Family who dictates Pt's care in ER, sorry long

jacads · Jul 23, 2006

My advice start sending out your apps for CRNA school and you will be done with this BS. Then you will get all of your breaks (and then some) your lunches, make 3x the money get much more vacation 1/10th the paperwork, no more PITA families to deal with and any difficuilt patients are put to sleep so no arguments. You also get to leave early some days with full pay. In addition no supervisors to deal with and you are much higher on the hospital food chain.

debbyed · Jul 24, 2006

Through-out my experience I have found that many time an adult child has feelings of frustration and guilt when they are forced by circumstances {may it be health, money or time} to put a parent into an ECF. Many times these feeling are masked by a need to control little things. Like the patient initially refusing an IV, Or the daughter refusing to allow her mother to be straight cath'd. Although both the parent and the adult child both know there is limited mobility they sometimes need the illusion of being normal at times. Many times by giving these folks the ability to make little choices ie: would you like the lights turned down, or a warm blanket will lead to them trusting you to make the big choices.

tridil2000, MSN, RN · Jul 24, 2006

My advice start sending out your apps for CRNA school and you will be done with this BS. Then you will get all of your breaks (and then some) your lunches, make 3x the money get much more vacation 1/10th the paperwork, no more PITA families to deal with and any difficuilt patients are put to sleep so no arguments. You also get to leave early some days with full pay. In addition no supervisors to deal with and you are much higher on the hospital food chain.

oh that's a supportive response!

it sucks to get old jacads, and guess what, you're on a one way street there too.

tridil2000, MSN, RN · Jul 24, 2006

Last night I received an 86 y.o. female pt hx parkinsons, falls via squad from an ECF with c/o RLQ abd pain and distention, no n/v onset only a few hours. Abd x-ray showed a dilated stomach with air, dilated loops of large bowel with air. Her belly was sl distended and firm with tympanic bs in LLQ. In the report from the squad the pt. ( retired army nurse) was refusing to answer questions. The pt refused an IV for them and me from the start stating "they just drew blood last night". The pt's daughter had arrived seconds after the squad and was informing me that her mom was a retired rn and she would be watching my care, whatever. X-ray tech was there right away so I sent her to x-ray first since the pt was refusing blood draw/IV. So pt gets back and we need a urine sample ( after the IV finally and pt agreed), you know r/o UTI. Normally, what we do in our ER from what I've seen being off orientation 2 weeks and a new grad is that an elderly pt comes in with these symptoms they at least get I/O st cath for a UA/CX. The daughter refused to let me do this. She also refused to let me give her mom any pain medicine. She insisted we get her up to the BSC. We didn't have time for this. I told the Doc. The doc came back out and told me to get her up to the bsc. So with a tech we LIFTED her up to the bsc and LIFTED her back to bed again afterwards. Come to find out the pt doesn't even walk anymore and has had 2 hip fx's with bolts/rods from falls and seen twice in our ER for falls. This pt's daughter was poa and I felt she was dicating her mom's care ( by the ecf and her standards) and what she did was delay tests and treatment. I always appreciate family input it is very important but this case was different. The pt. also had a radical mastectomy left Br. but the ecf was drawing blood on that side. She wanted us to put the Iv on that side and me and another RN explained why that was wrong and we were not going to do that. How frustrating. These are just highlights of this case, more went on but I have vented enough. Any advice or comments would be appreciated. By the way, I still love my job.

you'll have families and pts like this er06. after dealing with people like this for many years, you're going to have to realize that they are NOT concerned with your delays. try to put yourself in their shoes.... maybe someday you will be.

that said, imo, your 1st mistake was running to the dr with your problem.... obtaining a c&s. it isn't the dr's problem. you need to explain to the family the absolute necessity of a clean catch, and since she can not void properly into a sterile cup, the standard procedure is to straight cath. if the family still refuses, you could say something "well, i'm sorry to hear you're refusing this test, as i really think it may help find out what might be wrong with your mother." no need for snootyness or a sarcasm tone though, just act very concerned ... like you never had anyone refuse.

if she still refused, and insisted on getting her up, tell her "under no uncertain terms can she get up until we have an idea of why she fell at the ecf.... we will be more than happy to get her on a bedpan."

collect your regular ua and send it. document the family's refusal of the c&s, even after explaining the necessity. if it comes back dirty, she'll have to be cathed and the dr will probably even order it that way.

quick ?-- was she the pt's poa?

dealing with people is an art, and a skill school doesn't teach. always know though people have issues and they aren't you. you just happen to be dealing with them that day. explain things respectfully and thoroughly.... seem genuine. if they still refuse or delay you, don't sweat it and move on with your day. document your attempts. you can NOT make people do things they just don't want to do for whatever reasons.

after some time, when a dr says "er06, why was the c&s not done" you can explain your efforts and soon the docs you work with will take you for face value bc you genuinely try to get people to comply.

a communication tip for people like this:

don't say "no." never use the word. say things like, "i understand you would prefer to walk to the bathroom, i would too! but you are not allowed up at this moment. let me offer you the bedpan for now."

you have to verbally take control of the moment. you must get the pt, or family, to think they're being understood and addressed, but at the same time, getting what YOU need done.