Have you ever had a patient who insisted on running the show when they were in the hospital ? I'm talking major "hard-headedness".
Just the other day I took care of a patient who was admitted for a Crohn's flare up. He had been having a lot of loose stool and pain so he went to see his primary physician and he recommended he be admitted to the hospital for some tests. The patient had been on steroids for awhile so had developed steroid-induced diabetes.
The normal treatment for Crohn's flare-up is pain management, NPO diet to rest the bowel, IV steroids to help with the inflammation and tons of diagnostic tests.
This patient was interesting. He came to the hospital prepared. He had all of his gadgets, his laptop, iPod, iPhone, kindle, etc. But that's pretty normal nowadays.
The part that got me was when I explained to him that he was NPO, he looked at me with a straight face and said, "that may be what the order says but I'm eating." Of course he has the right to refuse treatment but I couldn't help but think, "Um ok, then why are you here?". It's almost like he got a kick out of being defiant.
Then when it was time to check his blood sugar he told me it wouldn't be accurate because he had just eaten a bunch of candy. At that point I'm looking at him like he's crazy. My internal dialogue continued with, "Your blood sugar is already out of whack because of the steroids and then you're eating all of this sugar that is not going to help your Crohn's." All I could do was shake my head. I just said, "I'm not going to lecture you. You already know what I'm going to say." The patient just smiled and said, "yeah I know, these docs are used to my ways by now".
Uhh, are you serious?
I understand some patients tend to be non compliant due to fear but this was ridiculous. He had been through all of this before so he knew the routine. He certainly wasn't a novice at being in the hospital. So maybe it's just a power trip. I don't know. It's hard to believe he had a wife and kids at home who want to see him get better and he was on disability because of his illness. So why agree to be admitted to the hospital only to make your own rules and tell everyone what you're not going to do.
I guess it is what it is. As nurses we can only do so much. We can only help those who help themselves.
How do you handle non-compliant patients? I'd love to know! Leave me a comment below
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Tasha Nelson is a registered nurse who works the night shift at a large midwest hospital. She is also a total wellness enthusiast who firmly believes in the importance of taking care of yourself. A healthy mind, body, and spirit makes for a happy person. Isn't that what we all want?