triage and family

[canoehead, BSN, RN]

About once a shift I get a patient come into the triage area with family, and the family member won't allow the patient to talk, even answering the pain scale for them. If they are interrupting I ask them to let the patient finish. Or I continue addressing my questions to the patient and ask family of they have anything to add when I finish.

Every six months or more someone shows up and their family interrupts and contradicts everything they say. Family says the patient is minimizing their condition, or they have a poor memory, or the family might be reading more into the situation than the patient admits. To the point that I can't get a coherent sentence from the patient. I've asked family to leave, they refuse, and unless I want a physical fight they stay. Or finally the patient is able to speak, and they look to family for something, like the name of a certain med, and family refuses to give any information "the nurse said I wasn't allowed to speak."

So clearly I need a different way to handle it. Calling security is not an option, they will not physically remove anyone, unless staff is getting assaulted. I think other triage nurses have strategies that are better anyway, we're a wiley group. Help me out.

[JenERally]

I'm not sure if it's an option for your triage setup, but the prospect of impending "lady" questions seemed to have a dispersing effect on family members. Something about lady partsl discharge that makes people run for the hills :)

[canoehead, BSN, RN]

Ha!, yes, I've used that!

I'm talking about family that will tell you the color of the discharge while the patient insists they have none. On further questioning, they had a yeast infection six months ago. Unhelpful, and freaking rude. If it was my coochie, I'd want to be considered the authority on it's comings and goings. Even at 70 years old.

[Anna Flaxis, BSN, RN]

Obviously the first strategy is to let the family know that I need for the patient to answer my questions, as it is part of my assessment.

There are times, however, when cultural considerations come into play, and so I will defer to this and not make a big issue of it.

In the event that it does not feel like an issue of cultural competence, but rather, an overbearing family, I will simply include these observations in my triage note. It's part of my psycho-social-spiritual assessment.

The family unit and how it functions (or doesn't, heheh) is an important part of the picture, even in the context of triage.

[Altra, BSN, RN]

(Addressing "head" family member directly - they like that):

"I'm going to ask Sue some questions now and in order to move things along (place hand on or gesture towards computer) I need to record *her* answers. We will certainly listen to all of your concerns."

But as noted in the post above -- you're not going to single-handedly change ingrained family dynamics in the space-time of triage.