Family member sabotaging patient!

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I work on a surgical unit, we have an elderly gentleman in for I/D of his left elbow due to bursitis and cellulitis. He has end-stage Alzhiemer's. We are running tube feeding through a Dobhoff. His orders include having his HOB at 30 degrees at all times. He has already been diagnosed with aspiration pneumonia. His son and daughter-in-law (happens to be pediatric surgeon) flew in from out of state to be with him. They are with him almost around the clock.

So here's the issue. I noticed this evening, when they returned from dinner, the first thing the DIL did when entering the room was to put the bed flat. The pt has a one on one CNA with him, and she told the DIL nicely that the HOB needed to be up, per doctor's orders. Since family was in the room, willing to montior the pt, the CNA went out to help the other aides on the floor. The DIL proceeded to lower the HOB again. I went in and raised it, and explained again that it needed to be up. (I documented the education.)

I informed the charge RN of the situation, and kept a watchful eye that it didn't happen again. Thankfully the family left to get some sleep at around 2030.

When I was reporting all of this to night shift, the oncoming nurse told me that last night, as they were changing the pt's linens and repositioning him, they had to put the bed flatter, but the nurse turned off the tube feeding pump while she was doing this. In the middle of changing the bed, the DIL reached over and turned the pump back on! So the nurse turned it off, and the DIL reached over and turned it back on. The nurse confronted her about it, explaining the risk for aspiration. The DIL stated "He won't be lying down long."

She is a doctor for heaven's sake! I know she understands the physiology of all of this. The only explanation I can think of is that she is trying to kill him. Maybe that's blowing it out of proportion, but GEEEZ!

Have any of you seen a situation like this. Whan happened. What did you do? They are flying back home tomorrow, thank God.

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Specializes in Acute Care Psych, DNP Student.

Do you think the DIL might not be a physician? Perhaps a medical student with honesty issues and an ego problem?

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Specializes in Everything but L&D and OR.

Ok, it sounds like you've witnessed some definite inappropriate behavior!

You should probably contact you social service dept. They are the best at knowing what exactly to do about those situations.

Does your facility have an ethics committee? maybe that.

Plus, you can always discuss it with your nurse manager.

I didn't have an exact situation like that, but there was one time when I had a patient in the hospital from a nursing home. SHe had what looked like clear cut hand print bruises on her innner thighs and her suprapubic area were extremely swollen and bruised. This poor woman was confused and weak and could hardly talk. I had brought my concerns to my manager and I was shut down. So, I went to my socail worker for the dept. and then there was at least something done about it.

You have to trust your gut feeling and least you knwo you did something and you son't regeret letting it go.

Christy

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Do you think the DIL might not be a physician? Perhaps a medical student with honesty issues and an ego problem?

I was told that she was actually a professor to one of our surgeons when he was in medical school. He spent a while visiting in the room today, so I believe this is true. She also seems to use medical language appropriately has made useful suggestions regarding other aspects of the pt's care, ie how to better secure his PICC to prevent him from pulling at it. This is all so confusing, and infuriating.

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Specializes in Psych, Med/Surg, LTC.

Maybe she is looking for a lawsuit... Who knows, everyone is so lawsuit crazy now a days. Maybe she thinks she can sue if he aspirates and dies.

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Specializes in ER.
Maybe she is looking for a lawsuit... Who knows, everyone is so lawsuit crazy now a days. Maybe she thinks she can sue if he aspirates and dies.

Or maybe she simply thinks that she is so much better than everyone else because she is a pedi surgeon. I have encountered countless surgeons who think that because of their extra years of training that they are just so much better than everyone else. But the fact is that they are tampering with the pts equipment and directly going against MD orders for the pt. If it were my pt, I would tell the offending family member that if they continue to mess with the pts equipment and HOB that I will have security escort them out of the pt. room b/c they are causing the pt. to be in a potentially harmful situation. I have no tolerance for family members who directly defy MD orders despite repeated education and observed behavior. Family members do NOT have to be there in order for a pt. to receive care, and in this case, probably should NOT be in the room. It is a priviledge to be allowed to stay with/visit a pt. in the hospital. The pt. is under YOUR care, and it is YOUR license on the line, not hers (unless she kills him by doing these things), and you need to stick up for your patient. Glad you're so concerned and caring for this poor man!

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I deal with this so often in LTC. One of the biggies is the HOB/ Tube feeding issue, then we have the families that don't adhere to dietary restrictions....the diabetics or the thickened liquids/ puree food debate.

I always over document on these issues including notifying the MD. Sometimes we have the families/ pts sign a refusal of care form, saying they were educated etc and accept the risks.

Seems like the families will always win though. We had a pt come in with a 10 page list of instruction on how we were to care for him. Included was how to change his rectal tube every day and basic wound care and how we need to crush his meds....Things like this are lawsuits waiting to happen.

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I deal with this so often in LTC. One of the biggies is the HOB/ Tube feeding issue, then we have the families that don't adhere to dietary restrictions....the diabetics or the thickened liquids/ puree food debate.

I always over document on these issues including notifying the MD. Sometimes we have the families/ pts sign a refusal of care form, saying they were educated etc and accept the risks.

Seems like the families will always win though. We had a pt come in with a 10 page list of instruction on how we were to care for him. Included was how to change his rectal tube every day and basic wound care and how we need to crush his meds....Things like this are lawsuits waiting to happen.

I would write an incident report about this every time that it happened. There is probably a hospital policy about this somewhere. I would quote hospital policy if they do it again, and call the superviser.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Seems like the families will always win though. We had a pt come in with a 10 page list of instruction on how we were to care for him. Included was how to change his rectal tube every day and basic wound care and how we need to crush his meds....Things like this are lawsuits waiting to happen.

Does anyone ever stop and consider that with this type of patient, on home care, they may be actually attempting to help the staff, by furnishing his routine care management. And that they had no intention of suing. However, beging blown off, by staff, might have an impact on them. And they might become very watchful. And if their love one suffers any adverse actions, they will consider a suit. What difference does it make that they have handed a nurse a 10 page list of instructions. Take them thank them, review them, incorporate those you can. And explain to the family those you cannot and why.

Grannynurse

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Specializes in pure and simple psych.

You are correct to be concerned over this VERY dangerous behavior. :nono: Document, Document, Document. :typing :typing :typing After all, he might be sent to a LTC or other less vigorously watchful place. What if he drowns in the food, and it is reported as an accident?:eek:

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Granny....I actually like the instruction sheets that we get from families. This was a different case. There were a lot of issues involved. We were the 4th or 5th LTC that she put him in in that year. The only issues that I have with these types of plans is when the care that they want is just wrong or can harm the pt (Like the OPs problem with HOB vs tube feeding). I will not do absurd things requested by the family and risk my license.

Eduacating the pt and family is always a task of nurses. I can see the OPs frustration when the family member is highly educated, but is doing something to harm the pt. We can talk until we are blue in our face, but most families will still be permited to do as they wish.

Heck..I already have my list of requests ready. Beleive me...it is a control issue and the families/pts need to maintain as much control as they can given the circumstances.

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I haven't documented the incidents is witnessed, except for charting the education that I did with the family. I plan to talk to my Nurse Manager today, to see what she suggests. The son and DIL were flying back to their home town today, as I understood it. I didn't chart the incidents, because I wasn't sure how to without sounding accusatory, or including something that would be better documented in an incident report. I will ask my manager if I should chart those things. We have 24 hr to make late notes if we need to. Thanks for all of your input. I will update the thread.

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