treatment of IVDA patients

[browniepoints]

I am having real difficulty dealing with my feelings on this subject and would like the input of those of you experienced with IVDA patients. Long story short, I am just finishing up an externship in a large hospital on a Medsurg/oncology floor. I have learned so much and feel like I had a great experience. However, school did not prepare me with real-world type moral/judgement situations I keep seeing at work. My facility is in a crowded city witha lot of crime and very severe drug problems, so we see a fair amount of IVDA patients.

I have noticed that the care the IVDA patients receive, both from the doctors and nurses, is...well, different. There is an "attitude" that the staff has about these patients, especially for administering pain medications and comfort measures. I have been taking care of one pt with some serious problems who is in a lot of pain, and when I try to let the nurses know this, I get laughed off, and usually a comment is made about me being a "therapeutic nurse" and NOT in a positive way.

I KNOW that these people have often caused their health issues by drug use...but to me that does not make them any less deserving of pain relief or basic kindness. I KNOW that often these type of patients are manipulative, and come into the hospital seeking drugs, and lie to us, and do all sorts of things....but am I a fool to treat them with kindness and try to help them while they are in my care?

I'm feeling like a naive rookie in situations like this. When I sat down with one pt and talked with him about refusing care (ended up telling me how he was depressed and was suicidal and no one cared) I was laughed at for "letting him get one over on me."

I feel like no matter what a pt's background, I should care for him the same as any other pt, until they show me a reason not to. Am I being foolish, or is there some unwritten rule somewhere that because someone did 10 bags of heroin before he was admitted with kidney failure, that they are not deserving of pain relief measures or basic nursing kindness? Like is there a rule somewhere that because a person has a drug history that they can only have tylenol for pain of his compound femur fx, when the guy down the hall post-op from a prostatectomy is on a morphine PCA?

I'm really hoping not to have offened anyone. I'm trying real hard not to be too harsh about why other nurses/doctors do the things they do, but I feel like I'm missing something here.

[hrtprncss]

I personally feel that sometimes we do the patients disservice when we're witholding medications based on our own fear and ignorance, i've seen so many nurses who's so careful about giving medications to people that have or been addicted to pain medications. it's not aiding in their recovery when they're on the bed writhing in pain. i think as nurses we have the responsibility of making our patients comfortable and pain free. and unless they're actively seeking, then usually there's a reason why the medication is ordered for them, may it be post op mgmt or such and we should use it. remember a happy patient is a happy nurse.

[elthia]

It's difficult to explain. But when you have worked in the same place and seen the same people admitted over and over for "detox, polysubstance abuse, etoh, suicidal ideations, depression, homelessness" and they are noncompliant, rude, verbally aggressive, manipulative etc., it becomes hard to not be cynical. They are also the ones with an "entitlement" attitude, continually asking for snacks, soda, phone card, ice cream, etc, and verbally abuse staff when we state "the only snacks we have are for diabetic emergencies, if you like I will take your blood sugar and if it is below 70 THEN you can have a snack". I have seen a IV drug user steal a fentanyl patch off a bed bound terminal cancer patient. The IV drug user was kicked out, if he comes back we can't refuse him care. staff become frustrated, angry, cynical and develop an attitude that stereotypes all patients with polysubstance abuse.

Maybe you should consider doing an inservice, after all depression usually follows when a patient is "coming down". These patients are just as deserving as care, but at the so many are manipulative that staff have attitudes toward them. Sometimes I think having when there is an influx of substance abusers, we need a liason nurse who is trained in psych or substance abuse treatment to come over and "retrain" staff.

I can say that my floor did have a IVDA with osteomylitis of the spine, we had him for months. He was a success story, he actually refused to go to the inpatient substance abuse treatment program becuase "I need to be away from abusers, I need to be around those who can live without ever having used". After he was treated and went through therapy to relearn how to walk, he left and went to live with family. He is still clean, and comes by to visit at times. But i would like to mention that he has apologized to all staff for "my s&&&&tty a&& attitude i had when I first came here. It took months for me to realize how you all bust your butts for the patients. "

[zacarias, ASN, RN]

browniepoints,

I applaud your desire to give everyone, without judgment, good nursing care. Stay with that and never lose that focus because you know it's right. I've worked with a lot of IVDA and yes there are staff that definitely have an "attitude" with these folks. Sometimes the IVDAs are not the nicest patients to take care of and it is hard for staff to keep a "fresh" outlook on these folks.

But you are so right. Just because someone is a drug addict doesn't mean they aren't entitled to pain relief/control. You may have to be creative as a team, but you can treat it.

I'm sorry staff has belittled you as you attempt to provide good care too ALL patients. Yes you/we all need to be objective and not be "taken in" by any patient, but we also need not judge and let our preconceived notions diminish our abililty to provide good nursing care.