Unmotivated Patients

[hookyarnandblanket]

Lately, we have had a rash of patients who do not want to make much of an effort in their recovery. Some of it has been due to legitimate fear of overdoing it but currently we have a patient who displays what the nurses and the rest of us believe is simply a behavior as a ploy to be pampered and to treat this stay as a spa getaway. No amount of motivation seems to work on this patient. The nurses and the rest of the staff are extremely frustrated; the patient's attending physician has even to her that she cannot lie in bed all day long or she will develop pneumonia, and this particular provider is known to baby her patients to the point of enabling them.

So, what are good motivators or techniques to get through to patients who are clearly choosing to be lazy and try to get us to spoil them? Rest is always important when in recovery but to lie in bed for days on end, peeing in a brief, and the expecting staff to treat you as if you were in a five star hotel isn't going to get you better, stronger, or out of the hospital.

[TheNGTKingRN]

Don't put briefs on this patient. Place a BS commode next to the bed. Explain that when they feel the urge to go, to call. It will be terribly annoying and yes likely that the patient may soil the bed and that you may have to make a new one but I feel that this may begin to set in reality.

Sometimes you have to walk in there with big girl/boy pants and be authoritative, if the patient is choosing to act like a child it leaves no choice but to display kind authority and say enough is enough.

This patient may need a psych consult as well.

Also, is the patient in any pain? Pain will keep patients from ambulating and performing ADLs.

[icuRNmaggie, BSN, RN]

A friend who is a rehab RN, and a tough cookie, once told me they put their hands behind their backs in order to get patients to attain their highest functional level. Meals are served in a dining room and the meals served are very very good. Breakfast trays are delivered but if they want lunch or dinner the wheelchair or walker is placed next to the bed and they have to dress themselves, transfer themselves to it and get themselves to the cafeteria.

I agree with removing the briefs (that is ridiculous) putting a BSC ( only if she can not walk to the br) or a walker next to the bed, and if she wets the bed she will be placed on the bsc or chair while we change the bed. PT should be walking this pt in the hall 4x a day. The physician just needs to write the order. OOB to chair for meals , ambulate in hall 4x day.

Do check orthostatic BP and pulse lying sitting and standing to ensure her safety.

Put your hands behind your back if you want to help her. Do not dote on this person's helpless behavior.

The goal on the white board should say mobilize. This person probably is very depresssed. She needs firm kindness and maybe a psych eval.

I have been known to tell patients I am not going to baby you but I will get you better.

[hookyarnandblanket]

Thanks so much for the advice. This patient has been in a nursing home for what finally amounted to wound care and rehab. I took care of her when I worked there so I wonder if there is a psych eval on file. I know her care plan is good for another year. When i left the nursing home, she was able to do most of her ADLs herself.

She has a below the knee amputation which does cause her some phantom pain. However, the only time she complains of pain is when we tell her it's time to get up to the chair or to transfer to the commode.

Apparently, too, she has been living in an independent living site but she clearly won't be going back there if she doesn't start taking bigger steps to rehabbing. I think her provider ordered PT or was going to order PT for her.

I will admit that I sometimes revert to doing things for patients when I should be making them do more and this experience has been a good reminder that I need to encourage that more in patients. Sometimes it is just too convenient to do it for them.

[Esme12, ASN, BSN, RN]

Maybe she is depressed and has never dealt properly with the loss of her limb....I think she needs an evaluation to get to the root of the problem.

[Missingyou, CNA]

I once had a resident with "Mild mental retardation" but considered of "sound mind". He was deaf and only communicated by sign language and gestures. None of us knew enough sign-language. He had no "family" who visited regularly. He was admitted to our nursing home after a bad fall.

Anyway, he refused to do anything for himself, much like the OP described above.

Turns out, his brother from out of state came to visit and learned that he didn't want to go back to the assisted living facility where he lived. He told his brother he hated it there. Once his brother assured him he'd find him a new place to live, he started trying to do more things for himself.

...just sayin....

[hookyarnandblanket]

It's a weird situation. She wants to go back to the apartment but she misses the people at the nursing home. According to staff who have been there longer than I, she behaves this way nearly every time she's admitted and the provider caters to it to some extent. Her ability to retain her apartment hinges on her willingness to start taking care of herself while she's in the hospital; if she doesn't start doing things for herself and she continues to refuse to participate in transfers, and remains incontinent x2, she will lose the apartment and go back to the nursing home. We have explained that to her in dept but I don't think it has sunk in as reality. I know her DPOA well and saw her yesterday morning but did not have time to talk with her about what has been going on. I'm hoping the nurses have let her know about the patient's behavior.

[Red Kryptonite]

Knowing someone who doesn't like being accountable for her choices and has an insanely developed ability to tune out reality she doesn't like, I can visualize just how your patient is acting. The DPOA may not have much luck either. My family member had a sheriff's eviction notice in her hand before she finally believed she was actually going to lose her apartment if she didn't find SOME kind of job to pay her rent. There may not be much anyone can do, because no matter how much anyone explains, she'll just ignore the truth until she can't anymore.

[hookyarnandblanket]

She seems to have solved her future plans for herself. The care assessor from our "local" agency on aging came in and did another care assessment on her and she is going back to the nursing home. They will be quite cranky when they see how far she has regressed. It's pretty sad when another patient is in with a broken distal fibula, Parkinson's, and a host of other diagnoses and transfers better than this other patient. We are hoping the nursing home comes for her soon; she is a time suck because she wants to be pampered and census has been high lately. Spending as much time as we do in her room doesn't seem fair or equal for our other patients.