advice needed please for new RN

[tobycoop]

Hi there,

I'm a fairly new RN (May '08 graduate) and was wondering how you experienced nurses deal with "tough" family questions. For example, during my 1st month at work, a family member asked if their dad would make it thru the night. I don't know how to answer these kind of questions just yet.

Would you please give me some examples of tough family questions and how you responded to them?

Thanks so much for any input.

[HouTx, BSN, MSN, EdD]

Wow, that is a toughie.

One of the big downsides to nursing - knowing more than anyone else about what is likely to happen. I have learned to keep it to myself because it is usually not what they want to hear. I would just encourage them to speak with the physician & nurses who are caring for their loved one.

You have to learn when and where to draw the line. Me? I draw the line at providing medical advice. I will, however, connect folks with information sources so they can make up their own minds.

In this situation, it is one of those "man proposes, God disposes" questions. You could provide them with information about what happens as death is imminent - circ decrease/shutdown, resp changes, etc..... that would help them to understand what is happening. You amy even help them become more comfortable with the hospital setting so that they can participate in their loved one's care if they want that.... But I would advise never to make an estimate of when the Grim Reaper will arrive.

[Pudnluv, ASN, RN]

Wow, I hate that question. Usually when that question pops up, I tell them the truth....I don't know. If the patient is stable, I tell them that if they want to go home for awhile, I'll call if there are any changes. If the patient is not stable, and death appears imminent, I tell the family that they may want to consider staying through the night and that it doesn't appear to be much longer. I do qualify that by saying that some people can linger for longer periods of time. If the family is really anxious, I just tell them to stay through the night, it certainly won't hurt anythingand helps to put them at ease.

[cherrybreeze, ADN, RN]

For the death time question, I tell them the truth..."there's no way to know." I tell them what to expect as it gets closer, but qualify that with, patients can hang on longer than you'd expect when you see those things, OR that they can progress through those things very quickly. I usually also say that I wish I had a better answer, but that I just don't. I've never had anyone get upset by that.

[racing-mom4, BSN, RN]

I have been asked that question many times an I usually reply with something along the lines "If I could predict the future I could make a lot more money than I do now" I try to keep it light. My new favorite line that seems to get the families to at least smile and laugh a bit if it is an elderly patient I will say "From what i have seen so far it doesnt seem like your grandpa plays by the rules very well does he---" they usually will smile and agree with me.

Or I have said the facts. Thier B/P is awfully low we have gone as far as we can with the medicine we have, or thier resperation rate is very eratic and one can not sustain that long with that type of breathing pattern.

[Christen, ANP]

I usually answer that question with "it's up to him / her now." Depending on the needs of the family, I will follow that up with information related to why the patient is dying, what they can expect, etc, but ultimately it's up to the patient when he or she is ready to let go.

[mama_d, BSN, RN]

Assuming that there are indications that death is actually imminent, I'll tell them that there is no way to know for certain, that patients surprise us sometimes by hanging on for longer than expected, and sometimes they let go earlier than expected. Then I encourage them to have family stay at the bedside with the patient because signs such as x, y, z are indicating that although it may not be tonight, it will likely be soon.

Of course, you also have to take into account how well you know the family and patient, and what you think they will respond best to. We had a cancer patient whose daughter asked this of the oncologist, his reply was "I told her she'd die six months ago, it depends on how long she decides to keep proving me wrong." It was the correct tone to take with that family, but would have been blatantly wrong to tell the family right down the hall (in a similar situation) that same thing.

[mpccrn, BSN, RN]

i'm asked that more times then i care to think about. IMO there is only one way to answer , i tell them the truth, good, bad or indifferent. i prefice it by saying there is no way to tell for sure but.......grandpa's BP is critically low, his O2 sats are very low etc. then i usually ask them what is important to them.....the answer becomes pretty clear.....do they want to be there or would they rather not. if they choose to leave, i ask them if they want me to call if things become worse. at this stressful time the dying patient is yours to take care of but so is the family.

[tobycoop]

Thank you all for replying. I appreciate all the input. If anyone else can think of how to answer pts tactfully when they ask, "Should I get X (any) surgery?" "When will the MD come? Why won't you move my water for me even though I'm perfectly capable? :smackingfOK, that last one snuck up as a frustrated common event.:icon_roll