Patient family issues

[foxc1121]

Hello everyone,

I am going to throw this out to ALL nurses. I have alot of issues with family members - yes most of them are a god send taking care of their loved ones - cleaning them up and feeding them - those patients that have loved ones that do for them are soooo lucky. I recently got attacked because I voiced my opinion about this type of situation. Family is so important to patients - I understand this and I encourage their participation in their loved one's care - and me, as a nurse try to keep them in the loop as much as possible.

Here is my problem - which to me is a real problem - family that stand around staring at their loved one - for example - when their meal tray comes up - they call for the nurse to feed them. I would not even complain if it was a patient that had no family there - but when I tell you that I could not even walk into that particular room because there were so many family members present - I tell you no lie - it was ridiculous. Could no one help him to eat???? They all stood around staring and complaining at the nursing station - time that would have could have been well spent, in my opinion, feeding their loved one. My nurses aide was busy helping a patient that was incontinent and I was busy handing out medications (to my other six patients)- I am not trying to avoid my responsibilities, but it seems ridculous to me that if you are standing around why would you not help your mom, dad, aunt, uncle etc eat???

I have gotten attacked by so many other boards telling me telling me that if I feel this way I need to not be a nurse - that I need to give up the profession. I have been a nurse for only six months and the pressure that is put on me is ridculous. In my opinion - my presense is better spent with my patient can't breathe, and have no family members present to call me, rather than the room that is full with family members - yet they refuse to lift a finger to feed their "LOVED ONE" and want to wait for the nurse to do it. I am only one person with 6-7 patients to care for - and management breathing down my through about customer service. I will say this - if I don't get that lopressor or vasotec to someone whose pressure is through the roof - or suction someone that is aspirating (which by the way all happenened to me while taking care of this particular patient as well) that is more of a proprity to me than feeding someone who has ten or more family members in the room. Think about it it - it could be your're loved one choking or stroking out and where was your nurse?? Feeding a patient that had ten family members watching her do it.

Do not send me back negative feed back telling me I should not be a nurse - as I have heard that before and trust me - I am really reconsidering my profession. I am only one person with only two hands and can only be in one place at one time. I think my time is better spent with the patient that cannot breathe (that has no family members present)- calling a code rescue- than feeding someone or cleaning sheets of an incontient patient - that have ten or more family members present (I really, truly am not lying about this particular situation- in fact other nurses refused to care for this patient because the family complained so much). Remember what we learned in nursing school? The ABC's take priority.

Dee:idea::angryfire

[woody62, RN]

As a nurse and patient, I've had experience on both sides of this issue. Yes, family members could do much more then take up space in the patient's room. But it really boils down to one issue, who is responsible for the patient and his care? Would you expect a family member to suction a patient? Would you expect him to change and IV? Would you expect him to change the bed? No, of course not. Those are all our responsibilities. But why do you expect a family member to feed a patient? To lighten the burden on you perhaps? That is not the responsibility of a visitor. I'm sorry but I have a problem with nurses who complain about family members but expect them to assume some of the burden and responsibility for caring of a patient. We complain about family members not helping us, then we complain that they are too numerous and in our way, when we are caring for our patients. We can't have it both ways.

By the way, where is the hospital whose CEO wants patients and families to think of it as a five star hotel? I'd like to be a patient there the next time I have to be admitted.

Woody:balloons:

[mom4josh]

Wow... 6-7 patients on days as a new nurse? You've got to be kidding!

First, kudos to you for getting as far as you have and managing your time wisely. Hugs for the nasty people that are called patients' "families".

Obviously, nobody is doing this for them at home, as evidenced by a patient we had this week who came in with decubs all over, a gangrenous foot, and maggots all over her legs. Lucky for her, she died the next day... all the while the "family" was around doing nothing.

Take a deep breath and maybe talk with your charge nurse or manager. First about your patient load, next about "dumping" the heavy patients on you day after day (share the wealth is what I always say), and also about your concerns. You are not wrong. But please don't give up just yet. You sound like a good nurse and we need you and more like you!

(:icon_hug:(((( HUGS )))))

[MG-NotANurse]

This is a great time to do some education with the family. Maybe they are scared their loved one will choke, etc. Showing them how to feed a few bites, then saying, "now you try", might be the best way to go. I know it is frustrating to feel like the family is not helping , but maybe this is all it would take for them to jump in and help!

As a family member of patients, I think that you make a very good point.

In the past, I've been genuinely afraid to try to help loved ones in the hospital, for fear of dislodging any of the tubes or lines. (I've also encountered staff who seemed to spend considerable time telling me to leave the room).

Designating a family member as the point person and showing him or her what to do is an excellent idea: you should also consider asking everyone else to take a breather elsewhere while the patient is being fed, bathed, etc. Nobody likes to be fed or washed in front of an audience.

[AngelfireRN, MSN, RN, APRN]

OK, I'll jump on the bandwagon here. I absolutely do expect family to help out, unless they are there for just a few minutes. If you have time to go in, sit down, and order room service, you have time to help out. Y'all can flame me, but first, hear me out.

My grandmother was severely burned in a house fire in November 2006. She spent a month in a burn unit, and then came home to a rehab facility. I am an RN, the only one on that side of the family. I will soon be an NP. I witnessed this problem with my own family, especially my aunt. My aunt would feed Grandmother, but when Grandmother soiled herself, my aunt would run out and grab whoever she saw and say, "Mama' Pamper needs changing". On one such occasion, she found me (I had taken a job there to be near Grandmother), and told me that. I just stared at her for a minute, and finally said, "Is she out of diapers"? "No, she just needs changing". After that, we had a little come-to-Jesus meeting and she changed the diapers if she was there. See, my aunt did not want to stay and do the dirty work, she wanted to play the dutiful daughter and stay in there during dressing changes and hold a hand and weep and wail. My father was not about to change Grandmother, but that I could understand more so than my aunt not wanting to. I did ask Daddy at one point who he thought was going to change her when she came home and it was his shift to sit with her. (She never did come home, God rest her).

When Grandmother went to the hospital, as she lay dying, all my aunt wanted to do was get a nurse in there to "listen to her". Like there was a timer in Grandmother's chest that told how long she had left. If I tried to listen myself, she would say "You just be a granddaughter now", which meant "I need my audience to see how much I love my mother" (Funny, all she did was complain about caring for her before the fire). Please don't think I'm heartless, I was devastated. But someone had to keep it together at that point, and poor Grandmother did not need someone poking and prodding every 5 minutes.

So, yes, I expect family to help if they stay a while. It's not feasible for a nurse to have to drop everything and feed when she has nine jillion other things going. If there were no family there, feeding is a different story. Just my experience and my 2 cents. Thank you.

[ShayRN]

The feeding part of it gets me, too. I don't understand why if your just sitting there watching TV you can't feed your loved one. I think it boils down to "its YOUR JOB, not MINE." I DO completely understand not changing a loved one. I think as nurses we get so use to dealing with body fluids and stool that we forget that not everyone does handle that stuff well. I cannot for the life of me see my mother cleaning a dirty behind that belongs to someone over the age of 2, lol. Matter of fact, I tell my stepfather all the time (he has 6 kids of his own) that he better be nice to me because I am the only one who will make sure he isn't laying in poop when he is old:lol2:

[Natkat, BSN, MSN, RN]

You found a safe place to vent. I don't see anything wrong with what you said.I think I might probably ask a family member if they would like to help out. I'd probably feel them out first, try to figure out who might be most open to the suggestion. I love the question about "who does this for him at home?" That's a wonderful way of getting the point across.One of my classmates had someone chew him out in clinicals because no one would wipe her after the pooped. The nurse went right in there and said "do you wipe yourself at home? Then you can wipe yourself here."I also agree that there's a chance they didn't think they were allowed to help out. It gets frustrating having to explain the same thing to people over and over again. The few times it sinks in are very rewarding. Keep trying.

[woody62, RN]

Color me strange but if I am ever incontinent or need to have a bowel movement cleaned off of me, please keep my daughter, SIL and brother away from me. I do not expect them to do your job. And like it or not, it is your job, even in a LTC facility. Of course if you are willing to discount my stay, based on the services that my family provides to me, that you should, then I'll accept their care. But not even at home do I expect any family member to clean up after me or provide nursing care. I guess nursing really has changed since I was in school, back in the middle 1960's. And it hasn't changed for the better.

Good grief, we complain when too many family members come in. We complain when they don't help us do our jobs. We complain they get in our way when we are trying to provide care. Seems like some of us are always complaining about families.

Woody:balloons:

[Agnes Anne]

So we are now catering to family members who ask for coffee, water, sheets etc (For themselves.) I never mind doing it for a patient, or even family members occasionally, but when the CEO states in public address at our ribbon cutting "We like to call ourselve the 4 Seasons" well, ahem,.....

Anyhow. I agree with you 100%

Well that's just Faaabulous! Now they can hire maids to provide the 4 season touch while you attend to your nursing tasks!

gm

[foxc1121]

Thank you all for replying to my frustrations - most of you in a positive light. I would like to reply to Woody and your concerns that as nurses, well I can only speak for myself, we are passing the buck on doing our jobs. No - you misunderstand what I am saying - I am not saying that I will not clean someone up if they soil themselves - even if family are present. I am not complaining about family being present - I understand that some are scared to do anything for their loved one and others have a problem cleaning up bodily fluids. What I am saying is that I cannot drop everything to run into the room to clean up their loved one immediately.

In my one particular situation - the patient that I was complaining about - I was in the middle of a code rescue - my other patient was aspirating - crash carts came out, ICU nurses, nursing supervisors, and respiratory came running to my patient's room to help me get him breathing again. I was in there for a good hour with everyone before my patient was stable - then I had to call the MD and get him transferred to the ICU unit. During this time my other patient soiled himself - my charge nurse was in my other patient's room with me - the family got so upset that no one came immediately and called the unit manager to complain about me.

I am not talking about doing my routine work and someone soils themselves and I don't want to take care of it. I have never, ever refused to care for a patient in any situation. I got called into the manager's office to discuss this situation - which in my opinion there was no situation to discuss - I was in the right place, at the right time - I was a prudent nurse and realized that my patient was in trouble and called on all my resources to help him. As a newbie, I was scared to death that my patient was going to die on me. The last thing on my mind at that point was cleaning a soiled patient. Needless to say I saved a man's life that day and I feel darn good about it. This was something that I would not have been able to do if I had run to take care of my other patient first - he would have died.

I welcome family members, even if they don't lift a finger to help - I don't expect them to do my job - the only thing that I am saying is that I cannot be there immediately. The presence of family helps patient's recover quickly, makes them feel loved and wanted and keeps them from getting depressed and lonely. I did not mean to give the impression that I don't want family there - just their presence alone can help my patient. I think it was silly of you to say that I expect them to change an IV, no I don't. Do I expect them to suction a patient, feed them or change them? It depends on the situation. If I know this patient is going home (for example with a trach tube) and they are going to be responsible for caring for them - then yes, I do expect them to do it in the hospital with me teaching them how to do it - empowering them to care for their loved one - otherwise they will be at a loss when they get home on what to do.

I am sure that even you would agree that you would want a nurse that realizes her priority is to help a patient breathe rather than first running to clean up a patient.

Dee

[MAISY, RN-ER, BSN, RN]

When I have a family on the floor, the first thing I do is orient them to the area. If they want extras, they do not have to wait for me...help yourself. That being said..I do expect if the patient needs a pillow, blanket, water, cup, straw, towel, or anything else NOW...(other than medical care) the family can get it! If they require me to provide...they will wait until it is on my priority list. My priorities the sob patient, the cp, and the actions/meds required to fix them....

I am one of the few nurses in my ER that will give am care or feed a patient being held while awaiting a room(we have limited ancillary help...despite holds of 20+ in winter). If a family member is on site, I expect they will assist. Truthfully, I don't have the time...but feel that many of my elderly patients will not be so lucky on the floor or on a different shift...so I'd better get some food into them while I can. Sometimes that's a whole meal, sometimes it's whatever I can do. I actively seek out volunteers, or the patient rep to assist when possible. It truly frosts me when families will not help....sorry Woody.

I believe nurses on the floor are being charged with large assignments with much sicker patients. If we want to ensure good nutrition, bring back candy stripers, encourage volunteers through our high schools or better yet....get those families moving. I cannot assign blame to a nurse who is caring for "sickness" . While cleaning and feeding are part of our patient's basic needs-I have to stress the words BASIC....we are forced to make priority decisions again and again. I can imagine an assignment where they may never make the top 3 much less the top 5 priorities of a shift. It's a shame, but its the truth!

Wouldn't it be nice if we had good staffing ratios, enough staff, and CEO's who had a clue.

Maisy;)

[Virgo_RN, BSN, RN]

I think it's obvious that many, if not most, of our patients and their families do not understand how we have to prioritize, and that we are often attempting to remain focused while dealing with continuous interruption. They see things from their perspective, and us from ours. Some of our "frequent flyers" eventually get the hang of the hospital environment and are better at functioning within it. But I try to remember that while I am used to functioning within the hospital environment, for most of my patients and their family members, it is a foreign environment and they do not see things from my perspective. That is no fault of their own.

One of my peeves is the family member who comes out into the hall, sees me sitting at a computer (this is the first time in three or four hours that I've even had an opportunity to get off my feet and do any charting), and, whether I am their family member's nurse or not, ask me for a warm blanket, cup of tea, or to fax their menu to the kitchen, etc. Folks, this is what the call light is for. If you're afraid to bother anyone by pressing the button, understand that it is MORE of a bother to come out and interrupt whatever it is I am doing with a small request like this. I have literally had my hand on the door, entering the room of a painful patient with a syringe of morphine, to have a family member a few doors down come out into the hall and ask me to help them with something that could have waited. But I understand that this person is not a mind reader and does not know that I have a syringe of morphine in my hand for a painful patient, and that that is my priority.

These family members need teaching about the call light system, and that even if it takes longer to get help than going out into the hall and finding someone, it really is how they need to signal for assistance, unless it is a life threatening emergency. There are ways to communicate this information to them respectfully. Same goes for feeding. At my facility, the aides do the feedings, but if there is a family member present, we don't hesitate to ask them to help.