Ever experience a patient's family member grieving in an odd way?

[shhhh]

My patient came in with a devastating injury and he has a very poor prognosis. The trauma docs I work with made this prognosis very clear to his family, and all of them seem to grasp the situation well except for his wife. After the trauma attending spoke with the family, he brought the wife and her friend back. He and I were at the bedside trying our hardest to be supportive, but we grew more and more uncomfortable watching the wife with the patient. While this was going on, her friend was looking at ME with this mortified expression on her face.

While acting pretty histrionically, she began kissing his hands, then she kissed his face and neck repeatedly. Then a couple minutes later, she pulled the blanket off of him and unsnapped his gown and started stroking and kissing his bare chest. The doc kept looking at me with this "What the heck do we do?" look on his face, and I'm sure I was giving him the same expression. At first, I thought that if she wasn't really doing any harm to him, then she should be able to do what she needs to do to help her grieve, because her husband will most certainly die from this. Then a couple minutes later, I thought that how she was exposing his chest and touching him like that in front of her friend wasn't giving him much dignity (the trauma surgeon and I were talking after and we both thought that a lot of what we saw bordered on sexual...bleuughh), so I decided enough was enough. Before I got my courage to say something about her behavior, I had to leave the room to take a phone call. Then the doc left the room to return a page. When I came back, she was basically straddling him in the bed. I said, "I need to collect labs. Do you want to go get coffee downstairs while I get them?" They left, but came back a couple hours later. I made it clear that she can't expose him (he had a low temp, so I put on a Bair Hugger) and that touching him so much interferred with the EKG. She didn't really listen to me and I returned to the room to find her laying next to him in the bed with her legs draped over his, stroking his chest. I told her she couldn't be in the bed with him and she got out, reluctantly, but as soon as I left and then came back, she crawled back in the bed with him. I needed to retape his ET tube with RT, so I asked her to leave again. I ended up putting the bed high in the air and put all the bed rails up so she couldn't climb up into the bed when she returned. She never did return to the room by the time my shift was over, but I reported all this to the on-coming nurse, who's a very seasoned nurse and she was a little shocked by what I told her I witnessed.

Part of feels like I'm being way too judgemental about this, but I've been a nurse for almost 8 years and have dealt with a lot of end of life cases, and this was by far the most bizarre reaction I've ever seen. Would you agree that this reaction is pretty off the wall, or do you think I'm being a bit too prudish? Do any of YOU have a comparable story (or more odd story) to share?

[CT Pixie, BSN, RN]

Even with the added info, I still don't find it odd for a person to grieve in that way.

But I better understand your reasoning for trying to limit her contact with him.

[Whispera, MSN, RN]

the added details are good to know...

[Esme12, ASN, BSN, RN]

Speaking as a critical care nurse I have witnessed many different greiving processes. I have bore witness to vodoo rituals, exorcisms, healing rituals, prayer vigils, pagan rituals, hex removals, onion rubbing on feet,observed symbolic thrashings to beat the devil out, as well as the hiring of professional fully black clad mouring whailers or cryers. I have opened windows, burned candles, allowed various ICONS to be placed on the bed and in the room in observation of a persons culture and beliefs. I have snuck babies, dogs, food, and other paraphernalia into patients room and beds to fullfill dying wishes. But even I would stop short of allowing this wife from leaping in bed with a critical patient and endanger his health and welfare even if his prognosis is poor.

Even before the OP posted the details, I agreed that this woman went past what can be allowed in an ICU setting with a critical patient requiring frequent interventions to keep them alive no matter how futile. When you have a critical patient, whether or not they have a good or bad prognosis, your efforts are focused on saving whatever you can of the patients life and prevent them from coding. The presence of an additional body in bed to accompany the rest of the tubes and IV lines is just logistically impossible. Especially in view of the fact that the patient was a head trauma and if stimuli caused his B/P to elevate one can only guess what his ICP was doing. The goal of head trauma is to decrease stimuli as much as possible which includes allowing the wife or ex-wife to be straddle his insert form in a bed filled with life saving equipment.

I understand that people who are distraught can do really bizzare things and say equally bizzare things. It is our job to give them the support and resources needed to deal with their feelings amongst the tragedy of the situation. I would request the clergy or pastoral care and social services to assist in the situation of controlling the wife or possible engage other family member to help control the situation. If the patient is a full code and require critical intervention and the wife in bed makes the situation worse she can't be in the bed.

A long time ago I took care of an 8yo litttle girl. I remember her name, her face, her hair......she was struck by a car. Her condition was so critical that she could not be taken to the OR to stablilize her femur fracture and her leg was left in the Hare traction for EMS. Her ICP remained impossible to control and I allowed her mother to participate as much as possible in her care and allow her to touch her whenever possible to maximize the mother being able to touch her daughter when she was being stimulated so that there was some contact between them.

While she was a full code I could not allow her mother to hold her daughter no matter how much she begged and I agonized over this for a long time. If she leaped up on the bed I would have had to have made her get off. I would make sure I would let it be know it was for the best interest for her daughter and I did not mean to hurt her or keep her from her daughter. ICU is not hospice, while we try to respect families wishes and feelings, we need to set limits so the patient can remain safe and try to recover......... unless they are a DNR.

When it was determined that her daughter had suffered brain death.... :crying2:I removed her from life support and disconnected her from all those tubes (they had to remain as she was a coroners case) and place her in her mothers arms who was sitting in a "borrowed" :orocking chair from OB. I gave her the call bell and left the room. I did not return unitl the mother rang the bell and was ready to say goodbye.

The OP was absolutely correct to not allow the woman in the bed of the patient reguardless of the state of the marriage or separation. It would be based on the saftey for the patient in the critical phase of his injury. Like I said....... I have allowed all kinds of things to go on in the patient room and around me...... but there are times the condition of the patient prevents the families full expression of love for the patient and limits have to be set and if they refuse they need to be escorted somewhere quiet until they can control themselves.

I mean really.......... think about it ...........a fresh admit to ICU with a critically injured patient.......many families are so intimidated by all the equiptment. I have had trouble getting them to enter the room let alone getting them to touch the patients hand..........and this one leaps in bed with the patient rubs him all over and straddles the patient in her grief? I have to admit it makes me go Hummmmmmm:confused: It would have taken me by suprise too and that doesn't even add in the icky factor or a oozy goozy trauma.....yuck:smokin:

It is very hard as an ICU nurse to walk that fine line between family "rights" and what in reality is possible. What a long shift that must have been......((HUGS)):heartbeat

[GilaRRT]

However, before the additional information was available, many including myself thought we were talking about a patient who was simply going to die. In that case, I'd be much more accommodating, ICU or not.

Of course, the updates change the scenario significantly IMHO.

[mcleanl]

However, before the additional information was available, many including myself thought we were talking about a patient who was simply going to die. In that case, I'd be much more accommodating, ICU or not.

Of course, the updates change the scenario significantly IMHO.

What is so interesting about this thread is that it was never stated that the patient was about to die....only that his prognosis was poor. It seems thateveryone jumped on the bandwagon.....even though it was pointed out several times that the patient may still be a full code.

I find it very interesting and I am not sure how it happened.

Sent from iPhone ....please

Ignore typos

[mcleanl]

Oooh....Gila.....I didn't mean to quote you. Not

Sure how I managed that! My apologies

[blueyesue]

No matter if the husband was at death's door, or was given a poor prognosis, the wife was grieving about what had just happened. This thread is about how nurses view and handle different styles of grieving. I think this is a great topic that needs more discussion and understanding.

[Up2nogood RN, RN]

The wife does have a right to grieve but in this case the pt had initiated a divorce and can't communicate his desire to have this woman getting physical with him. I would say sorry no can do. End of story.