case manager taught me a gem about families

[SNB1014]

so, it was the morning after the "incident". I was caring for a 85yo man in icu step down who has BP that hovered 80/50 and we had finally gotten his a-fibb rate controlled. but he was now diagnosed with pneumonia. he had a hx of dementia and couldn't catch a break.

well, as you all know, sometimes it is a great triumph when you get a sickly,confused elderly man simply out of bed into the chair. I wanted an award!! It took a lot of coaxing to do this. he was on multiple IV antibiotics and had tubes and wires everywhere.

then he daughter came in to visit. normally, i enjoy families, I enjoy their help, their perspective and teaching them about our plan for the day or giving updates on loved ones.

all his daughter would say is "DAAAADDDDDDD, why aren't you walking? Has he walked? You know right before he came in , he went with me to the grocery store! I can't believe you wont let him walk!"

She repeated the same concept, different anecdotes and phrases, for around 15mins at change of shift. urghhhh. I tired to explain that when he walks, his 02 goes down to 86%, his feet hurt so bad he won't move them, it took 15mins to get him from the edge of the bed to the chair, he has pneumonia so bad I can hear him without a stethoscope, we had to have him in trendelenberg AND a bolus of NS just to maintain 85/55 bp. I said I was more concerned about his heart and lungs than him walking down the hall at this point.

Oops. Family didn't like that.

So in the am, I saw case management, and she must have overheard me discussing this with my charge and she chimed in:

"well, families focus on what they can understand. they dont understand afibb with RVR, pleural effusions, vanc. troughs, the seriousness of low potassium. walking is a measurable, concrete indicator of how her dad is doing. she couldn't care less what the number on the monitor says because she doesn't know what it means. when dad comes in being able to do certain things and now he cannot or refuses to try, its terrifying for families. They focus on what makes sense to them. "

A-Hahhhhhh!

I now saw the daughter wasn't trying to give me the riot act over walking him, but she wanted me to understand this is NOT dad's baseline. that he is 85, but normally he is strong.

So i made sure first thing after case management interjected, that I put in a request for pt/ot.

When I told the daughter that later in the afternoon that as long as he was hemodynamically stable (i say, "as long as his numbers look good....") pt/ot in addition to myself will be working on getting him as ambulatory as possible, but to please be patient because when our older folks get sick, it takes them longer than you and I to get back into fighting form."

she seemed happy with that answer, and therefore so was i :-)

[calivianya, BSN, RN]

Sometimes I think that some family members are just so ignorant that they are beyond help. I try my best to teach things at their level, but when people look really confused when you tell them their father can't move his leg because "The brain is what tells the legs to move, but the stroke hurt his brain so his brain can't tell his leg what to do anymore," and then they say, "I get that he had a stroke, but why can't he move his leg?" what do you say? How do you make it any more simple than that? I think with this one particular family in question I tried to explain how a stroke affected the legs about five times before I gave up.

[myjade_84]

A good story. Lesson i learned: Be patient with idiotic families!

[Kencanwin]

Kudos to the case manager for reminding that you gotta simplify it for the non-nurses/ medically unindoctrinated.

[ktwlpn, LPN]

In LTC many family members are in such denial that they focus on things like Mom's hair,Dad's nails,the contents of the meal tray, ANYTHING instead of acknowledging that they are LOOSING their loved one.Sadly many people can do this right up to the end and avoid the emotional work they need to do at the time and they will push futile and painful teatment on their loved ones and act out towards the staff.You folks get to see alot of that when we have to ship them out to you. Please believe,we do try to give these family members a reality check.

[SummerGarden, BSN, MSN, RN]

A good story. Lesson i learned: Be patient with idiotic families!

Nurse Case Manager here! These patients and his/her family members are not "idiots"; they just cannot cope with their new reality despite the fact that this reality may have been in their faces for a long time. As nurses we need to be the professionals we claim to be. We need to assist the patient and his/her support system to be able to cope with their new reality in a short period of time. This way they are more receptive to working with us as a team and are able to learn to follow courses of treatment inside the hospital setting and after discharge.