Bedside Nursing and Families

getoverit, BSN, RN, EMT-P · Jun 2, 2011

Family-centered care, open visitation or any of the other names has pros and cons. I am polite but will reinforce some basic rules about visiting, e.g. please call us from the waiting room before just walking through the unit. I try to explain that it's for privacy and I'm respecting other patients the same as I am for their family member.

Rude and obnoxious visitors are a different story. But it's a balancing act to get your point across without coming off the wrong way. Most times I let it roll and have a good story to make my co-workers laugh about. but at times like you described, here's what I've done on a few occasions (some might agree and some won't...bottom line is I always hope to avoid these situations):

I've asked the visitor where they work, what they do for a living or something along those lines. then I'll ask them if anyone has ever shown up at their place of work and rearranged things, turned things off or on without asking, and generally interfered with their work. Some get the hint by that point, others don't and I've said "that's kind of what's happening here."

I do take extra lengths to make sure my tone is not curt or angry and I reassure them that everything is being done according to the plan of care and most importantly I acknowledge how stressful it must be to have their loved one in the hospital. Sometimes I'll print off a copy of the MAR and let them look over it (of course only with appropriate release of information, etc). some people are incorrigible and you just have to stay out of their way but most people are reasonable.

good luck.

nursej22, MSN, RN · Jun 2, 2011

I can see both sides of this issue:

The obnoxious family member who thinks because their cousin's brother's neighbor is a vet tech that they would know better than a health care professional. Or that internet access grants prescriptive authority. Arrrrrgh! I have had them clean out the pantry and the blanket warmer. Messing with IV pump, monitors, walk in and disrupt a procedure....

But.... I've seen my dear old 80 something dad receive meds he was allergic to, "resume his usual home meds" that he hadn't been on in over a year, among other things. He was recently hospitalized and I asked repeatedly that the bed alarm be used. It was never on in the several times I visited. I brought in his electric razor on day 1. Home on day 4 with 4 days of stubble and not a single shower.

My advice: kill 'em with kindness. Acknowledge their concern and thank them for their help. As cliche as it sounds, get their input on the plan of care. Maybe they can assist with bathing, feeding, ambulation.

I agree with providing a MAR (with proper approval), and reinforce what you're giving and why. Family may be responsible for giving meds at home so they need to know. Most family-centered care advocates that one person be the primary spokesperson and I try to promote that. Put them in charge of controlling the rest of the clan and relaying info. Better to have allies than enemies.

mama_d, BSN, RN · Jun 2, 2011

The med thing is easy...give them a killer smile, tell them you're so glad that they're involved in Dad's care, and give them a print-out about each med. Likewise with procedures, etc. We routinely get dinged on pts and family feeling like they weren't educated enough, so I try to be sure that they get print-outs on everything. It's reassuring to them, and can really help show that you're on their side in helping them navigate what to them is a stressful situation.

Sometimes I'll tell them something along the lines of "I know for you, this is all overwhelming and stressful and new, and you probably feel a little lost. For this floor, though, this diagnosis is like our bread and butter; we see it all the time and know exactly how to deal with it. Why don't you tell me what you've been told already and I'll try and fill in the blanks." For some reason people seem to think that just b/c they've never heard of afib or TIA or a heart block, neither have we. Being able to tell them in a confident tone what the next few days of treatment might look like, always with the caveat included that treatment is adjusted on an ongoing basis based on constant re-evaluation of the pt, usually makes them more comfortable with the fact that we know what we're doing.

Then there are the awful ones...the ones that you know are just exceedingly obnoxious and overbearing and nothing you can possibly do or say is right. For the worst, risk management gets involved after we've been through all the other links in the chain. I've told people before that if they continue with certain behaviors that are creating an unsafe environment for my pt that they can have their right to visit revoked, as part of my job and license requires providing a safe environment. It's rare that it gets that bad, but sometimes it happens. And my manager gets an e-mail detailing what happened, what steps I took to remedy the situation, and what the outcome was.

TheCommuter, BSN, RN · Jun 2, 2011

Nurses who can skillfully deal with the loony-bin family members have my utmost respect.

I, on the other hand, cannot do it. I cope by working night shift with the hope that the families and visitors will want to catch up on their sleep during the late hours.

imintrouble, BSN, RN · Jun 2, 2011

Wait til the patients and families realize they can call a rapid response. :no:

LouisVRN, RN · Jun 2, 2011

Wait til the patients and families realize they can call a rapid response.

Thats one of the things I always tell my patients and family members. Family members as obnoxious as they are are often more able to recognize subtle changes. there have been so many times where I've walked into a situation where family is obviously concerned and as soon as I come in its evident a rapid response should have been called awhile ago. The family almost always states they brought it to the previous nurses' attention and yet nothing is done about it.

While it can be annoying I try to put myself in their shoes. I'm already explaining the meds its side effects and why they are taking it to the patient so there's no problem including the family. Sure if they want to clear out the pantry it means a call to dietary to restock but in the end there's no harm done, besides these are the exception.

Now messing with the IV/bed alarm/tubes/drains etc I lay the law down and dont tolerate that as that presents harm to the patient.

Just feel fortunate if you've never been the obnoxious family member who has gone out of their mind with worry for the patient they are leaving in your hands. :heartbeat