First week with patient, family driving me batty!

[MsBlissful]

I have a new patient under my care at one of my facilities that I case manage.

This little lady is a typical dementia patient with some manefestations of psychosis, she goes from being calm to screaming out all hours of the day, has sun downers.. etc. She is medicated with the good stuff and in all honesty she is doing MUCH better after a few tweeks of the meds.

My issue? The family. I have done.. count them... 5 visits this week with an extra visit in the evening by our prn nurse and also a "meeting with the SW". My visits are not patient centered. the family is there waiting for me asking me the same repetitive questions. Its like a broken record. I have talked to the same person today as a matter of fact for another hour of my time to visit the same stuff from Monday, Tuesday, Wed, Thurs, Friday. I get the same over and over questions.

I finally had a hear to heart with them and explained I feel somehow I am not meeting their needs. I took a spiral notebook out and asked them give me their goals for the patient and them. Guess what? I got 3 all of which are being met.. currently.

I can't fix the broken, but I am on my last bit of patience with these folks. If they are not there during a visit, they want a call. These calls take 20-30 minutes and its all repetitive.

My social worker is doing the same. but it seems like I am not meeting their needs.

[SuesquatchRN, BSN, RN]

You can't fix crazy. You can also set limits, maybe with the help of the IDT.

[tewdles, RN]

I agree, discuss this in IDT and develop a plan of action.

Schedule regular family meetings, say every two weeks before or after IDT. Create an agenda for the meeting so that it is controlled. Invite them to the IDT.

Just a couple of ideas...

like Sue said, you can't fix crazy, but you do have to work around it sometimes.

[MagnoliaBlossom]

I have just had a patient die last week whose family did this to us. Although he was at home. After the second week, my LPN and I had answered the same questions over and over and over - well, you get the idea. Every thing they asked was well addressed in our patient guide. I had highlighted, LPN had underlined, MSW had circled (the guide looked like a coloring book when we were finished). By week three the plan was that every time the family repeated the questions, we asked where their guide was and showed them the answer. It took about a week but they finally figured out that the answers were not going to change.

I realized early on they were so fearful that they really just wanted someone to talk to them. I would make sure I had some time and when they would seem to be wandering into the question mode - I would just ask them, "how are YOU doing today?" "what's happened since my last visit that's been especially difficult?"

That may not work for your family, but it seems you've addressed their presumed concerns. See if you can figure out what's really buggin' them - or they're just crazy! (happens!) Good luck