I am struggling with patient families lately. - page 10

by jennilynn

16,932 Views | 146 Comments

I am fed up with patient families treating the hospital like a family reunion site. I am tired of the family members that insist on staying the night, why? In some cases I get it. But when your boyfriend has the flu or your nana... Read More


  1. 1
    Quote from ~*Stargazer*~
    I was interrupted during my last post, so I just want to add:

    When a person is venting, they are not seeking solutions in that moment. What they want is to feel heard and understood. The search for solutions begins later. To be met with unctuous sanctimony camouflaged under the banner of "problem solving" only makes the person feel invalidated and defensive.

    When the person is ready to seek deeper understanding and solve the problem, sometimes they don't ask for feedback because they already know the answer, or are good at problem solving themselves. Sometimes, they do ask for feedback because they realize that hearing others' perspectives can deepen their understanding in ways that listening to their own inner voice can't.

    To tell the difference between a vent and a request for help, look at the subject heading. A statement ending with a period is typically a vent. This person just wants to feel heard and understood. A sentence ending with a question mark, or a statement followed by a question such as "Any ideas?" is a request for help. This person wants feedback that is problem solving oriented.


    Understood.

    The replies seemed to be moving in a southern sort of direction, lol. So regardless of cigars (never knew there were so many until recently), there is no need to throw the baby out with the bathwater on FCC/PCC.

    And when one vents on an open forum and negativity regarding one side of one aspect/concern regarding an issue as important as this one comes into play, it must also be understood that reasoned responses from another perspective will be given. That's part of the beauty of discussion boards. Growth and maturity dictate not being hurt over fair opposing responses.

    Susie2310 likes this.
  2. 1
    I don't think anyone is throwing the baby out with the bathwater. I would venture to say that most who have participated in this thread see PCC/FCC as a good, neccessary thing. Speaking for myself, I enjoy when individual patients and their loved ones are involved in the plan of care. I like it when people ask questions. I find it gratifying when I see that light bulb turn on. The core of the problem lies with the customer service mentality that is so pervasive today. It's like you can never say "No" or set limits without starting a poo-storm.

    Also keep in mind that the environment in which you function on a daily basis helps to shape your attitudes. You work with critically ill children and their families. That is a unique environment which surely poses interpersonal challenges, but it is very different from an adult acute care unit.

    I've often thought of the Standford Prison Experiment. When I worked in the ED, it didn't matter how hard I tried to resist becoming hardened, jaded, and skeptical. It didn't matter, because every single day I was faced with mean, nasty, ugly, dishonest, manipulative, violent, demanding, selfish behavior. Of course it affected my outlook. How could it not?
    jrwest likes this.
  3. 1
    I hear ya, but I have done both, and I have used the same principles with both adults and peds. At the end of the day, people are people, and loved ones are loved ones. When they are sick enough, you don't say, "Well let me choose between who is more important, and thus needs me to advocate for them." People in need are still, people in need--and if they are loved ones, it's really hard to turn away. Suffering and loss is often present with both groups of people.

    Wow, I don't think I could have stayed in the Standord Prison situation. That kind of things wears at a person.

    I hear what you are saying about the "no" and customer service side of things. CS can't get in the way of efficacious treatment for the patient or other patients. I am so fortunate, b/c most of the nurses were very good about me being there. I didn't try to be all up in their faces with "I'm a nurses. . .blah, blah, blah." In fact I tried to steer away from that. When things went south with my loved ones and it became obvious that I didn't work with trains for a living, I still asserted where it was most necessary, but I didn't try to usurp the nurse's role. I didn't feel that kind of approach was appropriate or beneficial. In fact, I tried to be as quite and out of sight as possible, except when the situation called for me to say or do something--or when one of my loved ones asked me to address something. They never asked or demanded for anything ridiculous, but certain things you can wait and see on. So when they asked of me, and if it was important enough, I would approach about the particular need. These loved ones when through extended periods where they were more acute sometimes and then critical at others. It was very tough. And no. I couldn't stay there all the time, b/c of family and work--but whenever I could, or if their situations went south, I'd switch with someone and be there. Again, no one wants to do this kind of thing. We'd much rather be at home with our other family members or getting some needed sleep. Conscience and good sense dictated when I had to go the extra mile with loved ones in my family. It was hard. I know I did the right thing, and I have no regrets.

    I think the issue is how to apply FCC and PCC, and how to set policies with certain parameters in place. It is different in that for children, many parents will basically live there, when their kids is sick enough or if they live far from the particular hospital--to the point where actually their other kids get neglected. But it's understandable. They also have Ronald McDonald houses and places within the hospital for families to go to get away and get rest. I don't necessarily think this would be the case with most adults in serious situations. But there are certain factors we have to keep in mind, and I believe close loved ones, like the primary spouse or son or daughter or partner should have accomodations in certain situations. It's just the whole idea hasn't taken off to nearly the same degree in adult care. If my spouse were critical enough, no. I wouldn't leave him. And I shouldn't be asked to do so unless I am way out of bounds.
    Susie2310 likes this.
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    No, it is not the same. People have different developmental tasks across the lifespan. Taking care of a 2 year old little girl with cancer and taking care of a 25 year old man who just had a lap appy require their own unique approaches. This is the basis for Patient Centered Care; taking into account each patient's individual circumstances when developing the plan of care. Taking care of the 2 year old necessitates involving the family. The 25 year old adult is an autonomous human being who gets to decide for himself how involved he wants his family to be.

    My philosophy of nursing includes protecting patient autonomy and promoting self efficacy. This does not mean excluding the family, but it puts the patient at the center of what I do.

    You and I could keep going round and round, but I stand firm in my commitment to my patient, and each patient has individual and unique needs when it comes to family involvement.
    PalmHarborMom likes this.
  5. 1
    Quote from ~*Stargazer*~
    No, it is not the same. People have different developmental tasks across the lifespan. Taking care of a 2 year old little girl with cancer and taking care of a 25 year old man who just had a lap appy require their own unique approaches. This is the basis for Patient Centered Care; taking into account each patient's individual circumstances when developing the plan of care. Taking care of the 2 year old necessitates involving the family. The 25 year old adult is an autonomous human being who gets to decide for himself how involved he wants his family to be.

    My philosophy of nursing includes protecting patient autonomy and promoting self efficacy. This does not mean excluding the family, but it puts the patient at the center of what I do.

    You and I could keep going round and round, but I stand firm in my commitment to my patient, and each patient has individual and unique needs when it comes to family involvement.

    A. You have engaged me before in an attempt to argue with me. You fail to see that I have no interest in win-lose approaches to discussion. My philosophy is one of balance and problem-solving, period. Personally, after many years, for some reason I have found more of a barrier with nurses in taking on this approach than with, say, physicians, or respiratory therapists. The first step is to take the emotional element or the psychological need for win-lose dominance in argumentation out of the discussion. It blocks problem-solving.

    B. Now, back to your comment here. The process of human development indeed moves through the entire lifespan. It does not stop with adolescents. What's more, we easily may see people that are severly ill, or somehow unstable, even as adults, that will often show signs of psychological and emotional regression if the stress continues over a long enough period of time. And that stress response is different for different people. Each individual is hardwired somewhat differently.

    What is the same is the need for family and family support--especially as people are severely stressed and vulnerable, which includes a significant other or family for THE ADULT client as well.

    When the family member is demonstrating that they are there in order to put the sick loved one first--to be patient-centered, and the adult patient desires the family member's support and presence, patient-centered care would say, by all means, include that significant other!


    The example of the 25 year old lab appy is on the ridiculous side of things for the discussions and positions I have previously posted here-- that is, unless that person had had severe complications.

    No one ever said anything about precluding the will of the adult patient in having a family support there. You have read and put too much into what I have said--or are suggesting something other than what I have been discussing.

    Of course the adult has full rights as to who is there and why. This was never questioned in the whole of the tread. Don't know why you are throwing it into the mix now. ??? n

    Also, I don't know why you took an argument of extremes--the 2 year old with CANCER versus a 25 with a lap appy. You should have compared them both with a similar diagnosis to be in keeping with what I have been discussing. This is a strange turn of the discussion.

    Nonetheless, I can guarantee you, depending on the severity of the cancer, treatments and complications, and the will of the the 25 year old to have family or S.O. support present with them, the 25 year old with cancer, in all probability will need S.O. or family support, and indeed, they may even have need for them to attend a few sleep overs at the hospital. So what? It depends upon how sick and vulnerable they are. So, let's please compare like severities rather than something such as, say, full blown AIDS to a rhinovirus. If both clients, pediatric and adult, were dealing with the complications of full blown AIDS, they would still have need of S.O. or family-member support. It's just that the child is at a totally different place in terms of coping, understanding, and emotional adjustment. But the adult will still have seious need of support regard to these things as well, depending upon the individual, his/her hardwiring and experiential growth, and the severity of the illness.

    C. A family-centered approach has NOTHING at all to do with the ability to promote autonomy and self-efficacy or not. That's a entirely separate issue. One has nothing to do with the other or has no need of conflicting with the other. ????



    D. Totally agree with the individual needs part of what you have said--don't know how that conflicts with anything I've said.
    Last edit by samadams8 on Jan 2, '13
    Susie2310 likes this.
  6. 1
    The idea that my point of view differs from yours really seems to bother you, as is evidenced by the increasingly supercilious and pedantic tone of your posts. Personally, I find such behavior off-putting. It doesn't really win me over to your way of thinking, but rather causes me to dig in my heels and trust in my own experiential frame of reference. I suspect I'm not the only person who responds to you in this way. If you truly care about problem solving dialogue and not simply about being right, if you want people to respond differently than that, you might try putting down the boxing gloves and stop with the browbeating. I really don't mean to sound nasty, and I hope you take this feedback in the spirit in which it was intended. I would invite you to return the favor, but you've already done so under section A above.

    At any rate, my apologies to the OP for my participation in the derailment of your perfectly good vent thread! I'll stop now.
    Last edit by ~*Stargazer*~ on Jan 2, '13
    monkeybug likes this.
  7. 0
    well, it is what it is.
    We can all agree to disagree.
    There will always be two sides to a story.
    If allowing families to do whatever they want is the definition of patient/family centered care , so be it.
    No one ever said we had to like it.
    Apparently, in some areas of the US, this works with no problems. In other areas, people have learned( been taught) to take advantage of " the squeaky wheel gets the grease".
    After reading the news, I don't even know why it surprises me that some people are just plain jerks, and others are sweet , wonderful people.
    Just another day at the office.
    That is all.
  8. 1
    Quote from ~*Stargazer*~
    The idea that my point of view differs from yours really seems to bother you, as is evidenced by the increasingly supercilious and pedantic tone of your posts. Personally, I find such behavior off-putting. It doesn't really win me over to your way of thinking, but rather causes me to dig in my heels and trust in my own experiential frame of reference. I suspect I'm not the only person who responds to you in this way. If you truly care about problem solving dialogue and not simply about being right, if you want people to respond differently than that, you might try putting down the boxing gloves and stop with the browbeating. I really don't mean to sound nasty, and I hope you take this feedback in the spirit in which it was intended. I would invite you to return the favor, but you've already done so under section A above.

    At any rate, my apologies to the OP for my participation in the derailment of your perfectly good vent thread! I'll stop now.
    ??? You brought up the straw man in your previous response, not I. Honest discussion would work on keeping comparisons similar. I have no boxing gloves. Strong responses are not boxing gloves. Section A is a personal observation from previous interactions. Take it as you will.

    Problem-solving is focusing on the issue/problem/concern. In the past, I have noted that many of the things we were ultimately saying were very close and not as different as you had set out by your tone. In doing this, and also not fairly looking at where we are agreeing and how to focus on the real issue, suggests to me a desire to debate for debate's sake.

    I care more about the issue of opening up views to and the value of family-centered care for all people, regardless of age. I have clearly stated limits must be set in its application. I never suggested that the adult pt's wishes be ignored--don't know where that came from, and I asked that fair comparisons be made.
    Susie2310 likes this.
  9. 1
    Quote from jrwest
    well, it is what it is.
    We can all agree to disagree.
    There will always be two sides to a story.
    If allowing families to do whatever they want is the definition of patient/family centered care , so be it.
    No one ever said we had to like it.
    Apparently, in some areas of the US, this works with no problems. In other areas, people have learned( been taught) to take advantage of " the squeaky wheel gets the grease".
    After reading the news, I don't even know why it surprises me that some people are just plain jerks, and others are sweet , wonderful people.
    Just another day at the office.
    That is all.
    No one in this thread ever stated that it's about allowing families to "do whatever they want." If anything, appropriate limit-setting, use of sound judgment, and balanced support of administration in its implementation was noted by me several times.

    It's a matter of having sound understanding, policy, and good, administration-supported boundaries.

    Also, it's important to note that no one ever said an adult family member would be in "moved in" mode like you see in pediatrics. But there are times when an adult family member of S.O. staying overnight is helpful to the patient. There are also issues regard rigidity of visiting hours in many hospitals that need to be reevaluated.

    It's not the philosophy, it's about how it is implemented. . .all I am saying.
    Susie2310 likes this.
  10. 1
    Personally, I think you guys are talking from two different places. The vent threads here about families are usually about the extremes, or about minor requests in the midst of chaos that a family loses their **** over when they aren't attended to immediately.

    I don't think anyone is denying the importance of FCC or PCC to promoting healing in nursing, but when the complaints about how those minor requests have not been fulfilled get a nurse in trouble, that's where FCC/PCC gets it's bad rap. Application of it requires context, and, sadly, administration sometimes doesn't care about context.

    In sum, samadams is talking about the importance of it, and Stargazer is talking about the extremes of it, and it's difficult to not get all riled up when, from the start, the two participants are coming from two different places on the same subject.

    That's my take on where this thread went, at least.
    Esme12 likes this.


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