Family members at bedside

[sissiesmama, ASN, RN]

Hey - this is an issue I encountered a few years ago while working on a busy medical unit. I didn't think about it again, until I re-encountered the same type of episode and was wondering if anyone else had. I was caring for a woman who had lung cancer and developed a PE. The patient was on a heparin drip and BR, as well as IV pain mgmt. I walked in the patient's room one afternoon and the daughter, who was an RN, was trying to get mom out of bed, which she would not be able to tolerate. The daughter did tell me at that time she did not want to see her suffering any more, so she was going to get her OOB to make her "throw the clot". This situation was handled, and I didn't think about it again until recently.

Again, different hospital, medical unit. I had a patient with lung cancer admitted for pain control. I had been caring for this patient and her family for a little more than a week. The daughter called out for the patient's Morphine and was waiting outside the room. She asked me what dosage I had and when I told her, she requested a higher dose be ordered by the MD, and 'the morphine be given "really fast"'. She said she didn't want the med diluted, and she wanted the MD to write an order for "20 or 30mg" ivp Morphine to be given rapid push.

I have had family members in the hospital, and I have had them pass away while they were there, and did not want them to suffer, but had never even thought to cross my mind. In the latter situation, when I went to my unit manager, she just laughed and called me "Nurse Kevorkian". (Of course, I did not do what the daughter requested and earn the nickname, but I thought the manager would have not have made that comment either.

Have any of you experienced this? Thanks!

Anne, RNC :paw::paw::paw::saint: Shadow, Sissie, Bea, Sam, and Cookie

[RN1982]

No but that one particular family member who wanted you to push the morphine rapidly and wanted an increased dose sounds psychotic. Makes me think that she has an alterior motive for giving more morphine, BUT she could have just wanted her mother's pain controlled too.

[sissiesmama, ASN, RN]

Right. She was a handful, to say the least. And, she did tell the MD later that "if a vet did it for animals, then why couldn't we..."

This comment got the MD motivated and transferred the patient to ICU for direct observation andf monitoring the visitors.

Thanks, Anne:banghead:

[RN1982]

Right. She was a handful, to say the least. And, she did tell the MD later that "if a vet did it for animals, then why couldn't we..."

This comment got the MD motivated and transferred the patient to ICU for direct observation andf monitoring the visitors.

Thanks, Anne:banghead:

No way! Um, we're human beings not dogs. Ok, the thought about alterior motives is just confirmed.

[TheCommuter, BSN, RN]

I hate family members, which is why I purposely choose to work the night shift.

[nrsang97, BSN, RN]

Even if my family member was suffering I wouldn't ask the doc or nurse for euthenasia (sp?). I would ask for hospice and pain management. I cannot believe some people.

[nrsang97, BSN, RN]

I hate family members, which is why I purposely choose to work the night shift.

We have 24 hour visitation in my ICU so no escaping them some nights. I wish we could though.

[sissiesmama, ASN, RN]

I hate family members, which is why I purposely choose to work the night shift.

Oh, yeah!! And when I transferred to the ER, I thought I was getting away from some of the visiting hours, well, not at my hospital! Some of the ER employees give out the patient's families the code to the ambulance ER doors. Out of the frying pan, into the visiting hours fire! Then, you combine the fact that we hold inpatients so long with it andit's a pain in the toocus!

Anne, RNC

[Grace Oz]

I hate family members, which is why I purposely choose to work the night shift.

:chuckle:chuckle:chuckle This made me laugh!

Can't say I blame you though, some family members can present a challenge at times!

Still, we need to try and imagine walking a mile in their shoes.

Having been on both sides of the bedsheets, there's two sides to the situation.

I'm not for one minute advocating sanctioning inappropriate behaviour by family members! No no no! Those folks certainly need scrutinizing. But we do need to be patient and tolerant and understanding where possible.

Just my :twocents: worth.

[SillyStudent, ASN, RN]

I hate family members, which is why I purposely choose to work the night shift.

Preach it, Sister.

I am not good at dealing with long, drawn out conversations with families. I actually had to tell a visitor to shh! the other day. I wanted to give the patient (her sister) some pain meds and was trying to assess her pain, nausea, etc. She kept answering the questions for the patient. I politely told her that I needed to hear it from the patient, and she answered ANOTHER one of my questions. I just said SHH! and held up my hand finally....lol.

That worked! I would have been so mad if the nurse shh'd me! lol....but she actually smiled about it, and apologized for being in the way a little while later. I told her that my big sister would have done the same thing. :)

As for the 'Nurse Kevorkian' angle, I was asked by a family member during my first 'terminal wean' if I could make her dad die faster. "Maybe with some more medicine?"

I told her that I gave the amount prescribed by the doctor, and that giving more would be illegal and just plain wrong. I noted that he was resting quietly, and that if at some point we felt that he needed more meds to keep him comfortable, I would call the doc.. He died like an hour later.

[nursbee04]

Wow. I have had family members burst into tears and tell me they feel so guilty because they are praying for their loved one to move on so they don't have to suffer anymore... I've had family members who were terrified that their loved one would have to feel ANY pain or discomfort and requested pain meds at the slightest sigh or twitch the pt made...both of which I can absolutely understand...but never have I had a family member outright ASK me to give a lethal dose.

I am one hundred percent for pain control and palliative care...Too many times I have seen patients and families hit in the face with EOL issues because no one addressed any of it until it was too late...but my goal is to keep the patient comfortable and pain free. Not to facilitate death, but to make the dying process EASIER on the patient.

[sissiesmama, ASN, RN]

Wow. I have had family members burst into tears and tell me they feel so guilty because they are praying for their loved one to move on so they don't have to suffer anymore... I've had family members who were terrified that their loved one would have to feel ANY pain or discomfort and requested pain meds at the slightest sigh or twitch the pt made...both of which I can absolutely understand...but never have I had a family member outright ASK me to give a lethal dose.

I am one hundred percent for pain control and palliative care...Too many times I have seen patients and families hit in the face with EOL issues because no one addressed any of it until it was too late...but my goal is to keep the patient comfortable and pain free. Not to facilitate death, but to make the dying process EASIER on the patient.

Thank you!! My thoughts exactly! I would NEVER want my pts or family members to suffer, especially in the terminal stages of an illness, but just the thought of requesting a lethal dose of meds, OMG! And, the thought of a family member comparing taking care of one of their family members pain like a vet would at their office, just made me sick.

At first, I looked thinking I had misunderstood her request, or her statement, but, no......

Anne, RNC