Did I do the right thing?

I think you did the right thing! Did you explain to them (the family) that she was in pain and anxious and if she wasn't given her meds she may have been in pain through thanksgiving instead of sleeping, which would they rather?

If it were my family member, and you expained it to me, how could I contend with that! Treat them as you would your own and you can rest assure your doing the right thing!!

I tried, I did manage to explain it to one of the family members, who works in a md off. she understood. the rest of the family was so irate, they either ignored me or gave me dirty looks, so i just charted and charted to cover my butt. nothing was ever said of it from my DON or assis. DON ... so i'm assuming they got over it ... just makes me doubt myself ...

(((((AndiMac)))))

I think you did the right thing. Your duty is to your patient first and foremost. I am sorry the family acted like that; it was particularly selfish considering they should be thinking of the comfort of their loved one as well.

They should be thankful that she is here still for Thanksgiving, awake or not.

Originally posted by AndiMac

I recently got my rear chewed off by a family of a resident. This res. had severe back pain, she couldn't stand from a sitting position. This res. is also notorious for having anxiety attacks. I gave her a PRN Darvocet and a PRN Ativan. She was unable to slow her resp. rate, she was obviosuly anxious. With that kind of pain, you're going to be anxious, correct? Well, anyways, it was Thanksgiving, and her family chewed my butt because she went to sleep. This has been giving me grief, I was taught anti-anxiety and pain meds in this kind of scenario go hand in hand. I feel bad, because it was Thanksgiving and all, but still, was I supposed to let her sit and hyperventilate, pass out, and drown in her gravy?

It appears to me that the family doesn't seem to be capable of taking care of the resident themselves otherwise she wouldn't need to be in a LTC facility. Although you're not necessarily going to hyperventilate from pain it certainly is possible. It sounds to me as if she were hyperventilating due to over stimulation from the number of family members that were surrounding her. She's probable not used to seeing them more than a couple times a year. You did the right thing. You're going to have to thicken that skin. You can't let family members dictate how you're going to take care of your patients. You're the one with the nursing license. Not giving her the pain medication and/or anxiety medication in that state of discomfort could arguable be considered neglect. If they have a problem with DR. ordered medications then they need to take it up with the DR. that ordered the medication.

If she was in this kind of pain as you described, I'm sure the family (if they had any heart at ALL) would NOT have wanted to see their loved one in such anguish on any day, much less this special holiday.

I'm with Lisa here... they should have been THANKFUL she was resting painfree... I don't care HOW far they drove to visit with her. Sheeeesh.

I hope MY family never calls ahead and says "oh, by the way, don't medicate Mom.. we don't care how much pain she's in, we want her to see that we actually came to visit her on the Holiday !"

I'm with Lisa and Jeannette. Part of our job is patient advocate and sometimes that comes down to protecting the patient from family, well-meaning or otherwise. You clearly were acting in your patient's behalf so don't give it a second thought.

Andi -- I'm sure the family finally "got it" after talking it, and thinking it, through. If they're big enough they may even surprise you with an apology next time... as they should.

Under non-ideal circumstances, you chose the best alternative. Recognize that and move on... even if you never get the "I'm sorry."

Sorry you were put through this after providing your resident professional care.

Maybe the patient did not WANT to be with the family on Thanksgiving, maybe that's what provoked the high anxiety level prompting her to need the medication. You did what was required to adequately care for the patient. Whatever the complaints of the family, they were probably more due to the fact that they went out of their way to spend Thanksgiving with her, and now she would not realize it. You could have reminded them gently that there are other days during the year they could visit and maybe the patient would not be so overwhelmed with everyone converging on one day.

I see this so often too in my ICU. Not just families: even neighbors and acquaintances. Sometimes I have to be blunt : "He is in pain and that is my priority of care... he's in critical but stable condition, he's resting now after a bad day. You may sit quietly with him but I ask that you not overstimulate him."

Had a vented septic patient the other night...necrotizing pancreatitis with an open infected belly wound who needed pain meds and sedation to be comfortable. Neighbors asked me ' Nurse, can't you give him 'something' to wake him up more so he sees we're here'?.

Also amazes me when visitors bring in nudie playing cards and start a loud raucous party in a fresh MI's room. ICU party central...

The public sometimes has no clue what our patients are going through and their priorities just baffle me sometimes.

Now that I know there are several nurses that would have done the same, I don't feel so bad. It never seems to be the patient, it's always the family. Never fails.

I think the families and friends of these critically ill patients try to act as if nothing is changed. That their family member/friend is the same person as they are used to, with the same interests.

You, as a nurse, realize that if someone has a life-threatening illness, or a fresh MI, their lives are nowhere near what they used to be, but rather are drastically changed. The patient probably does not have the realization or energy to express his/her feelings to the family/friends. That's why we're there..to do what is needed for the patient at this unusual, critical time.

Never doubt your priorities as long as the best interest of the patient is in the forefront. It's also good to keep a sense of humor!

Originally posted by Scis

I think the families and friends of these critically ill patients try to act as if nothing is changed. That their family member/friend is the same person as they are used to, QUOTE] That is true in acute care but LTC is a different story.Most of the time it IS about the family or the friend or neighbor....Often families expect us to do exactly what they were not able to do but within the parameters of the regulations.Dad has had his days and nights turned around for 3 years yet they expect him to be bright eyed and bushy tailed during their obligatory Saturday morning visit....Mom has screamed and fought through baths and shampoos for months yet they want her hair shampooed and set weekly..."Mom-Don't you KNOW who I am"?.....No-Mom does not know YOU-she only knows that someone is very close to her face and talking loudly...She feels scared because she can not understand the words and their meaning....We often have to spend a great deal of time educating families so that they do not expect their loved ones to perform like a trained seal..."Mom-wake UP,I came all this way to see you" ...Mom-SEE ME-acknowledge me.....KNOW ME.....We have to help them accept that they are loosing their loved one and often already have done so years ago but are just waiting for a funeral...Adimac you did well......You are your resident's advocate-and educating the families is a big part of the job but the resident's well-being comes first...There is no pill for dementia or old age.....