Should families, etc. be held accountable for participating in patient care?

[Mijourney]

Hi. This topic is in response to the topic "Angry Nurse" posted by goldilocksrn. Is it reasonable for facility administrators and the public to continue to expect nursing to be a "one man show" in light of the fact that patient care is much more complex today, staffing levels are low, and rules and regs by different entities add additional pressures? Is is fair for families to completely "drop the ball" once patients are admitted to a facility? Parents are held accountable as primary educators for their children in most countries even when the children attend school. How should family participation in patient care be approached? How can nurses solve the problem of passive family involvement in patient care? Please post your opinion.

[This message has been edited by Mijourney (edited November 03, 2000).]

[TKOLRN, BSN, RN]

Hi Mi,

Good point..I just had this discussion with one of our newer nurses the other day. I work in a very busy ER that, like most others, could use more staff. He wanted to know why I wasn't helping a patient get his pants on, as a family member sat at the bedside. I reminded him that one of the goals of nursing care is to maintain or promote the current level of function. I believe that applies to patient and family. They want to be involved in every other way...present during exam, blood draws, EKG, decision making, all treatments, then I believe they should also maintain whatever they did for the patient themselves at home, with whatever assistance I can offer. For example, a family member came to me the other day and said her mom needed colostomy care. When I inquired as to who usually does it, the daughter replied that the patient does with her help...I simply asked what supplies they needed and offered assistance should they need it. This does not always work, but in those cases, I explain my rationale to the patient and family-basically that me taking over those tasks would be a setback to the patients independence. In this day and age when it is a struggle to provide even mediocre care some days, I think the family should be encouraged to be as active in the care of the patient as they can safely and reasonably be.

I will be anxious to hear other thoughts on this.

Ted

[goldilocksrn]

It all depends. If family can safely assist the patient, and their need just can't wait for staff, then by all means do it! If the patient and family perform certain ADL's at home (ex. colostomy care), then they should continue to do it in the hospital. The truth is, they probably wouldn't like the way we did it anyway!!! Our job as nurses it to assist patients in getting back to a point where they can care for themselves.

[Jenny P]

I think it all depends on your definition of patient care. In "Angry Nurse" the nurse was speaking of getting a glass of water for the patient. ANY family member could do that, once the nurse has explained if the patient is on I & O etc. With colostomy care, I'd want o observe the families technic in doing it first. I guess with any patient cares that the family usually participates in, I would like to observe their ways of doing things and make any suggestions or corrections that would help them with the task. If the family members sre exhausted (say, the S.O. of a patient with Alzheimer's); then I would insist on doing the cares for the patient and that they go home and get some rest themselves.

[MD_Rn]

When patients are discarged to home with home care, families are responsible for ALL the care. I see infusion patients at home and the families are responsible for learning how to administer the antibiotic, the TPN or whatever the therapy may be. They are responsible for learning to care for the central line, including dressing changes. They are responsible for learning to do any wound or colosotomy care. Unfortunately, when I walk into a home for the first time and let them know that I am here to teach them all this they look at me like I have 3 heads. Now, eventually they do agree to do it and do indeed learn it. But it would be nice if families and individuals were aware that they are responsible for their own care. And yes, in some cases I feel this should begin in the hospital. Too many patients tell me the nurse at the hospital said you would do everything and come every day. But sometimes I get one who tells me the nurse let him flush his line or showed him his wound care... Thank You! It certainly makes my revelation that I am only going to see them less than 5 times much easier on patient and nurse.

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Sure, they should be held accountable. When I used to work in home health, there were families who would wait on the aide or nurse, to come and "clean up" their loved ones...after the patient had laid in his/her own excretement ALL night. "I'm paying YOU to take care of Him/Her, I was rather arrogantly told many times. Well, some eighteen years later, as Medicare has cut reimbursement, resulting in the closing of thousands of home health agencies, this has resulted in beneficiaries and families being FORCED to doing things that they once relied on the nurse to do...or put their loved ones in a nursing home....