communication book

[WI_home_RN]

i have a situation that occurred this last week that has been bothering me today. right or wrong? the patient demanded to read, or be read to, out of the rns personal communication log book, which is private, or thought to be private, information between us nurses. i don't know if the patient was actually read the communication log book or if a family member discussed it with him, but now the patient is angry because us nurse's are "meddling in his personal life."

he is angry that it was written in the communication book what i stated above and us nurses are only supposed to attend to his medical/healthcare needs. its none of our business about his mail, visitors, etc. and to an extent i totally agree. i don't really care what mail he receives from whom, what visitors he gets from whom, etc. none of my business.

its always been the rule between the nurses that the communication log book is private between the nurses and not to be shared with the patient. can he still demand to see this book? does he have a right to see it? because now i am feeling bad for what i was told to do about information regarding the patient and the home he lives in. i don't want to get involved with family politics by any means nor was it my intention in any manner...but, what would you do? is this right or wrong? i feel like i'm stuck in a situation that i didn't want to be in in the first place. what would you do in this situation?

[CNAatHome]

This is always a "gray" area. It must first be understood who owns the logbook. My experience is that they are used for the benefit of the patient, so we will understand and follow their needs and requests. Sounds easy until questions like yours arise. First, the RN who developed a personal relationship was not following proper protocols by stepping out of the Professional Role. This in turn, has created mistrust by the Client. Not surprising. We think the logbook is just between caregivers--until the fateful moment when it does eventually get the notice of family, or the Client themselves. What you are upset about is the drama that ensues by the reaction to the notes. I would suggest using sticky notes that can be pulled off and pocketed by staff at report. This way, anything sensitive is not a permanent part of the logbook. However, in this particular instance, something may have been written in such a way, that it struck a nerve in the sense that someone was defending the fired coworker. We have learned that the less we say, the better off we are. It has also been pointed out, that if the logbook is not properly safeguarded and falls into the wrong hands, or is left open and a "visitor" walks by and reads it, that we could be subject to legal action against our licenses. Correct me if I am wrong about that. If your company is in support of the logbooks, perhaps someone should encourage the family representative to speak with a Manager in the office, to "air" the complaint, and possibly come to a resolution. At least they will feel like they are heard, and their explanation to the Manager may spell out the truth of what is really bothering them, so that the issue can be rectified. At least they might feel vindicated, and it gets the pressure off you for the time being -- until it blows over. Logbooks left in the home after they are filled out are a great history for caregivers and can provide better continuity of care. However, there is always a future dilemma of these records which could serve as a deterrent in the event the family decides that a lawsuit is in order. If you have a business card for your higher-ups, hand it to them. It may (re)build trust, and it WILL BLOW OVER. Just try to stay neutral, change the subject for a while and don't talk about it with anyone since that reinforces everything all over again. Best Wishes to you, it has happened before, same book different chapter.

[WI_home_RN]

Thank you for your kind reply :) I am feeling better after reading your words of wisdom and also since time has passed since "the incident" occurred.

I do not work for an agency. However, there are 11 of us RNs that work for our State as equal colleagues on the case, caring for the patient. We have no manager. There is no agency.

I also have to thank you for pointing out that the fired RN had developed an unprofessional friendship relationship with the patient, something that I think too often we overlook the importance of.

[caliotter3]

It is high time that a case conference be held or at the very least, this be brought to the attention of the nursing supervisor for her to get with the patient and family. Let the supervisor resolve this, this is what she is paid to do.

[caliotter3]

Just saw that there is really no supervisor; in this case, you need to come to your own resolution. You can not expect to be on the same page as the other nurses even though that would be desirable.

[caliotter3]

Communication books are used by agencies for the convenience of relaying information between nurses from one shift to another. Of course, families have access and read them. That is why you have to be careful what you write about and how you write it. And for the record, these communication books are considered part of the case documentation and can and do show up in the courtroom. You need to resolve the difference between what the patient wants and what the family wants. Sounds as if there is a disagreement there that can involve the nurses if you (nurses collectively) allow them to drag you into it.

[yola12]

I am wondering if this RN was fired how is it improper for her and her husband to be sending your patient mail? If she is no longer employed in the capacity of a RN, how could this be looked at as unprofessional and stepping out of bounds ? Did she have a improper relationship while she was caring for him? Also I am wondering about the patients right to privacy. Or is he not coherant or incapacitated where someone makes these decisions for him? If this elderly relative and her husband are looking thru the garbage at his mail, why? you said the patient spoke up and was angry and told the nurses they should be tending to his medical needs only. I must agree.

Why would nurses get involved in censoring his mail or his visitors? That should be a issue between this elderly relative and the relatives husband, and the patient himself. I worked three different homes and we have a communication book. It can be used in a court of law since it does contain the patients information in it. We also must show the patient anytime he or she wants to read it to them. However, family members must first obtain premission to read it from the patient. This all protects the patients right to privacy.

[CNAatHome]

WI, you are welcome!

I wanted to add that a client with dementia will not remember a visitor, and if the spouse is absent, and/or the family is intermittent in their involvement, it may be a good idea to note it that people are coming into the house (unless you know them). I would want to know if it were my parents due to all the funeral, cemetery and financial scammers.

As to the mail, again if the client has altered mental status and family is absent, it may behoove a caregiver to glance for "IMPORTANT NOTICE" mail from the local electric or gas company.

In the case of the former caregiver, if you know this piece of mail is going to upset the client, you might save your entire team a lot of agony in the effort it may take to help restore the client to their previous state of "norm." How you would go about this would be the arrangement decided upon by all concerned parties, including the client.

Sorry to hear you do not have a "go-to" person, but it sounds like you are doing an outstanding job as a Home Care Nurse.

Best wishes!