Does anyone have suggestions for dealing with patient's families in life and death situations? Especially now in the 'customer service' atmosphere hospitals are trying to create- (at least in my hospital). We have to keep everyone happy, while trying to provide the best possible care to the sickest patients. Taking care of the patients is the easy part. I'm much more stressed out by the emphasis placed on providing customer service in stressful situations.
Oct 19, '01
lol, val..I've got a feeling you may be starting another battle. Some feel it is our duty to care for the ENTIRE family, others, like myself would like to focus on the patients. In peds, this is a huge problem, sometimes you spend more time dealing with family needs than patient needs. We have an ongoing joke with the docs when we call to request an order "for Mom's comfort". Thank God, for the most part, families are thankful and not too overbearing, BUT when you do have that one family that is demanding, it's a nightmare. Funny thing to me is those who are demanding and time consuming are also more likely to be critical and not appreciative of the staff. Also, it seems the less critical patients have the most demanding families, whereas the sickest patient's have the most helpful and understand families. I think we have to find a fine balance between "customer satisfaction" and patient care. Customer satisfaction is wonderful as long as the patient is cared for and the staff has done their necessary work for THE patient. Then, and only then, do I feel we should concern ourselves with "customer service". In the time of nursing shortage, that kinda cuts the family short, eh? I'm also curious to see what every one else thinks!
Oct 19, '01
We actually had a mandatory seminar by our Nursing Director....in which she instructed us to treat our facility as HOTEL RIC**AND.
We had a doorman, valet parking, we (RNs) had to deliver the food trays, we had to keep the coffee pot full, we had to provide little toiletry kits for the family members staying overnight, and if we made a "mistake" we had little raffia wreaths we had to give to the visitor as an "apology."
It was called SERVICE EXCELLENCE.....aka CRAP! If we were really, really, really good we might get a comment from a former patient and then......drumroll.......we got a......drumroll....
Well even with all that, we noticed NO change in visitors and family members attitude.....the nice ones stayed nice the nasty ones stayed nasty.......but we kept a running account of all our balloons on a bulletin board..........
Oct 20, '01
Interesting this topic would be brought up tonight. I had an Amish family that was just unbelievable!! Usually the Amish are pretty easy to deal with and aren't unreasonable, but this one son was the exception! His Dad was admitted to R/O MI. The MI has been ruled out, but there was a suspicious looking mass in his lung that needed investigated more. Anyway, to make a long story short, this poor man had a least 10 of his visitors just leaning over the top of him and not giving the poor fellow any space. The patient knew that the Xrays had showed something questionable, so he was anxious. This guy would start having chest pain and get very anxious. You could actually see the man's hands trembling he was so nervous. I explained to the family that I thought that so much company was upsetting the patient, but that got me no where. So, I got a sign and placed it on the door stating that visitors were being limited to 2 visitors at a time. The son goes and calls his Dad's doctor and tells him the nurses have just taken over his Dad's care. (DUH!!) The office nurse got a big kick out of the whole situation and I did get an order to limit the visitors to 4 at a time. Some Amish guys don't like to see women with authority over them either, so that might have been part of the problem. I was glad to leave that family tonight to another nurse. I was just about at my boiling point!!
Oct 20, '01
Stop and think back to nursing school..remember we treat the patient..and the family...because the patient has many roles within the family..mother-daughter-wife-aunt-sister...family dynamics are the real source of frustration. The key is to figure out what MOTIVATES the families...what are the issues??? guilt from a far away fam mem who arrives on scene to "save the day"??? anxiety perhaps...not quite ready for life threatening or life altering changes...unresolved issues(this is a biggie)--saying I am sorry in a thousand different ways...even if it is to harrass the nurses on your behalf,Mom....I see every day I work many nurses who turn away...who suddenly become busy when a family member apporaches..who avoid speaking to the family like the plague...and I work in a critical care setting ! Just today , a doctor was at the desk ...and an innocent and overwhelmed son asked him a simple question. The son not only recieved royal rude trmt from the doctor, but also was barely away from the desk when the great MD whined about how it wasn't even his patient.
I am a strong believer in patient and family education. I honestly believe the family that is labeled "difficult" is simply scared to death and feels they have no control. And control is what gives us our comfort zone. If we have some sort of control over whatever happens to us in life, we can feel ready to handle it. I always make myself available to the families at visiting hours..or when I see a wary look. Simply explaining the monitor or giving them busy work(lotioning the hands is a favorite) makes the family feel like they are doing something to help the pt get better..no matter what the motivation!!! and many times I hear.."oh, I wish you were here yesterday!" or " why can't the other nurses tell me this?" it is not because the others I work with are horrible or incompetent in any way. It is not because I am super nurse...or even an overly competent one...it is simply because I address the spiritual needs of the family..a hug, a pat on the shoulder,humor to lighten the stress...honesty at all times..no sugar coating is needed..no brutal truth either...it is ok to say I don't know..but I will find out for you...take a good look at your approach..your attitude..your level of comfort in talking to the families. They are a great resource and sometimes better than any pain med I can give. This came from 10 years of learning and making mistakes along the way. keep the explanations as concrete as possible..simple..direct. go slowly. do not overload them with too much info. do not confuse...I wish you luck!!!
Oct 20, '01
wonderful advice grnville
Oct 20, '01
in all, they said, to care for your patient you have to think about the family ....but sometimes as for me to be honest...the demanding family members makes me wanted to explode...
Oct 20, '01
greenville..if I me or a family member ever need hospital care, we're leaving the big city and the big named hospitals..we're coming to da country to see YOU!!
very well said, slap all of us back to the basics!!
Oct 20, '01
Thanks to Greenville for your great suggestions and everyone else who took the time to answer.
Oct 20, '01
...feeling guilty here.....agh!
Oct 21, '01
As a Pedi nurse I end up dealing more with family than patient. I resent 10-15 people in a small child's room. They are there to see each other, not the child and the child just wants his parents. We have a "patient advocate" nurse on days who tries to smooth over things with family. Of course I work nights and have to be the meanie that refuses visitors after hours, etc. It is a BIG mistake to create a Hotel atmosphere. People then think they deserve room service and the nurse is a servant, not a professional. Keep a diary of true incidents and discuss with other nurses on ways to handle situations. Some of these can evolve into policies to back you up. As always, the work is easier if we are a team.
Oct 21, '01
Glad to hear I'm not the only nurse going into the 'hotel business'. I have no problem being courteous and going out of my way to help people. At my hospital we are instructed to say before we leave a patients room, "Is there anything else I can get for you, I have the time" We have stufffed teddy bears from the gift shop that we give out to families who have been offended to smooth things over, if we are unable to do so by apologizing for whatever upset them. We also can give them a meal tray form the cafeteria to smooth things over. Visiting hours are history, it's open visitation. We aren't really backed up enforcing only 2 visitors at a time in ICU. It seems customer service is the priority instead of patient care. Now there is a similar crusade in place to increase physician satisfaction. I really do think my hospital is a great place to work otherwise, and I'm really glad I found this website and all of you who keep writing.
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