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- by LiveandLearn88 Jul 19, '12How do you guys handle it when your resident has a very pushy family member that insists on treatments and interventions that do not seem necessary? For instance, family member insists that resident needs a pain pill or "nerve" pill immediately and when you enter the room the resident is sitting calmly in bed sometimes even sleeping. This has also gone the other way for me when I had a resident who was literally crying from pain (she was 2 days post-op back surgery) and the daughter was upset at me for giving Mom the prescribed Norco 5/325 instead of Tylenol because she doesn't want her mom to get addicted to the pain meds. I know we are supposed to be advocates for our residents and do what's best for them after OUR assessment, but how do you gently and professionally explain to a family member that you are not going to do what they feel is best?
- Jul 19, '12 by Ashley, PICU RNI work in Peds, not LTC, but we often have parents/family who say the same thing about their child.
If the family says the child needs something for pain, I will ask, "What makes you feel that way?" That gives them a chance to explain what they have observed (if anything) that makes them think the child is in pain. If the child was recently medicated, or has been showing no signs of pain, I'll usually suggest alternative methods first- holding, feeding, distraction, less stimuli, etc.
If it's an older child, I'll ask the child directly if they are hurting. If it's an infant, I'll sometimes explain the FLACC pain scale that we use to assess pain in infants so the parents can understand how we are judging if their child is in pain.
If the parent does NOT want a pain medication given, and I feel it's necessary, education is key. Explain that the dose of medication is an appropriate dose for the patient's pain. (If it's a lower dose, say that.) Explain that using a narcotic pain medication periodically or for a short period is not going to cause addiction. Explain the difference between tolerance and addiction. Believe it or not, we have many parents who don't want their fresh post-op, NPO child given IV morphine because they think they are going to end up addicted.
For an alert and oriented resident, just ask the resident directly if they need something for pain. Keep in mind that some older people do not feel comfortable expressing to the nurse that they need something. Many residents feel that they are burdening or bothering the nurse by pushing the call bell and requesting something for pain. Others may be used to the "tough it out" mentality with which they were raised. They may be more willing to verbalize pain to their family.
I try to remember that, before the patient came to the hospital, they were cared for at home by their family. The families often know the patient the best. In my job, this is often most true of children with chronic medical conditions who cannot communicate (such as CP with contractors.) This is also true of LTC residents. They have gotten to know how their loved one usually reacts and behaves, and what mannerisms they exhibit if they are uncomfortable.
If the resident is not able to communicate their needs, has a PRN order, and giving the medication will not cause harm, consider just giving the pain medication and chart "upon request of the POA/family." Pain can be difficult to assess in the elderly who cannot communicate. Normal age-related changes, arthritis, joint stiffness, being contracted, or even lying in bed for extended period can cause pain. Remember that sleeping or the appearance of sleep does not mean that the resident is not in pain- if the nervous system is overwhelmed by pain, it may just shut down. So at the very least you're making the family feel as though their loved one is being well cared for, and you may even be treating pain as well.
- Jul 19, '12 by LiveandLearn88Wow, Ashley, your message provided invaluable measures for which I can provide care, children and the older adult are very much alike in the instance of pain and I had not considered that they may be expressing pain to their family member instead of the nurse due to their level of comfort. You have really given me a new outlook on the situation. Thanks!
- Jul 19, '12 by imintroubleTry to view the family's request in the best possible light. They simply don't want them to suffer any pain. Whether you see it or not. If there is an order, I give the med.
There are ulterior motives sometimes. I had a daughter who would not leave until her mother was sound asleep. She started demanding I call the MD for sleepers so she could leave before dark
I reserve the right to call "foul"
- Jul 19, '12 by tewdlesIn hospice we work with the family to insure that their loved one is as comfortable as they would prefer. Sometimes the families expectations are not realistic or in the best interest of the patient, that creates a need for increased education and intervention with the family.
In this specialty we do not discount the opinions of the family regarding the comfort of the patient, we try to incorporate them into the POC.
- Jul 19, '12 by loriangel14I assess the patient and medicate accordingly.I don't give meds just because a family member requests it.If the patient is in pain our professional practice manager states that it is unethical to not treat for pain.I assesss and medicate accordingly.
- Jul 19, '12 by Ashley, PICU RNQuote from LiveandLearn88Thank you. I have learned a lot about the psyche of parents with hospitalized children. They are used to being the caregivers, but in the hospital they often feel so helpless that they need to make requests for their child just so they feel like they are doing something. Educating them and reassuring them that their child is being assessed and cared for can be very helpful. I image LTC families must be much the same.Wow, Ashley, your message provided invaluable measures for which I can provide care, children and the older adult are very much alike in the instance of pain and I had not considered that they may be expressing pain to their family member instead of the nurse due to their level of comfort. You have really given me a new outlook on the situation. Thanks!
- Jul 19, '12 by Nascar nurseJust today the group of nurses decided we should talk the Dr into a routine order for resident "Sally" to get a pain medication every Thursday at 1pm (knowing her daughter comes Thursdays by 2 pm and tells us how horrible Momma's pain is). The resident calmly denies pain all week and there is no outward signs of pain either. Daughter walks in and suddenly she has pain of 10/10.
- Jul 19, '12 by CapeCodMermaidThere are many ways of assessing pain in elderly patients. They are NOT children and shouldn't be given medication they don't need or have medication withheld because of a family member's request. We would be cited if we documented given upon request of the family. WE are the ones with the license and the assessment skills needed to determine if our patients need medication.