Would you call a patient's family at 3 am?

[VAC]

Trauma pt, bike vs garbage truck, trached, vented, pegj-d, Awake on Diprivan... Plastic surgeon writing strict orders NOT to repostion patient, and to keep room 78-80 degrees (to protect her graft). Family left at 11pm.. At 3 am she wants me to call her family to come back in and sit with her. I went up on the Diprivan, pain meds, etc, as much as I could to buy time to a more reasonable hour. But at change of shift she was CRYING, because we hadn't called her family. Passed it on to the day nurse to feel out this family and find out if they wanted to be called at all hours. But I went home feeling really guilty. Would any of you have called???

[colleen10]

Like Nick, I too wonder if the drugs could make her more, for lack of a more technical term "loopy", could it make the situation worse. If she is allready distressed and crying uncontrollably could they make her worse - maybe out of control.

Can that possibly happen in other situations like this, depending on what drug is given?

I'm sure the ideal would for the drugs to calm her down and maybe even let her sleep, but do some people react to them differently?

Just curious on what any of you may have experienced.

[prmenrs, RN]

I would call--because sometimes a pat has a premonition of impending death--and it turns out to be true!!!

When I was a night supervisor, that actually happened--a lady was admitted to CCU after the neighbor brought her to the ER for chest pain. I called the son, he asked me if I thought he should come in, I told him I couldn't make that decision for him, but that if it were MY mother, I sure would want to come and check things out.

Well, don't you know she coded about 2-3 hours later--Thank God he DID come in and saw her before she died. Imagine the guilt if he'd turned over and gone back to sleep!!!

Imagine YOUR guilt if she had passed before the family came in the next day! Even when ICU pts seem "stable", they still have the potential for sudden and unexpected events!!

Bottom line, call. If the pt asks for it every night, confer w/family to see if someone can stay w/him/her. I'm a big believer in involving the family, altho I know they can be a PITA.

[live4today, RN]

Ya darn tootin' I would! :rotfl: :rotfl:

[purplemania, BSN, RN]

I have been a pedi nurse for years and I definitely would have called the family. They can always saw no and go back to sleep. I started to ask how old the pt. was but it really does not matter. They had a need. HOWEVER, I don't think feeling guilty will help. Just think of this as a learning experience.

[micro, RN]

still say it is a grey area......

and you have to take each situation individually.......

hey to any out there working pediatrics.......well I have been on the other side of the bedrail in that one'........and I know for a fact that I cried out many times and no not every noc did they call "mom"........

not being argumentative here, just saying this is a grey area and calls for nursing judgement and it is your call......

never wrong to call, but if you do not.....that is not wrong either...................

and after......we can second guess until the 'cows come home' but

VAC and any others dealing with the same issue, like me and all of us', we have to make judgement decisions like this all the time...........

utilize your charge, utilize yourself and your knowledge, gut feelings and nursing experience.........you will not be wrong........

micro and out

only my humble opinion'

[pebbles, BSN, RN]

Given your situation, I would have called. But on the ward where I work, I generally don't call.

I think critical care areas are a bit different. I work on a surgical ward - I base the descision on the condition of the patient. We are pretty strict about NOT allowing vistors after visiting hours as we have problems with gangs, so I don't really want to encourage it.

Lots of times a patient will ask for family - but they are confused about the time of day, or can be calmed wiith other methods. Re-orienting them to the fact that it is nightime and their family is asleep often helps. We have a portable phone (not a cellular), so I'll let someone call home sometimes if they are really in distress. But most of our patients just aren't sick enough to justify waking up family at 0300. Family need their sleep too, so that they can BE supportive during the recovery process. Some patients are a little "clingier" than others too, and will not ever emotionally let go of their family.... does that mean that we, as nurses should impose on the family consistently... micro is right, this is a grey area.

[Joan Saunders]

You know forearmed is forewarned. It was just really unfortunate that before the family left that it wasn't clear when you'd call. I would have called but, i can empathise with your dilemna. You sound a very compassionate person.

[2amigos]

While I'm not a nurse........yet, I agree with the general consensus about calling the family. I do think that nurses sometimes forget that family sometimes can't stay with pt's. The family may have outside concerns that can't just be put on hold or health issues of their own. Our youngest daughter is adopted. We got her at 6 weeks old. She has Down's Syndrome, had an ASD &VSD, severe reflux, had a NG tube, and was in CHF when she came home with us. Needless to say, I spent most of the first year with her in and out of the hospital. Most of the staff were great about me not being there all the time. One nurse was just nasty about it "Didn't I care?....Why wasn't I there during the day?..." That night when I came to the PICU to spend the night with our daughter, I brought pictures of five other children and another nurse taped the pics up by her bed. I told them, "This is why I spend my nights at the hospital and can't be here all day during the day, why I call in for info and updates."

Sometimes people just can't stay or even shouldn't stay at the hospital with their family. Just my opinion......... Thanks for letting me state it. Hope I didn't offend anyone.

[P_RN, ADN, RN]

Yes I'd call. And if possible I'd have called from the bedside even using the WATS line if I needed to. Holding the phone to the patients ear so he/she can hear the loved one speak may be all that's needed. That may provide sufficient comfort .

When you say "family," that's a grey area. I would NOT want my sister-in-law there..... I'd want my sister and her husband though. My son couldn't handle it, my daughter could.

Leave it to the patient and the family for this decision. When my husband was in the hospital a few weeks back, I went home one night. They called from his room and I was glad.

[2MagnoliaTrees]

Don't beat yourself up over it. I hated having to make choices like that when on the night shift. Next time you'll have more insight into the situation.

[mattsmom81]

I guess I'm going to take a stab at this from a different perspective.

If my patient was agitated and needed rest, I feel my priority would be to increase analgesia/sedation. My first call would have been to the surgeon's office for new orders if I was at the high ends of my drugs' parameters.

Don't beat yourself up over this, as a lot of this stuff is judgment calls.....if this family was a calming influence on the girl, I might call them in if visiting hours and my coworkers in ICU were agreeable. Nights in my ICU is where we the majority of daily cares, like the baths, linens, bedscale weights and chest films/xrays...we're busy weaning our post hearts off vents and vasoactives.... and we don't like visitors for that reason; they generally take time from our patients' rest and disrupt staff routines. We don't have the staff at night that day shift does and prefer visitors come then....

I don't like making exceptions to posted visiting hours, as if you do it for one family, the other families expect it too.....but lots of nurses are for open visiting now and would disagree with me, which is OK. :)

[-jt]

I didnt get the impression from your post that the pt was in a life or death emergency situation at this point. The family had already been there till late at night. Its their business why they left - nobody should judge them for that. Maybe her husband of the same age wasnt able to sit in a hospital chair all night long. Maybe he had to go home & take his own meds. Who knows what else they have to deal with.

I agree with you not calling & for your same reasons. I think you did the right thing.

I work day shift in the ICU & pts have sometimes asked that I call their families at 7am. I tell them "its a little too early, I dont want to scare them into thinking something is wrong when the phone rings at this time of the morning, so lets give them about an hour to wake up."

I would NOT have called your pts family at 3am either - unless she was crashing.

Id make sure the IV was working & she was getting enough sedation & pain meds. If shes sitting there awake & crying, I think she can stand a higher dose. Id increase her meds until they took effect. If she was resistant to high doses of it, I would have asked the pt what meds she usually takes at home to help her relax or sleep & I would have gotten whatever that was ordered for her. Id ask if she was a smoker & if so, gotten her an order for a nicotine patch. Who knows - the lady could have been having some kind of withdrawals ontop of everything else. Nothing a little ativan cant take care of.

If it turned out that all it was was that she was in pain & afraid of being alone & so had increased anxiety, maybe a little IV benadryl or IM Vistaril would have helped along with more pain meds.

I would have done all the reassurance/comfort things as you did, given her the call bell to hold so she knows she can get our attention if needed, increased the meds more, spent as much time with her as possible & told her I would call the family after they had some time to get some rest themselves. If there was an aide in the unit, Id have her sit with this pt a while too.

But giving her family a few hours to rest & recuperate some strength after such a long trying day is nothing for you to feel guilty about.