Help! What is the line where family members are banned from the facility?

[InSaneMembraine]

Ok, I am a CNA that works in an inpatient hospice center. Of course we deal with difficult families, as do all of you. My situation is this; We have a pt that is dying (shocking!), and his POA is his wife. The poor woman has been caring for her husband for 9 months, and now the end is coming. Understandably, she already was having issues where she would ask questions, and the answers are all in one ear, out the other. She has not been sleeping, even when she went home to rest.

Here is the issue- she has a daughter and a son. They are not coping well, but the son is a problem. There is some kind of psych going on there, and even though he is a grown man, he lives at home. So mom is basicly caring for both. He is the kind of guy that follows you around, asking 7million questions. Mom is now a zombie, like totally insane now. I feel that the patient's care is being very impacted by this son. Mom does not seem able to handle the situation now. The daughter is also kind of this way, but the son is looking up stuff online, trying to tell us we are killing his dying father, and the family is just being pulled by that persuasion.

There have been many caring discussions with this family, to no avail. They have lost it. And when we try to care for pt, it's all "No, do this. No, do that. I read this/that online." And we have lost a grip on caring for him. What do you do in this situation? I, being a CNA, am not an authority figure. I do the best I can and get along with patients & families, and this behooves me. What do I do?

[LockportRN]

Dear Mike,

My heart is so with you! I have read some of your other posts and what you say about praying for a miracle still resonates with me. Our situations sound similar, though it was my mom not my dad.

My ambivalence at 'letting her go' was met by various hospital staff members in a meeting to passify me by trying to tell me that even though I am a nurse, I can't always save everyone. Painful thinking about the many that I had but in this case,, there wasn't a thing I could do but cry. Hang in there my friend.

For the OP, it sounds like it is time for a meeting with all involved. Establish POA for HC and decide if continuing with hospice is the POC. Once this is established, it may be best if the POA is the person that staff speaks to in regards to this patient's care. Once bounderies are more clearly established, it may even be evident that this family member may benefit from hospice sponsored counseling. After all, with hospice it isn't just about the patient but the whole family that needs education and care. It is very difficult to 'let a loved one go' especially if a person is not prepared or if the patients wishes haven't been established in advance. Even then, it can be hard to see a parent pass when you have seen this person as strong and healthy for you whole life. It can feel as though you are letting them down by not 'trying everything'.

Speak to the nurse manager and see if a family meeting can't be planned. Tell the manager what has been happening, this may make all the difference in the world. Best of luck to you.

[bluegeegoo2, LPN]

In the neck of the woods where I live, difficult family members are coddled and dealt with (unfortunately).

Several years ago a family member ran after a floor nurse, followed her into the bathroom and slapped her. The police were called and the officer issued a citation to the family member. In spite of this, management still allowed the difficult family member to have limited, supervised visits with the patient.

In this day and age where 'customer service' rules, the family is unfortunately treated as if they are always right.

I believe we live in the same state, and if that's the case, I totally agree with you. We recently had the son-in-law of a resident show up, stinking drunk, who proceeded to loudly curse at, belittle, and otherwise verbally abuse one of our nurses. Was he banned or even kicked out? No ma'am. He was asked nicely to please stop acting that way. That wasn't the first time he had done that and likely won't be the last. Anything to keep family happy and keep that census up!

[Bhavana]

A family member has to do a wee bit more than be difficult to be banned from a facility. If we banned all the annoying family members, our patients would have no visitors at all. Myself, I just ignore them when they start acting up. I pretend they just don't exist. But for the average pain in the butt relative? Not much you can do. I try to think about what is really going on with them - they are dealing with one of life's greatest stresses. We need to have some compassion in this case. Then you have people who want to complain, and will never be happy, no matter what you do for them (these are the ones I deal with by ignoring - which works well, because they eventually walk away and find someone more responsive to annoy)

Truth is, dealing with the families is part of the job. No one knows as well as me that even the most well meaning of them can suck up all your time and energy, but what can you do?? Just smile, grit your teeth, and keep on going.

[cienurse]

There needs to be a discharge planning meeting with the family. If he were at my facility, I would be having the physician discontinue the care and comfort orders and send this patient to the hospital. The family obviously is not ready to deal with his death in a very real and compassionate way. They have the right to change their minds about the care they'd like for this poor man and the hospice center has the right to reserve beds for those patients and families who would like the end of life experience to be dignified and comfortable. There's no need for the hospice center to deal with unrealistic families. Discharge to the hospital and fill the bed with someone who needs it.

[Daisy_08, BSN, RN]

It is very difficult to ban someone when your giving end of life care. There is no ''you can visit when they are discharged''. We get sw involved, and make an assessment (is mental health a factor?). Then sw and management write a contract for the visitor to sign, they manager is the bad guy. They tell them visiting is a privilege not a right. If they violate the contract (staying past hours, threatening staff or others, talking to someone they should not, giving the pt things they should not have ect) then they go on supervised (by security) visits at a time we set. If they behave and follow the rules for X amount of time then they can go back to unsupervised visits (gives them motive to behave) if not then they are banded.

I do work in an inpatient palliative unit so there is more support.

One thing you could try is all giving the same pre-written answers: when he asks about medical things 'I'm sorry MR.X I am here to care for your dad. Any questions can be directed to my supervisor Jane' or if he complains about other ''I'm sorry Mr.X I am only responsible for the care I provide and cannot comment on anyone else'' You just have to be consistent and stick together as a team.

Best of luck

[Daisy_08, BSN, RN]

There needs to be a discharge planning meeting with the family. If he were at my facility, I would be having the physician discontinue the care and comfort orders and send this patient to the hospital. The family obviously is not ready to deal with his death in a very real and compassionate way. They have the right to change their minds about the care they'd like for this poor man and the hospice center has the right to reserve beds for those patients and families who would like the end of life experience to be dignified and comfortable. There's no need for the hospice center to deal with unrealistic families. Discharge to the hospital and fill the bed with someone who needs it.

I kinda agree - here where I live in Canada we have so few stand alone hospice beds that they are very selective on who they accept as not to deal with these types of issues

[carolinapooh, BSN, RN]

I believe we live in the same state, and if that's the case, I totally agree with you. We recently had the son-in-law of a resident show up, stinking drunk, who proceeded to loudly curse at, belittle, and otherwise verbally abuse one of our nurses. Was he banned or even kicked out? No ma'am. He was asked nicely to please stop acting that way. That wasn't the first time he had done that and likely won't be the last. Anything to keep family happy and keep that census up!

Me, at nurse's station: Security, we have a problem.

Barney Fife: Uh, ask him to nicely stop.

Me, at nurse's station, after hanging up on Officer Useless: Hello, Anytown PD? Uhm, yes, this is Nurse CP over at Local Hospital, we have a family member on our unit who's potentially drunk - I can smell the alcohol on him - who's intimidating and verbally abusing our staff. Yes, I called Barney already. He asked me to ask him nicely to stop. Yes, really. Okay, we're on Floor D, unit X. Thank you.

Me, still at RN station: Yes, Nurse Manager? I've had to call the local police about a family member up here who is obviously intoxicated, reeks of alcohol, and is verbally abusing our staff and making everyone nervous. Loud, yelling, very intimidating and quite frankly, I'm scared of him. No, security did nothing. PD said they're en route.

Me: reassure staff, go to computer and type up a word document of everything that just happened and email it to myself in the body of an email.

Local Hospital tries anything, I'm calling a lawyer. I'm an ex cop. Alcohol = bad situation gets worse. You cannot under any circumstances reason with a drunk. And I don't advise you to try. We reasoned with handcuffs and citations for disorderly conduct, public intoxication, and all sorts of other fun things. That's a cop's job. Don't ever, ever tell a drunken idiot you're going to call the cops, either - just go call them, for God's sake, and try to contain the situation as best you can until they get there. If cops use the force continuum to reason with a drunk (and essentially, us talking to some joker like this is considered to be on the force continuum), and I was in prime shape, carried an Asp, 32 rounds, and a trained attack dog as backup, what in the world makes Jane/Joe Civilian (because you are just Joe Civilian) think they can do it after a simple, 'sir, please, I really need you to stop' fails epically? Let's face it - the cop's a bigger threat to that person. Exactly what are you bringing to the party that someone who would probably survive a car accident that would kill you instantly doesn't have?

What if he hit you? Are you supposed to just take it? You've got to be kidding me. There is nothing rational about a drunk. Nothing. Once 'Please sir, we need you to stop and let's talk this out' doesn't work, it's over. What if he's also on drugs along with the booze? Ever seen someone on PCP? You can shoot someone on PCP and they literally keep coming. If you're coming into a public place reeking of alcohol and you're causing a ruckus, I can't say for sure what's beyond you. This isn't drama - this sort of stuff goes on, and yes, I saw it in the military! And people walk around armed to the teeth - no sign on a door will stop someone from bringing in a weapon if they want to. I'm a bit disgusted (if this is a recent occurence) that given the state of the world today this fool wasn't OVERreacted to in the name of general safety. I can assure you in a Federal facility there'd be more action - Fort Hood, anyone? How about that guy at Fairchild AFB back in 1996 - walked into the hospital and started shooting the place up?

It's stuff like this that keeps RNs under administration's thumb. We need to stop being doormats for this sort of crap. Any other workplace in this country, this tool would be forcibly removed. (And yes, he's a tool, and an assortment of other choice words I'll keep to myself.) Why do we put up with it in the name of freaking ADMINISTRATION AND PATIENT SATISFACTION SCORES?

[carolinapooh, BSN, RN]

Yep, a rant. Because hearing about this sort of stuff is really, really starting to burn me up. I'm actually a very rational, very organized, very intelligent person.

But seriously - either we stand up for ourselves, or administration will continue to treat us with the same regard a lot of people give trained monkeys. Or the way they used to treat mental health patients: gentle disregard, like we don't even exist.

Thanks for listening. :) Not trying to hijack if that's indeed what happened.

[Irish_Mist, BSN, RN]

Actually, that's full-fledged battery (assault is the threat of violence, and battery is carrying it out) and hospital or not, I would've filed charges and let the hospital hang itself.

Wrong choice of words or not, the person should have been arrested. I find it inexcusable to hit anyone and a citation would have not cut it for me if I were to have been the one hit.

[carolinapooh, BSN, RN]

Wrong choice of words or not, the person should have been arrested. I find it inexcusable to hit anyone and a citation would have not cut it for me if I were to have been the one hit.

That is exactly what I meant. My intent in pointing out 'battery' is that the charge of battery is higher up the scale than assault, and carries higher penalties (unless the assault is with a deadly weapon, as in a robbery - the threat of using the pistol, let's say, is assault with a deadly weapon). And I am ten thousand percent in agreement with you. But they can't always arrest for that without the victim pressing charges; it depends on state law.

This is an ex-cop talking; I'm not giving legal advice (at least, not trying to).