Talking/dealing with families?

  1. I'm a new grad in a CVICU, and I'm having a hard time talking to families.

    I've tried just being basic, once I've determined that they already know the patient is in the ICU, and is a family member, I'll say things like "His vital signs are stable, and we're trying to keep him comfortable right now." This doesn't seem to be working, I'll either get more questions, or look/tone that says "I'm not satisfied with the care."

    Or I'll get questions about a test that the doctor hasn't talked to them about yet, and I explain that it's not in my scope, but they'll act like it's my fault that the doctor hasn't come up yet to see their family member.

    Mainly my problems are with HIPAA, it's hard to know what info to give out when the pt is intubated/sedated, etc. Also, I think I'm probably projecting the message "I'm not a competent nurse" (3 months exp. so far), and they can pick up on that.

    Any suggestions on how to talk to family members?
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  2. 4 Comments

  3. by   leslie :-D
    Quote from RoyalNurse
    I'll say things like "His vital signs are stable, and we're trying to keep him comfortable right now." This doesn't seem to be working, I'll either get more questions, or look/tone that says "I'm not satisfied with the care."
    honestly, i would not say "we're trying to keep him comfortable".
    it gives the impression that pt is not comfortable, but golly, you guys are trying.
    if pt is comfortable, say "vs are stable and is resting comfortably now".
    if pt is not comfortable, say "vs are presently stable and it's too early to report on anything re his status".
    in other words, don't even bring up comfort level.

    sympathizing and reassurance, go a long way.
    "i understand how frustrating this must be for you..."
    encourage them to write down concerns and share them with the md.
    and keep on empathizing.

    best of everything.

    leslie
  4. by   elizabells
    To go along with what Leslie said, here's one thing I learned the hard way:

    Do NOT answer a question they haven't asked. I still get somewhat nervous when talking to families (and since I'm in a NICU, it's unavoidable), and I understand the compulsion to just keep talking so they know that you know what's going on. But that's the easiest way to dig a nice hole for yourself. If you have a piece of unadulterated good news, that's okay to volunteer. But any kind of "well, this bad thing happened, but we fixed it/the MD says it's fine" is never a good idea if they didn't ask about it directly.

    In re feeling like it's your fault the MD hasn't come up: I don't really have an answer to this. You're the only person they have to get frustrated at, so even if you've run your butt trying to find the doctor (and the fam has seen you do it!) you're still going to catch heat on that one.

    And I PROMISE it gets easier. I've gone from rank terror to (usually) gentle quivering!
  5. by   jb2u
    As a new grad in the ICU, I can tell you that many other new grads feel the same way!!

    I handle it like this....

    First, during report I ask the night nurse exactly what I know the phone will be ringing and I will be asked within 30 min of getting report...."How was he/she last night?". Then repeat the answer to the caller on the phone in 30 minutes!

    Second, look at the progress notes. This will tell you exactly what the MDs are thinking, what their plans for the pt are, and anything else you can think of. This helped me out tremendously!!! I now feel confident when a pt's family has a question. I know why he is on that med, what the MD plan is and then recite..."we are given meds to get the fluid off his lungs, our goal for today is to try to get him off the vent. I am not saying it will happen today, everyone's different, but we will see how he does." Where did I get that? From the progress notes!

    As far as HIPPA, I do not really get into test. I'll ask them "what has the doctor told you about the x-ray?" If they say we haven't seen him today, I will either say, well I am not allowed to discuss the xray until the doctor has looked at the xray and has spoken with the family. Or, if the person is a friend, I will tell them that I am sorry, but there are certain laws that restrict who and what information I can release without getting into trouble; however, his sister "mary" has been updated and you can ask her for anything specific. I can tell you that he is stable/critical/guarded and that we will let "mary" know if there is any change in his condition.

    Being a new grad is scary, I can't wait to be an experienced nurse, but right now I am getting that experience. Don't forget to look through the progress notes and ask the experienced night shift nurse how the pt was (just like the family will ask you). There is nothing wrong with borrowing a seasoned nurse's wisdom, this will only make you wiser in the end. One day, when you are seasoned and you see this new grad sweating as he/she talks to the family of a pt, remember today. After they leave, go over to the new grad and give him/her some pointers on how to handle it!

    I wish you lots of luck. Hang in there. One day you will be as confident as those experienced nurses are around you now.

    Sincerely,
    Jay
  6. by   RoyalNurse
    Thanks for the suggestions, everyone.

    I wish there was a mnemonic like SBAR for giving info to families, but I think you just have to gain experience at this.

    I'll definitely stop saying "trying to make him comfortable", that does sound bad!

    Maybe if I started thinking about what they're going through, instead of viewing them as the enemy.

    Thanks again!

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