I can recall taking care of a patient once who was younger than myself, and naturally when I saw the age I wondered what terrible diagnosis had led to the downward spiral of his health. As the report continued I couldn’t quite pinpoint why he was so sick, but it became apparent once at the bedside. He was the reason he was sick! Have you encountered this type of patient before?
“Just leave me alone,” he yelled!
Even as I tried to explain myself in a soft, reassuring tone, he still refused my care. He didn’t want his vitals taken. He didn’t like being turned. The SCDs were annoying. And he didn’t want to take his medicine right now. Except the pain medicine, that is. He refused finger sticks and lab draws. He scowled at his caregivers and just wanted to sleep. Naturally, my immediate response in caring for someone who doesn’t want my interventions is to bristle like an angered porcupine.
In fact, at one point I remember saying, “fine. Maybe you should be your own nurse since you know how to take care of yourself.”
And I left the bedside angrily.
Trying to take care of noncompliant patients is probably one of the hardest things we do as nurses. It’s aggravating to see that same “frequent flyer” grace your floor again because they haven’t been following the medical advice of their provider. They’re the diabetic patient whose family brings them a six pack of Mountain Dew. They’re the ones who set their alarm to wake themselves when pain medicines are due. They’re the CHF patient eating fried chicken from the local gas station, or the morbidly obese patient who refuses physical therapy to regain strength, day after day. They’re the Hypertensive Crisis who didn’t fill their prescription for Lisinopril, or the COPD exacerbation who still smokes two packs a day.
With this particular patient I listened as another staff member called him a name I had honestly thought myself, but I couldn’t stop thinking, what happened?! I mean, what made this guy just decide he was going to let his health go down the toilet? And at such a young age? As I contemplated this question I realized that surely he didn’t want to be bed bound. Surely he didn’t want to go through the painful procedures his body now required. So what had happened in his world that made him give up on a full life? It’s a question we should always ask before we write a person off.
I’ve realized over the years that a big part of being a nurse, and more importantly a decent human being, is the ability to try and walk in another person’s shoes. It’s not easy. I think it first really began to occur to me when I saw my coworkers talking about an overdose patient. They called the woman crazy, and I guess it hurt me because I come from a family full of generations of people who had problems with addiction and suicidal ideation. When I saw this patient I saw a hurting mother, not simply a crazy, attention-seeker who had caused her own problems. Yes, she had been the cause of many of them, but did that mean she truly wanted them? I doubted it.
So, back to my young fella refusing care. As I stared at the computer, scouring his history, I realized there really wasn’t a physical cause that accounted for his physical decline. He had just stopped caring about his life. And how sad was that?! What I had in my bed was a hurting individual, and he wasn’t just hurting from the physical ailments his own noncompliance and neglect had caused. He was hurting emotionally, psychologically, and spiritually. I couldn’t even get him to accept a thermometer under his tongue, so it was unlikely I could cure his scarred psyche. I wasn’t under some delusional savior complex, but I was willing to try and lay down my own anger and offense to offer him the only thing I could provide that he couldn’t really refuse. It was the thing he probably needed most.
Love.
I approached his bedside again. I approached in a spirit of love. Despite his erroneous decisions and disrespectful demeanor, I approached him with an attitude that he was worth something. Even if he had caused his own problems he still was worthy of respect. I did not know the road he had walked, or what had led to this moment. I just knew being sick stunk. I spoke with kindness, I empathized, and I didn’t really explain my purposes for the interventions I needed to perform any differently, but I suppose my own attitude and assumptions were different. So in turn, he responded differently. He accepted my care and allowed everything he had previously refused.
It’s not easy taking care of noncompliant or difficult patients. It’s easy to get angry and feel taken advantage of just for doing your job. It’s easy to be offended, and no one faults us for doing so. We’re all humans just trying our best. But it’s also easy to only look at things from our view. He’s refusing my care! Right?! The harder and more challenging part, though, is to try and take the focus off self and see the patient. Why are they this way? What must they have endured to get to this point? You may never know the answer to those questions, which is hard, but asking them opens your heart to take care of even the most apparently difficult patient.
I always consider myself a work in progress, and this is just another area I know I could improve. I’ll never advocate taking abuse from patients or their families, and I’ll never suggest we should be martyrs for the cause. Nurses should stand up for fair treatment for ourselves and our patients. But perhaps sometimes that fair treatment starts with us. We desire the world to see the hard road we walk as caregivers. Shouldn’t we also try and see the hard road our patients have traveled?
Maggie says
I myself “quit life”. It was a conscious decision at the time.A lifetime of abuse, hurts and rejections.Years of “talk therapy”.Dozens of prescriptions I reacted badly too until I refused to try any more drugs. The deaths off too many friends and family was the “final straw”. I know my GP doesn’t get why I don’t want annual blood work-cause I’m not going to change anything! Cancer screening? Nope-not going for chemo or surgery. I WAS a nurse. I’ve seen it all. Just let me go home to Jesus where I can be with my family again in as pain free a manner as possible. No codes,no tests. I just want to go home! You have to accept that you can not help everyone, and most especially the ones that don’t want to be helped any longer. I’ve improved! I no longer beg Jesus to take me home hourly. Sometimes it weeks now instead, but the underlying thought is always present. I just want to go HOME. HE is my comfort now, and for me, this life, is my cross to bare.It really isn’t about You. Its about everything that happened before that young man met up with you. If , like me, he rejects thing that are meant to keep him alive-its because he doesn’t want to be kept alive. No one knows the life someone else has lived to reach that point. Certainly, offer all in love, but don’t be personally insulted when things are not negotiable.
Nancy Obrigewitsch says
I think you are so right about this attitude be it as a nurse, doctor or or medical professional or even just a plain ol’ human. It is really easy when you are in hurry though and trying to do your job and treat a patient, whether it be vitals or anything at all. Unfortunately I think the way medical “people” are forced to taken on more patients, more tasks, just more, more, more has really left little time for that humanity to be able to come out. I remember wanting to chat more with patients and feeling bad that I had to run from room to room, literally just pasting on a smile and trying not to cut off what they were saying. I spent over 20 years as a Respiratory Therapist working with all ages. I absolutely loved my job but hated how it was just being piled on and on seeing more patients in less time. I remember going home at night sometimes and replaying things in my mind, just cringing thinking could I have done something, said something more in the time I had. I think what you said is a good reminder to just step back, breathe, think, what if, what if that was me?
brieann.rn@gmail.com says
Thank you so much!
Lisa Pierce says
This brought me to tears. I have a family member who has Hep C and refuses treatment. Instead she smokes pot and lays around doing nothing all day. She has no job, no ambition and evidentally no desire to live. She is only 21. She did manage to get off meth but she is hurting in many ways. I am at a loss as to how to help her other than praying fervently for her. I pray constantly that God will give me words to say to her to help her. She tells me I’m the most encouraging person in her life but I feel so helpless.
We don’t understand what makes people think the way they do, but thank God, some of them encounter people like you who have the empathy to know how to help them. God bless you for your endeavors.
brieann.rn@gmail.com says
You will never realize how your kindness and love to her effect her. Even if you don’t see an outward change, I believe you’re impacting her heart with your prayers and kindness.
Lisa Pierce says
Awh, thank you so much Brie.
Charlene says
Dear Brieann, I love the way you worked through this thought process with the non-complaint patient. My daughter is an ICU nurse and has said the very same things you have. She wants to see the patient with eyes of love and compassion and is always asking the Lord to show her how to minister to her patients in loving/positive ways. I believe this is what you have done in this case – you removed yourself and inserted God’s truth instead which showed love and compassion for your patient. Thank you for making a difference in your world.
brieann.rn@gmail.com says
Thank you so much for commenting.
michelleonyourside says
I think you may be the first blog I ever followed!
I really enjoy your blog so I nominated you for a blogger recognition award.
https://michelleonyourside.com/2018/09/06/blogger-recognition-award/
brieann.rn@gmail.com says
Thank you!
Debby Heider says
I feel as you do with my dialysis patients. Trying to find a connection helps, but it’s not always possible. What bothers me even more, though, are the staff members who have no inclination to look beyond their own feelings and try to put themselves in the patient’s place. As an example, we have a dementia patient who is quite elderly with multiple comorbids who cries out during her treatment that we don’t care and no one pays attention to her because we can’t terminate her treatment. She’s not aware of how bothersome that is to the other patients, yet I have staff members loudly trying to reason with her and wondering out loud in front of her and the other patients why her caregiver just doesn’t take her off treatment. It hurts my heart and I have had to take several of them aside and try to reason with them that the poor woman doesn’t know what she’s saying. I actually had one tell me “Well, she should get it, we’ve told her enough times.” My reply, “You don’t have dementia yet you don’t get it when I ask you over and over to stop berating the poor woman.” Went right over her head.