Can we add "Biting the family" to the Nursing Process??

RNforLongTime · Sep 5, 2001

The pt's wife said to me today (yes I was assigned to him again) that she is glad when I am taking care of her husband.

And like Marla said, I too have learned which face to "wear" when in the presence of family and which face to "wear" around my fellow nurses.

Sadly, though, he will be leaving our unit soon and yes I will probably miss taking care of him and his wife.

And also as Marla said, I come here to vent! As do a lot of other people.

Thank you.

Kelly:)

res04lly · Sep 5, 2001

I can understand your frustration on this subject-but i know how it feels from the other side of the bed also and it is an eye opening experience. You feel everything the staff's body language is giving off, posture to the tone of voice. I watched how my mother's anxiety increased as staff began with the nonverbals and tone of voice that really didn't need to be there. Do you think it is easy to give up a husband or a wife of 40 -60 years so easily? when they have shared so many things together? Do think that maybe it is hard for the children who remember them for who they were and see what is happening now?? I can tell you it is Hard as Hell to watch it and experience it and whether you visited once or 60 times don't you think it has to something to do with the individual's coping skills in this situation. I can tell you first hand as a nurse i was horrified to see how my father was treated and my aunt but most of all my mom, it really ticked me off ,to be blunt about it ,so little compassion, so little caring, so little professionalism and to much nonverbal junk. I have worked in ltc and in hospital situation with the dying for 17 years and i hope i never ever made a family member feel as we were made to feel. I have always allowed the family their privacy, offered my best cna, provided coffee, and tried to give my best care to that individual Yes i have been buzy but if you let the family know that you will attempt to met the need whether they are a no code or not it helps lessen the loss and the families pain. You also need to be careful how you vent in the breakroom also, a family member could be in ear shot as i was and the nurse was taken aside by me and told to Chill out and put herself in my mom's shoes. She got my understanding real quick. After my father died i sent a letter to the head of the hospital thanking those who helped my mom but what was interesting about the whole situation was that the compassion mom received was not from the Nurses but from a wonderful Cna who had the compassion to offer her a cot 24 hours before dad died so she could be with him and to say her good byes. It was not nursing, or social work, but someone who was in tune with what was going on and reached out. That is what your families really want is for you to stop for 5 minutes and reach out them and let them know you care. Is this not what nursing is about??

Little_Bit · Sep 5, 2001

In my 13 years in this profession I have worked in LTC,ER, Med-Surg, Home Health, Institutional, And Agency Nursing.

One thing I've learned in my varied experiences is that no matter how unlovable, irritating, or "undeserving" of care my pt. (or his family) may be, I AM A NURSE!!

It is not my job to judge or discriminate against my pts, it is my job to provide them with the best care I can give. I could not live with myself otherwise. Nursing is not a "profession" or a "career choice". It is something that is inside of me. I AM A NURSE!!

That said- we all have those individuals that DRIVE US CRAZY! But, I've found that usually the reason pts. & families choose a particular nurse to be this way with is because they recognize that nurse's skill & knowledge of his/her craft.

The next time a family has you on the brink, tell yourself its probably because of their confidence in you that they feel they can demand so much from you.

And keep telling yourself- I AM A NURSE!! It has become my mantra for those times when I just don't know if I can get thru this.

BackInSchool · Sep 9, 2001

If we are going to pick on people for sharing their problems, then are you a caring nurse? I grit my teeth, I try to catch myself and turn it into a grin. You know what, sometimes I don't catch myself. I am a nurse. I am a human being. My Lord says that I am not perfect but that I should look for help. Please focus on empathy and solutions and don't point fingers. Don't eat our young. Be as nice to your fellow nurse as you are to your patients.

frustratedRN · Sep 9, 2001

kind of funny now...

but it wasnt then...

had a family last week whos mom was dying. comfort measures only. began deteriorating quickly. pt was 5..sat was in the 80's. serosangious fluid coming out of her nose cos her lungs were full. massive generalized pitting edema. tachy and thready pulse.

family quite aware of her condition and i felt so bad for them. their mom was in the same room my grandma died in two years ago. she was dying the same way except their mom had a morphine drip where my gma didnt and their mom was at least comfortable. in short i spent my whole damn shift with these ppl tryin like hell to minister to their needs.

they kept calling me into the room to check her vital signs...like every hour. she was dnr.

finally i asked them what they wanted me to do if i found something out of the norm. they said there was nothing i could do. now you would have thought that would have clued them in....well why take vitals hourly? nah...they still insisted. and i complied cos i felt bad for them.

then they started calling me in for whacked questions....

is the morphine keeping our mom alive?

they were considering stopping it. i explained the role of the morphine and told them if they decided to stop that drip i would ask to be reassigned because i believe that would be ethically wrong.

they kept the drip.

then they asked me what that stuff was coming out of her nose...i told them. and i told them it was the end...they knew that.

then they decided to have mom bathed...my assistant told them that she hadnt bathed her earlier because she was afraid to turn her and start moving her around.

so to them this was a conspiracy of some kind...they were all upset cos mom couldnt be turned...i spent a half hour explaining why we didnt want to turn mom and the possible consequences of moving her all round the bed.

they still wanted mom bathed but not turned.

ok...no biggie.

bottom line was that i BENT OVER BACKWARDS to accomodate these ppl. moms only pass once and i really wanted to help them.

in the end they BLAMED ME COS MOM WASNT DYING FAST ENUFF...lol

they called the doc and complained that i told them it was bloody fluid coming out of their moms nose. IT WAS...the doc knew that but he would not be pushed in the corner.

they started DEMANDING to know when mom was going to die. i kept telling them over and over that there was no way to know this.

they started DEMANDING to know what that fluid was exactly and where it was coming from. they wanted it tested.

then they were thinking about having her lungs "drained"

i very very politely told them there were two options for doing that. one was a chest tube. moms pt was 5...we werent even doing accuchecks on her anymore. a chest tube would hasten her death..which is what i think they wanted anyway.

the other option was suctioning which would remove the little o2 she had left.

THEY removed her oxygen. then they were mad at me cos i LET them...lol

they absolutely blamed me cos mom wasnt dead yet. they asked the oncoming nurse what i charted and what i said in report.

i went back in that room when the doc was there. he felt that the oncoming nurse and myself had a communication problem in report. we straightened him out quickly. it would have been easier for the doc to just blame me too...i shouldnt have said what the fluid was...but he stood by me.

all the time i was compassionate and empathetic regardless of the stupid things they were asking me to do. regardless of the fact they were taking up all of my time. regardless of the fact that i had to stay 2 hours after just to catch up cos i spent all my time with them (at one point one of the daughters began hyperventilating and i cared for her too and i let one of the children hang out with me so they could be in their moms room)

above and beyond...yes but even still i wouldnt do it any other way.

i never wanted to bite them but i would have liked to let them know just exactly what was up with their attitudes. i never let on they were starting to piss me off.

mom finally passed the next night. none of us could believe she lasted that long. it prob had something to do with the fact that the family was there crying and begging her not to go.

frustratedRN · Sep 9, 2001

the next day they demanded and got an order for suctioning. mom was suctioned all afternoon. they had to be wondering why that fluid was still coming out of her nose even tho she was constantly being suctioned.

suctioning wasnt for mom...it was for them...

and even after she had passed they were arguing with the nurse about time of death...

**canoehead, BSN, RN** · Sep 10, 2001

For crying out loud, let's throw the whole clan of them out the window. :rolleyes:

You are a saint in white nurses shoes, good job.

frustratedRN · Sep 10, 2001

thanks ...these days that means a lot

MollyJ · Sep 10, 2001

As a friend of mine said in general, but it fits for "your" family:

Some people just can't take the uncertainty.

Sounds like you did an awful lot for them, but they obviously were having trouble coping with the whole experience. Sometimes you just have to feel your feelings.

fugitiveRN · Sep 11, 2001

It would be nice to put that in the nursing process!I've got the same issue here-worst actually My license is being held for much of the same thing,24 other patients waiting for me while this family member complains about my lack of concern to her dying brother!I've been complained to the board about this and apparently without much ado, i'm suddenly cut back to the nursing profession!It's been 9mos and nothing has been said about this,i'm totally ex-communicated as if i don't exist!

Over-the-hill-Nurse · Sep 11, 2001

Wow,, some of the scenerios sound just like a few that I have been in as well. It seems sometimes that no matter what we try to do, the family sometimes has to "blame" someone cause they don't know what else to do with all the stress, grief, and pain that they are experiencing while watching their loved one pass on to a better place. it took me along time to understand that they didn't really mean to hurt but felt like they "had to do something" to help their loved one so unfortunately it is taken out on the nurses... and the docs are the first ones to back you in a corner....cause the patient is always right....but I am just like all of you...I continue to do it cause I wouldn't want to be any other place. Its a good thing that nurses have broad shoulders and ready smiles... how else would we be able to deal with all the things that go on? You gotta love it!

MRed94 · Sep 11, 2001

Thanks for sharing, and thanks to all of you for the backup you provided to us who vented.

"Bite pt and/or family tid. " Jon Doe, MD