[Michigan RN]

I just want some advise about how I would handle a family like the one I had today. I am brand new to SICU. I worked in Progressive Care for two years.

Took care of a patient today who was twe weeks post/op gastric bypass with subsequent evacuation of a hematoma beneath incision site. The patient weighs 600lbs and has a history of some autoimmune disease that affects the liver in such a way that it causes severe anemia and coagulapathy. Patient's vented.Hypoglycemic all day. Renal and Liver failing. Patient is now chem only, no CPR, defib or cardioversion. On Levo, neo, vasopressin, amicar, continuous FFP infusion. Thats some background.

The family all day is constantly asking about his INR level. That was the only thing that they were so focused on. His INR, yeah was high when he came into the hospital, but it was 1.5 today, docs weren't gonna do anything with that. Do families usually focus on one thing as a means to cope with the prognosis of the patient? I know they had a meeting with the doc yesterday who explained what was going on the patient but they still seem very unrealistic. What is a polite way to show the family the bigger picture?

[lorilou22RN]

YES. I had a family once who was so fixated on getting the guy OOB to prevent pneumonia, yet he had renal failure, liver failure, and was so encephalopathic, would NEVER had followed directions to stand. He was on HD, yet his liver was gonna do him in. The family just couldn't understand the big pic, and fixated on a potential that could happen. It was very aggravating.

[sharrie]

It is difficult when you get a family who fixate on something that you know is not going to make a big difference in the overall care, the only advice I can offer is to be understanding. These families are incredibly stressed and anxious, they have a loved one critically ill and may not always understand what is happening and the implications of that. There may also be an element of denial, if thier family member is unlikely to recover it may be a bit of a comfort to them to focus on something they have some understanding of such as INR rather than acknowldeging that thier loved one may not survive.

Explain, be patient, show compassion and understanding. They are not doing it to make your life difficult, it's because they are in a situation they have little control over and need something they can hold onto and understand.

[Michigan RN]

I thought I was going crazy. I know its extremely stressful. I think what bothered me was when there were 5 family members hovering over the patient and one of them looked at me and in a very snotty tone "His levels are normal, aren't they?" and gave me this look like I was gonna be in big trouble if they weren't. I asked her kindly to explain which levels she was talking about because we were monitoring many levels, but before she could say anything, the patient went into SVT and I had to make everyone leave the room. Thanks for the advice.

[oneillk1]

Originally Posted by Kati2005

I just want some advise about how I would handle a family like the one I had today. I am brand new to SICU. I worked in Progressive Care for two years.

Took care of a patient today who was twe weeks post/op gastric bypass with subsequent evacuation of a hematoma beneath incision site. The patient weighs 600lbs and has a history of some autoimmune disease that affects the liver in such a way that it causes severe anemia and coagulapathy. Patient's vented.Hypoglycemic all day. Renal and Liver failing. Patient is now chem only, no CPR, defib or cardioversion. On Levo, neo, vasopressin, amicar, continuous FFP infusion. Thats some background.

The family all day is constantly asking about his INR level. That was the only thing that they were so focused on. His INR, yeah was high when he came into the hospital, but it was 1.5 today, docs weren't gonna do anything with that. Do families usually focus on one thing as a means to cope with the prognosis of the patient? I know they had a meeting with the doc yesterday who explained what was going on the patient but they still seem very unrealistic. What is a polite way to show the family the bigger picture?

I usually say something along the lines of "we are keeping a close eye on 'x' but at the moment we are a bit more concerned by y and z." And take it from there, sometimes the families accept that, othertimes they want a bigger explanation. My explanations do tend to get shorter though the more times people ask the same question!

Also probably the obvious thing of the family becoming fixated on the aspect of the patient that they know something about, as a way of clinging to the last big of control.

Good luck!

[RNFELICITY]

Originally Posted by Kati2005

I just want some advise about how I would handle a family like the one I had today. I am brand new to SICU. I worked in Progressive Care for two years.

The family all day is constantly asking about his INR level. That was the only thing that they were so focused on. His INR, yeah was high when he came into the hospital, but it was 1.5 today, docs weren't gonna do anything with that. Do families usually focus on one thing as a means to cope with the prognosis of the patient? I know they had a meeting with the doc yesterday who explained what was going on the patient but they still seem very unrealistic. What is a polite way to show the family the bigger picture?

I think that sometimes, we assume that families understand what we are saying to them because they nod their heads and pretend. Somewhere along the way, they probably heard all about that INR which was high on admit and they thought it was the most important thing going on. It takes a lot of constant teaching and constant repetition to make an impression on families because they are only half hearing you because of all the stress and worry that they are going through.
Keep hanging in there and just keep teaching!

[Michigan RN]

Thank you for your input.