Difficult familily members (VENT)

southernbeegirl, BSN, RN · Dec 11, 2009

LOL.
Don't let it get to you. I had to deal with a "CNA" who insisted I clean her grandmothers peri area with soap each time the diaper was changed (the pts was on massive ammounts of IV fluids, peed about a gallon a day and had to have a diaper change every hour) and SCRUB OFF the barrier cream each time in order to apply a new portion!
I called the wound nurse, who gladly explained why the idea was complete rubbish. She still didn't believe we weren't neglecting grandma... oh well...

you dont clean a patient with soap/water or peri cleanser when you change their brief? the barrier cream is to protect their skin from the urine during an incontinent episode. it in no way replaces or takes away the need to provide pericare after incontinence.

wow.

cherrybreeze, ADN, RN · Dec 11, 2009

you dont clean a patient with soap/water or peri cleanser when you change their brief? the barrier cream is to protect their skin from the urine during an incontinent episode. it in no way replaces or takes away the need to provide pericare after incontinence.
wow.

You don't scrub the barrier cream off down to the skin, though. That defeats the purpose and in fact causes much more damage. Our wound nurses' catch phrase is to apply it like "cake frosting" and you clean off what is soiled only, and apply more on top of it, but do NOT take it all down. So no. It doesn't "take away" doing peri care, but you are in fact wrong in your assumption that this person is not doing the proper care.

Flatbelly · Dec 11, 2009

you dont clean a patient with soap/water or peri cleanser when you change their brief? the barrier cream is to protect their skin from the urine during an incontinent episode. it in no way replaces or takes away the need to provide pericare after incontinence.
wow.

When diapers have to be changed very often (and no bowel movement is present) I use plain water and gently pat the area dry so to not remove the barrier cream. Frequent use of soap dries and irritates the skin, it also unnecessarily removes some of the barrier cream. I do use it though while cleaning the peri area while giving a full bedbath. I was instructed so by the wound nurse.

BTW if it were up to us, the pt wouldn't wear diapers at all (I hate diapers). IMO a pad, especially when urinating is frequent, is better for a pt who is bedridden. But the family member insists on diapers.

Virgo_RN, BSN, RN · Dec 11, 2009

Flatbelly, that's how I was taught too.

southernbeegirl, BSN, RN · Dec 11, 2009

I just dont agree with not using soap. Water does not get rid of the urine smell, IMO. if nothing else, then instead of just water, use baby wipes. we used to use those at a facility i worked at. we never had any problem with patients smelling of urine after incontinence. those would work to get the soiled cream off as well.

how bout that for a compromise? lol

southernbeegirl, BSN, RN · Dec 11, 2009

forgot to add!

i hate briefs too! i prefer pads myself.

tewdles, RN · Dec 11, 2009

yup...we use wipes...something less harsh than soap but smells good. Nope...don't wipe the barrier away, as said before, clean up the soiled stuff and replace as needed.

There are ALWAYS family members who are rocket scientists in disguise when it comes to grandmas care. I have the advantage of working in hospice...I simply put them to work...that generally solves everything.

I love the post about HH and the condition of the family home...indeed...some think we are supposed to do their dishes, clean the toilet and take out the trash. Some families will take advantage in every way possible no matter where they are.

southernbeegirl, BSN, RN · Dec 11, 2009

yup...we use wipes...something less harsh than soap but smells good. Nope...don't wipe the barrier away, as said before, clean up the soiled stuff and replace as needed.
There are ALWAYS family members who are rocket scientists in disguise when it comes to grandmas care. I have the advantage of working in hospice...I simply put them to work...that generally solves everything.
I love the post about HH and the condition of the family home...indeed...some think we are supposed to do their dishes, clean the toilet and take out the trash. Some families will take advantage in every way possible no matter where they are.

family members who are rocket scientists in disguise

that just absolutely gave me the best laff ever!! and it's so darn true, lol.

( i had a dementia patient that really was a rocket scientist once. you ever notice that the smarter you are in life, the more demented you are gonna be? i tell my husband all the time "we are so doomed" because we both also have dementia on all sides of both families. so we are planning our nursing home days NOW. and we tell our boys if they act like butthades God will get them. we are trying to train them to be good family members for when we are demented and running around the nursing home nekkid)

OldPhatMC · Dec 11, 2009

So I have this little old lady on the floor, who is by the way, cute as a little button. She is pleasantly confused, admitted for pneumonia. She has a little great grand daughter, who is maybe 18. Well, not only is she a graduate of the University of the Internet, but she is a CNA (licensed) and is Pre-Med at her school where she is an intern. She wouldn't tell me where she was an intern, where she goes to school ect. ect. Now I get it. She loves her great grandma, and wants her to get good care, but PUULLLEEEZZZ give me a break! Threatening the staff isn't going to get you any favors!!!

Oh she's an INTERN. She doesn't have permission to either speak to nurses or raise her eyes from the floor unless her R3 is present!

Seriously, the comments about involving them in care and open communications are very valid. I get this a lot. Sometimes my patient load has included families members such as nurses and even an ER doc that I knew from my EMS days.

If you are confident, know your skills and can articulate your intentions clearly, that defuses a lot of the testing. Sometimes I will ask what they would do differently. (Sidenote: yep, we're all busy and in a hurry but ten minutes up front is worth preventing days of hostility and CYA charting). I ask for research references supporting their ideas -- some of which are actually valid -- and share what I can with them. I also like to help the "medication loggers" get the right pills written down. If for any reason I have to bring an unwrapped pill into the room, I'm ready to explain exactly what it is, and why it doesn't look like what their pharmacist gives them at home.

Let's face it, sometimes its all in the presentation. I tend to milk my "old flatus" status. When they assume I am a doctor, I correct that immediately. When I'm the charge nurse on rounds, their assigned nurse is the best one in the building, and I let them know that I have confidence in that nurse.

Sometimes it's salesmanship. Remember, the puff up is almost always because the person doing the puffing is fearful and feels powerless. It takes time and patience to build the rapport and get beyond the fears. Most importantly, it takes the ability to manage your own emotions.

In two years, I've only refused to care for one patient, and that was due to a family member that was really hell bent on litigation. I embrace the patients with the the co-morbidity of "crankypants".

Someday it will be you in that bed!

Guest343211 · Dec 21, 2009

OK, how is she in a four-year med school program and also an intern. Usually the first two years of MS are pre-clinical sciences--though some now have an integrated program. The second year is specific pathology related to system/diseases/tx's etc and clerkships. When they are clerking they are med. students--and usually sign as MS III or IVMS (fourth year med student), etc. When they have graduated but are not through the process of licensing and then further on boarding, they will write as PG1 or PG2 or PG3, etc to reflect where they are in their residency. Fellowhsips are a bit different.

My point is, she can't really be in med school and internship (meaning res 1 or PG1) much less pre-med and in internship. Now, if she means a different kind of internship, that's different; but it sounds as though she has not been to nursing school, so I'm not sure to what particular kind of internship she is referring .

Physicians are looking at NO LESS than 11 years of education, including their undergrad work, which is vital and will be scoured over w/ a fine toothed comb--every single credit for their cGPA as well as science GPA they've ever taken will be scrutinized. If a person lives say 77 years, this process of education will take no less than 14% of their lives. Now when you consider that sleeping ideally is supposed to take at least 1/3 of your 24 hour day, that's a pretty big chunken percentage of your life--not to mention added subspecialty, fellowship, etc. And basically you are incurring a huge amount of debt for 11 years, and don't get to see any decent return on it until after your last year in residency or fellowhsip.

Anyway, me thinks the family member is speaking out of her behind.

So how did she threaten the staff? She might of been talking to help put her two-cents in order to let the staff know that she is watching and she's not going tolerate substandard care. And as harsh as that sounds and as out there this person is w/ her supposed assertions, you cannot blame a family member for looking out after their loved one while in the hospital--least not nowadays in my view. I try to stand on the other side, where they are.

Just have the staff give her reassurance and then back it up with great care and follow-through.

Nurses rate of being sued is rising today. And w/ some nurses that seem to be totally or at least pretty much in the field for themselves or to stroke their own egos, or to make more money than working in the convenience store--well, I don't have a lot of sympathy for those nurse-types. They don't get it; and sadly they may never--surprisingly even after thy or their loved ones have been on the receiving end of care. Those are the ones that blow me away the most. To go through some major things with their loved ones and still take that narcissistic, it's all about them attitude. Wow is all I can say.

Thankfully I can say that most of the nurses I've worked with genuinely cared about their clients--even when some of them or their families were being major pains. But for those nurses that you can perceive really don't--even if they try to sound that way--and that just can't stand getting their hands dirty or working together in the throes of stress or can't empathize with patients and families, again. . .I have absolutely NO patience or sympathy for them--and no decent discerning nurses that true do care should either. I'm not saying be judgmental or jump to conclusions about people; but I'm see a lot more nurses entering the field and it's really all about them. These are the folks that kill a profession and professional reputation with the patients and the general public. Yes they may get some praise from those few that they sucked up to or played nancy nurse with--but it is overtime where you see it trended w/ them.

LOL Amazingly some of these folks actually making it into management and administration. Apparently expanded college credentials matter more than true empathy, leadership, having a genuine servant-heart for those in need and using excellent critical thinking and sound experiential judgment. Nah. A piece of paper and schmoozing with the"right" people is all you need. We've seen these types. They make us sick, and we truly know they are killing the profession--yet just like high-ranking politicians that steal the votes by good press and charisma, they get ahead until more people wise the heck up.

Moogie · Dec 21, 2009

Actually, I kind of feel sorry for any patient or family member who has to tout his/her credentials (real or imaginary) in order to get good nursing care. Some of these folks seem to think that if they're just plain John or Jane Doe, no one is going to care but if they're John or Jane Doe, future Medical Deity (or a variation) people will bend over backwards.

It's sad when you think about it. And yes, many people do give extra special care when they think the patient or family member is any way a VIP. (I'd like to think everyone is a VIP, but then again, that's another day, another discussion...)

BTW, maybe the sweet young pre-med, CNA was really an intern---but perhaps a summer intern in the business office, at a newspaper, whatever...

allnurses Guide · Dec 21, 2009

When diapers have to be changed very often (and no bowel movement is present) I use plain water and gently pat the area dry so to not remove the barrier cream. Frequent use of soap dries and irritates the skin, it also unnecessarily removes some of the barrier cream. I do use it though while cleaning the peri area while giving a full bedbath. I was instructed so by the wound nurse.
BTW if it were up to us, the pt wouldn't wear diapers at all (I hate diapers). IMO a pad, especially when urinating is frequent, is better for a pt who is bedridden. But the family member insists on diapers.

I HATE diapers and I HATE disposable wipes.

Worked in a FINE nursing home for a good decade and do you know what?

We NEVER put the pts to bed in diapers... just chucks.

They were turned and changed religiously q2h and wiped down with plain warm water when wet.

Know what we used for a barrier cream?

Crisco.

And it worked.

No you do not remove the barrier unless it's soiled.

And you don't EVER scrub and if you MUST use soap, use it sparingly and rinse it off completely.

Not a single bed sore in our place unless the pt came to us that way.

Just my 2 cents.