Comatose/TBI patients

Nurses Professionalism

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I work with mostly comatose or patients whose TBI is severe enough that they cannot care for themselves. My concern is actually how to help my CNAs. We work in teams and care for 10 to 12 patients. My concern is with family members, from 1500 to 1530 my CNA will take vital signs, then start caring patients. Now being comatose or with TBI they are all incontinent. With 10 to 12 patients to clean, it takes a while, they usually start with the ones whose family are fussy. Problem is, being incontinent, after they are changed they sometimes go again a few minutes later. Family arrives to a dirty patient my CNA just changed 20 minutes ago and now I have the family claiming no one is caring for their loved one and blaming the CNA. We can't watch their family members like sitters, which some families have done, hire a sitter who lets us know to change the patient and the sitter helps. I'm sometimes at the point I want to tell the family that they are harassing my CNAs. We care for our patients, otherwise we wouldn't be there. Any advice?

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Specializes in SICU, trauma, neuro.

Maybe make up a schedule/activity log to be kept in the resident's room for the CNAs to initial as the tasks are completed.

Say, 0600 a.m. cares/toilet

0700 breakfast/feeding assistance

0800-0900 bathroom assistance

1000-1100 bathroom assistance, nap

1200-1300 bathroom assistance, lunch

Etc. etc.

I would leave a window of time, that way they can't gripe about not being "on time." The family could then see that if they arrive during lunch that the res. was toileted/changed just prior.

They should be advised that urinary incontinence care is performed q 2 hrs. Education should done re: incontinence care, e.g. they can safely stay for two hours due to wicking, barrier creams used for skin protection. If the family insists on more, they would provide privately hired staff. It is simply impossible for the CNAs to change the brief after Every. Single. Void. Incontinence of stool obviously would be cared for promptly -- even if brief was just changed five minutes ago. It's necessary, as annoying as it is to have JUST changed them.

A family conference to discuss expectations might be in order. If they are badgering the CNAs to the point of interfering with their work, assuming they are doing what they are supposed to, it's very reasonable to remind the family that the CNAs have done their jobs (see the log) and now have other residents to attend to.

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I, too, think that a log or whiteboard notation would help. People must be faithful with using it though. If the family comes in and the log hasn't be updated for 2 shifts or the whiteboard says that the last personal/toileting care was completed yesterday, it won't work. But things could possibly improve greatly if family can see that a log is being utilized appropriately to provide excellent care.

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I'm sometimes at the point I want to tell the family that they are harassing my CNAs. We care for our patients, otherwise we wouldn't be there. Any advice?

Unfortunately that is not the case everywhere, and then there are additional places where the staff does indeed care very much but institutional/employer-controlled factors make it such that they can't do the job the way they want to do it and know it should be done.

Don't forget to see if there are ways you can make allies out of these difficult familiies. Some are maladjusted but many are just doing what you and I would do - - seeing to it that their LOs are cared for appropriately.

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Specializes in retired LTC.

Even with having a log at the bedside, the family can argue that the staff can just be lying about filling it out.

They'll find a way to complain about something if they want to.

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You are correct, there is a schedule and my CNAs follow it, otherwise I'd be on them about it. I don't think it's fair that a couple of families want all our attention on their loved ones, we're caring for everyone else in our assigned rooms too. The family is aware of incontinence and what it is. The family once threatened to tell the DON, I asked my CNAs, were you doing your jobs? They said Yes, I told them they have nothing to worry about, let them complain, they never did. I just hate their loud voices letting everyone hear how no one is caring for their loved one. I feel so bad for my CNAs.

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Yes they find ways.

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Specializes in retired LTC.

And then all the families band together.

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All our patients are checked at least Q2 hours, we change them 2 or 3 times a shift. I think the family knows they are being unreasonable, they don't complain to me or my charge nurse, just take it out on the poor CNA, if they had a case I think they'd complain to us. After loudly airing their displeasure, if my CNA is not available they would kindly ask me or another LVN for help. SMH

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It's just 1 or 2 families our of the 40 patients we have, and boy they are loud. Some are nice and approach me and say, I'm sorry my loved one needs to be cleaned again, I see the CNA is busy, please let them know. I wish they were all that understanding.

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I think the family knows they are being unreasonable, they don't complain to me or my charge nurse, just take it out on the poor CNA, if they had a case I think they'd complain to us.

Then the way that I would handle this (with whatever approval you need from higher-ups) is to instruct the CNAs to come to you right away when they are being treated in what you believe is an unfair manner - or when you hear the commotion yourself. You will then respond to the room with some sort of inquiry..."The CNA let me know you had some concerns?" or "The CNA has asked me to inquire if there is a problem?" or "I heard a commotion, is everyone okay? What can I help you with?" While you're there you can reassure them, provide the care, and then kindly lay down the law about yelling in the halls and berating staff - again, you'll have to have the backing of whomever you report to.

If your contention is that you know they are treating the CNAs unfairly but then deal with you appropriately, then you need to step in.

But you're not going to change this unless you develop some sort of rapport. I can almost promise that.

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Even with having a log at the bedside, the family can argue that the staff can just be lying about filling it out.

They'll find a way to complain about something if they want to.

Perhaps, but if that's the assumption right out of the gate without even trying any interventions then there really is no staff-level solution to this problem.

I would still try it. I'd make sure they were there when care was being provided, and I'd make sure they saw me write in the log/update the whiteboard. If they accused me of falsifying it some other day, I'd remind them that they've been around to see how we are using it appropriately. I actually would probably involve them in helping keep the log/board up to date. There are about 100+ ways that rapport can be worked on/fostered.

If they're the kind of people who won't be pleased no matter what, then it becomes an issue for management.

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