What can you tell family?

  1. I know that there are lots of veteran nurses out there that can help me with this. I am new out of school and have been working in the MICU for about 4 months now. I am having difficulty in knowing just how much I can discuss a pt's condition with family members... not really pt privacy issues but MD issues.
    For example, recently I had a 90ish y/o guy COPD exacerbation bad heart problems (ejection fraction 10-15%). Anyway came to ER, intubated, etc etc.. Then his family member who is a nurse comes to me asking all kinds of questions about his condition, prognosis, what do I think about this, what do I think about that.... I just kept repeating what I had done on my shift and what I had seen on my assessment b/c I am so afraid of bringing up anything that the MD has not yet discussed with the family. I just don't know, I am not even sure what I am asking. Maybe I am frustrated b/c I don't know what to say and I feel like I am of no comfort to the family. This family really needed to talk to someone about this man's condition and I kind of feel like I let them down b/c I am too afraid of saying too much too soon.
    Do I make any sense? Thanks for any advise if you have it!
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  2. 11 Comments

  3. by   CoffeeRTC
    That is a good question. I know things are a little different in LTC. For example if a pt had an XRay or culture done we are able to tell the pts and thier family the results (not diagnosis, just the results) "Looks like mom has a UTI or lower lobe pneumonia" There is no way they are able to wait for a doctor to come in (most come in only once a week or less) to tell them the results. When I have had family in the hospital...the nurses cant or won't even tell them the results of these simple tests... What's the protocol in acute?
  4. by   purplemania
    our patients have to sign a form on admission stating the names of individuals to whom we may share information (medical and financial). If that person's name is not on the form we do not discuss ANYTHING. Look for HIPPA info on www.cms.hhs.gov
  5. by   Janet Barclay
    Hi, I've worked in critical care for 15 years, and when you are starting out it is really hard to know how much information to divulge to families, espescially when you are still sorting the information yourself. Tell families only what you are comfortable discussing with them (this will get to be more as you gain experience), and offer to set up a family conference with the Doc ASAP when they have a lot of questions that you can't answer. When it comes to prognosis etc, even us "old-timers" don't usually hazard a guess until we have a really good idea about what direction the docs are going to want to take, particularly if there are end of life issues involved as it sounds like there were with your patient. Above all, be honest, a sincere "Idon't know, but I will find out" goes a long way.

    be patient with yourself
    Janet
  6. by   leslie :-D
    because of the hipaa regs, we are now very ltd. on what can be said, if their name isn't on the consent forms. i will usually tell them that i'm not at liberty to discuss specifics and will refer them to the MD.
  7. by   Tweety
    You did very well. Refer them to the doc to answer questions you can't. With experience you'll be able to say things like "in my experience as a nurse, I've seen.............". It's tough because medicine and the human body isn't an exact science.
  8. by   llg
    In my children's hospital, the story is the same as the posters have said above. Only people who are on the list can receive ANY information. (That includes grandma and grandpa! ... and Aunt Susie, the nurse! etc.)

    Even with parents and (other approved people) nurses often find themselves in a bind when questioned about lab results, x-ray results, etc. In general, the rule of thumb is: the more critical the information is and/or the more it involves a medical diagnosis -- the more important it is that the nurse NOT disclose it. For example, it is the physician's job to tell the parents that the child has a heart defect, or cancer, or an abnormal anything, NOT the nurse's job. I encourage new nurses to practice saying things like, "The interpretation of those tests involves the physician, so you really need to speak with her/him about that. Would you like me to help you set up a meeting with her/him about that?" A nurse will tell things such as the baby's weight today, how much they ate, how much urine output there was, comfort level,etc. -- things that the parents would have seen for themselves had they been there and don't involve medical diagnosis.

    I think the line is "medical diagnosis." Anything that involves medical diagnosis is outside the scope of nursing practice and needs to be first conveyed by the physician unless there is some special permission given or a protocol established by the institution.

    llg
  9. by   NsgTiger
    Thank you all for your responses. This particular situation was so frustrating. I knew how gravely ill this man was and so did the family member. Problem was that without an official discussion from the MD I couldn't talk to and comfort the family like I would like to have (and like she needed). With her being a nurse, she knew how really sick her father was more so than the rest of her family understood. She was really upset because she knew that this was the begining of the end for her father. The rest of her family did not see this so she needed someone to talk to. I felt like my hands were tied due to politics, and therefore, she found no comfort in me. And that just sucks! Pardon my expression. I feel like my job as a nurse is to comfort families, and here I couldn't. Any way, thanks again!
    Last edit by NsgTiger on Apr 30, '04
  10. by   lsyorke
    Knock, knock- who's there?-Hippa-Hippa who?- I can't tell you!!
  11. by   ktwlpn
    Quote from NsgTiger
    Thank you all for your responses. This particular situation was so frustrating. I knew how gravely ill this man was and so did the family member. Problem was that without an official discussion from the MD I couldn't talk to and comfort the family like I would like to have (and like she needed). With her being a nurse, she knew how really sick her father was more so than the rest of her family understood. She was really upset because she knew that this was the begining of the end for her father. The rest of her family did not see this so she needed someone to talk to. I felt like my hands were tied due to politics, and therefore, she found no comfort in me. And that just sucks! Pardon my expression. I feel like my job as a nurse is to comfort families, and here I couldn't. Any way, thanks again!
    But-as a nurse she WELL KNEW the problem with trying to pin you into a corner like that.....All you can do in that type of situation is offer support without offering specifics and encourage the family to have a meeting with the doctor....Encourage her to seek support appropriately (with her family,friends,etc) Get some referrals going-social services,home care....She knows what those numbers mean and what his prognosis is. I am all for the holistic approach but often there are factors that we know nothing about and the doctor that has been treating this patient for months or yrs may have a better grasp of the situation and you could inadvertently cause a lot of upset in the family........The rest of this family of yours will or will not accept their loved one's prognosis and nothing you can do will change that....I am betting,too that you DID give her lots of comfort despite your perceptions..We can do that without violating any unwritten rules of communication...Can you tell I just recently got my butt spanked at work in a similar situation? I felt sorry for the family,too and tried to do all I could to support them-and almost got my butt in a sling ....Don't ya hate the politics of the job?
  12. by   Brownms46
    Quote from purplemania
    our patients have to sign a form on admission stating the names of individuals to whom we may share information (medical and financial). If that person's name is not on the form we do not discuss ANYTHING. Look for HIPPA info on www.cms.hhs.gov
    EXCELLENT RESPONSE!
  13. by   mattsmom81
    Recently an old alcoholic was brought into our hospital by his drinking buddies. Somehow in the ER his 'buddies' got themselves down on the release of info form. His family was not even aware the old guy was even in the hospital for days and were very angry. These 'friends' manipulated the system to their benefit.

    The pulmonologist refused to discuss the case with the old man's daughter. It broke her heart and things will likely end up in court, cuz the man died while his 'buddies' were trying to run the show and eliminate family ...tearful daughter says they robbed him while he was in the hospital....broke into his home, stole $$$ and credit cards, car disappeared, etc.

    This HIPPa stuff in action. Sometimes it really sux.

    Nurses who routinely break HIPPA rules make it hard on those of us who are being careful. Some nurses tell everybody everything and then WE are the bad guys when we take the cautious road..

    A point not mentioned yet is that it is wise for a nurse to not divulge TOO MUCH data to anxious family members... who frequently brood and obsess over details they do not understand. I've had families calling every 15 minutes in ICU for lab results and watching monitors like hawks worried about every little blip....things that they don't really need to be worrying about. I suspect some nurses enjoy an audience ... like to lecture and explain minutiae...which is really unhelpful to anxious family, IMO.

    I agree its the doctors job to discuss details of medical diagnoses and prognosis. They don't pay us to make them look good....so let them do their job. In time we find our comfort zones and how to manage the millions of questions from anxious family; also how and when to turf questions to the physician.

    Something I learned fast in ICU is some families will completely dominate your time if you allow it. Setting limits and boundaries is very important. So many ICU nurses I know burn out letting family control their entire shift....particularly in the open visiting setting I just left.

    Good luck to you!!

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