What do you do with a patient who is refusing select portions of their treatment? You push, and plead, and bargain. You explain, educate, bribe and *sometimes* just go ahead and do it amid their complaints. It's for their own good, you rationalize. Depending on the patient's mental status, health condition, and nature of the care they are hesitant to participate in, you strive to do "what's best", even if they don't immediately agree.
So it goes with the protagonist in my current saga.
85 yo well nourished white female who looks to be of stated age. Health history includes HTN, CHF, CAD, and numerous fx including bilat wrists, right clavicle x2, and compression fractures of thoracic, lumbar and sacral regions. Recent ORIF of right femur, and currently in a sling for management of right clavicle (3rd fx).
Will she wear her Kendalls? No. "They hurt." For whatever reason, they opted for ace wraps instead of TEDs, and more often than not they are too loose to do any good.
Does she do her incentive spirometry? No. Partly because "It's too hard", and mostly because she can't coordinate inhaling instead of exhaling on the mouthpiece. She has a weak, non-productive cough.
Four days ago I playfully tweaked her toes to check for blanching. She yelped in pain. I took a good look at her feet. Horribly edematous (chronic), I didn't even check for pitting. No discoloration present, but her RLE was notably warmer than her left. Incision site looks great. Minimal discomfort up there. I attempted to palp a pedal pulse - poorly. She could not bear to have me move that leg. I passed it on to the staff. I told her daughter, who looked at me blankly. "She needs to wear those compression stockings
," I stressed. "And teach her how to suck air out of that contraption!
" Well, she told me, mom was refusing. She's a grown woman, we can't FORCE her to do anything, she continued. "Like hell", I thought.
Somehow, I'm the only one who is complying with the doctors' orders. Even her nurses are letting her fall by the wayside, I assume because it is easier than arguing. WTF?
Am I wrong? I mean, she's not actively fighting
the anti-DVT measures (and she is on Lovenox) - she just says "No" and then bitches about it until the other caregivers give in and let her have her way. I'm not meaning to imply I'm the "only one" who does anything the right way, but my word, people... there are protocols to follow, and her minor discomfort now will be a fond memory when her condition accelerates to ICU. Is it unethical to force
compliance on a patient? What if it is your own family? Does that cross the line from professional to personal measures?
She goes today for non-invasives. Followed by a CT, if I'm as good at predicting outcomes as I like to believe. And I hope I am wrong, this time.