The Family

  1. I work in the icu where family members are given certain visiting hours but almost always fail to acknowledge them. My patient had spiked a fever while recieving ffp prior to a scheduled open lung biopsy for the next day. His wife, sister and mother were all in the already small room swooning over him rubbing his legs, up in his face. They were driving me crazy too, coming out the nurses station to tell me/ask me something every two minutes. I was getting so far behind, I had barely payed much attention to my other patient. I called the doc to notify him of the spiked temp and he instructed me to continue the infusion (given he had spiked temps all day and he was admitted for neutropenic sepsis secondary to leukemia) but I was just doing the cya thing in case of a possible rxn. I just could not concentrate with this family up in my face and up in my patient's face. I was fed up, walked in the room looked at my patient and asked him if he would like to sleep, he looked up at me like a sick child would look at his mother and shook his head yes, I felt so bad for him. How could he realize the situation was not conducive to his healing, his pulse was up in the 130's partially d/t his fever, but also his anxiety from these three women hovering. I looked at the wife and said- maybe it's time for you to leave. She looked at me like- how could you say that! But i guess something clicked in her head and she immediately complied with my request. So they gathered up thier things and the sister asked me 3 times if I would come get them if anything happened, as if i'm retarded or something. UGGGH! I just thought to myself if this guy codes you will not be the first thing on my mind! Shortly after they left his temp came down from a whopping 39.5 back down to 37 within two hours.....hmmmm... I wonder why. He actually got to get some sleep.

    I just think it is fascinating how a reasonably stable situation can worsen tenfold when you are struggling with the family. Maybe I was harsh in asking them to leave but it was certainly in the best interest of my patient.

    I understand looking at it from their perspective how the majority of their actions were emotional, however I can't get over how angry it made me.

    Thanks for listening to me vent!!!
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  2. 37 Comments

  3. by   RNforLongTime
    Nope you did the right thing. I work in critical care too and families can be overbearing. That's why I choose to work night shift. Visiting hours end at 1830 at my facility, so the families are supposed to be gone when I arrive to work at 7pm. You just have to very kindly but firmly explain to the family that visiting hours are set so that the pt can get some rest which is very important to their healing.

    Your co-workers have to be consistent as well! We've had problems in our unit where one nurse is a stickler about visiting hours and some aren't. Then when I ask the family to leave, they whine "but the OTHER nurse let us stay past visiting hours."

    Good luck!

    Kelly
  4. by   Talino
    Their actions disgusted and annoyed you??

    These are immediate family members - a wife, a mother, and a sister.

    Obviously, the fate that the patient was enduring was very distressing to them. They're not medical professionals who like us understand the process of a disease. When they rubbed his feet, his legs, his face, they were conveying their love and support because that's the only assurance they can give him. When they hovered around him they didn't know what else they can do and wished they did.

    They kept asking questions? Did you ever pause a few minutes and explained to them what was going on?
    Did you tell them before they came in that the patient could really use rest and ask that they limit their visit to 10 mins.?
    "Can you please wait outside for a while, we'll be doing a few procedures for the patient, I will get you as soon as we're done." Did you say that?
    Did you ever ask yourself, what if that was my spouse, my Dad, my young brother who's suffering from an unknown illness and an unknown treatment and an unknown prognosis? (That's how laymen see an illness compared to us medical professionals)

    Oh I know. You don't have time, you've got other patients to take care of. And maybe, this was your second shift.

    There are scenarios where the presence of visitors do interfere with care. And I've had my battles with them, too. Your situation is not one of them. You executed a common pitfall of a nurse-client (and family) relationship -- a failure to communicate.

    You're burned out!. We're all burned out! But, I won't let a dispirited family have it.
  5. by   DIPLOMATICRN4HIRE
    Im sorry , I dont know you ... but your posting of how the family disturbed you, DISTURBED me.... Yes I know you have a schedule and you were also looking out for your patient and his well being... and maybe I just read your post wrong and without enough coffee in my system. But your comments made me sick... and thats not easy to do. I guess Im just used to seeing familys not giving a rats ass about the patient, maybe thats it? The 3 woman doted over the patient rubbed his legs, remained at his bedside, and asked you questions....... HMMM , and your problem is??? Did you wonder if the questions were their way of being envolved with the care given since it was obvious the care had been removed from them, you stated he had Leuk, imagine how many times those 3 woman had taken care of this man .... Im sure it was more than once. You also stated he was having a lung biopsy in the morning..... did you talk to the Mother ,sister,and His wife.. about their anxiety about his impending surgery? Maybe in their head they had the worst case senerio running through their mind. Would he make it through?,Is it cancer?.What if its worse?, He can die from going into the OR., Will he have a nurse in the OR that will care for him, like I would?. Kind of get my drift... Understand this I am not flaming you or making your job trival by any means... I respect you for the fact that you are a RN and you have done what it takes to get there, This is a post where you vented and Im glad you got whatever you had in you out. I wonder if you had just given them a little more information, maybe their fears and anxiety would have been relieved, which would have lessend the questions, lessend the swooning, lessend them being in your face.... . Just wondering.
    Zoe
  6. by   montroyal
    Established visiting hours are set fot the benifit and care of the patient. They are the primary responsibility of the nurse and are the ones we are advacating for. Patients families needs should never come before the needs of the patient. There are always rare exceptions were the rules can be bent, but never shattered. Any nurses who doesn't want to follow the hospitals set policies, needs to follow the procedures to get these policies changed. Until this happens, all staff should follow the procedures.

    With that said, you did the right thing asking for the family to leave(especially, since this is what the patient wanted). ICU patients have minimal time to rest. They are evaluated every hour, have machines buzzing constantly,frequent lab work, a long parade of md's/ resp therapy/dietary/and other services in there room. All this increase the stimulation and stress. Our job is to help control this for the good of the patient. Patients family members should expect to have their questions or concerns answered but they should not expect you to devote all your time and energy to just their family member. If thats what they want, hire a private duty nurse. Most hospitals require the family pick one family member to act as spokesman for the family and to receive all the info about the patient. All other family members are then directed to that family member. This helps ensure the accuracy of the info the family receives and controls the time lost to answering the same question multiple times. Families with constant concerns should plan a time to meet with the patients MD once a day with a list of there questions and concerns. You should also think about utilizing the hospitals chaplian service to help the family thru this crisis. Thats what they are there for.

    Hospitals have cut the number of nurses while increasing the number of patients. Nurses have done so much for so long with so little, we are expected to do everything with nothing forever. It can't be done. Priorities must be set and the patient is number one. If this means family members are low priority, then so be it. Any family member who is upset because nurses will not meet their needs before the patients, shows no actual care about the patient.
  7. by   SmilingBluEyes
    Just my observation here. I only think this was a vent. I found myself feeling badly for this patient's family----- and this nurse. I don't think she is an appalling nurse, especially--- when I put myself in her place. Her thoughts, she is entitled to. Her frustrations are shared almost universally by anyone in the "do more with less environment" in which nursing finds itself today. But what do I see here? a RANT/VENT...and it's appropriate and in the right place. On a board, and not at that family or patient. Can we allow this or anyone in her place such a luxury? I say it's a must. Now... That said, the suggestions about including family in careplanning are very valuable. It can save us all immense trouble and often they are very HELPFUL when we work WITH THEM AS MUCH AS POSSIBLE. But I have to ask: can we reserve judgement on this overworked nurse for the time being and just let her let it all hang out?
    Last edit by SmilingBluEyes on Jan 30, '03
  8. by   bossynurse
    well put SmilingBlueEyes andmontroyal
  9. by   bossynurse
    well put SmilingBlueEyes andmontroyal
  10. by   Dr. Kate
    Been there, been that frustrated.

    Deb is right, this is just a vent.

    One of the hardest things in working ICU, I think, is that you don't have just the patient in the bed to care for, but also the assorted family members. It can be hard to swtch gears as you deal with two sets of needs at the same time, in the same space. It's especially hard when what the patient needs most is not the same things as what the family needs most.
    You were absolutely right to ask the patient (and were lucky he could and would answer honestly) what he wanted. And really lucky the family got it fairly quickly.

    As ICUs more and more family friendly (open visiting hours, fewer visitor restrictions) these issues will come up more and more often. It takes skill and finesse to deal with families who feel they have a right to be there because they do. But first and foremost we protect and care for the patient.

    It's easy to say make the family part of the team, it's not always easy to do. It seems families should know the sensible thing to do, but most don't. It's up to nurses to teach them what they can do to help. It will take more than once, it may take telling them every time you see them.

    When families are being difficult from the point of view of me as the nurse, I have found that telling them what I'll be doing, that I will call them if anything happens, etc., before they have a chance to ask, helps me and them. Sure, they usually ask again, they want only to be sure you know how important this is to them.

    As for codes and family presence, it's worth getting onto the agenda for you unit meetings. There is evidence that it is helpful to families, results in less futile attempts and prolonged codes. When I'm working as a supervisor, the nurses aren't always happy (though that has been changing as we officially went to family centered care in the ICU) but they cope when I bring a family member in and stay with them (or place them in the hands of a chaplain) during a code in ICU.

    It really does take a team to care for a patient.
  11. by   2banurse
    Originally posted by SmilingBluEyes
    Just my observation here. I only think this was a vent. I found myself feeling badly for this patient's family----- and this nurse. I don't think she is an appalling nurse, especially--- when I put myself in her place. Her thoughts, she is entitled to. Her frustrations are shared almost universally by anyone in the "do more with less environment" in which nursing finds itself today. But what do I see here? a RANT/VENT...and it's appropriate and in the right place. On a board, and not at that family or patient. Can we allow this or anyone in her place such a luxury? I say it's a must. Now... That said, the suggestions about including family in careplanning are very valuable. It can save us all immense trouble and often they are very HELPFUL when we work WITH THEM AS MUCH AS POSSIBLE. But I have to ask: can we reserve judgement on this overworked nurse for the time being and just let her let it all hang out?
    Well put, Deb. Actually right in NurseKrissy's post she thanks allnurses for being able to vent. It is frustrating when someone vents that someone else needs to be judgmental. Not everyone might be able to put their thoughts in exactly the way they may occur.

    I think that sometimes a little more empathy is needed.

    Kris
  12. by   NurseKrissy
    Their actions disgusted and annoyed you??

    These are immediate family members - a wife, a mother, and a sister.

    Obviously, the fate that the patient was enduring was very distressing to them. They're not medical professionals who like us understand the process of a disease. When they rubbed his feet, his legs, his face, they were conveying their love and support because that's the only assurance they can give him. When they hovered around him they didn't know what else they can do and wished they did.

    They kept asking questions? Did you ever pause a few minutes and explained to them what was going on?

    Yes, I stated in my post that they were asking me something every two minutes, and of course I answered them. But I'm SORRY!!! I can not teach people everything about nursing in twelve hours!

    Did you tell them before they came in that the patient could really use rest and ask that they limit their visit to 10 mins.?

    Why would I do that, Family can be good to have around, until they start freaking out on you and make your patient anxious. Every hear of Maslow? Physiological needs come before psychological.

    "Can you please wait outside for a while, we'll be doing a few procedures for the patient, I will get you as soon as we're done." Did you say that?

    I asked them nicely to leave when the time came that their presence was not in the best interest of my patient, that is called being a patient advocate.

    Did you ever ask yourself, what if that was my spouse, my Dad, my young brother who's suffering from an unknown illness and an unknown treatment and an unknown prognosis? (That's how laymen see an illness compared to us medical professionals) I ask myself these questions every day at work, I never said I did not have any empathy for them, The point to my "vent" is I could not do my job with the family around, and when someone's life is depending on you being in an optimal state of mind you need to acknowledge that fact and do what needs to be done.

    Oh I know. You don't have time, you've got other patients to take care of. And maybe, this was your second shift. Are you even in the nursing field?

    There are scenarios where the presence of visitors do interfere with care. And I've had my battles with them, too. Your situation is not one of them. You executed a common pitfall of a nurse-client (and family) relationship -- a failure to communicate. Ummm were you there, because I didn't see you in the room?

    You're burned out!. We're all burned out! But, I won't let a dispirited family have it.

    Once again, I was polite and simply asked them to leave I didn't beat them with a stick! Are you sure you are a nurse?
    I thought this site was a place for nurses to support each other, not eat each other alive.
  13. by   NurseKrissy
    Originally posted by ITSJUSTMEZOE
    Im sorry , I dont know you ... but your posting of how the family disturbed you, DISTURBED me.... Yes I know you have a schedule and you were also looking out for your patient and his well being... and maybe I just read your post wrong and without enough coffee in my system. But your comments made me sick... and thats not easy to do. I guess Im just used to seeing familys not giving a rats ass about the patient, maybe thats it? The 3 woman doted over the patient rubbed his legs, remained at his bedside, and asked you questions....... HMMM , and your problem is??? Did you wonder if the questions were their way of being envolved with the care given since it was obvious the care had been removed from them, you stated he had Leuk, imagine how many times those 3 woman had taken care of this man .... Im sure it was more than once. You also stated he was having a lung biopsy in the morning..... did you talk to the Mother ,sister,and His wife.. about their anxiety about his impending surgery? Maybe in their head they had the worst case senerio running through their mind. Would he make it through?,Is it cancer?.What if its worse?, He can die from going into the OR., Will he have a nurse in the OR that will care for him, like I would?. Kind of get my drift... Understand this I am not flaming you or making your job trival by any means... I respect you for the fact that you are a RN and you have done what it takes to get there, This is a post where you vented and Im glad you got whatever you had in you out. I wonder if you had just given them a little more information, maybe their fears and anxiety would have been relieved, which would have lessend the questions, lessend the swooning, lessend them being in your face.... . Just wondering.
    Zoe
    You apparently have the same attitude as talino.....WHATEVER
  14. by   sjoe
    "When they rubbed his feet, his legs, his face, they were conveying their love and support because that's the only assurance they can give him. "

    Don't kid yourself. These peole are only trying to assure THEMSELVES. If they were actually focused on the patient, they would be seeking advice from the people actually taking care of him to find out the best things they could do (which certainly include letting him sleep).

    They need to be gently (if that works) or not-so-gently when to leave, and possibly to be given tasks and errands to assuage their feelings of guilt and helpless (IF the nurse has time to deal with them)--BUT the patient is in the bed, not all the people who wander in with their own personal needs, and this is the person whose needs come first.

    The patient is depending on his healthcare providers to take care of and protect him from everything that might interfere with healing (infections, intrusive visitors, etc.). Sometimes social niceties and potentially wounded family members' egos are much more distant goals--whatever nursing theories and textbooks and "well-meaning" people might have to say about it.

    IMHO.
    Last edit by sjoe on Jan 31, '03

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