phenomenon of pseudo-addiction ... the use of addictive behaviors to obtain real pain relief. OY!
Specializes in Med Surg, Nursing Administration for SNF.
i have such ambivalence with the following:
i've been to aa meetings/educational seminars.
i when an addict is in the throes of their disease, i agree they are powerless.
but once they detox, i think it's important to take their powerlessness back and take control.
after detox, you don't have to struggle with the physical withdrawal, your mind is clearer and are able to truly make decisions.
no longer powerless, no longer a victim...
as long as they stay clean.
Leslie - you are so right in many ways. It is why we say in the rooms, "its alot easier to stay sober than to get sober." However, :wink2: (didnt ya know that was coming!) Problem comes in a couple of months down the road. Youre sober, got your family back (maybe), a job again, you gain a few pounds back and start looking human again. You say to yourself, ok Im back. And you have a couple of beers with your buds while saying to yourself, "surely I can have just one or two", then maybe not right away but . . . BINGO! Youre off and running. The reason (one of many) thaat AA works so well is becsuse you are taught to do many things to maintain your sobriety. Readings, journaling, prayer to a God of your understanding, a sponsor, working the 12 steps, and going to meetings so that other alcoholics can KEEP your memory green. Step one admits defeat (powerlessness), Step two renews your faith in someone other than yourself, step three is a commitment to that entity, step four involves cleaning your side of the street and then making amends later, continuing to practice spirital principles in your daily life, admitting when your wrong, more prayer and mediation in an effort to improve that relationship, and the last step tells us that to keep it we must give it away. I left a couple out but that basically sums it up. It is a blue print for living and works for many, many, people. I guess what Im trying to say is that there is a solution that involves daily maintenance. This disease is a disease of perception tho, and some fall prey to the lies they tell themselves. Why? Not sure. I hope that clears things somewhat, thank you to you and to all the nurses who are professional enough to provide quality care without bias, and a special thank you to those who do it with compassion for one of Gods children who is lost. :loveya:
I have very little sympathy for drug users who blame the world on their problem. Maybe I am judgemental but about ten years ago my partner completely wrecked his life because of crystal meth, heroin, anything he could get his hands on and inject himself with and he nearly took me down with him. I tried my hardest to help him but he wasn't willing to go to rehab and I wasn't willing to stay with someone who was leaving needles all over the place and stealing my stuff and selling it for more drugs. I don't know if he's even alive now, probably not I think. His friends were all pretty bad as well and they all had one thing in common. It's never THEIR fault that they ended up addicted, always someone else's fault. This sort of attitude really angers me. I've had BAD problems in my life, was unemployed for some time and I used to drink heavily everyday just to forget about past events. But I woke up to myself and went back to school and eventually became a nurse and moved on.
It's not that I don't care because I hate to think of the lives that they lead and inflict on their children. I've seen it and it's not something I'd wish on my worst enemy. But it's the failure to take personal responsibility on their actions and do something about their problem instead of whinging about how bad the world is,and it's never their fault which makes me give up on them. I do consider them to be victims but I agree that they have made themselves victims. No one forced them onto that path they did it to themselves. I know my partner and his mates all had drug education in schools, they knew the risks they were taking.
As patients I do not treat them any different because I'm there to be their nurse not to judge them. But I won't tolerate abuse from anyone, and I'm not there to be blamed for their substance abuse problems.
Unless substance abusers are willing to take responsibility for their actions and see the damage they have caused, as a nurse there is not a lot you can do for them.
But, I must admit, this type of patient disillusions me...
al7139, ASN, RN
618 Posts
I truly understand the OP's need to vent her frustration. I may only have 1 1/2 years of experience, but on my telemetry unit, I see pts daily who are drug addicts and alcoholics, as well as a variety of other mental illnesses like schizophrenia, bipolar disorder, etc. Just because the pt is there for a medical reason does not mean they do not have other problems.
Yes, I have those pts who are obviously drug seeking. Usually these pts know to the minute when they are due for pain meds, and also know that if they say they are nauseous they get phenergan or zofram. They also know what mg strength the narc is. You can set your watch to them because they will ALWAYS call when it's due. Yet, they are doing things that are atypical of a pt who legitimately has severe (8-10) pain, like walking to the cafeteria, going for a smoke, walking (with their IV pump (I swear it's true!!!)) to the grocery store two blocks down to panhandle money.
I have had a pt all this week who based on her history has all the signs of a drug seeker. She is a heroin addict (20+ years), and a prostitute. But she is also married and has several great kids that I have gotten to know over the last few days. She is intelligent, nice, and educated. Lots of the nurses who work with me hear "Addict" and immediately go to "Drug Seeker" I tell you that this is not so. She presented for chest pain that turned out to be related to pneumonia, and she has a history of septic emboli. She is on methadone for the heroin withdrawal, and can get either dilaudid or nubain PRN. She rarely calls, is a quiet patient, and I have to ask her if she is having pain. Her pain is quite severe after a coughing attack, or exertion, but she will try to sit it out rather than ask for meds.
After talking to her a little, I realized that she had had a bad experience with a previous hospital stay where she was treated like a drug seeker, rather than a pt with a legit medical problem..
Yes she is an addict, yes her problems are likely due in part to her drug abuse, but her problem and her pain are legitimate.
Addicts do not often seek help voluntarily without intervention. It is our job as nurses not to judge, but to take the time to acknowledge them as human, not question if they are drug seeking or truly have pain, and most importantly to educate them as to what their addiction can lead to and to provide resources for help whether they want them or not. You never know, you may be the first person who has provided them with the help they want/need.
And they just might do it!
Amy