Picture yourself in this situation and tell me what you think or what you would do differently:
I am in orientation in an ICU with one patient assigned to my care. Since I am still orienting, I have a preceptor for the duration of my day, I am still not really familiar with this environment, and I am only able to perform basic care tasks on my shift. This particular patient who I am assigned had a major MI a few days ago and is currently on ventilation, has a balloon pump in his groin, has continuous vital signs, and is hooked up to multiple IV drips including a sedative, insulin, heparin, and a vasoconstrictor. The family, who are not very educated and not as capable as most to do and to have access to research, visit frequently. I inform them that they can ask questions if they have any and they almost immediately begin asking me questions such as "What are these numbers on this machine (talking about the ventilator) and why are those numbers different from these numbers (talking about the vital signs being consistently read in comparison to the numbers on the ventilator)?" I explain to them how the ventilator works, why the numbers are different on the two machines, and why the patient needs these machines during his stay in the ICU in as elementary terms as possible. The family also begins to ask about how his vital signs have been doing, if these numbers are good, and if any significant changes have happened over the patient's stay. I explain to them exactly what each vital sign was, how they are read, what the normal ranges for each are, how some of the medications are helping these vital signs stay WNL, and why we need to reinterpret them so frequently. As I was explaining this, my preceptor interjects by saying that she needed to show me something in another area, pulled me to the side, and proceeded to reprimand me for giving the family too much information. She told me that with all of this information the family might make judgments about our care or begin to think that we were attempting to make the patient DNR (which I really didn't understand). She proceeded to tell me to keep it simple and to not disclose so much information about this patient's care.
These are the people who care about this patient most. These are the people who will be caring for this patient for the rest of his life. These are the people who are taking the time out of their days to visit their family member and make sure he is being adequately cared for and comfortable. With all of this being said, not only was I completed offended by this statement by my preceptor and very taken aback by such a bold statement but I was also very curious as to what others would think about this situation. So, my questions for you all are:
Did I go too far?
Did I give too much information to the family?
Does the family deserve to know this information?
Isn't it our jobs as nurses to be patient advocates and give the family as much information and teaching as possible to help them understand that we are doing all we can to help their loved one? And if so, why was my preceptor so adamant about me giving the family too much information?
Is my preceptor feeling guilty about something and therefore not comfortable with disclosing information about this patient's care?
Is this teaching and education within our scope of practice?
Was I wrong to inform the family of and keep the family informed of the patient's situation?
I also think it is very condescending to tell people not to worry about anything or that they should just focus on being with their family member. Sitting beside your loved one and watching lines and number changing on monitors, and not knowing their prognosis, and hearing beeps and people coming in and out can be very anxiety provoking. Families do appreciate someone who takes the time to answer their questions and I fully support you in respecting that. Knowing what is happening can actually lead to fewer questions as now they know that it is 'normal' for the number to be changing or that beeping might just mean a positioning change is needed and its not a crisis.
You will find that different hospitals have differnet philosophies as to how family centered or unfamily centered they are and on this board you will see nurses also have a wide range of attitudes and philosophies towards family involvement.
Talk more to your preceptor and find out what her thoughts were. If it is just she is worried about liability if you do something wrong and they can figure it out that isn't a good reason. If you were talking so much it was keeping you from getting your work done - that is a good reason. If you were giving them more information then they were asking and overloading them, that is a good reason. If your preceptor just isn't very family friendly, that isn't a good reason.
Take into account her opinion but use your own professional judgment. As long as you are giving objective data that is going to help the family better understand the patients illness and care and support their coping with the situation, I am all for it. If they start asking too many questions you can put boundaries on when or for how long you can talk. Also writing things down for them that they might easily forget (and ask repeatedly) can help - things like what BP/pulse/O2 range is acceptable for this patient.
Granted, I have a greater interest in science and technology than most, but having someone talk to me like I was a child and tell me "my job is not to worry about the numbers" would cause me to be incredibly angry/frustrated. I guess it depends on the person - some people that would fly for, others its absolutely the wrong approach and the implication that technical/specific knowledge/information would be "too much" for a family member to handle would make me want to change hospitals.
I think the point she was making was to help the family to focus on the patient and not stare at the monitors. I believe even those visitors with technology and science interests do not have enough medical background/patho knowledge to really understand what the numbers on the monitors mean. Some will get panicky if any of the numbers decrease or increase even slightly.
If they are really anxious about the monitors and ask "what do all those numbers mean?" I will explain the basics. "The green numbers are the heart rhythm and HR, pink is BP, white is RR and blue is oxygen level". I, too, frequently tell my family members not to focus on the monitors. I do not say it to belittle them and I say it nicely-not in a condescending way. . I gently explain that we look at trends and not individual numbers.
Specializes in ICU, Home Health, Camp, Travel, L&D.
Did I go too far?
Did I give too much information to the family?
Does the family deserve to know this information?
Isn't it our jobs as nurses to be patient advocates and give the family as much information and teaching as possible to help them understand that we are doing all we can to help their loved one? And if so, why was my preceptor so adamant about me giving the family too much information?
Is my preceptor feeling guilty about something and therefore not comfortable with disclosing information about this patient's care?
Is this teaching and education within our scope of practice?
Was I wrong to inform the family of and keep the family informed of the patient's situation?
What do you think?
1. Absolutely NOT... While I do think the big picture w/ the patient, not the equipment, should be the focus, those numbers do matter because they are pieces of a puzzle that help drive our interventions. That's how I start & finish with the education, because it keeps them from stressing so much about the dread numbers dance.
2. If you answered their questions, and they were able to understand what you said, absolutely not. If they gave you the deer in the headlights, perhaps you should have put all the cookies on a lower shelf. If you can picture teaching at a 4th grade level, that's not necessarily a bad thing...stress of a family member being critically ill can set back the most intelligent, savvy families.
3. OF COURSE they deserve to know the answers to anything they ask about their family member...it is THEIR family, not ours, and the incredible arrogance in thinking otherwise sickens me.
4. YES, you are the advocate & teaching is one of the most important roles of an ICU RN...this is the bread & butter of your scope of practice.
5. PRECEPTOR MOTIVES: maybe she's been to court & is gun shy, maybe she's just a paternalistic, ethnocentric arrogant ass who is still living with the delusion that The Doctor is GOD and we, as His Handmaidens, need only dole out the "keys to the kingdom" to those we deem worthy. Very little in medicine irritates me more (can you tell?)
6. Ummm, no. Educated families are happier families. When you build rapport, listen and provide emotional support, you actually strengthen the family's belief in what you are doing. These families are less likely to complain, less likely to sue, less likely to make your life a living torment even if their love one achieves a less than optimal outcome.
So there. While I wouldn't recommend your doing it, I'd love to flip your preceptor the bird.
Your preceptor is partly right. I once educated a family member that a bp range of 120s/70s was good especially if someone has hypertension. The next few weeks were nightmares, they did not grasp the concept, bp would be 118/67 and they would request bp to be retaken, waste staff time and just give us headaches
Patient and family education is important, and I often find it to be one of the more rewarding aspects of nursing. I applaud you for caring so much about the needs of this patient's family. I agree, however, with the posters who have encouraged you to simplify and generalize as much as possible when giving information; giving too much info can backfire on you and cause the family unnecessary anxiety. Over time you will learn to assess that family the way you assess the patient so that you give enough info to educate but not so much that you overwhelm them or cause them to obsessively watch the monitors as if it were a Keno screen at a casino.
Your preceptor was wrong to come down so hard on you, but you will find that nurses have really strong feelings about how to deal with patient family members. Don't dismiss your preceptor's advice outright; just take it with a grain of salt. You felt hurt and angry about what she said, but there was still something valuable to be learned from the advice.
I still spend more time educating family than most nurses on my unit (when I have the time!), but I have dialed it waaaaay down over the past few years for the reasons already mentioned by other nurses in previous posts.
Patient and family education is important, and I often find it to be one of the more rewarding aspects of nursing. I applaud you for caring so much about the needs of this patient's family. I agree, however, with the posters who have encouraged you to simplify and generalize as much as possible when giving information; giving too much info can backfire on you and cause the family unnecessary anxiety. Over time you will learn to assess that family the way you assess the patient so that you give enough info to educate but not so much that you overwhelm them or cause them to obsessively watch the monitors as if it were a Keno screen at a casino.
Your preceptor was wrong to come down so hard on you, but you will find that nurses have really strong feelings about how to deal with patient family members. Don't dismiss your preceptor's advice outright; just take it with a grain of salt. You felt hurt and angry about what she said, but there was still something valuable to be learned from the advice.
I still spend more time educating family than most nurses on my unit (when I have the time!), but I have dialed it waaaaay down over the past few years for the reasons already mentioned by other nurses in previous posts.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i'm interested in what you're not saying about the family -- do they not have education and access to research because they're poor? (the public library is free). or because they're not very bright?
i think that if the latter is the case, you did indeed give them too much information -- not because they're not entitled to information, and not because they might "make judgements" but because they probably don't have the background to understand everything you've told them. and now you've created a situation where a family is going to sit and stare at the monitors and ventilator and react to the numbers. every nurse who follows you will be treated to "dreamsdocometrue said that number should be a 99 and it's a 94. is that bad? how come you're not doing something about it?" or "yesterday that number was 16 and today it's 14. is that good?"
families, for the most part, don't need to know all the "numbers" and the normal ranges. what they're most interested in (or should be, anyway) is how well mom is doing. i would have told them that "we're monitoring her vital signs and her breathing, and today she's doing just a little bit better. we're having to use less of the blood pressure medication to keep her blood pressure where we want it, and she's doing more of the work of breathing on her own. our plan for today is to get rid of some of the extra fluid she has that's making her so puffy -- we'll give her a medication to make make her pass more of the fluid out in urine. and we plan to improve her breathing muscles by letteing her do more of the work for a few hours, and then we'll let her rest for awhile. those numbers let me monitor how much of the work she's doing, and i'll be able to tell when she starts to tire out so we can let her rest." or whatever your plan for the day might be.
i'd rather have a family looking at the big picture -- is mom getting better or not? and is her breathing improving or not? -- than focusing on numbers that they don't understand and pestering whoever is taking care of mom to explain each change in the numbers.
besides, looking at the numbers can make you crazy. i make sure i don't look when the patient is my family member! or at least not to stare at them, transfixed, when i should be looking into mom's eyes and reassuring her that i love her.
i agree with ruby. i try to give them as much information as possible but i avoid getting into the monitors. i tell them the monitors do just that....monitor. if they were always right.....i wouldn't be needed. if i'm not running they shouldn't be concerned. i tell them i went to school for a long time to learn how to take care of all this equiptment and their loved one........they need to visit with the family member and whisper for them to get better. i have even threatened to turn the monitor as dim as possible if they continued to fixate on the numbers;) ......as that was my job.
i tell them what the goals are for the day......wean not wean.....whether they are "stable" or are they more labile. i will tell family if their family is not doing well by saying they aren't having a good day and the medicine to keep their b/p up is very high and we are worried and doing everything humanly possible to smooth things out. when they ask "are they going to die?" i do tell families that there is only one person who knows that answer......whether you think it is god or buddah, muhhamid or noone......i believe that god has that answer and i am not privy to his meeting.....we can pray for them to not suffer and for me to do my very best to be sure to give them the very beat care i know how.
you will find you own way that you are comfortable with for dealing with families. i think your preceptor is uncomfortable with this and therefore will discourage you. while orienting you may have to bend to her wishes but remember. the famiily has the right to know......you are the patient advocate and you will find your neiche....i think you did very well........:heartbeat
I'm thinking. Now the family members that visit aren't necessarily family members. Often times the patient's room will be filled with people and it appears that it's family, but it could very well be co-workers, neighbors and members from their church. So, yes, be careful when you're giving information to the patient's "sister". All of the loving and caring people in a room may not need to know what medication is doing what. Just be careful. I've often found it quite annoying when I'm visiting with a family member and the nurse comes in smiling and makes the assumption that it's okay to start doing procedures or discussing things. Just because the family matriarch is in the room doesn't mean that everyone surrounding her isn't from her lodge. Just one way to look at it. Maybe talk to your preceptor again to find out exactly where she's coming from.
Posters from both sides have made some very valid points. I usually start out with a very general answer, and then wait for them to ask another question. What they ask will tell you if they are still processing information. Give them time to think. Family educated in healthcare will ask more and more detailed, relevant questions. Laypeople will ask the same question in a different way 30 min later. Turds will ask detailed questions about things that don't matter, and stuff you haven't begun to think about. If your patient is tubed and waiting for surgery only a dink wants to know how he'd order dinner after surgery. Redirect to the issues at hand, and see if they get it then. Family should leave with a good idea about the main problem(s), and some idea of the plan to deal with it.
Picture yourself in this situation and tell me what you think or what you would do differently:
I am in orientation in an ICU......
Did I go too far?
Did I give too much information to the family?
Does the family deserve to know this information?
Isn't it our jobs as nurses to be patient advocates and give the family as much information and teaching as possible to help them understand that we are doing all we can to help their loved one? And if so, why was my preceptor so adamant about me giving the family too much information?
Is my preceptor feeling guilty about something and therefore not comfortable with disclosing information about this patient's care?
Is this teaching and education within our scope of practice?
Was I wrong to inform the family of and keep the family informed of the patient's situation?
What do you think?
I personally saw your time being used up answering questions that the family did have a right to have answers to. They do have a right to answers, but unfortunately we don't have all that time. Sometimes you might have time to sit down and talk. Other times you won't. Maybe next time, when a family starts asking questions, anticipate and give them a big old summary to nip it all in the bud. Don't wait for their questions, if you see it coming. :) One day you will know how to "see it coming"! haha.
-- I wouldn't worry about it as much as you are, or take the preceptor personally. If there is one thing I tell new nurses (I'm not so experienced myself), it is to not take things personally and that you will experience a lot of things you "should have done differently" but you have to make your own "goofs" to learn from your own experiences yourself and get your own "flow". No one can tell you how or why, exactly, to handle this situation. This preceptor used a lot of words and energy to try to teach you but you will learn from it what you need to. :) You'll be surprised how quickly you will learn to group and summarize all that info and be brief. That is how new nurses learn best and more experienced nurses need to remember this. You need to stay within your standards and scope of practice, and you did that.
If there is one thing I tell new nurses (I'm not so experienced myself), it is to not take things personally and that you will experience a lot of things you "should have done differently" but you have to make your own "goofs" to learn from your own experiences yourself and get your own "flow". No one can tell you how or why, exactly, to handle this situation. This preceptor used a lot of words and energy to try to teach you but you will learn from it what you need to. :) You'll be surprised how quickly you will learn to group and summarize all that info and be brief. That is how new nurses learn best and more experienced nurses need to remember this. You need to stay within your standards and scope of practice, and you did that.
Meraki
188 Posts
I also think it is very condescending to tell people not to worry about anything or that they should just focus on being with their family member. Sitting beside your loved one and watching lines and number changing on monitors, and not knowing their prognosis, and hearing beeps and people coming in and out can be very anxiety provoking. Families do appreciate someone who takes the time to answer their questions and I fully support you in respecting that. Knowing what is happening can actually lead to fewer questions as now they know that it is 'normal' for the number to be changing or that beeping might just mean a positioning change is needed and its not a crisis.
You will find that different hospitals have differnet philosophies as to how family centered or unfamily centered they are and on this board you will see nurses also have a wide range of attitudes and philosophies towards family involvement.
Talk more to your preceptor and find out what her thoughts were. If it is just she is worried about liability if you do something wrong and they can figure it out that isn't a good reason. If you were talking so much it was keeping you from getting your work done - that is a good reason. If you were giving them more information then they were asking and overloading them, that is a good reason. If your preceptor just isn't very family friendly, that isn't a good reason.
Take into account her opinion but use your own professional judgment. As long as you are giving objective data that is going to help the family better understand the patients illness and care and support their coping with the situation, I am all for it. If they start asking too many questions you can put boundaries on when or for how long you can talk. Also writing things down for them that they might easily forget (and ask repeatedly) can help - things like what BP/pulse/O2 range is acceptable for this patient.