Can we add "Biting the family" to the Nursing Process??

  1. Funny question, but a very serious one....

    Scenario:

    Last night, LTC patient is at death's door. Family has not seen her in about 8 months. Priest came in for last rites, family at bedside.

    I am her nurse. Have been for about 1 1/2 years. Family only comes about once a year.

    Family sitting at bedside BAWLING like babies. Family wants nurse (yours truly) to GET NOW, RUN FAST, DO THIS, etc.

    Nurse (again yours truly) has 25 other patients and 2 CNAs to cope with......

    "Mother needs more morphine....please get it now." (Mother had morphine about 45 minutes ago, not scheduled for 3:15.....)

    "Sure I will get the morphine, if you are sure you want your mother to stop breathing right now....."

    GRRRRRRR. Can I bite them????

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  2. 35 Comments

  3. by   P_RN
    THEIR guilt not yours. Perhaps...probably not.....you could ask the doc for a morphine drip.......Mama needs to be comfortable, you need the time for your other 24 patients.

    Biting the family...probably not the best.......maybe a transfer to the ER?

    I'm sorry you had to go through this. I have seen my own in-laws trying to tell the nursing home.......what to do....from 2000 mi away, when they hadn't seen grandma in 2 years even when they were 30 mi away.

    Seems those of us who did the 24/7 with her all this time are all of a sudden too stupid to think. Sometimes I wonder what the hidden agenda is anyway.

    All I can say is good luck.
  4. by   RNforLongTime
    Oh, I can sympathize 100% with you.

    Let me describe my situation. There has been this elderly gentleman on our unit (transfer from ICU) for 15 days now. He is a full code per the wife even though he has a living will on his chart. We cannot get 2 MD's to write that he is terminal in order for this living will to become effective.

    He has a trach which is now connected to O2. When he first came over from ICU-he was on blow-by(CPAP). Has a tube feeding, is a dialysis pt (was before he coded) and has a triple lumen catheter. He is a lot of work for an RN. His wife is at his bedside for a good 10-12 hours a day. When I come on shift at 3.30pm, she is usually at the nurses station--waiting for me--with a litany of complaints and questions--she NEVER asks the doctors on the case--always me. I save this pt for last--when I go around to do assessments cause I know that I will be in the room for a good half hour at least. Did I mention that the pt has MRSA? He's in isolation. So gowning etc to go into the room is also a pita. Plus, I have usually 4 or 5 other pt's to care for as well.

    The wife is driving me batty! I hav been assigned to take care of this man EVERY DAY THAT I HAVE WORKED EXCEPT ONE DAY!!!
    I work 5 days a week! Have asked to be rotated to another module--to no avail.

    I don't know if I can handle the wife anymore! He is SUpposed to go to a local nursing home soon. Th wife is unaccepting of this pt's poor physical condition. She is thinking that he will be back to his old self again and that is not gonna happen. This has been explained to her over and over again but she doesn't want to give up yet as her husband is all that she has as the never had any children.

    It gets extremely frustrating. But I have learned to just grit my teeth and be as sweet as I can cause you never know--one day I may be in that same situation.
  5. by   MRed94
    This poor lady is comfort measures only....no transfer, no IV, no nothing.

    This family is a pita, and all I can do is explain the best I can, that Mama had a living will, and these are HER wishes, not ours.

    We are trying to keep her as comfy as possible, but the family is in the way, and attempts to stay in the room for EVERY thing that we do. I finally threw them out, and brought 6 other people into the room to do a "bed bath" and there wasn't room in there for all of us and them.

    I chew nails when I get home.....

    I hate families like this. That is why I sit in the hallway when one of my kids needs hospitalization, and bite my tongue to stay out of what they are doing.

    Makes me crazy, I don't do it to others unless I need to step in when I see something WAY out of line.

    I still wanna bite them!!

  6. by   essarge
    kaknurse,

    While I can understand your feelings of "The wife is driving me batty! ", please stop and think how afraid this poor woman must be!! She has probably been with this gentleman for years and is soooo afraid of "losing him"! Remember on of the stages of grief is denial!!!

    You stated that you save this patient for last because "I know that I will be in the room for a good half hour at least". Perhaps, you could use this time for "patient teaching" in a gentle manner. Trying to alleviate this poor woman's fears!!!

    I am kind of upset to hear a nurse, that may someday, be taking care of one of my loved one's (or perhaps already has) to say ". But I have learned to just grit my teeth and be as sweet as I can cause you never know--one day I may be in that same situation.". You are right kaknurse, someday you may be in this situation, and hopefully you won't have the nurse who is gritting her teeth because you take up 1/2 hour of her time.

    Please, please, please take some time to help this woman through this. Let her be involved with taking care of her husband. I understand that you have a zillion other things to do, but maybe, just maybe, by speaking to some of the other nurses on the floor, the other nurses would be willing to help you out while this gentleman is on the floor.

    If that seems impossible, do you have a grief counselor available to talk to this poor woman? Perhaps that would help!

    Just my opinion.
  7. by   DanRn
    kak nurse,

    I understand your position about the wife. what really needs to be done is to secure help for her thru other areas of the hospital.

    the social woker. patient laison. your charge nurse or manager. co-worker.

    they should all be at your disposal to help you help the wife.

    but the real problem---->

    also after a week, demand to your charge nurse or manager that you need a different assignment. if it doesnt happen, follow the chain of command.
    overall, it really sounds like u are being dumped on.
  8. by   frustratedRN
    i dont see anything wrong with your attitude. id want to grit my teeth too. and you know you cant say...i have other patients cos they dont care. if it were my family i wouldnt care about your other patients either.
    fact is tho that you ARENT being rude to the wife. harassing you is probably the very last thing she is going to be able to do for him. in her mind shes thinking she is coordinating his care.
    i deal with families like that all the time. i help them all i can. if i see families sleeping in the waiting rooms i will take them some linnens and pillows. i try to make them feel welcome and comfortable. sometimes, yeah it backfires and they just harass me but still i feel good about what im doing.
    i just went thru this last week. we had a patient who had been sick for a long time. she was on our unit for nearly a month. i took EXCELLENT care of her. i was the ONLY nurse that didnt hate her.
    this woman was on the call bell constantly, and yelling as well. she was constantly calling for the bedpan cos she thought she had diarrhea...then she would demand to be washed. one night we gave her 4 baths. my assistant was in that room nearly all night leaving me to care for the rest of the patients by myself. on top of that she was demanding breathing treatments hourly. she would scream NURSE!!!! for us to answer her phone. first time i thought she was hurt.
    mainly this woman was anxious. the anxiety would cause hyperventilation. that would cause more anxiety.
    her sister came in every day and kept coming out to the station demanding breathing treatments. demanding bathing. demanding the bedpan. demanding the sister be put in a chair. while these are all reasonable requests the number of times she asked for them, plus her regular medication care, was unreasonable. her sister started keeping a log of how long it took us to answer her call bell.
    the patients daughter came to see mom once the whole time i cared for her. but she was always calling the DON or the supervisor to complain about her care.
    the last night i had her i called the supervisor at the begining of the shift when i learned the sister wanted her put on the bedpan q15 mns. no way.
    the supervisor came in to talk to her. good thing too cos later that night the daughter called to complain that mom was on the bedpan too long. the supervisor was well aware of what was going on because she saw her in action. i was glad i covered myself.

    just keep gritting your teeth. you have every right to do that and not feel guilty about it.
    he will be gone soon enuff
  9. by   RNforLongTime
    Ok, guess, I didn't explain the situation very well.

    Our social worker has been working with the wife of this patient for weeks. She is still very unaccepting of her husbands poor physical condition. He is actually very stable right now-as stable as he is going to get. I have spoken with her as well as other staff nurses about his condition. Our social worker has even tried to see if they are eligible for medicare/medicaid and I guess that they are not.

    I have been extremely nice and patient with her. I was only venting my frustrations here. I am very well aware of what I must do to take care of the patient and his wife.

    I have requested to have a new assignment--to no avail. I believe that he should be rotated every few days among all of the nurses. I am off today so Tuesday, believe me, I will be requesting a new assignment.

    Essarge, I know you are still a student and I thank you for your advice. Until you have walked a mile in my shoes you should not judge me. I was quite taken by your comment that my "venting" upset you. But when you get out into the real world you will see and experience how frustrating it is to care for patients and family members such as this. We as a whole are doing whatever we can to assist this lady as much as we possibly can. We have spoken with nieces and nephews about offering their aunt some support during this difficult time. Like I said earlier. I am always very nice and patient with her and try to answer her questions as well as I can. She actually likes when I am caring for her husband. But sometimes, no matter what we as nurses do or say, cannot get certain information inside a family members head.

    The biggest thing here is, I know that she doesn't want to see her husband in a nursing home but there is no way she'll be able to take him home in the condition that he is in.

    Essarge, I feel as though you are saying that I am a "bad nurse" because I get frustrated and need to grit my teeth? You will see how it is when you are on your own when you finish nursing school. A half hour is a long time because when you have 5 other patients to care for and another admission on its way, it gets to be very time consuming. So most times I can forget about taking a lunch.

    I have learned to control my frustrations and save it until I am in the medication room and can vent to another nurse out of earshot of any patients or family members. That is what I meant when I said gritting my teeth. Believe me honey there are a lot worse nurses out there than I. And as far as getting any help from my co-workers? I work with a bunch of slugs. Nuff said.
    Last edit by RNforLongTime on Sep 3, '01
  10. by   essarge
    Kaknurse,

    I never meant to insinuate that you were a bad nurse. I was just stating that with you gritting your teeth is probably sensed by this woman.

    You are right, I am "just a student", but I was also looking at it from the patient/family point of view because I have been on that side more than once. A patient/family can see/sense when another person feels that they are an inconvenience. This making it even harder to deal with this type of situation from the family's point of view. That was all that I was saying.

    I'm glad that SS is involved in this particular case. I am disappointed that non of your team members would help out or that they rotated this assignment.

    I'm sorry if I offended you. It was not meant to do that, but maybe allow people to think about the approach that they use in different types of situations.
  11. by   delirium
    Kaknurse:
    I have read many of your posts in the past, and I just want to say that you sound like a GREAT NURSE. You always express concern for your patients, and clearly do your job to the best of your ability. I don't think gritting your teeth is a bad thing. Anybody in any sort of customer service job has to grit their teeth at one point or another, and its not because you dislike this woman, or find her to be an "inconvenience", but because nursing is a stressful occupation, and you probably have a thousand other things on your mind, and you don't have time to comfort this woman, and discuss her husband's case as clearly and fully as she would like you to. Wow was that a run on question. Sorry Professor Karlin (he used to kill me with those... red pen everywhere).
    Anyway, I just wanted to say that. I am also a student, and I aspire to be such a competent nurse.
    God Bless you.
  12. by   MollyJ
    I think patients/families/nurses fear two things above all else. One is loss of control and the other is death. (Existential psychotherapists use a framework that says that there are four domains that are core problems or issues for all of us and they are: death, freedom, isolation and meaninglessness. Going into all of this just is more than we can accomodate here.)

    There is nothing like a trip to the hospital to bring you into contact with the two great human fears of death and loss of control. For my case management cases, almost every blow up could be traced back to these two issues.

    As nurses, we wait for our patients and their families to come to the conclusion that death is, simply, part of life and that we are not in control here. Sometimes our grand medical technology enables families to think that they can permanently run from this FACT. As nurses, we WANT to say, "Look, lady, your husband is never coming home. Even if we get his body home, he's gone." If we do, they are not ready to hear it and they call us callous or rude (and saying it like that is pretty bald).

    Aided and abetted by the medicare funding system, physicians who are taught to sustain life at all costs or live in fear of the dreaded lawsuit and OUR OWN DEVOTION TO TECHNOLOGY we actually become part of the fantasy that death can be forever put off and the family is in control (one unfortunate aspect of the consumer rights movement).

    But there is nothing like nursing to let you in on the secret that Death Happens and We Are Not in Control Here. Just because our spiritual genesis, attained in the care of hundreds of patients, has brought us to that point, doesn't mean our clients are there. In fact, they usually aren't. And the system enables.

    As nurses, we are left with little more than trying to meet the client and the family where they are. Gently, oh so gently, we can occassionally, let the family talk about their concerns that "things will never be the same again." It is then our job to simply agree with that statement and to not falsely reassure. Not in the way of the crusader, but as the opportunity presents itself, we can point out the limitations of our technology, but only time can help these patients and their families arrive where we are or will be.

    The greatest act of love is letting go sometimes. How hard would that be to do if it was my husband, my son?

    All too often in my CM cases, I asked, "What are we doing here?" And I learned patience but I still railed against what I saw as an essential denial of facts in many of my parents.

    No answers. We just plod on.
  13. by   Mijourney
    Hi MollyJ. If you'll forgive the pun, I think you're 'dead on.' This, in my opinion, is another area where the treat and cure mentality fails miserably.

    Doctors, in particular, have historically been brainwashed to believe that they can defy death, and that were they can't, it was nothing that could have done in the first place.

    Nurses have been the ones caught in the middle of the process of death and illness. We have been the glue that have kept doctors, patients, and their families together and going. That is a very tall order and nurses frequently and understandably get overly stressed in these situations.

    As MollyJ indicated, our system enables this to happen. In fact, it's gone beyond the system, because I feel that in the states it's now imbedded in our culture. At some point, we must understand that illness and nonviolent death is a part of life. Unfortuately, there is not enough staff or funding to expand hospice services.
  14. by   hoolahan
    kaknurse, I have to say ditto what MsPurp said!


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