Family member in the hospital

[Apples&Oranges]

Hey guys, it's been a while. Looking for some advice. My dad was admitted to a local hospital this weekend (thank goodness not mine!) As a nursing student preparing to take boards, I am at least minimally aware of some aspects of the "textbook" care he "should" be receiving - things like infection control, labs, (some have been wacky) mobility (major pneumonia risk,) I am also ABSOLUTELY aware that the experienced nurses are EXPONENTIALLY more knowledgeable than I am in every aspect of patient care. I trust them almost implicitly. As a daughter, I am a paranoid mess, but doing a very good job (I feel) of keeping my mouth shut and not sweating the small stuff - I don't want to be that pain in the *** family member. As an APCT (and a damn good one) for quite some time, on a busy, high acuity unit, I am well aware of the realities of hospital life - I know he is one of 23 pts, may not get mobile, cleaned up, whatever, basically the level of attention and help that we would all ideally want for ourselves and our loved ones every minute of every day - I'm realistic, and thrilled to be there to do as much as I can.

Situation: I feel that things are being...overlooked:

-Gave rapid acting insulin and didn't make him eat - next BG, at 28.

-No incentive spirometer, coughing, getting him up, even encouraging sitting up except for 10 min of PT a day (yeah, it's a respiratory issue.)

-Totally immobile in bed for DAYS, but no SCDs (yes SQ heparin)

-No foley care for 36 hours (and yes, I know for sure, one of us was here continuously)

-Intermittent S/S of confusion/delirium -- this just scares the hell out of me, and I can't seem to convince the staff that this is NOT his baseline - he's normally sharp as a razor!

Question: How do I get my concerns addressed without coming off as an *******? It drives me nuts in the ED when a mom says, "Um, you know you didn't scrub that with alcohol long enough, right? You're supposed to do it for a full minute." Hm, I don't think so. Or "OMG!! STOP!! You can't get BP on the left, he has an AV fistula!!!!" Yeah, pumpkin, I know, if you had let me fully open the door, I would have actually made it INTO the room and eventually to the other side of the bed.... Sheesh.

So how do I keep him safe without being that girl they talk about in report and say "he's a sweetheart, a little confused, but the daughter - OMG, she's a pain in the ***."

How do I get them to say "he's a sweetheart, a little confused, and the daughter is a NS, but super helpful, seriously. No really, don't roll your eyes, I know nursing students suck, but this one... you'll be glad she's here."

[Apples&Oranges]

Thank you, surfer, for clarification on that. On the clinical unit, our pts usually have both. I'm glad I asked.That makes sense.

[Brandidrn]

I want to say this: if you were caring for someone's dad would you give the same level of care your dad got? If the answer is no then start making some noise girl personally I don't care what they think of me. I only expect the level of care I would do for any patient. When my husband was recently in hospital I did all his care I could like shower, bed changes, ice or pillow fluffing so his nurse had to do the rest and correctly or I told them. Bottom line I never ask anyone to do anything I wouldn't do if this were my patient.

[OneDuckyRN]

The delirium/intermittent confusion is alarming. That should be the focus of your concern right now if there is no explanation for that. Has he had any temps? Have they done blood cultures? It could just be him reacting to being in the hospital.

This...or, if he hasn't had foley care in 36 hours, maybe a UA/culture is in order??

I agree that you need to be your father's advocate. I'd do the same thing, PITA or not. I hope he gets better soon!

[Lev, MSN, RN, NP]

pain meds

That may be the cause. What is he on for pain?

[ComeTogether, LPN]

I don't think you're being unreasonable at all. He is your Dad, and you need to advocate for him. I would bring up your concerns with his nurse, for sure. If that didn't get me anywhere, I'd move up to the charge nurse, et al.

[Whispera, MSN, RN]

The family members that bug me the most are those that tell the nurses what to do but don't lift a finger themselves. Ask to be involved in your dad's care. When there's not enough time for staff to do things you know how to do, volunteer to do them.

And if he's getting worse (confusion, lack of mobilization, low blood sugar due to mistakes) be a pain, in as non-aggressive way as possible. These things have to be addressed.

[xoemmylouox, ASN, RN]

Sometimes you have to be a PITA. I know I was. When they were giving my father meal trays and fresh water all of time despite him being NPO for aspiration precautions and sedation.. or when they were trying to give my father other patient's medications. etc. I made sure we had someone there as much as possible after the many issues we dealt with. If your loved one is in danger speak up and help out. I don't like people telling me how to do my job or nit picking. If you see a legit issue.. PLEASE tell me.

[Sisyphus_01]

OMG, this is so hard. My grandmother had an "accident" (she peed and pooped on herself) because her call light/alarm wasn't answered in time. She was in this "skilled nursing facility" after surgery for a broken ankle until a week ago, if she had been staying there long term I would have reamed their asses out. Also, I know this wasn't a one time lapse because when visiting her I sat there as call lights and alarms from multiple patients went unanswered for 45 minutes on multiple days!!! I checked on the people myself to make sure they weren't in acute distress and they weren't at the time. But seriously???! If a patient were choking or having a heart attack and they pressed the call button they would be dead before one of the staff got there. That is unacceptable and criminally negligent in my book, especially when I look down the hall and see three staff members sitting on their asses.

Oh and this was great too. She took off her walking boot on the day the doctor said to do it but quickly developed pitting edema and warmth and redness in the foot. My father and I were out of town at the time but we called her doctor and the orders were to make sure she elevated her foot and iced it... the staff didn't direct her to do either of those things. I asked them and they basically said, "Oh... my bad." UGH Plus, she has diabetes... you'd think they'd be hyper vigilant about any foot issues in her case especially, but nope.

[Sisyphus_01]

I agree with the first response, you have to be an advocate, and I will add that you must maintain this stance even if your family member is pissed at you. I wish I'd spoken up recently, but I clammed up at my husband's bidding, and to his detriment.

Here's what happened. My husband is currently dealing with an undiagnosed illness (he's being sent to Mayo in the spring) and hubby thinks I am all UP in people's sh*t, but in truth, I'm usually just reminding him of things he forgets to tell the clinicians. He has gotten so frustrated with me that he has told me, "I don't want to hear a PEEP... not a PEEP, OUT OF YOU!" However, I seriously regret not being the b*tch and saying something in one particular situation. My husband was sent for PFTs when COPD was suspected after preliminary spirometry tests. I knew they should have included body plethysmography in his tests, but he had been so angry with me in the car ride over, making me promise not to say anything. The booth was in the room, but they did not perform the test and I did not say anything. The doctor concluded he did not have COPD. After 6 months of additional testing and visits to many specialists assuming a rule out” of COPD we finally went to see another pulmonologist who did a body plethysmography test and diagnosed my husband with stage 1 COPD. This is not his entire diagnoses as there are neurological, constitutional, and other symptoms but it would have been nice to know that he did have COPD!!!

Stick to your guns, be polite, but if they don't listen I say you're entitled to open up a can of B*tch craft… cause you gotta take care of your family :)

[Gooselady, BSN, RN]

You can't do ANYTHING to adjust or influence how another person 'takes' you. That's actually good news, a huge relief, as I well know, having spent most of my life trying as hard as I could to 'control' what other people thought of me!

This is your FATHER. The only one you'll ever have. Fiddlesticks on the nursing staff who heatedly whisper about that neurotic NURSING STUDENT DAUGHTER in the report room! Your list of 'not done' is credible and their excuses for not performing those simplest of nursing duties is professionally unacceptable. What you describe in his care are not massive sentinel event type oversights, but they are still oversights that shouldn't happen. They are likely to be a direct result of typical overworked and understaffed nursing units, though that is no excuse -- just a reason fwiw.

[ak2190]

I watch my family members like a hawk when they're inpatient. I make sure to be polite to everyone, but I let them know if something is a concern and make sure it gets addressed. SPEAK UP! Be an advocate for your dad.

[TriciaJ, RN]

That may be the cause. What is he on for pain?

Or the pain itself could be making him squirrelly if not well controlled.