Dealing with Family and feeding issues

[nkochrn]

I have a patient who's dying of colon cancer. Social Services has spoke with the family and she's basically comfort care now. However one of her sons does NOT seem to get it. EVERY night he comes in and tries to force EVERY bite of food down here. He seriously sounds like he's coaching a whole football team, yelling, "Come on, Open UP, C'Mon, Let's Go!" I can't take it!

This is the first night I've heard him do it, but I've been told it's this way EVERY night. I'm not sure if it's just that he doesn't understand what's going on or if he thinks feeding her is gonna help miraculously cure her. I CAN NOT take it anymore though. She's sick, dying, and DOES NOT want to eat. I'm not sure what else to do other than just have Social Services and the Doctor try to explain things to him a little more tomorrow b/c he's obviously not getting something here. I'm not sure how to approach him about myself without causing a major blow up. She was previously in a bigger hospital and he himself told me he pretty much raised hell with them there about everything. It's to the point that I feel like he's abusing her in a way by forcing her to eat.

[Guest219794]

Assume that the son is dong this because he believes it is in his Mom's best interest. Since you and he are both concerned about what's best for Mom, you are on the same side, not in conlflict.

Part of our job is to educate families. If he is in denial about death, then teaching about the difference between palliative and curative approaches might be a bit much for him to handle. It goes into a whole lot of philisophical issues. Also, he may disagree with the family's decision, and you don't want to enter a debate that would cause him to harden his position. It may not be productive to open that door.

I would focus more on the concrete here and now. I would avoid words that could sound judgemental, like "forcing". In all likelyhood, when he was sick as a child, his mom showed her love by making him eat.

Your mom is so lucky to have you here to help take care of her. I'm sure it means a lot to her. As important as nutrition is, in your mom's case it might be better not to encourage her to eat when she isn't hungry. I am concerned about a couple things: In her state, some food might go down her airway causing pneumonia. She is not strong enough to handle a pneumonia. I am also concerned about her experienceing any additional stress. Her body is being very challenged right now, and adding anything stressful won't help.

I have encoutered similar problems in ICU, where despite instructions, family try to rouse a sedated patient. They have it in their head that the pt's well being is directly related to their ability to respond.

It's in John's best interest to remain sedated right now. I am doing that with the minimal amount of medication possible. The more stimulation he recieves, the more medication i need to give him, which isn't good for John. In the morning, Dr xx is going to come in and see if it's appropriate for us to lighten John's sedation, and see how he responds.

Most people act out of a combination of ignorance and love. It's a dangerous combination.

[travel nurse2009]

i have seen this happen so many times.i have to deal with my anger first before i can help this family member who is obviously in denial.it is almost like dealing with a wounded animal,this guy is scared and emotionally is probably about 10yrs. old.try to develop a rapport with him, ask him about himself,active listening,all that stuff,sometime people just want someone to listen.don't come at him all nurse in charge as he will get very angry and defensive.

[heron, ASN, RN]

true...

and so, the pt is the one who suffers because her son can't deal?

sorry, but i have told those in denial, that their actions are only contributing to pt's distress and suffering.

typically, they'll become even more upset and demand to see the dr.

enter the doctor, who vindicates every word i've said.

and then we elicit more support for family member.

everyone on the hospice team, should be on the same page and present a united front.

i refuse to placate a family member by sacrificing any part of the pt's comfort and well-being.

leslie

Agreed, leslie, but the OP gave the impression that the patient was making a choice to accept the food and she never mentions physical sx of distress or aspiration. My point is that we don't get to override the competent pt's choices. My opinion is based on the clinical info given. She later added that pt was "... not opening (her) mouth when someone is putting a spoon to it ... ". If she is doing this with her son as well as with staff, then that changes the picture.

I'm glad the OP had the chance to ask the pt what she really wanted ... now she can approach the son with info directly from his mom as well as the care team. Perhaps by being at the bedside to see for herself what non-verbal signals mom is giving to the son trying to feed her, and pointing them out to him.

I wonder if the pt fears that her son will leave her if she doesn't cooperate. On the other hand, she may well have told him she doesn't want to eat and he just didn't listen. From the OP's post about her talk with the pt., sounds like there's a lot the pt isn't saying. Perhaps addressing her (theoretical) fear of abandonment would open the door to a more realistic attitude from the son and allow staff to redirect his efforts as suggested above.

I, too, have had the denial talk with families and can be pretty blunt-spoken. I have been known to literally pull a family member away from the pt to stop the bullying (in my case, a daughter trying to force mom to undress and into the shower).

It's when the pt at hand is competent and is saying one thing to caregivers and something else to family (usually to avoid being abandoned) that it gets frustrating ... and these situations are sometimes refractory to intervention because they involve long-standing family dynamics.

I never proposed that the son's bullying not be addressed ... just pointing out that we can't control the competent pts choices, only support them and that sometimes it ain't pretty.

[lisamc1RN, LPN]

I've only been a hospice nurse for 4 months, but I've seen it a lot since I've been one. Most often, it's family members who loves their mom/dad/brother/sister etc, very much. They are in denial, in pain over their loved one's illness, and truly think that what they are trying to do is best for their loved one. I've heard over and over that they don't want to "give up" on their loved one. The best nurses I've seen and am hopefully learning from are the ones who are patient, keep repeating the same information over and over again (maybe in a different way), offer many resources, and continue to treat the patient and family member with dignity and respect.

[leslie :-D]

I never proposed that the son's bullying not be addressed ... just pointing out that we can't control the competent pts choices, only support them and that sometimes it ain't pretty.

thanks for clarifying.:)

obviously, i read too much into the situation, mostly r/t my experience w/these dynamics.

i would say that i lose one patient/month, r/t aspiration, and not their disease...

because of persistent force-feeding.

regardless if it's r/t a fear of abandonment or, the pt just lacks the energy to fight, i see too many folks who relent to family pressure, and end up dying of asp pneumonia...

usually within a few hours.

hate it.

really, really hate it. :-(

leslie

[heron, ASN, RN]

thanks for clarifying.:)

obviously, i read too much into the situation, mostly r/t my experience w/these dynamics.

i would say that i lose one patient/month, r/t aspiration, and not their disease...

because of persistent force-feeding.

regardless if it's r/t a fear of abandonment or, the pt just lacks the energy to fight, i see too many folks who relent to family pressure, and end up dying of asp pneumonia...

usually within a few hours.

hate it.

really, really hate it. :-(

leslie

Me, too ... (((((((((((leslie))))))))))

[tewdles, RN]

indeed, dying people need us to advocate for them because they are not up to a fight...