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Family member issue......

Posted

Okay so here goes..... I work for a multicare facility and I float, a couple of days ago I had a relatively tough assignment; myself to 12 residents, half of which were self care and the other half was split between total care and assist x2. Anyways one resident in particular had me a bit puzzled or rather her daughter who is "involved" in her care. Her personal belongings are arranged in her drawers in outfits that are labelled with the days of the week and wrapped in plastic bags and the aides are instructed/warned not to dress her mom in any outfit other than the one that is labelled for the day. Now this resident had an accident on this day and since we are to follow this rule she was dressed in a gown and put back to bed in the middle of the day per the nurses orders. This resident is semi alert and sometimes has no clue what is going on and this day she was visibly upset and I felt very bad about this:cry:. I questioned the nurse about this and she told me that the residents daughter gets angry if her wishes are not followed. I debated :argue: this situation with the nurse and in the end it was basically "get over it that is what the family wants". I understand about wanting to be involved but at what point does it stop becoming care and becomes control?

That's just wrong. I don't understand why some nurses don't stand up for the residents. Why, they let family members make decisions that are not in the best interest of the resident. I would have put her in the outfit for the next day. What are they going to do? Write you up for dressing the resident.

It is a skill you learn - not to take things personal. The problem is not about you. The daughter could make a Accident - clothing change bag as well, but of coarse in reflection having know such famility members there is the strong possibility that such a suggestion would explode in a mine field. Sometimes it is best just to let family members figure out their own problems rather than make a suggestion to them that could fuel thier fire. Part of the occupational hazard. Just keep things simple. :cool:

asun21ta

Specializes in LTC, Home Health. Has 5 years experience.

Try not to let it get to you. Some of the things my LTC let the family members get away with is astonishing. You can't take it home with you. Sometimes the "Family Requests" are a bit far fetched. Unfortunately, sometimes they are not far fetched enough that something will be done. Many times, the demands are enough to drive everyone else that has to deal with them crazy!:banghead: I know. It sucks when it affects the resident in a negative way. It may be a bit of OCD and ignorance on her daughters part. Since the daugther isn't there with her mom all day, she has no clue what kind of accidents may occur, nor does she know how her mom feels when she's laying around in a gown all day while her peers are wearing clothes. There's nothing like a hospital gown to remind you where you are!

It's sad to hear your Nurses aren't very proactive with things like this. There should be some kind of balance. I would suggest that someone mention to the daugther that it would be a good idea to bring extra clothes in case she should have an accident. Someone should let her know how her mom feels when things like this happen. Maybe she could bring in extra house dresses or gowns. It's worth a shot. Where I work, it wasn't uncommon for the CNA's to nicely mention these things to the family members. However, the nurse were aware and prepared to back you up if your request goes ignored. Is there a unit manager you could discuss this with? I would give it a shot.

mncna08

Specializes in assisted living & memory care.

I agree, i would just ask the daughter to bring in an extra couple of outfits, or just some sweats in case it happens again.I supose you could of put that new outfit on, then washed it later on and she could of worn it again the next day. :) just my thoughts.

I agree the daughter should be asked about bringing in extra outfits in case of an accident. I know family members can drive staff crazy but I always tried to remember at least they're here and doing something for their family member. I would take an over involved one to the dozens that get left without family attention any day.

I think one of the charge nurses should ask the family to bring in two sets of "emergency changes" for their mom. Easiest way to deal with this. Surprised nobody has done this already.

Thank you guys for your responses, part of my debate with my nurse was that maybe the daughter could maybe pack an extra set of clothes and I kinda got the dumfounded-why bother-look. I dont know. Today I kindly suggested to our CN for the unit that maybe this issue could be brought up to the daughter, but as texastar stated that maybe I might be walking into a mine feild. Well at least I gave it a shot and I kinda got the feeling that maybe others have in the past, judging from the response I got from the CN.

coffee4metech

Specializes in OR.

Well the situation was solved because she was put in a gown and kept clean emergency / extra pair of clothes should be set aside. And just for further reference be extra vigilant with her toileting so a accident doesn't happen again.

asun21ta

Specializes in LTC, Home Health. Has 5 years experience.

Well the situation was solved because she was put in a gown and kept clean emergency / extra pair of clothes should be set aside. And just for further reference be extra vigilant with her toileting so a accident doesn't happen again.

I agree with you, in regards to toileting. I agree that she should be toileted as often as possible. However, working in an LTC, I understand that sometimes you can't get to a resident quick enough-especially when you have many others. Every two hours isn't often enough for some folks. I had a resident, where if you didn't catch her every hour on the nose, there was a big mess to clean. Lets face it, sometimes you can't get back to that room every hour. I think the issue here is not the fact that the problem wasn't solved. It's a dignity and respect issue. Why is this resident wearing hospital gowns when she has clothes? Clearly is affects her because she is upset. For this reason alone, I feel someone should make the daughter aware of how mom is feeling. I would want to know if it were my family.

This is were the land mines start about incognent patients. All patients are different and of coarse - while each patient "Should Be" checked regular - meticulous (SP?) family members can easily go into the direction that Their loved one is not being properly attended ot. I do know that when CNAs have the same patients regular and there is good communication accidents/prime time for BM and so forth are known. I would still be very cautious about addressing this to the daughter because while you have more than one patient to attend to - One of Thoose Days even when you have do your best - there may be one patient that has A Big Episode be it the flue or whatever and you just may not be available to the other patient when they do the U/BM blow. There are so many different types of senerios and the bottom line is - all patients even with the best care and are in facilites with low patient ratios - these things happen/it happens with one on one care in Home Health also. A social worker may be needed for the daughter - otherwise keep the distance on this issue because it can blow up in your face with all well meaning attempts made on your part if you don't let the staff and higher up deal with the daughter.

Elektra6, ASN, BSN, RN

Specializes in Home Health, LTC, subacute. Has 16 years experience.

In our facility social work handled all clothing requests for the resident. It's worth a shot.

asun21ta

Specializes in LTC, Home Health. Has 5 years experience.

Yes. Brining this up to a social worker would be an excellent idea. I would do that, then leave it alone. She is a good CNA to be so concerned for this patient's well being. So many times simple things like this are overlooked.

Lets face it, sometimes you can't get back to that room every hour. I think the issue here is not the fact that the problem wasn't solved. It's a dignity and respect issue. Why is this resident wearing hospital gowns when she has clothes? Clearly is affects her because she is upset. For this reason alone, I feel someone should make the daughter aware of how mom is feeling. I would want to know if it were my family.

I 100% agree with u.. my problem with the situation is exactly as stated; dignity and respect of the resident. This resident is on toileting q2hrs and despite my heavy assignment I did take her every 2 hrs; it was just one of those days when an accident can and did happen I mean she's human, it happens. Anyways we had an inservice on residents rights and such; being that the state is coming soon and I found it ironic that the instructors were the same folks that were present during the aforementioned situation. I guess its just that I am green and expect too much.

jb2u, ASN, RN

Specializes in ICU, ER, Hemodialysis. Has 5 years experience.

First, I am happy to hear that you care so much!!! Second, this is what happens when "customer service" is connected with healthcare!! The fact is there are more nursing homes, hospitals, doctor's offices, etc to choose from. This daughter may just like to control the situation because she feels that it is the best way to protect her mother from all the horror stories she has heard about nursing homes. Maybe the daughter is just a pain. Only the daughter knows the reason why she does the things that she does. That being said, it is HER mom. You are responsible for the care, but she is the daughter. I would not say putting her in bed is abuse. If you did not turn her q2hours, that would be abuse. If the daughter said, "if she has an accident and wets her clothes for Monday, just leave her in them all day. It will be fine," and then you proceed to comply with her wishes....that would be abuse and should not be followed. My point is sometimes you will have difficult family members and the nurse should advocate for their patient if there is a problem. They may have already tried to talk to this daughter and she flat out refused to bring in "extra" clothes. NO, you can not just put her in another outfit if that is not the families wishes. It could get you fired and lose the nursing home a resident. You may be able to live with this consequence, knowing that you stuck to your beliefs; however, the number crunchers of the facility will definitely not see it your way. They will, SADLY, see a lost "customer."

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

The social worker can be contacted for two reasons, one to try and gently suggest to the daughter that maybe a second change of clothing should be made available in case of soiling. Another reason is to see if there are any extra clothing brought by volunteers or otherwise that can be labeled for this patient for those 'just in case' days.

And, out of curiousity...does the daughter come and see her mother daily? If she came upon this situation and saw that her mother has on different clothing and an explanation was given, is there proof, so to speak that she will blow up, even after staff tried to comply, keep her comfortable and clean?

Good news pagandeva I was on the floor again yesterday and the residents daughter happened by and saw her mom in bed very upset and "demanded" to know why her mom was in bed in the middle of the day. The aide who was assigned to her mom explained the situation similar to mine except this time she was taken to the beauty parlor and she was soaked by the shampooing of her hair ( resident has a tendency to sit up in the middle of a shampoo) so the aide had to take her to her room and place a gown on her. Daughter was ranting for a while until a senior/regular aide stated that her mom has no extra clothes and this is the procedure that we follow. The daughter demanded to know who decided on this and she was paointed in the direction of the CN who then explained the bigger issue. Last I heard a meeting was scheduled with the social worker to discuss alternate ways in which to preserve her moms dignity and to keep her happy, for a minute I felt as if I were in an episode of the twilight zone.....I mean I guess it had to take a situation where daughter walked in on to realize that maybe a compromise was in order. Anyways I am glad it worked out.

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

Good news pagandeva I was on the floor again yesterday and the residents daughter happened by and saw her mom in bed very upset and "demanded" to know why her mom was in bed in the middle of the day. The aide who was assigned to her mom explained the situation similar to mine except this time she was taken to the beauty parlor and she was soaked by the shampooing of her hair ( resident has a tendency to sit up in the middle of a shampoo) so the aide had to take her to her room and place a gown on her. Daughter was ranting for a while until a senior/regular aide stated that her mom has no extra clothes and this is the procedure that we follow. The daughter demanded to know who decided on this and she was paointed in the direction of the CN who then explained the bigger issue. Last I heard a meeting was scheduled with the social worker to discuss alternate ways in which to preserve her moms dignity and to keep her happy, for a minute I felt as if I were in an episode of the twilight zone.....I mean I guess it had to take a situation where daughter walked in on to realize that maybe a compromise was in order. Anyways I am glad it worked out.

Isn't it funny how things work out? It seems that the daughter was a bit inflexible and had unrealistic ideas, and here it is, she walks into a situation where it was plain to see that alternative plans needed to be made. Now, maybe instead of being a hinderance, she can become a help. And, if she doesn't, I would still continue to do as what happened...she cannot remain in wet or soiled clothing, so, something must happen. Great news.

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