Advise on Communicating With family members

jadelpn, LPN, EMT-B · Mar 3, 2013

I would make sure you are aware of the scope of your duties as a resident assistant. You can find that in your policy handbook, your job description--make sure you read it and know your scope.

Often times in my experience, I find that if one approaches anything they are to do by identifying themselves, the identifying what you are in the room to do, and asking if it is ok to do it at the time, you are less likely to get family members who then hover because they don't know who you are, what your role is, and what you are doing. And the resident/patient has the right to say no, not now, at which point, I would say that you will be back in an hour to check on them, but ring if they need you sooner. Another thought is to make a plan of care for the day in the morning, before visitors arrive. Then you can plan your day around the residents. There are those family members who just can't control putting their 2 cents in. For them, some generalized "thank you for pointing that out to me, your mother and I have had conversation regarding our plans for her care today." And do what it is you are supposed to do, unless the resident tells you otherwise. Because unless the resident is incompetent--they run the show.

dudette10, MSN, RN · Mar 3, 2013

I am a nurse in acute care, so apply my method as needed.

Usually when family members begin "ordering me around," there is no doubt that they have multiple, rapid-fire requests/orders given at a time, usually none of which are urgent. Assertiveness works wonders to getting family members to chill out. At this point, I usually say, with direct eye contact and an authoritative demeanor, "You have multiple requests, but I can do only one thing at a time. Let me address this first, then we'll talk." Then, I *do* talk to them! They might have never developed trust with the previous nurse or tech. They might be extremely anxious about their family member. They might feel a loss of control. Whatever it is, I try to get to the root of the problem and fix it head on. As jadelpn stated, do they understand the plan of care, which when explained, often takes care of anxiety and loss of control issues? At first, it might seem to be a time waster to discuss things with them for 10 or 15 minutes, but I have learned that the minutes I spend talking to them does wonders to stop the behavior, most of the time and at least during my shift.

You might have to repeat yourself because some things are so engrained in the person's mind that they don't get it the first time. I had one patient and his brother who wanted to know how long he would be in physical therapy/rehab as I was getting ready to transfer him to our rehab floor. Although I stated form the get-go that it depends on how quickly the patient met his rehab goals, I had to say it no less than FOUR times!

You'll always run across the family member for which this approach simply does not work. In that case, I have wasted my time with the discussion, but then I set limits and may even write a "rounding time" on the white board. Even if it does nothing for the family member, it saves my sanity and allows me to care for all my patients, not just *that* one.

Destiny'skid · Mar 3, 2013

Thank you that really helps!

Destiny'skid · Mar 3, 2013

when you say run the show, does this mean they have no limits is a cna the one job where you have no rights? I mean even as a waitress they couldn't order me around?

retiredlady · Mar 4, 2013

Since I have been on both sides as a nurse and a "hovering family member", lol, I will give a little advice. Always come in and introduce yourself, look professional, no winkled scrubs or long hair. Put it back in a pony tail or up. Nothing like long hair getting in the way (my pet peeve). Tell the pt what you are going to do and do it with confidence, they do need to have trust in you. Please smile. Ask if you can get them anything before you walk out. (When you are sick or older, or on pain meds it's hard to remember things) Last time I was in the hospital with a friend, nobody smiled. If they have been a frequent flyer patient, it's very annoying to go over all the paperwork for an hour, when it should already be in the computer. This can make them irritated, but it's not it's not the nurse's fault and they know this, but it's still irritating. I guess I will stop for now, ha, ha.

jadelpn, LPN, EMT-B · Mar 4, 2013

when you say run the show does this mean they have no limits is a cna the one job where you have no rights? I mean even as a waitress they couldn't order me around?[/quote']
I wouldn't necessarily say "order you around" however, they do have control on when or if they will allow you to do something. Always give patients/residents choices. Meaning either now, or an hour from now. And don't ever hesitate to say to a family member/visitor: Could I ask you to wait in the sun room while I help with some personal care? Thanks so much. IF they do not move, I would then say: If now is not a good time, when is it you would like me to come back? As a CNA or any other health care professional, we all have rights, but so do the patients.

Poochiewoochie · Mar 5, 2013

when you say run the show does this mean they have no limits is a cna the one job where you have no rights? I mean even as a waitress they couldn't order me around?[/quote']
Residents and patients have rights and one of those rights is to refuse what you are doing to them. I think that is what jade is saying when she said running the show.

Destiny'skid · Mar 5, 2013

Yes you are so right. Sorry if I kind of went off kilter there.

I think what I was trying to understand is why are we as cna's there? to do things they can do but would prefer not to. As a maid would be or because there are things they legitimately need us to do, and for sure in that sense they are in charge of those things.

Just to give you a little back round too, I got annoyed (which was wrong of me) because this mans wife was doing his dressing changes and standing there telling us to lotion his legs. my thought was if she can do a dressing change she can put some lotion on.

Interestingly enough there was a notice up today stating this exact issue basically saying their is a difference between what a patient (or there family member) needs us to do and what they prefer us to do. It said we need to have them do what they can for themselves because when they go home we won't be there.

So would it be completely inappropriate to say to that woman " actually I have several other people who need care right now, you did so good with his dressing change perhaps you could lotion his legs tonight?"

Again thanks all for your answers and sorry about my attitude issues!

SaoirseRN · Mar 5, 2013

Sometimes the only control people have is having something done "their way". As long as this isn't unsafe, against policy, or completely unreasonable in consideration of time/resources, etc, if I get the feeling that the family (or patient in many cases) wants something done in a certain way I will often ask them, "What way of doing this works best/is less stressful", or say, "Tell me how you'd like to have this done." Showing that you are willing to work with them is a great way to build trust and rapport. This could be something as simple as which side to help a patient turn to get on a bedpan.

That said, none of us are "servants", and everyone needs to treat everyone with respect. If somebody is demanding or rude, I might stop and say, "I'm here to help you (or your loved one), and I would appreciate if you did not speak to me that way. Let's please start over. What can I do to help you right now?" Often that simple, honest, and respectful statement is enough to remind people to find their own manners.