I'd like to hear other people's thoughts,opinions and coping strategies for dealing with dysfunctional patient family dynamics.
Scenario: Pt lives with girlfriend and her ex husband; domestic violence occurs (trying to make this brief) Small SAH's, DT's setting in, altered LOC. Calls from folks claiming to be family from all over. One claims to be oldest son, takes responsibility, wants others cut out, not informed, wants us to keep local visitors out. No signed health care surrogate forms. Another son wants info, states family is very dysfunctional,(DUH) When I suggest he might speak with other family members for updates, he states that most of them do not speak. (apparently the patient had scattered his seed during his life with several women, producing several children who are now not close.)
So... How do I keep myself out of the middle of all this, protect patient confidentiality, and promote the great customer service my hospital wants??
Aug 24, '02
For me, the patient's welfare and confidentiality come first. You're dealing with a very hard situation, especially with the dysfunctional family you have describe. I believe that the oldest child makes the decisions if there is no spouse, POA, or HCS. It makes it even harder when he wasn't close to some of his children. Maybe you could get social services involved.
About the "great customer service" the hospital wants...the first thought in my head is "Scr*w that." The patient is more important. Your taking care of your patient and trying to do what is best for them. You weren't hired to be a PR rep or kiss a**. (If you can't tell, I tend to be more of patient advocate and have a hard time buying into this customer service crap.)
Aug 24, '02
tried to post once before, but sure my own computer illiteracy.....
what a glamorous job nursing is, huh!!!!!!!!!
the calls from all over, no you cannot breach confidentiality, legality and even for your own nursing mind......
ask the patient if there is one person that it is okay to talk about condition with.......
or else answer none.....
and direct all questions to the doctor and the patient.................
Aug 24, '02
Just a thought on this one
Pass the buck to a suit
this is what they get paid for so let them deal with the disfunctional family politics and you take care of the patient.
Aug 24, '02
Thanks for answering. I like the suggestion to pass the buck to a doc or suit. Unfortunatley, we don't have bedside phones in our ICU, this patient was too confused/sedated/uncooperative, withdrawing from etoh, to make his own decisions or talk on the phone. I work nights so the suits aren't around, which can be a good thing in itself. Interested in more opinions.
PS, I knew you'd understand, cousin micro
Aug 25, '02
This is a job for SUPER DAY SHIFT!
They (nurses, social services) need to work with the family, the one who IS THERE, to designate him as the infor source. All info goes through the info source person. Is there a possibility that people who have a right to know won't get to know? Absolutely! However, there is a greater likelihood of people who have no need to know, getting info if you go on "gut", etc. Those folks who are calling you in the dead of night are counting on you to bend, twist, rattle or scrap the rules. They need to all be directed to the designated information source.
Aug 27, '02
I got some family disfunction for you. 18 year old was in a fight. His first story was that him and is mom where getting out of the car and some guys (30 to be exact) thought that is mom was a police officer so they tried to jump her. Son tries to save the day and ends up with a fractured jaw. Well mom look more like a prostitute than cop. This woman is not skinny and she was wearing a white lace tank with a bright blue bra underneath and very short shorts. Not to mention that the patients 2 younger brothers and sisters were at the hospital at 4 in the morning wanting to visit. Hello you are 12 you should be in bed and where is your mother. The next day was the first day of school.
That was the story when he came in. Well over hearing the patient talk to his friends it was a drug deal gone bad. The next day mom goes to one of the boys house and fratures his jaw. OK so the patient goes to surgery and the whole time he was gone the brother and his 12 year old girlfriend were shacked up in his bed. First they should be in school and second this is not the Love Shack. I told them that this was not a hotel and they needed to go to the waiting area. Well when he got back from surgery they all wanted to party. LOUD LOUD LOUD I had a fresh post-op in bed 1 and explained that they needed to be quite so that both patients could get some rest or I could ask them to leave. Well mom gave me this look like I do not have to listen to you and I can break your jaw too.
I just love trashy people.
Aug 28, '02
I agree with MollyJ - sounds like a classic case for an MSW
Aug 28, '02
Would the Suits be upset if you turned the shower hose on the Love Bed?
These Springer families definitely need to be handled from the very beginning by MSW (or Psych Eval, lol).
Page MSW on speed dial for "Code Springer" ...
Aug 28, '02
When I run into situations like these, I want to make sure it gets under control quickly.....I explain what the patient needs (quiet, rest, pain control, etc.....) and set limits with them around # of visitors, expected behavior, no unaccompanied children, etc. Then, when they start cutting up, I can call them on it. Of course, families like this always push the limits, so I give them one chance to clean it up--after that I call security. If they get belligerent, threatening or aggressive, they are escorted off the unit and, in some cases, banned from re-entering the hospital. The local police have had to intervene on occasion to arrest visitors who were really out of control and threatening the safety of the staff and patients. There is a chain of command in every hospital......it just needs to be followed everytime there are incidents like these.
We don't have to tolerate these kinds of behaviors from ANYONE--including the patient. And for the patient who was in surgery while the brother and 12 year old girlfriend were making a love nest......NOT!!!!!! I'd have had security and social work up there so fast.......that little boy wouldn't have had time to work up the interest in his jail bait there, and the 12 year old would have been picked up by a parent or off to Child Protective Services with her! At some point, we have to lay down the law--we complain about visitor anarchy, but we hold the controls. And if administration takes issue with protecting the rights and safety of the other patients, well.......I'm getting off on a tangent now.....time to get ready to go run errands!
Aug 28, '02
Definately get a social service consult, then give the phone number of the social worker to the callers.
Aug 28, '02
One thing I learned on nights, terf the calls to daylight. That's when the suits and docs work. Tell the whole family that nothing can be settled at night and they will have to get up early (wow, that will be a shocker for them) and talk to the HEAD HONCHO IN CHARGE! You are too far down the totum pole to be able to sort out the family dysfunction mess.
Sep 23, '07
At our local hospital the patient is given an ID number. The patient (or next of kin) gives this ID number to friends and family of people that the patient wants to have his/her personal medical information. If someone calls wanting an update on the patient, they are asked for the ID number. If they don't have it, they don't get the info. This ensures that confidentiality is not breached and it also leaves the patient in control over who knows what about their condition.
BTW, love the term "Code Springer". LOL
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