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....
Specializes in Critical Care, Pediatrics, Geriatrics.
I work in an ICU and we see a lot of this. I've seen several families insist on keeping miserable vegetables alive. It's disgusting, morbid, barbaric, grotesque, inhumane....shall I go on? I feel like I'm sinning by participating in their torture whenever I care for them.
absolutely!!!!! This is the only turn off I have to ICU nursing. I can not stand to see needless suffering. Its even worse when the family wants everything done to save 70 year old grand-whoever with no legs, no renal function, tube feedings, has a rectal tube, on a vent and sedated and is still not a DNR.....they lived a happy life, everybody has to die sometime. Quit being selfish! Then what really boils me to end is that half the time, the family won't even visit, they just call to check in, then want to come and yell at the nurses for every little thing they see wrong. I don't understand it at all.:angryfire
I saw alot of neglect and needless suffering in my home health rotation too. Some people just keep their elderly loved ones around to collect a check and really don't do anything but check to make sure they are still breathing every now and then.
Where I work the attending physician can write a DNR without the family's consent. He just needs to talk to the patient alone.
Four years ago I had a dear friend who passes. He wanted to be cremated. After he died the family said "no, we were just pacifying him" and they had him buried. I thought it was awful not to respect his wishes. :angryfire:angryfire:angryfire
And truly, the POA is supposed to be carrying out the patient's wishes. It's not..."Oh, I'm the POA, I can now make all decisions." It's supposed to be "Oh, I'm POA, I now have to carry out what so-and-so said that they wished for, to the best of my ability."
Guess what now??!!!! Today was supposed to be my day off and I was called to see if I would be willing to work - so I went in for a couple of hours this afternoon, and lo and behold when I got there, the patient was being transferred to another facility!! The nurse taking care of the pt and filling out the transfer orders told me that she found in his old records that a year or so ago the family tried to get a physician to deem the pt incompetent on a previous hospitalization - which according to what the nurse said, the Doc was unwilling to do!?! I AM FLABBERGASTED!!!!! What the hell is going on this world we live in???? Somedays I just want to give up!! I cannot believe it! I am just going to pray to the good Lord that this man's path will not lead him down a dark road. I pray for compassion and healing and peace of mind for him. I'm also gonna pray for that family - they probably need it more than anyone. I just don't understand what's wrong with people....
Specializes in neuro, m/s, renal, ortho, home health.
I too have had problems w/ family members thinking they know what is best for the patient. I work on a neuro floor and trying to do an assessment can be so difficult when family members are trying to answer for the patient. What I started doing was asking the family to leave while I did my assessment. This tends to help at times, but then there are the stubborn people that want to stay. I am so tired of the patients and family members running the hospital. At times they are rude, demanding and feel like we are their servants. Hospitals are so competitive they try to cater to pts and family. I feel like we don't have any control anymore. Don't get me wrong I will explain to a family member (in a professional way) that my responsiblity is to the patient and providing the best care possible. I will also explain that I'm feeling some resentment, attitude or what ever you want to call from them (the family or even the pt).
If this continues they will be asked to leave. I've also approached it in a way that I know they need rest and I will call them if anything changes. I had a pt's sister yell at the aide and myself every time I went in the room. When I told her if it continued she would have to leave. She said she wanted to speak to to charge nurse and the charge nurse calmed her down and offered another nurse. They refused. I can't tell you how many times this has happened to me. I see so many nurses going into areas where they don't have to deal w/ family members and I can understand why. I'm really getting sick of it all and on top of having to deal w/ them we are assigned too many pts. I finally got to the point where I told family members I had a heavy schedule and would have to discuss things later. Then management says don't tell pts and family members how many pts you are caring for. I got the impression they wanted us to apologize, look inadequate and go on. I refused to do that, when they asked I told them. When they were upset because I could not get to them right away I did apologize. If they still chewed me out I asked them to talk to the manager. She didn't like that either. I agree w/ the nurse that tried to carry out her pts wishes. I also agree w/ trying to do it and not advising the family. I really wish hospitals would go back to visiting hours. Our floor had all private rooms. Our manager said we did not have visiting hours and these patients and family members are our guests. We encourage them to stay. I don't have a problem w/ that as long as they (family members) behave themselves. And I do not feel like they are guests, the pts are pts, they don't feel good, sometimes are cranky and demanding. I don't mind that as long as they don't treat me like a dog. By the way if I had guests in my home that acted like some of these people they would not be visiting long. I wish nurses had more control over things like this. It is always such a struggle. I have had security remove visitors and family members before. I my biggest pet peeve is family sleeping in the bed w/ the pt. I think the only time this appropriate is when its a parent and child. The beds are for the pt, not the pt and S.O., wife, girlfriend, etc. There needs to be some changes made w/ these issues. I think we would all be happier if we felt like we had some control. After I worked a shift I am drained because I feel like I've had to fight on every little thing. How can we change this?
Specializes in LTC, assisted living, med-surg, psych.
Ahhhhhh, families: you can't live with 'em, can't shoot 'em........
I have one resident at my new assisted-living community whose daughter is old enough to be my mother, and she and I have already gone several rounds in the few days I've been at this job. One minute she's telling me what a crazy, manipulative, lazy, profane, sloppy you-know-what her mother was for the past 50 years, and the next she's pounding on my office door yelling at me because her mother is screaming and crying in pain, hasn't gotten ANYTHING for it (I'd just pulled off a major coup by getting the resident's MD to put her on a fentanyl patch and Naprosyn, plus PRN Lortab), and why aren't you people DOING something about it?!
Well, maybe because the resident has been up bebopping around all morning, took a shower, and even came down to the dining room for Bible study, and never made a single mention of discomfort until her daughter walked in the front door.........ya THINK??? But of course you can't say that, all you can do is grin and bear it and try to suppress the mental pictures when this person says "And WHERE am I supposed to go when I have to worry all the time because I know Mom's not getting the care she needs?":rolleyes:
i guess that we all have horror stories along these lines...if the patient gets overwhelmed by fly you know that they have different wishes but that they don't want the 'children to have bad memories of the last days...so they go along with what is not what they want and is not in their best interests
funny you know that guilt has a lot to do with this...they feel that they can make up for the times they didn't go visit grandpa by making sure they have control in the last days
i have a dtr who is a nurse and she will make decisions for me if i am not able to make them for myself...a nurse knows that death is not the enemy but that the loss of meaningful life is
Enforce visiting hours for pt. rest and lower stress. Have security escort them out. This needs to be handled very matter of fact. When the doctor comes have the family leave- don't ask if they WANT to step out- it's not an option. The social worker, pt. advocate, etc. cannot do a proper assessment with a crowd in the room. That's like asking someone if they are being abused in front of the husband/BF or asking a kid if they are doing drugs- in front of the parents. In order to do an effective psycho-social eval they must not be present. Once the pt. wishes are established and witnessed- that's it. If he wants to go, then you won't have to worry about refusing to do CPR or intubate- because you won't ever call a code.
WOW... ty so much for sharing these stories... A few years ago my Granny past away. Before then her health started failing quite rapidly. She had been a diabetic .. eye sight went.. soon her mind, well ..she wasnt "Granny" anymore and my mom ended up caring for her until she ended up in the hospital. When Granny was "herself" years before..she always STRONGLY told us she never wanted to be on life support. Yet, here I was...looking at her with a big tube down her throat...and tubes in her nose. I was standing at her bedside..and until now, I have always felt guilty for this; but I knew in my heart...Granny never wanted it this way. Mom had stepped out and I reached over Granny with a cloth to wipe the blood that kept just oozing out the side of her mouth.. she moved and tears were coming down her face..she knew I was there and she tried to pull at the tubes. A nurse walked in and I asked if there was anyway Granny would ever walk out of here without some kind of life support. The nurse said no. She gave her another dose of morphine and before the nurse walked out I asked if we were just prolonging the ineviteable. The nurse just looked away and walked out. I knew her health was gone and I knew this was wrong..I also knew mom was hurting cause this was not only my Granny, but her mother whom she loves dearly..as I do my own mother. I kept pleading with mom that Granny needs to go peacefully.. Mom and I went out to get some air..and I do not know what happened..but when we came back up..Granny had passed away. Mom flipped and was extremely upset..I cried more so for my mother and Grandpa than I did for my Granny.
Here's why I've alwasy felt guilty.. I knew the pain Granny was going through..the nurses were always dosing her up with morphine..I knew she never wanted to be on life support..I knew that Granny, wasn't Granny anymore.. and when she passed on, I felt relieved. Relieved that she was not suffering anymore, relieved that she was finally at peace.. And at the sametime guilty for feeling that way. I LOVE my Granny, she was a second mother to me. But I didn't even cry at her funeral..and I've always felt guilty for that...that maybe there was something wrong with me. I think about her all the time, I wish she could have lived forever...
Anyway..ty again for this thread. It's nice to know that maybe...it was ok to not want Granny to suffer anymore...
nurse4theplanet, RN
1,377 Posts
absolutely!!!!! This is the only turn off I have to ICU nursing. I can not stand to see needless suffering. Its even worse when the family wants everything done to save 70 year old grand-whoever with no legs, no renal function, tube feedings, has a rectal tube, on a vent and sedated and is still not a DNR.....they lived a happy life, everybody has to die sometime. Quit being selfish! Then what really boils me to end is that half the time, the family won't even visit, they just call to check in, then want to come and yell at the nurses for every little thing they see wrong. I don't understand it at all.:angryfire
I saw alot of neglect and needless suffering in my home health rotation too. Some people just keep their elderly loved ones around to collect a check and really don't do anything but check to make sure they are still breathing every now and then.