Comatose/TBI patients

[nurseguy213]

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?

[Here.I.Stand, BSN, RN]

amoLucia -- Oh trust me, I know some people are delusional enough to claim the CNAs would falsify a log. Maybe a week ago, I told a homecare or hospice(?) RN on here about my Aunt "Hazel" (the nut.) She is THAT family member.

But the idea of the log shows that their concerns are taken seriously and that the staff is going on written record affirming that cares were done (vs telling them their family member is part of the q 2hr incontinence checks/cares). Sure they can claim the work wasn't done....but they are ALREADY claiming the cares aren't done.

What about having two staff members in the resident's room at all times, so there is always a witness? We would do that if a pt is claiming the nurse didn't inject that Dilaudid into the pt's IV, or if there is allegations of abuse. (On my first job, we had this pt who had Munchausen's and who accused a young male MD of raping her. After that, no male staff entered her room without a female chaperone.)

One thing that I do know is dealing with them, diuscussing the care plan, and trying to convince them is way above the CNAs' pay grade.

Each and every time they gripe at a CNA, the CNA needs to end the conversation and summon the charge nurse. If the charge nurse isn't able to talk sense into them, they should summon the DON, or the admin on call if it's after hours. If ALLLLL of those people are liars too, then perhaps the family would rather choose a new facility.

And family should be made aware that going forward, they will not interrupt the CNA/interfere with her care of others -- unless they smell smoke. They will discuss any concerns with the charge or admin.