I have a private duty 65yr old quad, Pegtube, trache, catheter, and lives with daughter at home in his own house. Since day 1, daughter has been altering and not following with plan of care by PCP.
The problem is she expects us nurses to do the same. His feeding orders are continuous feeds at a certain rate. She decides to discontinue the formular altogether, and make up her own "food" of home made mashed potatoes,green beans, oatmeal and whatever she feels like adding in a blender and puree' it to be fed via Peg tube. She feels like her father cannot live on this "milk substance" alone and needs real food. Next thing tube is clogged, we're running to the ER to insert a new one. Pt has been loosing weight, his BMI below of what it should be based on his height and weight. He has had s/s of aspiration Pneumonia as said by MD, but refuses to send him to ER for abnormal sudden change of MS (less responsiveness), fever, thick/smelly mucus through trache and mouth. A Levaquin dose was ordered for 14days and she hid it away from nurses so as to not give the pt because as per her words "am sick and itired of him getting antibiotics." She insists it's just a cold. She has also decided to play around with his anticonvulsants, will sometimes give or hold Vimpat on her own discretion, thank God he hasn't had a major grand mal seizure. My agency office is well aware of this, and I document everything that happens in my shift, incl threats of "getting rid of y'all if you can't do what I want you to do", and "my father can't live on milk alone, he gets hungry for real food." This is a patient with a PMH of a CVA that left him aphasic and unable to swallow. She honestly believes her dad is not a quadraplegic, he was misdiagnosed. Her way of ROM for his extremities is to "stretch his left arm till it's straight" despite him being contracted and grimaces and moans when doing it to this extreme.
O and she discontinued his foley and changed it to a texas/condom cath w/o Dr orders.
I know family or POA cando the way they see fit at home, and we ought to respect that, but inorder for us to follow that, we need an MD order, and she feels like we need to stay away from the Drs this is her house/her father.
I'm getting exhausted of explaining the same thing over and over again of how important it is to follow 485, importance of treating Pneum and how vital it is to have him checked out should his VS become abnormal, and not missing a dose of his seizure meds and blood pressure meds. The last 2 shifts Pt's BP was elevated to 180s/100 due to the fact that his med was abruptly stopped by daughter about a month ago. I feel like it's unsafe for this man to be at home despite having skilled nursing because daughter wants to follow her own plan of care which can be dangerous to the Pt.
I would call my supervisor and list, again, what the daughter is doing and your concerns. I would then inform the supervisor you feel that since this problem has not been resolved you feel your only choice is to now call adult protective services to protect the patient and your nursing license.
I gotta wonder if the daughter's practice was influenced by cost issues ... was she caring for the pt without formal home care for any length of time? All the issues seem to reflect a preference for lower cost alternatives: blenderized real food tube feedings (what do you suppose we used before commercial solutions were available?), texas cath instead of a foley, etc. The complications described could have been facilitated by a failure of the system to adapt to the situation (ie larger lumen g-tube to allow the thicker feedings). The sad truth is that, more often than not, we insist that caregivers do it our way or twist in the wind to figure it out for themselves.
She sounds exhausted and frustrated and like she's been reading too many online blogs that like to bash the health care system.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I gotta wonder if the daughter's practice was influenced by cost issues ... was she caring for the pt without formal home care for any length of time? All the issues seem to reflect a preference for lower cost alternatives: blenderized real food tube feedings (what do you suppose we used before commercial solutions were available?), texas cath instead of a foley, etc. The complications described could have been facilitated by a failure of the system to adapt to the situation (ie larger lumen g-tube to allow the thicker feedings). The sad truth is that, more often than not, we insist that caregivers do it our way or twist in the wind to figure it out for themselves.
She sounds exhausted and frustrated and like she's been reading too many online blogs that like to bash the health care system.
But the nurses have educated her time & time again to no avail. Some people just want things their way or the highway.
My comment was a purely theoretical speculation, wondering if a larger lumen g-tube would have helped to solve some problems. Like I said, there's nothing strictly abusive about using real food instead of the canned stuff ... we did it ourselves for a long, long time ... or a texas cath instead of a foley.
However, the OP knows the context and I don't ... it's probably the best thing to report to APS as others have suggested. The relationship between the caregiver and the agency seems irreparable and the OP is in an untenable position. Continuing the power struggle will only hurt the patient. Best to end it early and decisively.
When I suggest contacting APS, I assume that the nurse has already interacted with the physician. Pretty silly to cause a whoop-di-do with APS when the MD is perfectly willing to collaborate to sign a 485 that reflects what the family will accept.
MD has totally opposed CG's home made plan of care. Dietitian has repeatedly refused to sign anything regarding this diet family has decided to take. CG will do whatever she wants, her way or the high way. She believes they're out to get her father's organs. Will be following advice received on this forum.
MD has totally opposed CG's home made plan of care. Dietitian has repeatedly refused to sign anything regarding this diet family has decided to take. CG will do whatever she wants, her way or the high way. She believes they're out to get her father's organs. Will be following advice received on this forum.
Specializes in Certified Med/Surg tele, and other stuff.
I couldn't get to the bottom of your post quick enough. I wanted to scream CALL APS. That is abuse..the torture exercises, stuffing food down a peg, and withholding all meds.
I agree with everyone above, call APS or whatever its called in your area. Especially if you've tried to work with the PCP to change the care plan. Your supervisor should be educating the family as well. A referral to a social worker is needed. The PCG needs to work through her issues and needs further education in order to properly care for your patient.
A trach (that doesn't have an e) isn't something to play around with. I've had patients with a blenderized diet. But the diet has always been approved by a dietician with those patients. If the patient is losing weight and not getting proper nutrition, that needs to be handled. Withholding meds is neglecting the patient unless there is a darn good reason to hold the med. The ROM sounds like abuse too.
This patient sounds like he would be better off in a nursing home or with another family member. Poor guy!
I'd report this and get out. You may end up in court as a witness. Find another case. They can and will try to make this your fault. Also, keep your own little notebook to record dates and times that you reported the issues as well as who you reported to. Good luck.
This is my second post (I think). I've been an RN for 23 years, mostly psych then the last six years in acute med/surg hospital work. I'm accepting a private duty position through a nationwide company and during my interview, the DON minced no words about 'difficult family members'. Your dilemma is unfortunately too common, but that it's 'common' has its upsides. You don't need to reinvent the wheel, you can take the steps so well outlined here, rather than see it as a unique situation particular to YOU or whatever :) That's the good news.
I look forward to working PD for some odd reason in spite of the issues that plague this kind of nursing. I told my potential new boss that dealing with difficult PEOPLE has characterized my experience as an RN and that I continue to work as one must mean I've found some peace with it. SOME peace . It's like having a sick loved one magnifies the good and the bad. This daughter/caregiver clearly has 'issues' coping with reality, accepting her father's illness. She has some idea that it's her against the world, from BEFORE Dad got so sick, and this has gotten out of control and I agree with the others that Dad is in danger.
So are you, potentially. That makes 'what to do' simple. The patient is in danger, so are you; therefore, action. Keep it simple.
Oh no. I would definitely report to supervisor file a formal complaint with them(so they can't say you never told them) and call aps. Some people actually believe medications are given to speed up the death process ( like my aunt). Anyways I would not work with this family. It sounds like the blame will eventually fall on you.
in spite of the issues that plague this kind of nursing. I told my potential new boss that dealing with difficult PEOPLE has characterized my experience as an RN and that I continue to work as one must mean I've found some peace with it. SOME peace
danarooo, BSN, RN
119 Posts
I would call my supervisor and list, again, what the daughter is doing and your concerns. I would then inform the supervisor you feel that since this problem has not been resolved you feel your only choice is to now call adult protective services to protect the patient and your nursing license.