Family dynamics

CANRN, MSN, RN · Apr 29, 2006

A few questions,
1) Can anyone recommend a good book on family dynamics? Our hospice did little training in this area. I've run into a few situations lately that I could have used some guidance on. (Forget the SW, he's never around and it apparently is acceptable to management...TM isn't much help, either)
2) What do you do with a family member who says "I don't want any medication added without my prior approval" and continually disagrees with your team's ideas and recommendations?
3) What do you do with the family member who has "some" medical background but the decisions they make are off the wall?
I'm finding family members are the hardest part of this job, not the care of the patient. I find myself getting frustrated, even angry inside. Education and teaching are usually effective, but not lately. I've been doing this job for 3 years now, maybe I'm just getting burned out? Yikes, I don't even know what I'd do for a change-I truly love my job....:uhoh21:

We recently had a patient's family who refused any meds that would "make him sleepy" and of course that pretty much did away with comfort for the patient. After many attempts with SW, our nurse manager talking to the family and even the pharmacy getting involved, our medical director said "discharge him" He felt that if the family did not want any interventions from Hospice, then why even keep the patient on. Made sense. He also said in situations like that, many times, the family will tell anyone who cares to listen "hospice did nothing for our Dad, Mom, etc" So the nurse went to discharge the patient and the family member who was making all the stink about comfort measures decided she would "try". The patient passed away comfortably and this particular family member was very grateful for what we were able to do for her dad.

Maybe that would work.

mc3, ASN, RN · Apr 29, 2006

My goodness, if I made the recommendation for discharge - which I believe we should have done a long time ago - my boss would kill me!

mc3

leslie :-D · Apr 30, 2006

there's never a one-answer-fits-all to these types of questions. family dynamics are as varied as the personalities that comprise them.

if the concerned family members do not have any legal authority to make decisions, then i find out what their specific concerns are. what is their knowledge deficit? what is their fear?

my first responsibility is to my pt.

and i always let the family members know this.

often i provide the same information over and over again, but that's ok.

if one of the family is the legal guardian, then i still need to know what their fear against medicating.

but for the most part, i have found that once the family is confident in the nurse's abilities, then they're usually receptive to the plan of care. and of course there are families that are more challenging than others to deal with; but still, i have found that when they see a confidence, a determination in caring for the dying pt., then they often concede and let you continue w/the plan of care.

actually many families are quite relieved when they see the nurse as being in charge. it relieves many ambivalent reactions from the afflicted family members and therefore, makes them feel more grounded.

it can be quite a dance we waltz to.....

leslie

mc3, ASN, RN · May 1, 2006

Thanks Earle58. The daughter is an ICU nurse, and is the POA along with the spouse. The daughter has stated that her mother would never be a DNR, and she does not want morphine, because "you'll just dope her up and let her die". Despite our attempts to educate, she could not - and didn't want to - look at any other position than that. We've pretty much done everything you've suggested. Our management doesn't have the courage - or financial desire - to suggest discharging the patient. It makes us wonder why she even signed the admission papers to begin with. When we asked her why she chose hospice, she said "I didn't. You (the facility nurse) told me I had to in order to keep her here".