Noncompliant Patient.

Compliance means to be cooperative, willing to follow Treatment Regimen.

Noncompliance means not cooperative, unwilling to follow Treatment Regimen.

The questions that arises is why will someone refuse treatment regimen?Why will someone refuse to cooperate with their plan of care.Why will you reject something that will make you better. Something that will keep you healthy and possibly prolong your life?

Here are Some Reasons:

“No English”.Some people will pretend that they do not understand English to see what the healthcare professional might be saying about them.Which did not make sense but for them it made a lot of sense.We should use the language line to make sure that they understand.

Denial of the problem: Refusal to accept diagnosis but did nothing about it .Some are too proud of themselves that they will not confess that they don’t have the resources. Therefore they rather hope against hope until it is to late.Then BIBA to the Emergency Room.

Importance of Previous Experience:One good experience deserve another. Bad experience is always discouraging.

Lack of Adequate Support System: It is very important to reject “NO”for any unreliable answer. According to WHO about 125,000 people die within a year due to noncompliance.

Other Factors include negative attitude, lack of motivation, cultural and Beliefs System,Educational level, Gender and Marital Status.

Cost of Treatment : Most people cannot afford to pay for treatment, but has no solutions.

Age.This is one of the factors that can affect compliance,because patient is demented and does not comprehend the needs to cooperate. So families or other social support should be involved.

Language barrier.Patient does not understand.It is very difficult for both the patient and healthcare workers when patient does not understand.Language line can help or qualify interpreter.

Belief System.In Africa in those days there was the beliefs that Cancer, Diabetes, hypertension and Aids are “White man’s” disease.This is due to ignorance and lack of understanding.

People were living longer then due to lack of Stress,their means of livelihood was Agriculture, there was no Processed Food,live was simple.Everybody was their brother’s Keeper, caring for each other .

Then came the era of processed Food,Greed,Stress,Dishonesty.The Culture,Norms and Value System of the Ancestors were Relegated to the Background.

So you get what you paid.You want to emulate the Western World.You must have a system that are in place to move the Country forward with modernization. But unfortunately for people in Africa they have No Adequate Healthcare System to take care of their “New attitude”And the current Death Rate is alarming.They have no solutions, the Government are Corrupt through and through.The rich seek Treatment overseas and the Masses die of diseases, hunger,and starvation.

We did a health Fair over in Africa twelve years ago, in which one of the client blood pressure was over 200 Systolic and diastytolic of over 120.She said that she had no money for doctor’s visit,we paid for doctor visit and medications .But she ignored all warnings.Did not take her medications.According to her “high blood pressure did not kill my parents and will not kill me”. She died three weeks later.Some people will just believe what they want to believe which might be detrimental to their live.Did she know what killed her parents since there was no autopsy?

No she did not.

I have hoped against hope that one day,reality will set in and they will realize the truth and that day may be “Now”.

There are people in various parts of the world that don’t understand the disease process and don’t want or believe in it or care.And there are other people who understand and do the right thing.Health Promotion and Disease Prevention.So life expectancy in third world countries are low due poverty,access to health clinics,knowledge deficits, finance, substance abuse,age,belief systems and so many other factors.

Finance.someone people have no means of transportation to the clinics or money to buy the needed medications.

Nutrition.So many patients do not follow the right diet.For example the dialysis patients should avoid the three Ps which are potassium, phosphorus and protein.But they do not because so many of them cannot afford it.

Substance Abuse.Most often patients that abuse drug and alcohol don’t follow doctors orders, so they end up in Emergency Rooms.According to World Health Organizations most of the hospitals and Nursing homes admissions are due to noncompliance.

Nonchalant attitude.Some patients don’t care and they don’t see it as their problem.Rather it is the doctors and hospital problem.”Is their problem not my problem”

Frequent Flyers.The frequent flyers do not pay attention to their health,so they come to the hospital frequently only to go out and continue to do the same thing again,and again.

Homelessness.When you are homeless it becomes difficult if not impossible to take control of your health or your life.

Poverty. Poverty can be a disease.Seek help from all the right places.Do not give up.There is government hospitals, Meals on the Wheels,Public Transportation systems,Homeless Shelter, and various places that you can go to get help.

SOLUTION.

Nurses to Educate Patients.Educating the patients about their disease process ,and how to manage their health is very important. For example a diabetic patient need to have accucheck machine, and all the needed supplies to check their blood sugar.

Patients Education .Educate patients on the importance of compliance.Explain to patients and families the disease process and the need to comply.Because noncompliance can lead to so many problems.

Education,education with case scenarios for those who believe that it cannot happen to them because it can happen to anyone.Educate on Prevention and Health Promotion and also explain the pathophysiology of the body.

Happy doctor with drug and patient on bed at clinic

Involvement patients in their Plan of Care.

Patients should be involved in their plan of care.Encourage them to follow up with their doctors orders.Take medication as prescribed.

Family Involvement.Involve patients families. Educate them on how to take care of their love ones.

Financial support: Refer their to the proper department to help with payment.

Social Work and Case Manager should be involved to follow up with patients and make arrangement to help with supplies of important medications for one to three months supplies.Until patients can find their grounds.

Mathematics Test( in relation to Flight and Fight).

The teacher wanted to give the students surprise Math Test . He distributed the test on their desk before the students came in.

As they walked in,he announced put away your backpacks bring out your pencils and have your seats.And he distributed the calculators.

They all sat down quietly.One of the students looked at the mathematics and said,”Math,algebra or whatever they call you .My teacher has never taught us this.Immediately

Pupils became dilated due to fear.

Flushed Skin

He started to tremble.

Heart Rate went up.

His breathing became fast.

His body is ready to respond.

The body ready to respond is been triggered by the release of hormones known as Nor epinephrine and epinephrine, released by

the nervous system and adrenal medulla.

Then the body now prepares to run or stay.And that is; do I take this algebra test
or do go home sick?.

Then here comes the teacher, Paul you are good at this.Remember last time you were helping other students.

Paul then relax did not run but stayed and took the algebra test.

DIFFICULT PATIENT.

The Doctor and His Patient.

Doctor M.X walked into patient room ,introduced himself to the patient as his doctor.

He told the patient that he want to assess him and change his wound dressing.The patient replied no you are not.

Fuck out, get out of this room right now.

The doctor tried to explain again what he wanted to do .The patient said ,”get your ugly face out of my room now.Go, I said leave.

Doctor :” You do not want me to check you and see how you are doing?

Patient : No I said fuck out,get out of my room.This is my domain.And if you insist I will file assault charges against you.

Doctor : Okay thank you very much.

Patient : Yes fuck out ,go and eat shit and die,ugly bitch.

Doctor : Walked away quietly and documented his experience.


PATIENT EDUCATION.

Nurse and Patient Husband.

Foley catheter was inserted in a fifty years old female due to urinary retention based on the Emergency Room doctor’s order.Patient was having difficulty to urinate,all effort for her to urinate before placing the Foley catheter in her was impossible. Bladder scan was done and it showed that she had over one thousand, three hundred urine in her bladder.

Upon insertion of the Foley catheter, one thousand of amber colored urine was drained out.Patient said that she felt better.Then came patient husband,

he pushed the call light and the nurse walked into the room.”My wife does not need that thing inside her private part.I felt insulted and violated that you put that thing inside my wife without consulting me.”(Husband)

Nurse : Sir I understand that you do not want the Foley catheter.

But why do you feel insulted?

Husband : Kept quiet for few minutes and replied because she does not need the tube inside of her.

Nurse : You feel that her private part is your territory.

Husband : Exactly,nobody has the right to put that thing in my wife. Not even President Bush can tell me what to do with my wife.

Nurse : Mr C.S you wife is not able to urinate.

Husband : I do not like it when you guys act like you know everything.My wife can make urine.And she has been making urine for a long ,long time.

How can you say that because I brought her to the hospital. And because I wanted the doctor to change her blood pressure medication and pain medications. Now she cannot produce urine. Who the hell are you? Are you God?

Nurse : We are not God ,the doctor ordered some test on her to see what is going on with her.And she will be admitted to the Med/Surgical floor to monitor her ,give her some fluid, antibiotics and run more test.We will make her comfortable.

Husband : Okay I still need that thing out right away.Now.

Nurse : Okay sir, I will let the doctor know. Can I get you something to drink?

Husband : No I will be leaving soon. We live two hours away from the hospital.Thanks Nurse you know what you are doing.Nurses are great people.I will call you when I get home.What is your name?

Nurse : My name is Jenny.



PATIENT EDUCATION

Nurse and Patient Daughter:

Patient daughter called the Nurse to the room because her mother wanted to urinate(void)The doctor has ordered to ambulate patient three times a day(TID) So when the patient called that she wanted to urinate.The Nurse was happy because it is a great opportunity to start the ambulation.

So when the nurse came in ,she said that she will take the patient to the restroom.But Patient Daughter said,” I prefer her to use the bedpan instead of walking her to the restroom.

The Nurse explained that the Doctor wanted the patient to walk three times a day.The daughter was furious “,You nurses are so lazy and do not want to do a shit.I do not care what the doctor said.The nurse went further to explain that walking your mother is actually good for her,it will increase circulation,and make her recovery faster.Also will help to prevent DVT (Deep Vein Thrombosis)

The Nurse decided to do patient/family education .

Patient Daughter: I am not interested in any of that ,call the doctor.

Nurse : Called the doctor and over the phone the Doctor explained the need for patient to ambulation three times a day.

Patient : Apologized to the Nurse.

Patient Daughter : Whispered to the patient,” I do not like her”.


Doctors and Nurses Relationship.(In my perspective)

Congratulations to Doctors and Nurses for providing excellent Patient care. Doctors and nurses have been working together as team for centuries  and will continue to do so.

A Doctor is a Medical Practitioner,a licensed Professional that Practice Medicine.It involves Promoting,maintaining health through,studying ,diagnosis and the treatment of diseases,physical injuries and mental health.
A Nurse is a license professional who is educated to the understanding and execution of Nursing diagnosis,planning,implement,evaluate,and outcome.Nurses understand diagnosis and treatment.

Maslow’s theory of basic needs involves assessment,planning,implementation,evaluation and outcome.

These are the five steps of Nursing Process.

Nurses are also involve with leadership training,Research and Education.

Nursing care involve many other activities such as carrying out complicated procedures to simple things as holding hands,bedpan,urinal and  Patient feeding.Nurses are patient Advocate.Nurses share themselves with others and enjoy sense of humor.

Advantages of doctors and nurses working together

Image of the hospitals: When doctors and nurses work together the hospitals do well.Patients and families are happy .More referrals are made.

The doctors are the mirror of the hospitals, let us make them happy.

Positive Outlook: Everyone is a winner.Invite your doctors to your potluck.

Management: Doctors ,CEO and managers are happy.

Increase Retention: Nurses get their raise and want to stay and support the establishment.

Stock Market: Hospital stocks go up.(check out the HCA stocks ,and Kaiser Permanent stocks)

Revenues :Increase in hospitals revenue,good insurance package.Happy employees,happy employers,and happy doctors.Moreover happy patients.

Outcomes:Safety and reliability in hospital Regulations lead to excellent patient outcome.

Teamwork : Teamwork ,team environment.Nurses are able to manage each other.”United we stand divided we fall” For example When Jury cannot reach a verdict ,the result will be mistrial and they have to start all over again.We do not want that.

Disadvantages

Bullies :Nurses became bullies against other nurses.They want to throw their colleagues under the bus.They want everything done before you leave.

They become disrespectful and disregard of their colleagues, who is also a license professional. For example if you tell an incoming nurse that the doctor did not call you back.She forces the outgoing nurse to stay behind until she reaches the doctor,write his orders, execute the orders before leaving.This leads to unnecessary overtime.

Hospital Reaction: Hospitals want good image,good doctors,more money.

Lack of Respect: The doctors have no respect for the Nurses.They stereotype nurses based on Social Media image of Nurses in the 1970s and 1980s.

So many hospitals prefer to hire nurses with Bachelor degree in Nursing rather than associate degree in Nursing, so that there will be better understanding among doctors and nurses.

So there should  be teamwork between Doctors and Nurses,and the Nurses and Nurses.

High Turnover Rate :Some nurses became burned out,because they were bullied constantly.And they start to leave. And guess what, because of their experiences in their previous place of work ,they tend to do very well in their new homes.I have taken the time to monitor nurses that left because of unbearable environment.

Obstacles That Need to Be Addressed.

Communication: Doctors not responding to their pagers or cell phone when they are call. Some of them will get upset with the nurses for example.Doctor :Why did you call me at 9PM?

Nurse: Doctor I need to get an order.

Doctor : Why 9PM?

Nurse: Because I have been calling you but you are not responding.And the previous nurse told me that you did not respond to her calls either. No need for argument follow the Chain of Command.
Unprepared Nurses : When you call the doctor,prepare your information before calling.Use the SBAR

S : Situation. What is the problem?

B Background .Brief information about the patient. 

A :Assessment .What did you uncover? What did you found out that is different from the previous.?

R : Recommendation Make your suggestions of what you think and then listen to doctor orders.

Lack of Respect by the Doctors: The doctors see the nurses as their Subordinates.Respect is Reciprocal.Give me some.

Clueless Doctors: Some doctors believe that the nurses do not do anything.They are just there to answer their phone calls.And accept orders which is far from the truth.

Frequent Callers: All questions make sense but some of the questions might not need to be for the doctor.

Here are my examples

Doctor, can I run Vancomycin and Zosyn on the same line? Some doctor might not know.So your best bet is your Pharmacist.So call the pharmacy Department,and ask to speak to the Pharmacist. Another question “doctor does the patient has Foley catheter or Supra pubic Catheter or three way Catheter?” Assess your patient ,if you are not sure ask your Charge Nurse,experience Nurses.Why call the doctor when you are with the patient and you can check it out with other nurses.

Call the Doctor :If you need an order from the doctor or your Patient is not doing well, abnormal vital signs and abnormal lab values.Change in patient condition you Must call the doctor.If the doctor is not responding follow the Chain of Command.Do not call the doctor because you like him,because he is handsome,cute or with a wonderful voice.

Or because you plan to date a Doctor.

TEAMWORK.

REFERENCES

Crowther,Christy L. Primary Orthopedic Care

Current Emergency Medicine More Than 500 Diseases

NURSES YOU MOVE ME by Philomena Okeke.

Nursing Collaboration.

Communication: Nurses understand that communication is a very important recipe for Nursing assessment.

This is one of the fundamental of nursing process.Great interpersonal skills are very important.It promotes good patient outcome,creates mutual respect for each other.

Proactive Nurses: These Nurses come to work ready to solve problems.They function effectively and efficiently within the Nursing profession and with other healthcare professionals.Their problem solving approach to patient care make them asset to Nursing profession.Kudos great Nurses.They understand Nursing ethics.That is the moral principles of nursing care.

American Nurses Association.

Smile: They smile like is Christmas,get along with everyone.But at the same time understand the Nursing process and are ready for the job.

Ready to Help: They know how to troubleshot and willing to help others.These nurses are not judgemental.Nurses with great interpersonal skills.

Leave Baggage Behind: These heroes leave their personal problems at home when they are at work.I remember a nurse that lost her parents at the same time .Her father died in July ,she kept quiet trying to deal with her lost,then while at work she received a phone call in September of the same year that her mom just died and she cannot see their bodies.She did not disclose it .She did her job quietly and never complained.


Nurses are educated and licensed to practice Nursing.And to understand diagnosis and treatment. How human being response to illness and recovery.

Unfair Assignment (In My Perspective). Nursing.

Unfair Assignment: Assignment should be distributed fairly based on experiences and categories..For example a new nurse that does not understand tracheotomy care and chest tubes should not be assigned with those patients.They cannot take adequate care of these patients without proper guidance.With hospitals shortage of nurses ,long hours and poor working conditions.The job become more difficult for the new nurses that are trying to learn their new roles.So manipulation of their assignments or anyone assignment is unfair.Provide support, be there for them.

Unhappy Nurse:As a result of the unfairness, many nurses became miserable and left.No Nurse will want to be involve with negligence.Because your assignment is so ugly you did not observe the abnormal lab values,and abnormal vital signs.

The Reality : Some nurses accepted to work in acute care hospitals but they do not know what they are up against.The truth is that the beginning of everything is hard.So you have to focus,focus and plan and organize your work.Once you are at work; your newly found love can wait because your hormone cannot be raging while you are trying to focus.So drop that cell phone. Call him back during your lunch break.(my perspective)

Manipulative employee:There are nurses that are insatiable.These group of nurses will always complain about their assignments no matter what.So they come in early and change the assignment with the permission of the charge nurse.They derive joy in making others unhappy because they have unhappy personal life.

Smile : Do not be emotional. Do not take it on your patients,the charge nurse or other nurses or the doctor.Your shift is only eight hours or twelve hours.So before you know it ,it is over.Be nice to your patients,create a positive impression.Use the resources available to you.Remember the acronym AIDET . Use it.Sometimes such situation test our patience and who we are as an individual.If it did not kill you ,it will definitely make you stronger.

Short poem by a Nurse

I walked into the nursing station

I looked, it was my assignment.

I felt like running away.

I must not run away.

I said “no”

I must face it.

Went to the Manager.

She asked how can I help you?

I felt like telling her that I want to quit.

Called my hubby.

He did not want me to quit.

Manager decided to change my assignment tomorrow.

I decided that I am done.

Politics and clicks in Nursing?


PATIENT CALL LIGHTS.

The call light is life alert or lifeline.It is a universal standard that demonstrates the quality of care.It should not be abused by anyone.

There are various types of call lights (Regular call lights,call lights for paraplegics and call light for quadriplegics.)

Who should answer the call light?

In my perspective everyone should answer the call lights ,from the Nurse Manager ,assistant Nurse Manager,Charge Nurse ,Registered Nurses and the Nursing assistants should all answer the call lights.Whoever that answer the call light Must notify the primary nurse immediately or assist the patient.

Not My Patient Syndrome must stop. We are members of the Medical Team.We should please work together as a team.Teamwork is the key. Our patients need our help.If your patient need a bedpan,give your patient the bedpan.Do not leave the room to call the nursing assistant.You have two hands .JUST DO IT. Prevent Falls,and provide Safety.Beds in low position at all times and call lights within reach.

Supervisor Notification: If a call light is not answered immediately the call should go directly to the supervisor.The supervisor should hold the Charge Nurse accountable because the Charge Nurse know the patients that need help more than the others .And must distribute the assignment fairly.And the Charge Nurse should hold the Primary Nurse accountable for not responding promptly to the call lights.

The Nurse On Cell Phone.Please put your cell phone away and take care of your patients.You cannot eat your cake and have your cake.If you do not want to work stay home.

Call Light Meaning: Call light means that someone needs help and should receive immediate response.Develop the habit of helping others because you never know when your favorite uncle is on the other side.

Distance of Room: The distance of one patient to the other can make a huge difference.For example Nurse Jenny has a patient in room 202,217,229A 229B and new admission in room 211. Three of those patients are in isolation.Do not set Jenny up for failure.Allow Jenny to fail based on her incompetent,laziness or unpreparedness.Unfair assignment leads to high turnover rate.

AMAZON.COM NURSES YOU MOVE ME.

Building Nurse Patient Trust Relationship.

NURSES YOU MOVE ME by Philomena Okeke @Amazon.com

Effective Communication:Communicate well with your patient.

Introduce yourself, for example.”My name is Jenny I will be your nurse from 07am to 3:30pm.Explain your role in the Medical Team to your patient. Write down your name on the chalk board.Update the chalk board.

Assess and Listen: Assess your patient from head to toe, and listen to their needs and concern.For example are they in pain,do they want to change position,use the urinal or use the bedpan.Or do they want to go to the restroom or make a phone call to family or friends.

Effective communication: Communicate well with your patient.Introduce yourself.For example “My name is Jenny I will be your nurse from 7am to 3:30pm”. Explain your role in the medical team to your patient.Write down your name on the board.Update the chalk board.Make the information on the boasess and Listen:Do your 5minutes head to toe assessment.Listen to their needs.What do your patient need ? Is he in pain,does he want to use the restroom,urinal or bedpan?Or does he want to change p

Show Empathy: Be compassionate to the needs and concern of your patient.Prevent falls,keep your patient safe and call light within his reach and the bed in a low position at all times.

Bedside Manner: Keep patient table clean and organized and what he/she needs within reach.For example glasses,earning aids,and denture.

Be knowledgeable: Know your stuff,if you are not sure tell patient that you will call the doctor or will find out and come back.Update them with their plan of care.

Validate Patient feelings: When you show that you understand and demonstrate that you care about what they are going through.It will allow them to trust you.And to discuss freely with you.

No defensive Mechanism:Do not use defensive mechanism.Nobody want or like defensive mechanism especially when you are sick.Tell the patient when you will be back after you finish with them.Be pro-active find out what they need before you leave.

Outside the Hospital: Ask them what they did before they became ill.

By doing so you are letting them realize that you recognize them as a human being that has life before hospitalization.

Involve patient in their care: Patient and his/her family should be involve in his/her plan of care.

Anticipation of Needs: Anticipate your patient needs and do hourly rounding on your patients to make sure that they are comfortable.We all want tender loving care.Will you want extra catch up or napkins from the Restaurants? So do your patient. Before leaving the patient always ask if there is any other anything that you can do for them.

Thank your patient and reassure them that you will be back in one hour.

Nurse Assessing, Communicating, and Changing Dressing.