Do you tell family members that their loved ones are nasty and combative

[DesiDani]

Or do you never go into detail and just say "everything is fine". Do loved ones have the right to know that their loved ones are acting out?

[amoLucia]

Discuss the behaviors. There is no need to add descriptions such as "nasty." Stick to the facts and leave the subjective statements out of it. The objective statements of specific behaviors pretty much tell the tale.

This.

I find it interesting that the word "nasty" is being used for this post. Many years ago, I attended a CEU program on legal aspects/documentation in nursing. The speaker was discussing objective versus subjective documentation and she used "nasty" as her example. She expounded that such words convey subjective impressions of the pt by the user and she explained how malpractice attorneys just loved subjective words in nursing notes.

She explained that "nasty" could be construed that the nurse had negative feelings towards the pt. And that this could affect the caliber of care that the nurse provided for the pt.

If the pt were to have sustained some type of injury or some type of 'distress', it could be inferred that such occurrence happened because the nurse was neglectful or biased or discriminating in her delivery of care and thus care was lacking and not up to 'reasonable & prudent standards'. Basically saying 'that the nurse didn't like the pt' so she treated him less than as well as she could have. Hence the claim of malpractice.

It was ironic that at the time we had an ortho pt, a high BKA. He was like a torso with arms and a head. It was true that that the word "nasty" should have been that guy's first, middle and last names. He was one angry, belligerent, difficult and non-complaint pt. I remember him well. One episode I walked in on was him playing with his bed controls. He would put the HOB in high 90 degrees and bend up the foot of the bed to its highest gatch. All you could see was his little torso stuck sideways in the little flat space between the HOB & FOB. He couldn't stop his slide without his legs. And he'd be screaming at us. Once his stumps were atop the footboard - if he could have flipped himself over to his tummy, he could have actually slid out, up & over, the footboard. I know, I know, he was just not dealing with grief & grieving well.

Turns out there was another new nurse on the unit with me. She freq peppered her notes with "nasty" & "mean" and "stubborn" etc. I just shiver to think if there had been any litigation.

Sorry, didn't intend to go off track on OP's post. But yes, I did discuss pt behaviours with family, This esp occurred in care conferences (LTC) and when explaining pt's psychoactive meds. It could be difficult to remain objective, but that's what is nec when in touchy situations. Other PPs have offered valuable approaches.

[DesiDani]

AmuLucia,

You are aware that this is a forum. And with most forums are typically informal. If that wasn't the case their wouldn't be threads discussing your worst experience as a nurse or funny nursing stories. Still, thanks for the detailed feedback.

Anyway, I've seen some hold back from the family that their loved ones are confused and disorientated, giving them a false impression of how their parents are doing

[ktwlpn, LPN]

AmuLucia,

You are aware that this is a forum. And with most forums are typically informal. If that wasn't the case their wouldn't be threads discussing your worst experience as a nurse or funny nursing stories

Wow.....just....Wow.

[hppygr8ful, ASN, RN, EMT-I]

Well without going into details which might compromise HIPAA I had a relative say to me as I was admitting a resident "I'm so sorry in advance, I just could not do it anymore!"

Hppy

[la_chica_suerte85, BSN, RN]

I wouldn't say "nasty and combative" but would describe what they actually did to the pertinent family member(s) and see how the behavior compares to their baseline. Like other people said, something different might be occurring that the family was unaware of or that might be normal and they need help managing it.

[TheCommuter, BSN, RN]

AmuLucia,

You are aware that this is a forum.

Yes, she's certainly aware this is a forum as evidenced by her nearly 4,000 high-quality posts over the past few years.

[Ruby Vee, BSN]

AmuLucia,

You are aware that this is a forum. And with most forums are typically informal. If that wasn't the case their wouldn't be threads discussing your worst experience as a nurse or funny nursing stories. Still, thanks for the detailed feedback.

Anyway, I've seen some hold back from the family that their loved ones are confused and disorientated, giving them a false impression of how their parents are doing

Interestingly, the person with 15 posts is attempting to school the one with nearly 4000 regarding the nature of this forum.

[rachelraee25]

I most definitely do. I don't see the point in not informing them, especially if they inquire. Now whether this is a family member who doesn't believe that their family member is that way is another topic. But it doesn't stop my honesty.

[Cruella de ville]

I try to stay honest, so if we get to a point of medication they aren't surprised.

We have some families who have complaints about things, but if they understand we are dealing with combativeness they understand if grandpa might be wearing the same clothes or didn't get their face shaved.

[Txldy]

I have told a wife that her husband is having a challenging night, and perhaps she could help translate his needs so that we could better understand what is upsetting him. Perhaps one of his kids or another relative could take turns and sit with him. Right now he is presenting a challenge with his medical care, which requires he receive certain medications and/or treatments.

And blah, blah blah.... The thing is, it takes diplomacy. It takes years of experience to learn that diplomacy. Watch your more experienced nurses. You can make a point and get right to what you need right now, quickly. You just have to learn to say it right. You can take clues from family members, culture and even observed rituals.

[Txldy]

Just don't forget, DOCUMENT IT! The treatment interrupted, the behavior, the family contact, who you spoke to about this challenge and how they responded. There is no exception. Chart in your narrative about this like you're about to be sued. This could be a litigious situation.

[calivianya, BSN, RN]

It depends on what kind of nasty we are talking about. If we are talking confusion/delirium behaviors, I will say something. If the patient is perfectly alert and oriented and just chooses to be a terrible excuse for a human being, I don't see the point in bothering unless I think his family can talk him into complying with treatments. Odds are, if the patient is really a horrible person, his/her family members are already aware. Those poor people have to live with the patient when he's not hospitalized.