Dealing With Difficult Family

[shanyone]

I am a first year nurse on a busy med/surg floor. I have had a few families and sometimes a patient or two who were overall just a bit difficult to deal with but up until this week I've never experienced something so entirely frustrating. Over the last week we've had a family that has been especially trying for me (and several other staff members) to deal with. I'm trying to determine the best way to deal with folks like this for the next time. I feel like I dealt with any and all concerns/complaints from this family in a very mature, helpful manner but they were never satisfied with the answers or teaching we gave them. The last day I cared for the patient was the worst of all. The family claimed that they were very upset because they believed the pt. was "sedated so that we didn't have to deal with him/her". These were their words. The pt. had a knee replaced three days prior to this day and that morning the pt. had received two percocets. Overnight the pt. had received an IM of morphine and phenergan. These were the only instances of medication administration that the family was upset about and they claimed that this was putting him/her to sleep all day long essentially so that we didn't have to deal with him/her. Both the LPN and I spent a lot of time talking to them but they failed to believe that we weren't trying to sedate the pt. so I had the charge nurse get involved and she called the house supervisor. The family still didn't believe that we hadn't "sedated" the pt. but they didn't bring it up too much more after that.

There were two other things that this family was also upset about and in general they just sucked the life right out of me this week. I broke down in tears twice in the supply room this week (and I'm not a crier). I'm a pretty strong person with a great way of dealing with almost everyone, but this family was impossible for me. Each time you went in the room they were asking question after question and telling you that they wanted this information because two of the daughters were almost done with nursing school and they had all these questions, etc. Unfortunately, I have nine or ten other patients on our team to deal with and I can't be spending 10 minutes each and every time I come in the room. I'm always happy to answer questions and help with anything I can and I hear a lot from pts. and their families that I am very caring and take time to answer their question, but this one family took is far beyond normal questions.

I was told that I need to just let it go but I find myself still thinking about how I could have dealt with it better. These folks sucked sooooo much time out of me this week and it's just frustrating to think that it could happen again. I fully expect this pt. to be gone when I return (thank goodness) but I want to know if anyone has any other alternatives or ideas for dealing with truly irrational people.

I know I need to let it go, but I've been hashing it over in my mind and I'm just upset that they believed that we would sedate the pt. so as to not have to deal with them. That is an accusation that I don't ever want to have to hear again. I love caring for my patients and I take a lot of pride in it. Anyone have anything to share with me on how to let it go or how to deal with it better when I have a family or pt. like this in the future?

[ShayRN]

You are all so very right....thanks for helping me understand that I did what I could with what I had. Thank you even more for helping me to learn to think strategically if I run into this type of pathological individual or family in the future. I WILL set boundaries and not go in the room each time they tell one of the staff they want to talk to me. I will certainly take all that I've learned here and it will make me a better nurse (hopefully). I really appreciate all the advice and helpful hints!

And homicidal/suicidal....lol, I got them mixed up. I totally talked about the family needing to be thrown out the window and teased that this would be therapeutic in nature! So I get the homicidal feelings.....then I go home and get on the elliptical or go for a run to get those homicidal feelings out of my head.

I'll prevail and maybe some day I'll be more adept at dealing with these dysfunctional folks.

As you grow in your career and have more confidence in your abilities, this will come. There is absolutely nothing wrong with being assertive. Just be sure to document these encounters to CYA!:redbeathe

[santeeaholic]

OK. Lots of great advice here. And yes, I do realize this is an old post. But...I was hoping someone could offer me some advice.

In almost 20 years of being a long term care nurse, I have NEVER encountered a family member quite like the one we are dealing with now, and trust me I have seen some "doozies" over the past 2 decades.

When do we get to put an end to this? Do we have the right to stop this? How do we stop this? What can we do? What are our rights as a facility?

Any suggestions would be tremendously TREMENDOUSLY appreciated!!!

This family member writes down everything. From the time they walk into the building to the time they leave, they write down everything. Even the names of the maintenance personnel who have had to go into the room because "the nurse's can't hear mama through the call light system" (which was not the case). Asks them questions like "are you the head of the maintenance department?" "who is the head of the maintenance department?" "How long has he been here?" Steady writing the entire time.

They STEAL copies faxed to a referred physician's office and then come back to our facility and want to know why "bedtime snack" is on mama's physician's orders and why ALL of mama's allergies (we have been furnished quite an extensive list of allergies) are not printed on the orders by the pharmacy...where did this diagnosis of the bottom of the orders come from? Etc. etc. etc.

The resident is wonderful. No problems, no complaints, and sweet as the day is long. She is the kind of elderly resident that makes our job so very enjoyable. She smiles and laughs at us. She sings occassionally. But this family member is so bad that even the primary physician (who usually has the patience of Jobe) has started using the back entrance of the facility to try to avoid this person because this family member ties up 45 minutes of his time with all of their questions when he is in the building to make rounds for all of his residents.

This family member even attempted to get a diagnosis of "allergy to all generic medications" which is in and of itself rediculous because we've been administering generic medications since the day of admission.

The family member wants to know "the side effects of the medication at the current dose mama is taking" and when PRN meds are given due to complaints of leg pain "well what exactly did mama say". If mama recieves antianxiety medication ordered for anxiety, "what exactly was the anxiety? Was it different than her normal anxiety? What is the nurse's name that gave her that medication? What did she chart? Can we see if her doctor will order a substitute for the Klonopin and see if the side effects of confusion are not as much?" (mama has dementia at almost 80 years old)

This family member lives out of town (THANK THE LORD) but when they come into the building, they "make the rounds" to all the staff members. Social Services, Dietary, Medical Records, Nurses, Activities...and during these "rounds" as we now refer to them, this family member ties up about 30 to 40 minutes of time for EACH staff member. (the room is too cold, the room is too hot, the food is too salty, the food needs more salt, the (newly hung at their request) curtains need to be dusted, when is the church group coming back that was here 2 weeks ago on tuesday afternoon-not the one that was here tuesday morning?)

When they call instead of coming to the building, this family member ties up the nurse on duty for 30-45 minutes on the phone with rediculous complaints and questions not voiced by the resident.

We have had 4 (FOUR) care plan meetings with this family member in less than a week. (which decreases the time we can spend with other family members at care plan meetings) Each of which has lasted 1-2 hours. It is CONSTANT questions. No matter what our responses are, there is NEVER an end to the constant questions, or writing. The writing never ever ever stops. This family member comes into the buiding with an expandable folder to keep this "documentation" in.

And let me not neglect to mention the fact that this family member informs us of conditions that the resident has because they "Diagnosed them" and would like for us to do things like put baking soda on a rash (which wasn't even there)

HELP!?!?!?!

I have never encountered someone such as this, but before we lose really good nurses (who are threatening to quit over this family member) I opted to try asking this forum for advice.

We honestly believe the family member has some serious psychosis issues occurring. At the very least, OCD regarding mama's health care. What do we do?

[LarisaLee]

This is a very late comment since I just saw the post. This is a job for volunteers. If you ever come across a family like this again, call the chaplain and ask him/her to organize a group of people to keep this family busy. Tell them it would be doing God's work, since it would be allowing hospital staff to go about their jobs, properly caring for (rather than accidentally neglecting) a dozen other people assigned to them. It is quite possible the particular individual who is doing most of the pestering of hospital staff has serious OCD and has always been that way and cannot be helped in a short term situation. However, it is also possible this person is terribly frightened and needs spiritual and emotional guidance. Perhaps the entire family does. Certainly your staff needs some relief as well.

[SaoirseRN]

When families have that many questions, I will suggest that they have a conversation with the patient's doctor. Especially if they are constantly repeating the same questions. I will provide the publicly available office number for the doctor in question, and often the doctors will either plan to meet with them the next day on rounds or after clinic hours, or schedule an office appointment. Doing this shows that you care about their concerns and aren't trying to "brush them off".

Another option: "You have a lot of questions, which I understand. I have some tasks to do right now, but here is a pen and some paper. How about your write these questions down, and at MUTUALLY AGREED UPON TIME I will come back and we will go through them?" This addresses their need for questions but might make it more manageable.

This is creating a boundary (because you do have other things to do) without saying "well I have six other patients too you know..." because saying that doesn't work. In their eyes only their loved one matters, which isn't ideal but I do get the mentality of that thinking, so mentioning all your other patients ends up sounding like an excuse.

It's also a good idea for them to write a list of questions and concerns if they are speaking to the doctor.

[jadelpn, LPN, EMT-B]

Keep a log in the room and write a narrative per shift. They are to refer to that. A "communications" log that perhaps one nurse (the "primary" nurse) is "in charge" of. Or even better, a social worker. There often are times in many cultures where "putting Mama in the home" is downright the most outrageously awful thing that one can do. And the daughter has the ladies of the church, the ladies of Bingo, and the ladies of swim aerobic class NOT the mention the ladies of the neighborhood to answer to. In detail. Over cookies and tea the debate rages over "allergies" and "that poor ladies Mama on the Fox news who got hit at the home" and how ALL of it COULD apply to the Mama and the family you are dealing with.

The next family meeting (and alas, I am SURE that will be soon) should be focused on behavioral expectations of the family. We have established a communication log. Because Nurse so and so in not a private nurse, she has many patients, therefore, social worker whomever will be in charge of this. We will give you 1 report per day on how your Mama is doing. Social worker whomever will have a bi-weekly meeting with you to discuss the contents of the log. Phone calls will be directed to social worker whomever's voice mail. Any questions, please write them down. If Mama's condition changes, then by all means we will communicate effectively, however, for now, we understand that there's a great deal of anxiety about leaving your Mama in the care of others, however, your Mama today is stable and happy. Our intentions are to keep her that way. Because she is LOVELY, and makes us smile. Every day.

Set firm limits, and stick to them. Make sure administration is in your corner.