Difficult families

[HurricaneCasRN]

How do you deal with them? I'm talking about the families that take shifts and are on the floor all day and evening. Each shift wants to talk with you, complain to you and assess Mom and create complaints. They suck up HOURS of valuable nursing time, often with repeating the same things. It's SO frustrating. Mom never complains of Angina until the family convinces her that she is having it. Mom doesn't want ice cream until they wake her up and tell her she does. They TIME the call lights. In addition to the talks they wish to have about Mom, they are there so often, they think they are one of the gang and wish to just have general chit chat!

Our difficult family is on a hall with FORTY ONE other patients and one nurse. That 40 minutes of specific attention can result in a a huge back log on med pass. And MOM. IS. FINE. She never "needs" nitro except when her children decides she does, and her VS are always WNL.

So, what's the solution?

[assidere]

...Mom never complains of Angina until the family convinces her that she is having it. Mom doesn't want ice cream until they wake her up and tell her she does...

The best solution is to do what I did- move to an ICU where most of the patients are sedated and can't eat ice cream

But in all seriousness, dealing with families is most of what makes our job so hard. In the 16 months or so that I have been a nurse (and two years of nursing school that doesn't really count), I've only had two or three patients that I had a difficult time dealing with. Families are another matter, as there is usually at least one a week that really grates my nerves, for the same reasons you mentioned above.

In the ICU environment, we stress the importance of rest, calm, and a haeling environment. It really irks me to see family members run in at visiting time (we have 30 minute increments every three hours) and try to talk to an intubated, sedated patient...

But thankfully, for every family like that, there is usually at least one that is understanding and gracious, and those are the ones that make it all worth while.

I am thankful though, that I can leave my work at the hospital and don't have to bring it home with me....

Edit: realized I didn't answer your question at all- my solution was to focus on the patient. Its hard to realize that even though it can be annoying, families do what they do because they care about their loved one. It helped me to cope by thinking that I made a difference for that loved one, and if having to answer the same question 12 times made the family feel better about the care the patient was receiving, I could get through it

[sukh :), BSN, DNP, RN, APRN]

Hi,

I faced same situation a few weeks ago. Mom and husband knew how much pain my patient had. Pt told me 5 no, husband and mom said it was 8. pt said yes, it is 8. Had to spent hours in rooom for answering their questions that were repeated so many times. on the top of that MOm of pt and husband were fighting with me that pain medictaion was not wroking for the pt, but pt was sleeping comfortably on bed. I talked to my charge nurse and supervisor. they talked to family to not to interefere in patient care and called Dr. and asked her on her rounds talk about pain and pain medications to pt and FAMILY. Got everything sort out but by the end of the shift. good thing everything was smoothed out for the next shift.

[wooh, BSN, RN]

In LTC, I don't know how this would work, but what tends to work for me:

Breeze into the room and overdo the care. Saying exactly what I'm doing to make the patient sooooo comfortable. I'm so dramatically on top of things, the family is overwhelmed! I always ask their opinion, acknowledging them and their "knowledge of the patient," and if possible, I try to do at least one thing for the patient's comfort that the family would NEVER think of doing. I respect them AND I'm brilliant, what could make them more comfortable with me?

[nerdtonurse?, BSN, RN]

I've done the "over the top" like wooh -- sometimes, that works. Sometimes they just want an older nurse because they don't think anyone under the age of 40 knows anything. In ICU, we run into a lot of families who think there's a doc sitting in the unit all the time (only if there's food does the MD do that), and want us to call them all the time.

I had one memorably horrible family when I was in telemetry, and they all jumped the nurses about stupid stuff -- the window wouldn't open (sealed shut, presumably to keep the nurses from escaping), TV screen wasn't big enough, ice wasn't cold enough (still can't figure that one out), too hot, too cool, where's the doc, etc. The patient was the family matriarch, and a cough was pneumonia, a sneeze was the flu, a headache was meningitis, etc. In all the time for nothing. It got to the point where the house supervisor would just schedule a drive by of the room about every 6 hours to get the current list of BS complaints, which she just tossed. Finally, after one of the family members hit the code blue button in the room because we didn't bring ice water fast enough (the CNA was coming down the hall with it, we reviewed the tapes and it was 90 seconds between when they asked for the water and hit the big blue button), the doc came in and dc'd the patient at 0100. I'll always remember what he said, "We've got 38 patients on this floor, and we can make 37 of them happy, and you'll be unhappy, or we can make all of them unhappy because the nurses are always running and doing stupid S**** for you and you'll still be unhappy. So...go home." The family had an apoplexy, but they were discharged, and we fed that doc all the goodies in the station for days....They went on the ER's "don't admit unless she's actually sick" list.

[LTCRN4LIFE]

33 years in Nursing has given me hundreds of difficult families and I have to say the way I deal with it works for me and I will never change....but to each his own.....when I get a new patient and the family is in tow I make it my duty to win over their confidence of me. I believe the nursing staff has one shot at a good first impression. If the family leaves the facility feeling confident about the staff the stay will go okay....if not...we're in for a ride!

I never speak to anyone in the family without first asking for their name and then checking the demographic sheet to see if they were on it. I explain HIPPA if I have to. This presentation "knocks" alot of puffed up family members back in their place without me having to appear defensive. Administration needs to support you in limiting the camping out and you need to take a stand. I would tell Administration it is time to look at the discharge plan....Home with Services may be more appropriate for this family or administration can speak to the POA and establish reasonable visitor limitations that allow staff to continue to provide care. Good Luck!

[SuesquatchRN, BSN, RN]

snip

I just ant to tell you your post cracked me up. Thanks. I needed that.

[Quickbeam, BSN, RN]

a lot of families who think there's a doc sitting in the unit all the time (only if there's food does the MD do that)

That really made me laugh. Thanks for a day brightener. I've had MDs go through my lunch bag looking for food. They are like raccoons.

[CrunchRN, ADN, RN]

Get administration involved to set some limits. It is wonderful the family is so involved, but someone other than you needs to explain that you only have so much time for each of your 41 patients.....

[merlee]

Families can be very difficult. One of the issues is crowd control, and that has to be backed up by administration and security. I know that many facilities have 'open' visiting but that might not be what is in the best interest of a particular patient. There may need to be an agreement with the family, the admin, the doc, etc.

Further, the family needs to designate ONE person as the lead; and that person talks to the staff about the pt's condition/dx/labs, etc. ONE person. Cuts down on the constant repetition and heads off any HIPAA issues.

It is completely ok to ask for privacy to tend to your patient if you believe that the family is interfering or coaching the pt. When the patient says '5' and the family says '8' you need to be treating the patient.

Also, the family is not allowed to be a hindrance to care. If this requires a contract, so be it. And they are to be discouraged from asking for drinks, crackers, blankets and the like for themselves. Or dragging in extra furniture for everyone to sit. There needs to be room for the staff to get around the bed!

Hope these ideas can help.

Best wishes!

[Rodoon, BSN, MSN, RN]

HurricanecaseRN,

I asked them to write their questions and "our" answers into a notebook. Note: I didn't write they did.

That way when family were relieved they could scan the notebook for answers first. Most of them want a procedure to follow. Of course, if they get too demanding individually, then find the one you get on best with and ask for his/her help in solving the problem. Otherwise, it will escalate out of control.

[MombearNurse]

HurricanecaseRN,

I asked them to write their questions and "our" answers into a notebook. Note: I didn't write they did.

That way when family were relieved they could scan the notebook for answers first. Most of them want a procedure to follow. Of course, if they get too demanding individually, then find the one you get on best with and ask for his/her help in solving the problem. Otherwise, it will escalate out of control.

I like this response to the problem a lot! I am just getting ready to start my first job in a LTC/Rehab and can imagine having issues with family camping out. Asking them to write down their questions to share among the family is brilliant!