Family Behavior during a code

Nurses General Nursing

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I work as a float RN at an acute rehab hospital. I have worked there for 7 years. Two days ago, I had an elderly patient who had had a stroke. He had multiple co-morbidities. The son was in the room. They had been admitted the prior day. In report that morning, I had been warned that family was very difficult. I found the son to be suspicious. He demanded I explain each medication and why I was giving it. He chose the meds to be given or held. I complied with his requests. My patient load was demanding. From 0630 until 1350, I never hit the restroom or took food or drink. We have Spectra-link phones. At 1350, I did go the restroom and then spent 15 minutes in the breakroom eating. Shortly after 1400, I finally sat down on the unit to chart (since I had not had a chance to chart all day). At 1425, I heard a shout from my patient's room. The son had come into the hall shouting, "I need help, he's turning blue". A tech ran in the room, hit the code button. I was in the room within one minute. As the room was filling with the code team and additional staff, the son kept shouting that "I kept calling the nurse and she would not come". The pt was in full arrest and a code was conducted with eventual ROSC (about 15 minutes in). He was transferred to ICU. I was so horrified by the son's false claims that I had a charge RN look at my phone, both missed calls and received calls. There were no calls from that room to me between the time I was last in there (noon meds) and the code. I also took pictures of the missed call and received call lists on my personal phone. This has made me very nervous. I have . What steps should I take now?

10 hours ago, Susie2310 said:

This is correct. Also, patients' family members/POAs sometimes have good knowledge of the patient's medical history, current medical problems, medications, allergies, etc., and if given the opportunity to explain can offer good reasons for refusing certain medications.

19 hours ago, Horseshoe said:

If the son has medical POA, I think it's perfectly appropriate for him to want to know what each medication that his father is getting is and why he getting them. Giving this information is Nursing 101.

Yes, yes, yes...yep. It is nursing 101. So maybe we don't need to always assume more than what is conveyed in a well-written post by a nurse of 7 years. S/he used the word "demanded" because that's what he did. Haven't either of you ever had any one put a fist in your face before you could even state your purpose? Or despite the fact that you were already engaged in the very process of doing the thing that was being demanded? This guy didn't put a fist in the OP's face but it does sound like his behavior was the verbal equivalent.

Both of you I'm sure understand the concept of family members who are suspicious unrelated to any action (or lack thereof) by the person caring for the patient. Even if there is some actual precipitating factor for their suspicion somewhere in the family's history of medical experiences, the nurse who walks in to it still must be prepared, and should cover the bases I described above.

My take on the initial situation (irrational suspicious aggression) at the bedside is correct as evidenced by the fact that the guy continues to assert that wrong has been done when there is no reason to assert that. These people are troubled and occasionally they make real trouble for others.

Overall it is not a situation to simply pacify without letting others know, getting some help/reinforcement as needed, and accurately documenting.

10 minutes ago, JKL33 said:

Overall it is not a situation to simply pacify without letting others know, getting some help/reinforcement as needed, and accurately documenting.

Of course. Which is exactly why I said it's important that the nurse document, inform the doctor, and be very glad she has the evidence to exonerate herself. I don't see how we are in much disagreement. Basically I was saying the problem isn't so much that the son is wanting to know the drugs and rationale (even if he is "demanding"), it's the making the call to refuse certain meds and making false accusations that is the larger problem, so actions by the nurse to protect herself (and the patient) are key.

I felt the implication was that he was justified in his actions because the fact that he demanded (or, "had to demand") something was some sort of statement about the reality of the nurse's actions. That's generally why we would tell another nurse that something was "nursing 101."

My apologies if I misunderstood.

2 minutes ago, JKL33 said:

I felt the implication was that he was justified in his actions because the fact that he demanded (or, "had to demand") something was some sort of statement about the reality of the nurse's actions. That's generally why we would tell another nurse that something was "nursing 101."

My apologies if I misunderstood.

Nope, I was in no way justifying his actions...I'm very glad the OP documented and has the proof that she was in no way negligent in this situation.

With everyone's input, the thread is a decent blueprint for handling of suspicious family members. ?

1. Kindness and understanding of their position

2. Offering prudent nursing information as expected - don't feel intimidated and then neglect to do the things that would usually and rightfully be expected

3. Document concisely (this is actually a good scenario for pulling out the old nursing note or end-of-shift summary or situational summary note, there-by avoiding the mistake of documenting play-by-plays of each altered family interaction).

4. Make appropriate and timely referrals for assistance in the situation

5. Gain management's understanding of the situation

OP- I have been in your shoes too many times with suspicous/aggresive/ passive aggressive family members. It isn't just the obvious violence against heathcare staff that contributes to moral injury and distress. This behavior (I think) is huge problem. I agree with a previous poster that some sort of action needs to be implemented for dealing with/ deescalating this type of behavior. While I assume the behavior is coming from a place of stress and concern on the family members part, it is death by a thousand paper cuts on the front line providers.

In this case, that ship has sailed, but in the future; is there away to involve case management/social work/ risk management/ ethics (I honestly have no idea who would head up such an endeavor) and have a family meeting about this?

Perhaps this is a CN III project idea? (though it sounds kinda awful)

So, my lame advice:

If you have a union, is there a rep you can discuss this with?

I was going to suggest risk management, but then I don't know if they are more interested in covering the hospital and let an RN be the scapegoat.

Definitely contact your insurance as they certainly don't want to pay.

Take a deep breath knowing you did everything you were supposed to do that day.

good luck!

Let us know how it works out!

Oh- I'd also take this as a sign that no matter how hard you bust your butt, things will hit the fan... so please take care of yourself... get some food, get some water and for gods sake, go pee. You are not a martyr.

Any time I get matched up with a family who seem suspicious and demanding, I figure either they are very scared (lots of people view the medical community with distrust) and just are grasping for some form of control (or want to be able to say they did their best to advocate for their loved one), or they are actually hoping to catch you in a mistake (potential for lawsuit). In either case you must be meticulous with your documentation about your interventions, patient/family education, efforts to keep the whole team informed about the dynamics, etc. Of course, at the top of your priorities is patient well being and safety, but let's face it, you have to look out for yourself as well. Safe practice and accurate, thorough documentation is the best way to protect yourself.

To flip the script and work backwards, no actual harm came to the patient, right? So there is nothing to defend legally. Cases against nurses revolve around harm caused and provable negligence that caused that harm. You were neither negligent nor was harm caused. I would want to see that POA documentation or explain that it needed to be shown before you are ‘allowed’ to listen to the son. Without that document, I would remind the son that you are under orders and you will let the doctor know that he wants to talk over the orders. Correct me if I’m wrong, but without POA, sharing treatment information with the son (without verbal or written agreement from dad) is a HIPPA violation.

1 hour ago, _firely said:

To flip the script and work backwards, no actual harm came to the patient, right? So there is nothing to defend legally. Cases against nurses revolve around harm caused and provable negligence that caused that harm. You were neither negligent nor was harm caused. I would want to see that POA documentation or explain that it needed to be shown before you are ‘allowed’ to listen to the son. Without that document, I would remind the son that you are under orders and you will let the doctor know that he wants to talk over the orders. Correct me if I’m wrong, but without POA, sharing treatment information with the son (without verbal or written agreement from dad) is a HIPPA violation.

I don't normally correct spelling or grammar-it's not relevant to the subject. But I do note that it is HIPAA, not HIPPA, because that is something that we should be referencing correctly.

It's not clear from the OP whether or not the son is the POA or has permission to receive information. If he is "refusing meds" for the patient and that refusal is honored, I'd guess that an experienced nurse has already verified whether or not that refusal is legally valid. I doubt she is thoughtlessly violating HIPAA.

On 4/22/2019 at 10:31 PM, FolksBtrippin said:

Is it possible the son means that he called out "Help!" and not that he called your phone? His perception may be that no one answered him because he was distressed.

I wonder this also.

The OP referenced no calls to the phone because the call lights are directly integrated. So whatever he did, he didn't push the call light, which is absolutely fine and understandable. But since people clearly came running the instant he stepped out into the hall, we can fairly infer that no one knew he was calling for help before that, which was not what he meant to imply. At all.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 4/23/2019 at 9:07 AM, JKL33 said:

With everyone's input, the thread is a decent blueprint for handling of suspicious family members. ?

1. Kindness and understanding of their position

2. Offering prudent nursing information as expected - don't feel intimidated and then neglect to do the things that would usually and rightfully be expected

3. Document concisely (this is actually a good scenario for pulling out the old nursing note or end-of-shift summary or situational summary note, there-by avoiding the mistake of documenting play-by-plays of each altered family interaction).

4. Make appropriate and timely referrals for assistance in the situation

5. Gain management's understanding of the situation

I agree with all of your points -- especially talking to management before the suspicious family member. The other thing I would suggest, though, is documenting at the time which meds were held and why, including documentation that the provider was notified. I don't think this documentation can wait until after the family has escalated their negative behavior. It needs to be in the chart when the provider or management first looks into their concerns.

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