Inappropriate family members

[soxfan80]

Family-centered care is the model that my hospital follows. We don't have visiting hours; families can stay all night if they'd like. For the most part, I like the model and appreciate the information and relationship with patient's families, but some times, it can a nightmare.

Is it ever ok to tell patient's family member that they are being inappropriate and unrealistic? I admitted a pt at 1930 and left her room only 3 times. Once was to get meds for her and the other 2 times were to check on my other patients. Each time, the daughter would call the nurese's station or come looking for me. Once she called my wireless directly and said I had to come back because her mom needed the bathroom. It took me about 90 seconds to get there and then the daughter starts yelling about how I took too long and never should leave in the first place. The mother was so anxious that I called for ativan for her, and the daughter refused to let me give it to her so the patient refused it based on the daughter. The mother was so anxious an hour later that the covering MD had to come up to the unit and tell her that the mom needed ativan right away. It worked too. Imagine that! The pt was also in RAF so I need to push IV lopressor twice and although I told the pt and dtr that bedrest was required with such a fast HR, they demanded that she be able to walk to the bathroom. The pt ended up throwing a fit like 5 year old (which is why she needed ativan), and even refused a bedside commode. The situation was out of hand and they were incredibly uncooperative.

I'll stop ranting, but how are difficult famililes best handled. Am I really supposed to endure 4 hours of this with a smile on my face? What are the best ways to respond to demanding families who clearly don't understand how hospitals work even after you try to explain it?

[FLmomof5]

I was a new nurse and 3 mos pregnant when I had my 1st family member run in. B beds dtt in law had messed with A bed and was in a fit of rage saying that my cnas had ignored A beds alarm. She got in my face literally, we were touching noses & she was trying to get at my cna til I stepped in front of her and told the cna to leave. She ranted on and she grabbed my name badge which was on a necklace type thing and broke it from my neck. That was IT! I told her she had 2 seconds to back up away from me and that me or my cnas weren't gonna listen to her degrade us and that she was only there for B bed and was never to touch any other resident. She said she was going to report me to the don and administrator so I offered to get them on the phone myself. By the time I got the phone and took to her , numbers in hand she was gone. She never did report me and I filled out a grievance on her. I personally informed my superiors of what happened and told them I'd never allow somebody to get in my face like that. I found out later that this tyrant is a hOSPICE nurse! That was 5 yrs ago and to this day I haven't had a problem out of her since. Sugar wouldn't melt in her mouth when she's talked to me.

If shed have done that to me in any other setting I probably wouldve hit her. She's crazy as a bed bug. I guess she finally got the right one when she got me because shed done this type thing to several other nurses and made them cry.

Not me. My hormones took over and it was over. She really hated it when I told her she needed to mind her business and not touch others. Plus I found out her rant was all a lie! Every accusation she made was false. Guess that's why I didn't get reported. I was surprised my superiors even backed me, it sure wouldn't happen now since those are gone.

Dtt in law committed Battery. I would have pointed out that one 911 call is all it would take.

[caliotter3]

It is not passive aggressive to take care of your other patients. It is doing your job and tending to your legal responsibilities to them. You are wrong when you waste your time with this one family at the expense of your other patients. This one patient or their insurance company, is not paying the facility more money so that they have the right to monopolize you as their private duty nurse.

[Mulan]

Another tactic would be to educate the patient/family as to the reasons why things are done. They are anxious for their loved one and don't understand why we nurses do things the way we do.

quote]

I educated, and I educated but the stress was so high that no one was getting it, or they didn't care. They wanted things there way and that was it. The pt's daughter kept saying that her 86 year old mom hadn't ever been in the hospital. I wanted to say, "obviously". They had no clue about anything even after my 4 hours of trying to educate. Either that or they didn't care.

Some people are just ignorant. Some people will act badly no matter what you do or don't do.

[Batman25]

Unfortunately patients and families like this often can't be reasoned with so it's often a long ugly stay. Make your NM aware. Make sure this family is given to a new nurse every day so no one gets burnt out. Don't cater to them so much that other patients suffer. They will complain and lie about you regardless of what you do so give them the best nursing care you can and document like hell.

[nurse2033, MSN, RN]

You need to politely but firmly law down the law. Patients and families often don't know our routines, what to expect, or "how things work" in the hospital. First of all I would explain that Mom is not my only patient. It sounds like having a private conversation with the daughter might be helpful (to separate the two). If it seems like all attempts at reason are failing I would immediately pass it off to my charge nurse, or house supervisor so I can at least get to work with my other patients.

[imintrouble, BSN, RN]

When dealing with difficult pts and families I count down the minutes til my 12 hours are up. They suck the life right out of you. There is no winning. If you give them what they want, your other pts suffer. If you don't give them what they want, you suffer. The biggest loser is the pt themselves, though they are blind to that fact.

[Ruby Vee, BSN]

family-centered care is the model that my hospital follows. we don't have visiting hours; families can stay all night if they'd like. for the most part, i like the model and appreciate the information and relationship with patient's families, but some times, it can a nightmare.

is it ever ok to tell patient's family member that they are being inappropriate and unrealistic? i admitted a pt at 1930 and left her room only 3 times. once was to get meds for her and the other 2 times were to check on my other patients. each time, the daughter would call the nurese's station or come looking for me. once she called my wireless directly and said i had to come back because her mom needed the bathroom. it took me about 90 seconds to get there and then the daughter starts yelling about how i took too long and never should leave in the first place. the mother was so anxious that i called for ativan for her, and the daughter refused to let me give it to her so the patient refused it based on the daughter. the mother was so anxious an hour later that the covering md had to come up to the unit and tell her that the mom needed ativan right away. it worked too. imagine that! the pt was also in raf so i need to push iv lopressor twice and although i told the pt and dtr that bedrest was required with such a fast hr, they demanded that she be able to walk to the bathroom. the pt ended up throwing a fit like 5 year old (which is why she needed ativan), and even refused a bedside commode. the situation was out of hand and they were incredibly uncooperative.

i'll stop ranting, but how are difficult famililes best handled. am i really supposed to endure 4 hours of this with a smile on my face? what are the best ways to respond to demanding families who clearly don't understand how hospitals work even after you try to explain it?

it's called "limit setting."

if there are any rules in place guiding the behavior of visitors, outline them to the problem visitor and if possible, point to the written rules in the visitor's guide, the poster outside your unit or wherever you have them. and then stick to them. if the rules say no drinks in the patient room, then send her out to drink her starbuck's. if the rules say no eating in the patient room, no cell phones, or no more than two visitors at a time, stick to them strictly. as long as you have rules to back you up, you're fine. if you don't stick to the rules, then the next nurse who comes along and does stick to the rules is the "mean nurse." that will probably work out fine for her . . . . the daughter will request that she not take care of mom anymore . . . but it will suck to be the nurse who didn't get "fired."

the minute that visitor's behavior starts impeding patient care, limits need to be set. and if that means asking her to leave, ask her to leave. "your mom needs some rest" or "i need to do an assessment" or whatever excuse you want to give her, ask her to leave. if she gives you trouble, you can always call security.

but here's the bright side - - the more outrageous the visitor's behavior, the better the story you have to share on allnurses.com!!

[Ruby Vee, BSN]

it is not passive aggressive to take care of your other patients. it is doing your job and tending to your legal responsibilities to them. you are wrong when you waste your time with this one family at the expense of your other patients. this one patient or their insurance company, is not paying the facility more money so that they have the right to monopolize you as their private duty nurse.

i have heard of a sentinal event that occurred just because of such a family member. while they were monopolizing the nurse's time ranting at her about "not taking care of my sister because she's black" and about how important they are, the other patient in the room silently aspirated, coded and unfortunately didn't die. she's now blinking "yes" and "no".

at some point, you're going to have to ignore the boorish behavior and tend to your other patients. they need care, too.

by the way, if i had a patient in rapid atrial fibrillation (that's what you meant, isn't it?) and a family member was throwing a fit, i'd eject the family member on the theory that they were escalating the stress levels in the room and contributing to the problem.

[thehipcrip]

In addition:

Be upfront and tell her and her daughter that your notes will document each instance in which the patient refuses to follow your instructions about what's in her best interest, and when that refusal is apparently based on the daughter's advice.

As far as their unrealistic expectation about how much time you should spend with this patient...I would suggest telling them that since keeping your job requires that you care for six patients, not just one, the best way to meet the patient's need for one on one nursing care is to hire a private nurse who can supplement the nursing care you provide.