Excuse me, I wasn't talking to you!!

carolinapooh, BSN, RN · Feb 22, 2006

Sometimes, you just have to shoot folks, you know? :clown: :chuckle

THAT POOR MAN!!!

DidiRN · Feb 22, 2006

Can you get social services involved? They might be able to help with this situation. If the POA is just for healthcare, then I don't think they really have any say in his code status, as long as patient is mentally competent.

Don't you just LOVE when a pt's family knows more about how a patient feels than the patient?!? For a week now I have been caring for a completely alert and oriented person who just happens to be a little elderly and has a POA for healthcare. And since he is a little "elderly", his family seems to think that he has no business making decisions for himself! When I go to assess him, I ask him, "Are you having any pain?" (Mind you, I'm looking directly into the eyes of the pt) And from somewhere behind me in the crowd of family a voice appears "Yes, he is. Tell her, Dad, it's about time for your pain pill. It probably wouldn't hurt for you to go ahead and take your nerve pill, too." AAAAAHHHHHH!!!!! Does anyone have an oozie they're not using??? :angryfire The patient conveyed his wish to me and another nurse a few days ago that he wishes to be a DNR. However when this was brought to the attention of the family and the POA all he** broke loose and they were having NONE of that. The poor man just looks at you with pleading eyes everytime you walk in the room as if to say "Yes, I love my family, but they will not obey my wishes no matter what - I am simply no longer a human being to these people, and how I want to play out my final years on this earth will never matter to them!" i have told the family repeatedly that the pt is alert/oriented and can make decisions for himself as long as he is competent and that all questions directed to the pt are for the pt to answer and not anyone else!!! WOW! I am on a roll here!! This has been so hard for me to overcome this week - it's just so sad that I have literally cried all week about it? He is so powerless right now, and simply just looks defeated. Anybody have a similar experience? Sometimes need a shoulder....

thumperRN · Feb 22, 2006

Our social worker has tried to get involved, but the pt caves for the family. They are so barbaric and constantly in your face all the time. They have fired so many Dr.'s since being at the hospital and they all camp out like it's a hotel. They keep threatening to go to a different facility, but don't. I wish the pt had the guts to stand up to them! He is widowed and his children help care for him so I guess that makes them think that they get to make all the decisions. His grandkids are about 10 times worse!! I don't know what else to do - they are constantly hovering.

meownsmile, BSN, RN · Feb 22, 2006

I can so relate. Today i had a patient come back from surgery, the family immediately began their tyrate about the patient needing a PCA,, nothing else would do (despite the fact the dr had ordered ample pain medications post-op and she had a fem block prior to leaving PACU). They wouldnt hear the fact that i wanted to at least try to control the pain with what was ordered before i started calling the dr.(who was in another surgical case at the time). And had i called him, interrupted his case, for that without first trying what he had ordered i probly would have lost my head (although i didnt tell the family that).

Anyway, the family promptly went to the dr OFFICE, stomping and carrying on about her needing a PCA. The office nurse called the doc in surgery,, got him out of his case, he called me wanting to know what was going on? OMG

Give her the PCA and forget it. Dr totally understood my side of the picture. I think hes delt with these folks before!!,, LOL

ilostu12 · Feb 22, 2006

WOW! That is a tough one. If the pt gives in to the family there isn't much you can do. Very careful documentation should be priority. I don't know why but I get a feeling that should the pt turn bad or die the family is goning to be all over the facility with lawyers.

DidiRN · Feb 22, 2006

Oh, that's awful. Poor guy.

Our social worker has tried to get involved, but the pt caves for the family. They are so barbaric and constantly in your face all the time. They have fired so many Dr.'s since being at the hospital and they all camp out like it's a hotel. They keep threatening to go to a different facility, but don't. I wish the pt had the guts to stand up to them! He is widowed and his children help care for him so I guess that makes them think that they get to make all the decisions. His grandkids are about 10 times worse!! I don't know what else to do - they are constantly hovering.

The Sphynx · Feb 22, 2006

I deal with this stuff all the time in the ICU. If the patient is A&0x3 and states to medical personell what he wants..that's it! End of Story! Family can go find a judge to change it (they will not overide the patient w/o justification from medical personell).

Go in with the charge nurse and maybe the physician too.Document the neuro finding and what he tells you in quotations and write the DNR orders.

If family wants to get upset, direct them to the manager and administration. If they get biligerant,call security and have them removed from the building.

Medical POA only applies when patient is not able to make decisions for himself. General POA is a different issue and of no concern to the medical

facility/physician, orthe nurse. In states such as Nevada, the lines are clear: Legal spouse, children over 18, parents, siblings,ect...

Dalzac, LPN, LVN, RN · Feb 22, 2006

It is all guilt talking nothing, but oodles of guilt, and families like that make me crazy. I have gone over and over with my families how I wish to make all my decisions or my husband. And How not to let guilt do all the talking. Thank god they have the sense to do what I want and not what they want. My sister and I have gone round and round about this very subject. Even about my parents We are all pretty dang blunt about what we want.

DidiRN · Feb 22, 2006

I agree with you, but I worked at a facility that completely ignored living wills or the wishes of a competent patient, once they were unable to make any more decisions about their care, the docs always went with whatever the family wanted, even if it was opposite of what patient had wanted. It was so frustrating. The next place I worked at had what you just described; the way it should be.

I deal with this stuff all the time in the ICU. If the patient is A&0x3 and states to medical personell what he wants..that's it! End of Story! Family can go find a judge to change it (they will not overide the patient w/o justification from medical personell).
Go in with the charge nurse and maybe the physician too.Document the neuro finding and what he tells you in quotations and write the DNR orders.
If family wants to get upset, direct them to the manager and administration. If they get biligerant,call security and have them removed from the building.
Medical POA only applies when patient is not able to make decisions for himself. General POA is a different issue and of no concern to the medical
facility/physician, orthe nurse. In states such as Nevada, the lines are clear: Legal spouse, children over 18, parents, siblings,ect...

SLREGIER · Feb 22, 2006

Some hospitals have an Ethics Committee that will step in to help the patient. The patient's wishes should be honored!

Can you get social services involved? They might be able to help with this situation. If the POA is just for healthcare, then I don't think they really have any say in his code status, as long as patient is mentally competent.

bethin · Feb 22, 2006

Sorry, my uzi is in the shop. I know exactly how you feel. I just want to tell those kind of people to shut the **** up! Some people don't get it that if you are looking at someone that you expect a response from that person and not someone in the peanut gallery!

I suppose there's no way to speak to the patient privately? Do they stick around for baths? If not, maybe you could tell the patient that it's his decision regarding his health care, no one else's.