Family Members

[CBsMommy]

I have a question for all of you wonderful, experienced nurses out there!

I have seen the following scenario several times and want to know how you handle the situation...

You have a confused patient that keeps jumping out of bed every 5 minutes. Of course, they are a fall risk, possibly even on a heparin drip, have a bed alarm on (of course), but move pretty quick despite the fact that they sway if they stand still.

You find them in the bathroom, with their IV pulled out, with no socks on their feet, bed alarm at full tilt and nearly catch them as they are falling (or thanking your lucky stars they didn't fall).

And the whole time, there is a family member in the room with them! Wide awake, watching TV. And when you enter the room, they say, well, she pulled her IV out again. The RN I'm working with takes care of the patient, gets them back to bed safely, resets the bed alarm, fixes the IV, or places a new one, and goes on to check the next patient, not saying anything to the family member in the room.

I, personally, think this warrants a sit down with the family member to tell them that we are all on the same team, and that is to make sure the patient doesn't fall and hit their head. At the very least, the family needs to remind PatientX to stay in bed and then hit the call light to call for nursing assistance and we will be there in no time.

So, do you have the conversation with family or not? What's your policy/reasoning? TIA

[Whispera, MSN, RN]

I would. We can't be all places at all times.

[dudette10, MSN, RN]

Of course, you talk to the family members! When I start my shift, I educate patients and family members if present on activity restrictions (if any), how and when to call for assistance, diet/intake restrictions (if any), and what I know about the plan of care at the time.

If something happens during the shift that clearly shows that my first message didn't get through, I do it again. I also mention the idea of a bed alarm or other non-restrictive safety tool at our disposal. Sometimes, I just tell them I'm setting the bed alarm without giving them an opportunity to refuse it. The sound is as irritating to visitors and patients as a beeping IV pump, and voila', they'll use the call light just to avoid the sound. Problem solved. Sometimes.

ETA: Education and re-education has an unexpected effect in semi-private rooms. You can't always avoid roommates or their visitors overhearing your conversations. I've had a few of the roommates and their vistors report noncompliance with activity instructions to the nurses or CNAs. "Um, the person sharing a room is getting up again, and I've heard you all telling him to not get up on his own...maybe you can check on him?" The tattle-tales are helpful, too. In two particular situations, the tattle-tales were key to averting a fall.

[nightengalegoddess]

YES! On our documentation now, for at least three years in the hospitals where I have worked; there is a mandate that family education be given re: fall precautions and activated fall risk bundles. Since RNs somehow within their busy days had been neglecting properly charting for all these details, department heads have created 'check the box' documentation....and for fall risks, family education is one of the priority 'boxes'.

Maybe this RN was just too burnt, tired, hopeless this particular day to educate the family. Or maybe she/he already identified the family as passive aggressive attention seeking people who are rarely responsive to teaching. Maybe the RN was so PO'd she just chose to say nothing at all instead of sounding like Nurse Ratchet. Ugh. I DO get it! : )

[DixieRedHead, ASN, RN]

I would do the education first, and ask the family member to redirect the patient and call me. If it happens, I am not saying a word to them. If they had any sense they would have done it in the first place. No use beating a dead horse, or a stupid one.

These are the same people who ask you "Is someone gonna feed Mama?" And you ask, "Who feeds her at home?" "I do but I am afraid to feed her here, she might choke." Oh yeah, if you are at home feeding her it's just you and her, if she chokes, she dies. Here there are many people, we have suction, be afraid here!

Patients who have altered mental status can be a bit perplexing but seldom ever really bother me. But families...............families...........don't get me started.

[tewdles, RN]

Of course you talk to the family. In my line of work we would actually have a plan of care to specifically outline our goals and interventions related to that family behavior with MSW involvement.

I really appreciate the fact that you point out that the nursing care we deliver is in partnership with the patient and family, regardless of setting.

[nerdtonurse?, BSN, RN]

It's one of my personal pet peeves when you educate a family, (please call me if Mr. S starts trying to get up, and please try to keep him from pulling out his IV, keep him from falling until I get here, he may respond better to someone he knows, like you, rather than someone he doesn't, like me) and they sit there and let grandma hit the floor, I want to toss them out of the hospital on their ear. If you're just there to watch and get info for the lawsuit, as opposed to helping us help your family member, go home!

If you want to be a silent, passive "watcher," then you're going to watch me put them into restraints to keep the patient safe.

[CAPPYBARA BREAKFAST]

I would talk to the family and then request a sitter to be in there at all times. You can't expect the family to understand the magnitude of the responsibility the RN has when it comes to a patient.

[beckster_01, BSN, RN]

My favorite is when they have a 1:1 and, instead of redirecting the patient themselves, call you in to tell you "He is getting out of bed and pulled out both IV's." What are they getting payed for again?

I will talk to the family. I usually ask them to let me know if the patient is very restless and tell them that we can get a 1:1 ordered if needed. Some families refuse the 1:1 and stay with the patient, but I at least like to let them know that resource is available if indicated.

[CBsMommy]

I would talk to the family and then request a sitter to be in there at all times. You can't expect the family to understand the magnitude of the responsibility the RN has when it comes to a patient.

We didn't have the staff for a 1:1 at that time....I did suggest that to the RN.

I don't expect the family to "understand the magnitude of the responsibility the RN has when it comes to a patient" but do you think it's too much to ask that they just put the call light on and try to keep the patient in bed until we get there? If I had a family member that I was staying with in the hospital, and the RN asked me to do this, I wouldn't mind. I would prefer to keep my loved one safe. Maybe I'm asking too much...

[CapeCodMermaid, RN]

I would talk to the family and then request a sitter to be in there at all times. You can't expect the family to understand the magnitude of the responsibility the RN has when it comes to a patient.

If they can't understand the magnitude of someone yanking out an IV and falling, let's hope they took the BUS to the hospital since they must be as dumb as toast and shouldn't be allowed to drive.

[mama_d, BSN, RN]

I hate to say it, but if they're on a drip, especially if they're a hard stick, I try to get restraints.

If not, and they keep getting out of bed etc. ... Park them at the nurses' station in a recliner. If family objects, emphasize that it's for the patient's safety as you can't be in the room at all times. It's amazing how much more attention a family member pays when they're sitting there in the hall with the pt for all the world to see...or else they leave, which sometimes helps in its own way.