Family member sabotaging patient!

Nurses General Nursing

Published

I work on a surgical unit, we have an elderly gentleman in for I/D of his left elbow due to bursitis and cellulitis. He has end-stage Alzhiemer's. We are running tube feeding through a Dobhoff. His orders include having his HOB at 30 degrees at all times. He has already been diagnosed with aspiration pneumonia. His son and daughter-in-law (happens to be pediatric surgeon) flew in from out of state to be with him. They are with him almost around the clock.

So here's the issue. I noticed this evening, when they returned from dinner, the first thing the DIL did when entering the room was to put the bed flat. The pt has a one on one CNA with him, and she told the DIL nicely that the HOB needed to be up, per doctor's orders. Since family was in the room, willing to montior the pt, the CNA went out to help the other aides on the floor. The DIL proceeded to lower the HOB again. I went in and raised it, and explained again that it needed to be up. (I documented the education.)

I informed the charge RN of the situation, and kept a watchful eye that it didn't happen again. Thankfully the family left to get some sleep at around 2030.

When I was reporting all of this to night shift, the oncoming nurse told me that last night, as they were changing the pt's linens and repositioning him, they had to put the bed flatter, but the nurse turned off the tube feeding pump while she was doing this. In the middle of changing the bed, the DIL reached over and turned the pump back on! So the nurse turned it off, and the DIL reached over and turned it back on. The nurse confronted her about it, explaining the risk for aspiration. The DIL stated "He won't be lying down long."

She is a doctor for heaven's sake! I know she understands the physiology of all of this. The only explanation I can think of is that she is trying to kill him. Maybe that's blowing it out of proportion, but GEEEZ!

Have any of you seen a situation like this. Whan happened. What did you do? They are flying back home tomorrow, thank God.

I was told that she was actually a professor to one of our surgeons when he was in medical school. He spent a while visiting in the room today, so I believe this is true. She also seems to use medical language appropriately has made useful suggestions regarding other aspects of the pt's care, ie how to better secure his PICC to prevent him from pulling at it. This is all so confusing, and infuriating.

Regardless of her credentials she is not the patient's doctor.

Were it me...

I would definately give the social worker a heads up on the situation and possibly fill out a variance form every time the family put the bed flat.

I would just keep documenting what you see and any teaching you give and the familiy member's response to that teaching verbatum.

I would also check the hospital's policy on elevating the HOB and quote it chapter and verse anytime it comes up. If it is physican's order that it be up, quote that. If she isn't the patient's DPOA for healthcare than she can't waive policy on his behalf. If she is DPOA then she needs to sign a waiver releasing the hospital from responsibility if SHE puts the HOB down.

Specializes in NICU, Infection Control.

Another approach would be to ask her why she wants the HOB down. "I've noticed that we keep finding the bed flat. We're concerned about your FIL, he's already had an aspiration pneumonia--our protocal (or Dr's orders) requires that the HOB be elevated to prevent that. Is there some research of which we are not aware showing it's better to leave the bed flat?"

That would tell her you are aware of the behavior and requests a rationale for it.

Specializes in Gerontology.

You could also put up a poster with very large letters saying "Head of Bed must be up at all times when feed infusing".

We've done something similar - we have a patient who keeps asking for water and well-meaning visitors would give it to her -not knowning that she has almost no airway protection when swallowing and they were putting her in danger. The poster worked very well.

Specializes in Pediatrics (Burn ICU, CVICU).
Seems like the families will always win though. We had a pt come in with a 10 page list of instruction on how we were to care for him. Included was how to change his rectal tube every day and basic wound care and how we need to crush his meds....Things like this are lawsuits waiting to happen.

Does anyone ever stop and consider that with this type of patient, on home care, they may be actually attempting to help the staff, by furnishing his routine care management. And that they had no intention of suing. However, beging blown off, by staff, might have an impact on them. And they might become very watchful. And if their love one suffers any adverse actions, they will consider a suit. What difference does it make that they have handed a nurse a 10 page list of instructions. Take them thank them, review them, incorporate those you can. And explain to the family those you cannot and why.

Grannynurse

I totally agree with Granny on this one. Many of these type patients know how to better care for themselves than we do.

Is it possible she has a need to feel like she has some control over the situation? You know, like a lot of nurses do when family members are patients? I don't mean that we as nurses deliberately try to undermine the care our families get, but a lot of us do try to take some control.

Granny....I actually like the instruction sheets that we get from families. This was a different case. There were a lot of issues involved. We were the 4th or 5th LTC that she put him in in that year. The only issues that I have with these types of plans is when the care that they want is just wrong or can harm the pt (Like the OPs problem with HOB vs tube feeding). I will not do absurd things requested by the family and risk my license.

Eduacating the pt and family is always a task of nurses. I can see the OPs frustration when the family member is highly educated, but is doing something to harm the pt. We can talk until we are blue in our face, but most families will still be permited to do as they wish.

Heck..I already have my list of requests ready. Beleive me...it is a control issue and the families/pts need to maintain as much control as they can given the circumstances.

I believe we are talking about two different situations. The elderly gentleman, with the aspiration pneumonia and the DIL who is a physician, is a case that I would have referred to the social workers and given a heads up to the risk management division, as well. The patient who came in with the ten pages of instruction is an entirely different matter. In most cases, the family is very knowledgeable about their love one's care. And they do not wish the routine, which has been established, to be disrupted. And yes, it is a control issue. And having been a patient several times, in the past few years, I have a routine that with my chronic diseases, I like to maintain. And it is also a matter of control with me, as well. I lose enough of my rights, as an individual, when entering the hospital. I would like to keep a few rights, including my care and medications, when I am in the hospital.

Grannynurse

I would write an incident report about this every time that it happened. There is probably a hospital policy about this somewhere. I would quote hospital policy if they do it again, and call the superviser.

Lindarn, RN, BSN, CCRN

Spokane, Washington

I would definately document each and every occurrance, possibly finding some non-threatening way to let her know that you are doing so. Plus regardless of whatever her licensure is, unless she has privileges to practice at your facility, she should not touch the tube feeding at all. I would definately get case management involved, if not social services

Specializes in Education, Acute, Med/Surg, Tele, etc.

I may have spoken directly to the DIL to explain to her that even though she is an MD, which I respect, I do have to follow the orders left by the patients attending Physician as part of the checks and balances system to provide safety for a patient under my facilites care.

That if she wishes orders to be changed, to speak to the attending Physican and go through the proper channels, or we could always sign a Against Medical Advice for these issues.

I would also explain that the orders seem to certainly be in the best interest of the patient, and ask why they seem to be bothering her.

I may also check to see if the DIL is or has the right to POA medical. If not, I can have her excorted out if I so deem her to be a harm to my patient.

Just depends on how far you feel you should go to provide safety for the patient. Personally, and having this situation with MD's and RN's as family members...usually I can simply remind them of the proper way to quell these situations, listen well, acknowledge that I am hearing them...AND CHART CHART CHART!!!!!

Good luck...it is VERY frustrating!

Today I learned that both my nurse manager and the social worker were made aware of this situation. In fact, I was told that the DIL was witnessed injecting a syringe of something into the pt's PICC. I didn't see this. It happened on day shift. The DIL was only visiting for about 30 min on my time, during which she took it upon herself to untape the pts Dobhoff and retape it to his nose/face in a manner more to her liking. I wish I could figure people like this out. The pt will probably be at our facility until Monday, and then he will most likely be going to hospice. I am saddened by all of this, and I wonder how it will all unfold.

She is (supposedly) a physician, but acts like she is your father-in-law's physician?

If she is administering treatments to this patient, wouldn't that be malpractice, since it is NOT her patient? If she really does have a license, she should be reported.

What a sad situation. Thank you for being your patient's advocate, Sheri.

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