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?

[JustBeachyNurse, LPN]

What does the hospice nurse case manager have to say?

[TheCommuter, BSN, RN]

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.

[KelRN215, BSN, RN]

The line is nowhere near where this son is. I've seen family members banned from visiting at the hospital only for physical abuse. Working in pediatrics, I've seen a few cases where the child's father tried to do something like strangle the child's mother. That man was banned from the hospital. Other than that it was cases where the parents shook the baby and the state took custody or long standing abuse cases where one parent already had a restraining order against the other.

[nursemike, ASN, RN]

I am a hospice customer. I've not been entirely thrilled about the care my father has received. As a nurse, with real effort, I can step back just enough to recognize I'm not in my right mind, nor am I entirely committed to the hospice model. I am still praying for a miracle. There's a part of me that sort of resents the hospice workers being realistic. I think if I were able to look at this situation objectively, there are things they could do better, but I know for a fact I can't be objective, so I'm trying to take the help they have to offer and manage as best I can. I can only guess what this must be like for a layperson. Some people were jerks even before they were going through hard times. Still, they are going through hard times. We see a lot of the same thing in acute care, and it sucks, and it comes with the territory. Sorry I don't have any helpful advice, but good luck.

[calivianya, BSN, RN]

My facility is pretty good about banning people who threaten harm to the staff, but that's about it. Obviously, if they also harm the patient they would not be welcome back, but I have never seen family banned for being obnoxious. They have to be violent or threaten violence to be forbidden.

[Esme12, ASN, BSN, RN]

I am a hospice customer. I've not been entirely thrilled about the care my father has received. As a nurse, with real effort, I can step back just enough to recognize I'm not in my right mind, nor am I entirely committed to the hospice model. I am still praying for a miracle. There's a part of me that sort of resents the hospice workers being realistic. I think if I were able to look at this situation objectively, there are things they could do better, but I know for a fact I can't be objective, so I'm trying to take the help they have to offer and manage as best I can. I can only guess what this must be like for a layperson. Some people were jerks even before they were going through hard times. Still, they are going through hard times. We see a lot of the same thing in acute care, and it sucks, and it comes with the territory. Sorry I don't have any helpful advice, but good luck.

I am so sorry....((HUGS))

OP.....Unfortunately....we can't ban family for being pain in the behind. If that were the case...there would be many who would be banned from their family.People cope differently.....some are less capable to comprehend what is going on around them. They want to be heard. Unfortunately the more you tell them need to relax they feel they need to be heard. They really need to feel they are helping....whether it is guilt or some unresolved issues.

Sometimes it is best to engage them and let them feel they are being heard....useful.

[jadelpn, LPN, EMT-B]

This is a tough one. However, there are family members who will, in fact, follow the nurse around with a zillion questions, and they do deserve answers, even if perhaps they are not what the family wants to hear.

Hospice care's goal, as I understand it to be is peaceful and as pain free as possible. It takes the patient themselves to embrace this, and family sometimes feels like they are just "in for the ride". Which is all about loss of control.

With all that being said, when a family member approaches you with a litany of "issues", I would make sure that you respectfully say, "I am the nursing assistant" "I will be sure to let your primary nurse know you have questions". And do let her know, so that she can assess and perhaps decide that a daily meeting needs to take place to discuss plan of care.

You can certainly ask to be part of that, as you can also advise the family about what you will be doing for the day "I will be in about every 2 hours to turn your father....." and whatever else needs to happen from your end for the day.

Sometimes it is a matter of lots of "waiting" around leads to thoughts on overdrive. Constant bad anticipation. So remember, use eye contact, speak clearly, understand what the family's goal is, what the patient can tolerate.

You are part of a team. So be sure that you keep the primary nurse in the loop, so that if the case manager, social worker, or any other discipline needs to become part of the process more often, the nurse can make those arrangements.

[Irish_Mist, BSN, RN]

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.

This person was only issued a citation? They should have been arrested for assault.

[TheCommuter, BSN, RN]

This person was only issued a citation? They should have been arrested for assault.

I totally agree. Although this brute of a visitor escaped the harshest of consequences by being issued a mere citation, I feel this person should have been arrested.

Anyhow, I also disagree with the manner in which my former workplace addressed the visitor after she slapped the nurse. They allowed her to have supervised, timed visits with the patient. If things went my way, the brute would have been permanently banned from the facility for hitting a nurse.

[SNB1014, RN]

hospice is a whole 'nother breed, even when it is inpatient.

does your inpatient hospice unit have visiting hours? Or is the nurse able to "sternly request" the pt be able to get some uninterrupted rest? (aka go away?)

i am on the floor but had this issue with a to be d/c the next day with hospice pt. she refuses her bipap, all she could do was moan and groan, became increasingly anxious, shaking the siderails, trying to talk through/take off a NRB mask, while her sats would drop into the 70s. the whole time her son, (mostly) are 3 rotating family members kept asking her "MOM?GRANDMA!!! can you breathe? why cant you sleep? go to sleep grandma, grandma are you in pain, hi grandma, just relaaaaaaax!", lights on, hovering over this poor woman. i had had it. i said, politely, but it was clear i was not asking them, that "she appears to be working very hard to breathe and talk with you all and it appears as though she is trying to stay awake to interact with everyone. i think it is best that we all gve her 15mins of peace, lights off. door closed, oxygen mask on, some meds to help calm her, and see how that does. i also 'request' we rotate in 2 family members at a time. i am having a difficult time reaching over and giving her all that she needs"

it clicked, they left, her sats went back into high 90s, she relaxed, everyone remained more relaxed and she did better.

i admit i also give the most cliche answer of "if this is something you have concerns, questions, objections to, you need to ask the attending. this is something that the dr, the patient and the POA have agreed upon."

[carolinapooh, BSN, RN]

This person was only issued a citation? They should have been arrested for assault.

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.