family members questions

RoxanRN · May 11, 2005

I was taking care of a woman who came into the ER in cardiac arrest. Our staff was doing everything possible and we ended up getting her somewhat stable. The family members were with her and took turns coming into the room, first her son and daughter-in-law then her grandchildren. My problem came when the granddaughters came in and started asking me (a nursing student working in the ER) questions about how many breaths per minutes was she breathing on her own (she was on a ventilator), if she has not been medicated why is she unconscious (coma scale of a 4 at best), why was her tongue protruding out of her mouth, etc. etc. etc. Being children, 18 years old, I did not feel like they should be in the trauma room without a parent, and since they were grandchildren I did not feel like I should be providing them with information about their grandmother's health (HIPPA). Well as teenagers go, they started getting upset that I would not give them detailed information and would only tell them that the doctor had spoken with the son and daughter in law and that they should talk with their grandmother because she could still hear them. I wanted them to speak to her because it appeared that the grandmother was getting aggravated but in reality was beginning to have a seizure and the granddaughters had to leave the room. I am still not sure how much information HIPPA allows in situation of probable death
What is the correct way to handle this situation?

I think you did a wonderful job handling it. There have many times I've had family members show up and start asking questions. In technicality, it is a HIPAA violation to talk to any family member, except the MDPOA where applicable, concerning the patients condition.

My unit establishes a family spokesperson (preferrably the POA, though it's many times a younger, more knowledgeable family member approved by the patient/POA) with whom we try to exclusively communicate. When other family members/friends call, we refer them to the spokesperson. If we can confirm the visitors at bedside are immediate family, we will give a brief update if asked. If they start asking detailed questions, we will try to refer them to the spokesperson. This is in the ideal world. Doesn't always go this way.

I, personally, would have answered them in simple terms and still referred them to the spokesperson.

Roxan

Ruby Vee, BSN · May 12, 2005

i was taking care of a woman who came into the er in cardiac arrest. our staff was doing everything possible and we ended up getting her somewhat stable. the family members were with her and took turns coming into the room, first her son and daughter-in-law then her grandchildren. my problem came when the granddaughters came in and started asking me (a nursing student working in the er) questions about how many breaths per minutes was she breathing on her own (she was on a ventilator), if she has not been medicated why is she unconscious (coma scale of a 4 at best), why was her tongue protruding out of her mouth, etc. etc. etc. being children, 18 years old, i did not feel like they should be in the trauma room without a parent, and since they were grandchildren i did not feel like i should be providing them with information about their grandmother's health (hippa). well as teenagers go, they started getting upset that i would not give them detailed information and would only tell them that the doctor had spoken with the son and daughter in law and that they should talk with their grandmother because she could still hear them. i wanted them to speak to her because it appeared that the grandmother was getting aggravated but in reality was beginning to have a seizure and the granddaughters had to leave the room. i am still not sure how much information hippa allows in situation of probable death
what is the correct way to handle this situation?

you did the right thing. you're right about the hipaa situation -- you cannot answer detailed questions like that. you were right to refer them to the son and daughter-in-law. i would explain the hipaa consideration to them when referring them to the son. and i would also have encouraged them to sit and talk with the grandmother. the children are entitled to just as much information as their parents want them to have, and you were right not to make that decision for their parents!

[color=#4b0082]ruby

pricklypear · May 12, 2005

I think you did a good job, too. HIPPA is a scary thing these days. When I have family members call in the middle of the night "I just heard my mom, brother, dad, uncle had a heart attack! What happened?"I feel annoyed but also really sorry for these family members in other states whom I can't tell anything! I know the same thing would happen to me if something happened to my mom who lives out of state. But I have this little nagging fear in the back of my mind that it's the state trying to pull a fast one on me and that helps me keep my trap shut! I really do think it's up the families to establish their own lines of communication. I just tell them they need to get in touch with other family members. Sometimes they get REALLY angry, but I'm sorry, those are the rules! Sometimes if they want to argue, I ask them if they would like hospitals to give out any and all information to anyone who calls and says they're family if they were the one who was lying in that bed?

However - there is some information that I'm ok telling visiting family - like answering questions about ventilators, ivs, some treatments. Not specifics like what medications, diagnoses, specific test results etc. There is a fine line, though.

Remember, you can always ask an alert and oriented patient if it's ok to tell ___________ what is going on. Just document it.

Altra, BSN, RN · May 13, 2005

I've been in similar situations - I work as a tech in the ER.

However, the first thing that jumps out at me from what you described, is that the granddaughters' questions (at 18, they're adults, by the way -- I don't see any reason they shouldn't be in the trauma area with a critically ill family member) were medical/assessment questions about their grandmother's condition. You certainly know your facility's protocols better than I do, but should these questions have been better directed to the nurse or MD, instead of hedging behind HIPAA? I'm just not sure that I see it as a HIPAA issue (since the grandkids were there, in person, known to other family members -- not an anonymous telephone caller, for example). Instead, I'm wondering what info is within your scope to provide.

Patients & family members ask me questions regarding their conditions all the time. I provide objective data only (i.e., "that number on the monitor represents xxxxxx"), but anything that even remotely resembles involving assessment skills or nursing or medical judgement, I defer to the RN. It's just not in my scope as a tech. Yes, I often have an answer in my head, but just because I happen to be 30 days from graduating from nursing school doesn't change my job description.

That's just my take on your experience -- your protocols may be very different from those at my hospital. Sorry if I'm rambling ... it's post-12-hour-preceptorship-shift brain functioning. :chuckle

pricklypear · May 13, 2005

I don't think individual facility protocols have any bearing on HIPPA. I think it's always better to err on the side of too little information. And I don't agree that the OP was hiding behind HIPPA regulations. She directed the grandkid's questions to the "spokesperson" in this case who had already been spoken to by the doctor. The grandkids probably should have been accompanied by another family member.

Altra, BSN, RN · May 13, 2005

I don't think individual facility protocols have any bearing on HIPPA. I think it's always better to err on the side of too little information. And I don't agree that the OP was hiding behind HIPPA regulations. She directed the grandkid's questions to the "spokesperson" in this case who had already been spoken to by the doctor. The grandkids probably should have been accompanied by another family member.

I didn't say the OP was hiding ... just giving my perspective that the main issue might not be HIPAA, but what is/is not appropriate info for a person in her job position to provide. Again, as an example, I do not, as a tech, comment on a patient's medical condition or make statements that imply nursing assessment or judgement. I do this because I'm there as a tech, not as a nursing student. The OP's role in her facility may be different. :)

HyperRNRachel · May 13, 2005

I didn't say the OP was hiding ... just giving my perspective that the main issue might not be HIPAA, but what is/is not appropriate info for a person in her job position to provide. Again, as an example, I do not, as a tech, comment on a patient's medical condition or make statements that imply nursing assessment or judgement. I do this because I'm there as a tech, not as a nursing student. The OP's role in her facility may be different. :)

No. I was not hiding behind HIPPA. Having sent MLOS a few messages in the past, I do not think she was implying anything negative with her post. In fact she consistently provides me with very useful responses to all my questions. My concern was that even by providing general information could these girls come to a realization that grandmother, more than likely, was not going to live. My other concern was if the son and daughter in law had spoken to the doctor, then why did they not tell these girls what was going on. Another concern is how do I know these girls are the patient's granddaughter and not a next door neighbor or a friend of the family? Please, also keep in mind that all family members were not in the room at the same time, and I do not want to convey information to anyone about a process at a particular time that would not be given to someone else who may be in the room at another time. The situation was changing minute by minute. I did not want to add to the confusion and emotions going on during their crisis. I thought I knew the specifics of HIPPA, but when I had to apply those rules to this situation I did end up with new questions. Valid questions that I know I need to research according to my hospital's policy.

Thanks for all the replies. :)

pricklypear · May 13, 2005

I'm sorry!:imbar I didn't mean to seem argumentative. Teenagers (even 18 year olds) seem to want everything cut and dry. Either she's going to live or she's going to die. I hate it when families don't prepare kids for what is going on with a family member. Sometimes I think they avoid being honest to spare the kid's feelings. I have never thought it was my job to tell a family that "it doesn't look good." I always try to stick to objective answers as MLOS said. "Right now her blood pressure is good, but she is on alot of medication to keep it there" (I don't even KNOW how many times I have said that one). "She is not responding right now because when someone experiences cardiac arrest their brain is deprived of oxygen for a period of time. This causes people to become unconcious. We have to wait and see if she will wake up. In the mean time, we will breath for her, and keep her blood pressure up with medication." This way you provide information without making predictions. These kinds of answers don't violate HIPAA (I don't think) because they don't reveal specific information like test results or specific medications. It's all teaching types of things. I would think that as a nursing student, information like this would be well within your scope of practice.

elkpark · May 14, 2005

I'm just not sure that I see it as a HIPAA issue (since the grandkids were there, in person, known to other family members -- not an anonymous telephone caller, for example).

Keep in mind, too, that it doesn't matter whether you know for a fact that the people asking the questions are actually relatives -- it isn't okay to release information to any ol' family member who happens to ask! HIPAA requires that healthcare information be protected unless you have specific consent from the patient/client (or the legally responsible person, if it's someone else) to release the information. Legally, you can't tell anyone in the family anything (anything that would qualify as protected information under HIPAA, that is) unless you have consent to release that info.