They must think we are stupid...

Pamilina · Mar 2, 2010

oh goodness, not a very caring or professional attitude toward your patient. this is an absolute "no, no." these patients are vulnerable and as nurses we are not their rulers! they require the dignity just as anyone else. if you ask a patient a question and you feel they are lying to you, consider that they must feel very guilt ridden about whatever it is that you feel they are lying about. not every patient has a phd, m.d., or nursing degree to know the details of all the consequences to their actions. to belittle anyone is harmful, but to belittle a patient who is vulnerable, and requiring dialysis treatments on a regular basis, is reckless, and negligent at best. you may want to reassess your career choice. you or i could be this very patient, and this is the treatment we could receive???? horrible, this is not professional nursing!!!! i'm utterly embarrassed to learn that anyone in the nursing field could reduce themselves to treating, or verbalizing such a reckless disregard for anybody.

a patient that receives dialysis as part of a life saving protocol usually has diabetes or some other underlying condition that causes in addition to that, heart disease. retention of fluid is part of the signs and symptoms of heart disease in chf, and it is not entirely the patient's doing for fluid retention, but if they are non-compliant with their fluid and diet restrictions, and who isn't???? it's very likely they could have gained a significant amount, or calculations were off prior, or they missed a treatment as well. especially, diabetic patients having the voracious nature of needing to drink water, a major sign of diabetes can be such a difficult issue to live with, but an issue that can seem very urgent to the patient, and since they don't all carry a medical degree, and are trying to eradicate the urgency of thirst, means that they very well could be over stepping their fluid intake. however, this or anything else that a patient does that is non-compliant should not be a sign to treat with ill repute, belittling their person, reducing them to nothing more than imbecile, is a total disregard. they are human beings that have unfortunately lost the function of their kidney's and require a lifesaving procedure. not ridicule from the likes of the one providing professional care to them.

all you can do is educate, and make a note of the weight increase, investigate it for knowledge sake and to correct any previous error in recordings. re-educate, find out what their problem could have been if they feel they have one. possibly see about an evaluation with the nutritionist, and be sure to let the doctor know the variation right away.

please, do not ever diminish any human, and especially, a vulnerable patient that comes to your for aide. they are your mothers, fathers, brothers, sisters, aunts, and uncles. you wouldn't want anyone you cared for treated this way i am certain.

corky1272RN · Mar 2, 2010

I agree, that is the line they say! "I don't know how that happened" well I do, you drank too much this weekend.

Encourage the pt to put the amt of fluid they are supposed to drink in a container that fits and when that is gone..no more. Also encourage the pt to suck on ice, that seems to help some. There needs to be some accountability to the doctors for that pt. Sometimes a good "punishment" is to require the pt to come in more days or extra time in their treatment, it is unsafe to pull off that much fluid in one or two sittings.

allnurses Guide · Mar 2, 2010

Pamilina, would you like something to polish your halo with??

You obviously haven't worked with non compliant CHF or dialysis pts. It is common that they are non compliant with fluid restrictions, medications, any advice at all really. They most certainly do know and understand the ramifications of their actions, they just do it anyhow! There's a lot of literature about non-compliance in these patients. It's quite infuriating to care for them at times.

What nurses say to each other here does not equate to what we say or do to our patients. If you can't vent to your peers, who can you vent to?

Kymmi · Mar 2, 2010

Pamilia Im pretty certain that the OP did not tell the patient to save time and put a gun to her head and get it over with however I disagree with your thoughts for the most part. Patients need to be held accountable for their actions and health issues. I agree that patients need to be treated with respect and not ridiculed however I seriously doubt the OP belittled the patient. I do hope she did some teaching regarding fluid intake, disease process, treatment which I would imagine the patient has had numerous times in the past however the patient chooses to ignore her responsibilities and chooses to do as she pleases instead of owning her own part in her treatment. So many patients feel that they can do as they please and then have the nurse or the doctor "fix" it and make things better and they fail to own the fact that it is their actions that matter most when it comes to managing their disease.

I understand that diseases occur and alot are not preventable however most are manageable with proper medication, diet, exercise and lifestyle changes. Alot of patients that suffer from chronic illness and sometimes even those that suffer acute illness seem to have developed the idea that they will do what they want to do and then have someone else fix it then they get mad when their condition worsens and attempt to blame the medical field for not treating them properly. Until patients are held accountable for their actions in their own healthcare treatment we will continue to have the patients who feel they have done no wrong and its all the medical personnel's fault their disease worsened.

Im not saying do not respect patients but they need to know their responsibilities....I am not cold hearted and I do not lack compassion I just chose not to allow my patients to do as they please and not take responsibility for their actions.

You are responsibile for your actions as a nurse and you are held accountable for any outcomes that happen due to those actions....what if you did something you knew caused harm but your manager didnt want to come off as lacking compassion for you and therefore did not make you own your actions..what would happen at that point? Its the same principle...we are all responsibile for what we do and what outcome occurs.

If you chose to treat your patient without holding them accountable and just allowing them to do as they please and let you deal with the consequences then are you really doing your patients good or harm?

Trauma Columnist · Mar 2, 2010

Patients are suposed to be our "partners" in THEIR care. However, the way we do it, we have enabled them to become children all over again.

I'm an advanced practice nurse so have the chance to interact with many different dialysis pts. It is frustrating to attempt education for some of them. And...you have to understand that noncompliance is what got the majority of these pts to dialysis.

We are not going to make inroads for many of them.

We need to do what we can do and document the rest.

And...nope I don't have a halo!

(ooops.....lets push those pointed ears and horns down a little - lol)

Pamilina · Mar 2, 2010

you can throw mud, dirt, whatever. "your thoughts motivate your actions." think about that. sure this is a place you can vent, but it sounded like a statement of fact was being spewed out! we are not gods, we are nurses, we can only note that we discussed a situation or behavior with the patient, and their repsonse, and how we educated and notified the doctor, nutritionist, ect...re-educated patient and family member. we have no right to make judgements! as nurses, we are to care for the mind, body, and spirit.

i hear all the horror stories from patients, and how badly they are treated with such contempt in the clinics! that my friends speaks volumes to me!!! it should to you too. nursing in any area, should always be professional. i don't care that you think that they should know better and take responsibility for their actions, you have no professional right, and no right to treat any patient with such indignant behavior!!! if you are thinking it, i can certainly assure you, you are acting out those thoughts in some form that would get you yanked out of nursing so fast it would make your head spin! however, as long as professional nurses continue to allow bad behavior to continue by unprofessional nurses, we may revert back to the days we were shoveling coal, and washing the linens, because we aren't fit for anything more compassionate.

nursing isn't made for everyone, and if you are having these feelings, it could be a red flag to let you know that you aren't cut out for this field. i realize the times are hard, people out of jobs and all, but if you aren't doing what you enjoy, and find yourself thinking dismal thoughts, and feeling frustration and anger, it could be worth the effort to remove yourself from the field. if you recall "thoughts create actions" even unseen at times. if you harbor these bad feelings and exhibiting or thinking about contemptuous behaviors, remember that at the cellular level changes occur within your own body. to be healthy you have to change your thoughts.

Music in My Heart · Mar 2, 2010

Patients are suposed to be our "partners" in THEIR care. However, the way we do it, we have enabled them to become children all over again.

I often ask my patients what they think is the role of their nurse. They usually respond with something along the lines of "help me get better."

I always respond, "No. My role is to help you help YOURSELF to get better. It's really up to you."

To paraphrase Smokey the Bear: "Only you..."

Trauma Columnist · Mar 2, 2010

Right. It is the pts responsibility to be compliant. I do have the right and responsibilty to provide my pts with info regarding risks vs benefits of their behaviors. That doesn't make me a bad nurse but rather one who is trying to be compassionate. The way I sayvhingsxis geared to my audience. I am brutally honest with pts who consistently come in flud overloaded and yes I do tell them they are going to die if they don't make some changes.

HDNurse · Mar 2, 2010

Pamilina - My, aren't we Miss Judgemental today? You must think I'm stupid if you think I voiced those feelings to my patient. I calmly explained to her that such large fluid gains are extremely harmful to her and that it is making her heart have to work extremely hard and that at some point her heart won't be able to take it anymore. Truth? You don't know me or this patient. You don't know about the dozens (hundreds?) of times we have had this conversation about her fluid restrictions and day after day after day when she comes in with over 6 kg of fluid on. You don't know about the numerous times she has been in the hospital for fluid overload (last week she was in the hospital on a vent!)because we can't get it all during her regular dialysis treatments, or how she is now getting treatments more than 3 days a week because she is non-compliant with her fluid restrictions. You don't know how every day her blood sugars run over 500 because she doesn't like taking her insulin. I feel like I am beating my head against a wall with this patient. No amount of EDUCATION over the course of her treatment has made one damn bit of difference. It is because she did not control her diabetes that she is in kidney failure. She has a BKA as well with more certainly to follow. I CARE about this patient and that she is killing herself with this fluid just as easily as if she takes a gun to her head. I don't want her to die, I want her to be in better control of her disease and treatment. It is her actions that will determine her outcome and it makes me incredibly sad to know that no matter what I do, how much I care or how much I try to teach her it will not make one hill of beans of difference in the end. Her death will come sooner rather than later because she chose to ignore what I have taught her.

I must reiterate: I did not say one inappropriate thing to this patient, or treat her with anything but total respect. Nowhere in my origianal post did I say that I had done otherwise. I have treated that patient with total professionalism, just as I treat all my patients. I just wish she would treat me with the same amount of respect, and quit lying to me and admit that she can not control the amount of fluid she drinks. As long as she lives in denial, we will not be able to get her to change her behavior.

You mention contemptous behavior on my part. What contemptous behavior?Venting my frustration to a bunch of strangers who don't know me or my patient? Verbalizing frustration to an anonymous audience is a far cry from verbally abusing a patient. That did not happen, and I never said that it did. If I had, then you would be right to get indignant. Yeah, I use this site to vent. So what? I LOVE my patients, have an incredible relationship with all of them and they LOVE me. I feel incredibly proud to be able to be a part of their care and they appreciate all that I do for them. They tell me that they look forward to seeing me on their dialysis days.

Finally, I finish with your own words. "Do not deminish any human." Well, didn't you do exactly that to me?

Trauma Columnist · Mar 3, 2010

Many of us come here to vent and we as nurses, know that we can say things here that we wouldn't say to patients or families.

Pamilina · Mar 3, 2010

Please don't think that I diminish your importance, that is not at all my intention. I appreciate this forum like the rest of the people that come here. It just struck such a cord with me, when I heard your initial vent. I realize the frustration that nurses feel when we try to do all that we can to improve the quality of our patients lives. The thing that frustrates me so much, is the "belittling" that goes on behind the scenes, and sometimes not far from the patient/patients. I have heard one too many tales of the unkindly behavior that the patient's tolerate in order to receive their life saving Dialysis. I personally wish that we as professsionals could improve this situation. You may feel frustrated and bad for your patient(s), and we can be insulted by the lies that they tell us, but they have every right to do what they do, as they all have free will. They owe no one anything, and as long as they know the consequences of their actions, even if you repeat it ad nausea, or till you turn blue, the most we as professional nurses can do is document, document, document. Clearly, if this particular patient drinks excessively time and time again, and is able to understand the consequences of her actions, and continues this behavior, it is her choice and part of her illness. Her outcome will eventually be death, but you can't wear that on your sleeve. None of us can. We will go crazy if we continued to beat our heads against a brick wall. It isn't our place to insist that a patient do anything...if they choose to do nothing, we document and teach, and make sure that all parties are aware of the noncompliance. Though you state so elloquently your position, you still have in your thoughts "they lied" and therefore, what I am saying is this thinking, inside of your head can lead to negative behaviors. I've seen it, and see it daily. I'm not saying you specifically, but because you brought up your feelings it was concerning. I'm not any more special, or knowledgeable, or superior than anyone here. It just struck a serious cord with me when I read your first post. I'm sorry if I came off sounding all worldly, but my concern is that nurses burnout based on this type of frustration. We can't do it all, and we can't change the world, and when we have a non-compliant diabetic with severe heart disease and a double BKA, no amount of venting will change there eventual demise, and this is very sad. However, it is a part of the life of a dialysis patient. They probably feel so hopeless, worthless, and deminished as a human, and then with all their underlying medical issues, an uphill battle all the way.

I really appreciate the clarification in your last post. I am sorry you felt you had to provide that. I'm no queen of dialysis that is foresure. My heart goes out to these patients, and especially because we all know that they have a shortened lifespan because of it. Their quality of life is so poor, and how unfortunate it is. It was especially nice to see how you shared the endearment that you have with your patients.

As for being brutally honest, I am too. Of course, I say it matter of factly, if they want to get off dialysis early, or they drank too much fluid, or they skipped a week or two of dialysis. I educate letting them know that they death can result from noncompliance, and not getting their full sessions or no sessions, or eathing too much of this, or too much of that, you know. We can only educate. They should try to be responsible about their behaviors, but as I've seen in dialysis patients, some are very anxious and require medications of all kinds, and some are serious diabetics, and with all their underlying heart disease, I am sure that they are losing valuable brain cells. Neurological impairments, poor blood flow, consistent toxin levels, all amount to some serious distorted thinking, and non-compliance is a big part of it I am certain.

It is wonderful that there is this modality to keep patients alive that lose kidney function. However, it doesn't mean that they want to be alive like this, or have the right thinking because they are so sick and for so long.

Thank you for bringing this topic to light, again I am sorry if I offended. I learn a lot from everyone's input as well.

Thank you..