They must think we are stupid...

Trauma Columnist · Mar 3, 2010

Dialysis is meant to improve one's quality of life, not be a bridge from one dialysis treatment to the next.

I have many patients that continue to work full time while on dialysis. They are very compliant, ask great questions and overall have a positive outcome.

Natkat, BSN, MSN, RN · Mar 4, 2010

Noncompliant patients usually have other issues going on that keep them from staying on track. We can offer them help and try to get them to work through it, but ultimately they are in charge of their own care. If the patient is new to dialysis I will spend time educating them and explaining why they need to remain compliant. If they have been on dialysis for a while I save my breath. They know the deal. They understand the consequences so, in my mind, it's up to them if they want to remain compliant or not. I always give encouragement, but don't internalize if if they choose to ignore medical advice.

pussycat66 · Mar 24, 2010

sorry did you say you were a Nurse???????????????? good grief :eek:I hope I'm never in your "care"!!!!!!!!!!!

pussycat66 · Mar 24, 2010

Having thought again about what you said, yes renal patients must be the most frustrating. I often wonder what comes first - the renal disease or the mental health issues? However, as much as this is a forum for Nurses to "let off steam" to eachother - i found the "gun to the head" comment, immensly distasteful. :nurse:

Trauma Columnist · Mar 25, 2010

This is a venting thread - please take it that way.

Doubt any of us would think like this on a daily basis.

We provide care to a chronically ill population who, for most of our pts, got this way due to compliance issues. This can be a challenge since they didn't accept some responsibility for getting into this condition, doubt they want to accept responsibility and become a partner in their care now.

Chisca, RN · Mar 25, 2010

When I saw the title of this thread I thought it was going to have something to do with the way management treats nurses. The only hope this patient has is if somebody can make a connection with them and get them to see the harm they are doing to themselves. Many times it won't be the nurse. It could be the patient in the chair next to them. We have a tech that is the best person in our unit for making that human to human connection with those patients that are non compliant because she is able to draw them out and get them to talk about why they are doing things that are so harmful. If she draws them out it is at that point I can sometimes become part of the discussion. But alot of patients have this wall that I can never get over.

BabyLady, BSN, RN · Mar 25, 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?

You are correct....however....

If you have ever watched a family member go through dialysis, the toll it takes on the family, your lifestyle, the pain involved and the regimine just gets old and you get to where you are depressed and don't care anymore.

Trauma Columnist · Mar 26, 2010

If you get that depressed, then the pt/family member should seek help.

soulofme · Mar 27, 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.

wow... nothing else to say

soulofme · Mar 27, 2010

One of my patients came in today - Monday- having gained 11.6 kg over the weekend! When I talked to her about it, she adamantly insisted that she "doesn't drink very much and doesn't know how she could have gained that much." When I did the math and told her that was over 25 lbs, she still denied drinking very much over the weekend. Arrrrrrrgggggghhhhhh!!!! Why doesn't she just quit wasting our time and take a gun to her head? It would be just as effective at killing herself, just much quicker.
She must think I'm stupid.

No you are not stupid... the pts. will continue to play their game... we just have to deal with it... like it or not.. I feel your pain:redbeathe

anurseadvocate · Mar 28, 2010

One of my patients came in today - Monday- having gained 11.6 kg over the weekend! When I talked to her about it, she adamantly insisted that she "doesn't drink very much and doesn't know how she could have gained that much." When I did the math and told her that was over 25 lbs, she still denied drinking very much over the weekend. Arrrrrrrgggggghhhhhh!!!! Why doesn't she just quit wasting our time and take a gun to her head? It would be just as effective at killing herself, just much quicker.
She must think I'm stupid.

Wow, I hope you were not serious with your last statement.... First 25 lbs. Did you check your scale for calibration? Was she wearing different clothes than usual e.g. heavier? Is she urinating less? Did someone actually see the number on the scale or is it what she told you? If she told you maybe she made a mistake. I would think that 25 lbs would been further investigated as to why? Did you ever stop to think that maybe, just maybe, she is telling the truth that she did not drink much over the weekend? Did you ask her if she had alot of salt intake? Has the dietician talked with her about her intake to ensure she is doing the right thing so that she does not gain and of course, the last question -- Does the patient truly understand about intake and problems related to large intakes? Give the patient a break when you say 'she must think I am stupid'. Put yourself in her shoes and investigate more into the above, if you have not already. It is NOT easy being a patient... truly not easy and as I use to say to nursing students, 'put yourself in the patient's shoes and think if it were you, or think, what if this was my family member or a loved one?" It also sounds as if you truly care about your patients but, for me, the way you came across sounded a bit harsh.. if you did not intend such, accept my apology

Trauma Columnist · Mar 29, 2010

I am always respectful with my pts but we must be honest here too:

Chronic dialysis pts receive a ton of education: weekly from mid-levels, monthly from the docs, daily from dieticians, nurses and techs.

Unless the pts is new, they have been educated ad nauseum.

The real deal is that these pts have the option to be compliant or not. It is in our best interests to document all educatin and attempts to redirect their behavior.