First week with new patient. Family is driving me looney!

[MsBlissful]

I have a new patient under my care at one of my facilities that I case manage.

This little lady is a typical dementia patient with some manefestations of psychosis, she goes from being calm to screaming out all hours of the day, has sun downers.. etc. She is medicated with the good stuff and in all honesty she is doing MUCH better after a few tweeks of the meds.

My issue? The family. I have done.. count them... 5 visits this week with an extra visit in the evening by our prn nurse and also a "meeting with the SW". My visits are not patient centered. the family is there waiting for me asking me the same repetitive questions. Its like a broken record. I have talked to the same person today as a matter of fact for another hour of my time to visit the same stuff from Monday, Tuesday, Wed, Thurs, Friday. I get the same over and over questions.

I finally had a hear to heart with them and explained I feel somehow I am not meeting their needs. I took a spiral notebook out and asked them give me their goals for the patient and them. Guess what? I got 3 all of which are being met.. currently.

I can't fix the broken, but I am on my last bit of patience with these folks. If they are not there during a visit, they want a call. These calls take 20-30 minutes and its all repetitive.

My social worker is doing the same. but it seems like I am not meeting their needs.

[merlee]

These people are probably feeling very guilty about something. Express to them that you will come 'X' times/week unless they have something truly new/acute/different to discuss. Speak with only ONE person and only one; that person should be the one to call you.

Maybe one of the people you have been talking to ALSO has some early dementia issues, or anxiety issues that need to be addressed.

Tough situation. Best wishes.

[joe17]

I have a new patient under my care at one of my facilities that I case manage.

This little lady is a typical dementia patient with some manefestations of psychosis, she goes from being calm to screaming out all hours of the day, has sun downers.. etc. She is medicated with the good stuff and in all honesty she is doing MUCH better after a few tweeks of the meds.

My issue? The family. I have done.. count them... 5 visits this week with an extra visit in the evening by our prn nurse and also a "meeting with the SW". My visits are not patient centered. the family is there waiting for me asking me the same repetitive questions. Its like a broken record. I have talked to the same person today as a matter of fact for another hour of my time to visit the same stuff from Monday, Tuesday, Wed, Thurs, Friday. I get the same over and over questions.

I finally had a hear to heart with them and explained I feel somehow I am not meeting their needs. I took a spiral notebook out and asked them give me their goals for the patient and them. Guess what? I got 3 all of which are being met.. currently.

I can't fix the broken, but I am on my last bit of patience with these folks. If they are not there during a visit, they want a call. These calls take 20-30 minutes and its all repetitive.

My social worker is doing the same. but it seems like I am not meeting their needs.

touch situation....you are doing really well keep it up

[Jenni811, RN]

i don't do case work, i work on med/surg. But i once had a patient for several days. The family would call me ALL the time, and i was the night person!!! I can't imagine what the day person was feeling like. (it was always us two switching on our 12 hours).

I had my 5th call from the family, and i basically told the family that when they call i do not have time to answer their questions. I told them they need to delegate ONE person to talk to me, and the rest of the family can ask that person any questions they may have.

I was very firm with the "delegated person" giving her times she was able to call me. I assured her that someone would call if there were any changes or anything she needed to be concerned about.

It was going really great, but it back fired on me when i told the delegated person he was running a slight fever but was given some tylenol and his fever is down now. The delegated person called all 9 children, brothers, sisters, patients parents etc. and told them that "he was dying and we need to go say our goodbyes"

Imagine my surprise when the family showed up at 2am to say their goodbyes.

I had good intentions, and it worked out well, but i really should have picked the delegated person myself that would give the correct information and not overreact like this.

Perhaps you could pick ONE person in the family to talk to, one that you think is reasonable and close with the patient. It makes it less confusing for you and the family.

[Zookeeper3]

One family spokes person and refer all calls to that person, until they can decide on that person you appoint the next of kin.

You must dilegently never say anything to anyone from that moment forward or they will undermine you.

family meeting with the MD and social worker... lay down the ground rules, if you give an inch, it's all done.

Feelings of helplessness manifest in this behavior, you can if your feeling snarky, ask the most demanding ones to participate in care. Usually after the experience how difficult it is, they disappear and back off. i try to work these difficult ones to death when I can do no right. They soon find out they can't live up to their own expectations.