Dealing with Overbearing Visitors

[BellsRNBSN]

I'm coming up on one year in LDRP now (so, still a new grad) and an issue that I still haven't found a very effective way to deal with is having patients who have overbearing visitors.

To give a few examples:

- I was recovering a mom from a C/S whose sister (an LVN in an unrelated field at a different facility) put O2 on my patient while I had my back turned even though my patient's O2 sats were fine (not to mention the obvious fact that this non-employee sister performed a medical intervention on my patient, totally unacceptable) and then proceeded to cuss at my patient's newborn in a sing-song voice, despite my patient's repeated requests for her to stop. Yet my patient still wanted her sister in the room with her. (This was during my training however, and I now do not allow anyone besides the father to accompany mom and baby in C/S recoveries, but my problem was knowing how to deal with this sister.)

- FOBs laying a major guilt trip on my patients for wanting/getting an epidural

- Mothers of my patients ordering my patients around, speaking in condescending tones, and making them feel bad about the way they are trying to tend to/breastfeed/change their babies

- I even once had a FOB step in my way and try to stop me from repositioning and giving O2 to my patient in labor whose baby was having a big decel, despite having explained to both of them what was happening and the rationale for my interventions.

I worry about overstepping boundaries in doing something about these family members who mistreat my patients, and I know that some of the reasoning behind these behaviors is cultural. I realize that this will become easier as my confidence increases, but do any of you have tips on how to deal with family members/visitors like this?

[monkeybug]

I find that saying what I want to say, in a joking manner, sometimes works. "Oh, you don't think she should have an epidural? Come over here, and let her grab your crotch every time she has a contraction, then." Also, I will act as though they aren't in the room. Grandmother is discouraging breastfeeding, I pretend she's not there, and extoll the many benefits, including great weight loss for mom. Grandmother says someting about "shaping" the babies head. I go into what molding is, TO THE PATIENT, how it will resolve, and then say, "and of course would never, ever, ever want to press on the baby's head as this could result in very serious injury." I try to be nice to everyone, but honestly, I'm old and ill-tempered, and I just don't care anymore. My focus is mom and baby, the rest can kiss it. In the oxygen situation, I would have pulled it off and told her that I could call security if something like that happened again.

A few years ago, I had a family that wanted part of the FM strip for the baby book. I explained that it was part of the medical record, and told them how they could get copies of it after discharge. A while later, while charting, I noticed that about 30 minutes of my strip had gone missing. I asked, and was met with blank stares. I had had all I could take. I announced to the entire room that what had occured was theft of hospital property. I was going to leave the room and come back in 15 minutes. If that piece of strip didn't magically appear, I was calling security and there would be consequences. Five minutes later a family member appeared at the desk with the strip, saying that it had fallen behind the bed, and I must have just missed it. Sure, whatever, I'm an idiot. But, I got my strip back.

One of the many reasons I prefer LDR over LDRP! Usually only 12 hours at the most of any one difficult family.

[DoeRN]

I find that saying what I want to say, in a joking manner, sometimes works. "Oh, you don't think she should have an epidural? Come over here, and let her grab your crotch every time she has a contraction, then." I try to be nice to everyone, but honestly, I'm old and ill-tempered, and I just don't care anymore.

A few years ago, I had a family that wanted part of the FM strip for the baby book. I explained that it was part of the medical record, and told them how they could get copies of it after discharge. A while later, while charting, I noticed that about 30 minutes of my strip had gone missing. I asked, and was met with blank stares. I had had all I could take. I announced to the entire room that what had occured was theft of hospital property. I was going to leave the room and come back in 15 minutes. If that piece of strip didn't magically appear, I was calling security and there would be consequences. Five minutes later a family member appeared at the desk with the strip, saying that it had fallen behind the bed, and I must have just missed it. Sure, whatever, I'm an idiot. But, I got my strip back.

One of the many reasons I prefer LDR over LDRP! Usually only 12 hours at the most of any one difficult family.

Lol you just made my day!

[anggelRN]

It sounds like you need to be more assertive. There is no reason to be rude to the patient's guest. YOU have to take control of the room because ultimately you are liable for the care.

FOB can lay all the guilt he wants. Obtain consent fromt the pt and get her the epidural. He can complain until he turns blue. If they want to "shape" the baby's head- there really isn't much you can do about that once you've explained to them that is isn't needed.

Always keep in mind that you aren't always going to convince everyone in the room to trust you. As long as you provide good care to the patient, it really doesn't matter. Don't beat yourself up.