Comatose/TBI patients

  1. I work with mostly comatose or patients whose TBI is severe enough that they cannot care for themselves. My concern is actually how to help my CNAs. We work in teams and care for 10 to 12 patients. My concern is with family members, from 1500 to 1530 my CNA will take vital signs, then start caring patients. Now being comatose or with TBI they are all incontinent. With 10 to 12 patients to clean, it takes a while, they usually start with the ones whose family are fussy. Problem is, being incontinent, after they are changed they sometimes go again a few minutes later. Family arrives to a dirty patient my CNA just changed 20 minutes ago and now I have the family claiming no one is caring for their loved one and blaming the CNA. We can't watch their family members like sitters, which some families have done, hire a sitter who lets us know to change the patient and the sitter helps. I'm sometimes at the point I want to tell the family that they are harassing my CNAs. We care for our patients, otherwise we wouldn't be there. Any advice?
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  2. 12 Comments

  3. by   Here.I.Stand
    Maybe make up a schedule/activity log to be kept in the resident's room for the CNAs to initial as the tasks are completed.

    Say, 0600 a.m. cares/toilet
    0700 breakfast/feeding assistance
    0800-0900 bathroom assistance
    1000-1100 bathroom assistance, nap
    1200-1300 bathroom assistance, lunch
    Etc. etc.

    I would leave a window of time, that way they can't gripe about not being "on time." The family could then see that if they arrive during lunch that the res. was toileted/changed just prior.

    They should be advised that urinary incontinence care is performed q 2 hrs. Education should done re: incontinence care, e.g. they can safely stay for two hours due to wicking, barrier creams used for skin protection. If the family insists on more, they would provide privately hired staff. It is simply impossible for the CNAs to change the brief after Every. Single. Void. Incontinence of stool obviously would be cared for promptly -- even if brief was just changed five minutes ago. It's necessary, as annoying as it is to have JUST changed them.

    A family conference to discuss expectations might be in order. If they are badgering the CNAs to the point of interfering with their work, assuming they are doing what they are supposed to, it's very reasonable to remind the family that the CNAs have done their jobs (see the log) and now have other residents to attend to.
  4. by   JKL33
    I, too, think that a log or whiteboard notation would help. People must be faithful with using it though. If the family comes in and the log hasn't be updated for 2 shifts or the whiteboard says that the last personal/toileting care was completed yesterday, it won't work. But things could possibly improve greatly if family can see that a log is being utilized appropriately to provide excellent care.
  5. by   JKL33
    Quote from nurseguy213
    I'm sometimes at the point I want to tell the family that they are harassing my CNAs. We care for our patients, otherwise we wouldn't be there. Any advice?
    Unfortunately that is not the case everywhere, and then there are additional places where the staff does indeed care very much but institutional/employer-controlled factors make it such that they can't do the job the way they want to do it and know it should be done.

    Don't forget to see if there are ways you can make allies out of these difficult familiies. Some are maladjusted but many are just doing what you and I would do - - seeing to it that their LOs are cared for appropriately.
  6. by   amoLucia
    Even with having a log at the bedside, the family can argue that the staff can just be lying about filling it out.

    They'll find a way to complain about something if they want to.
  7. by   nurseguy213
    You are correct, there is a schedule and my CNAs follow it, otherwise I'd be on them about it. I don't think it's fair that a couple of families want all our attention on their loved ones, we're caring for everyone else in our assigned rooms too. The family is aware of incontinence and what it is. The family once threatened to tell the DON, I asked my CNAs, were you doing your jobs? They said Yes, I told them they have nothing to worry about, let them complain, they never did. I just hate their loud voices letting everyone hear how no one is caring for their loved one. I feel so bad for my CNAs.
  8. by   nurseguy213
    Yes they find ways.
  9. by   amoLucia
    And then all the families band together.
  10. by   nurseguy213
    All our patients are checked at least Q2 hours, we change them 2 or 3 times a shift. I think the family knows they are being unreasonable, they don't complain to me or my charge nurse, just take it out on the poor CNA, if they had a case I think they'd complain to us. After loudly airing their displeasure, if my CNA is not available they would kindly ask me or another LVN for help. SMH
  11. by   nurseguy213
    It's just 1 or 2 families our of the 40 patients we have, and boy they are loud. Some are nice and approach me and say, I'm sorry my loved one needs to be cleaned again, I see the CNA is busy, please let them know. I wish they were all that understanding.
  12. by   JKL33
    Quote from nurseguy213
    I think the family knows they are being unreasonable, they don't complain to me or my charge nurse, just take it out on the poor CNA, if they had a case I think they'd complain to us.
    Then the way that I would handle this (with whatever approval you need from higher-ups) is to instruct the CNAs to come to you right away when they are being treated in what you believe is an unfair manner - or when you hear the commotion yourself. You will then respond to the room with some sort of inquiry..."The CNA let me know you had some concerns?" or "The CNA has asked me to inquire if there is a problem?" or "I heard a commotion, is everyone okay? What can I help you with?" While you're there you can reassure them, provide the care, and then kindly lay down the law about yelling in the halls and berating staff - again, you'll have to have the backing of whomever you report to.

    If your contention is that you know they are treating the CNAs unfairly but then deal with you appropriately, then you need to step in.

    But you're not going to change this unless you develop some sort of rapport. I can almost promise that.
  13. by   JKL33
    Quote from amoLucia
    Even with having a log at the bedside, the family can argue that the staff can just be lying about filling it out.

    They'll find a way to complain about something if they want to.
    Perhaps, but if that's the assumption right out of the gate without even trying any interventions then there really is no staff-level solution to this problem.

    I would still try it. I'd make sure they were there when care was being provided, and I'd make sure they saw me write in the log/update the whiteboard. If they accused me of falsifying it some other day, I'd remind them that they've been around to see how we are using it appropriately. I actually would probably involve them in helping keep the log/board up to date. There are about 100+ ways that rapport can be worked on/fostered.

    If they're the kind of people who won't be pleased no matter what, then it becomes an issue for management.
  14. by   Here.I.Stand
    amoLucia -- Oh trust me, I know some people are delusional enough to claim the CNAs would falsify a log. Maybe a week ago, I told a homecare or hospice(?) RN on here about my Aunt "Hazel" (the nut.) She is THAT family member.

    But the idea of the log shows that their concerns are taken seriously and that the staff is going on written record affirming that cares were done (vs telling them their family member is part of the q 2hr incontinence checks/cares). Sure they can claim the work wasn't done....but they are ALREADY claiming the cares aren't done.

    What about having two staff members in the resident's room at all times, so there is always a witness? We would do that if a pt is claiming the nurse didn't inject that Dilaudid into the pt's IV, or if there is allegations of abuse. (On my first job, we had this pt who had Munchausen's and who accused a young male MD of raping her. After that, no male staff entered her room without a female chaperone.)

    One thing that I do know is dealing with them, diuscussing the care plan, and trying to convince them is way above the CNAs' pay grade.

    Each and every time they gripe at a CNA, the CNA needs to end the conversation and summon the charge nurse. If the charge nurse isn't able to talk sense into them, they should summon the DON, or the admin on call if it's after hours. If ALLLLL of those people are liars too, then perhaps the family would rather choose a new facility.

    And family should be made aware that going forward, they will not interrupt the CNA/interfere with her care of others -- unless they smell smoke. They will discuss any concerns with the charge or admin.

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