Maybe I am overreacting....or maybe I would be the same way if my family member was hospitalized...
I work in a busy ICU. Today my patient was s/p MVA, suffering from ARDS, multiple fractures. During visitation, the pt's brother in law, who is a nurse, came in and stripped the pt down in front of all the other family members. He had his own stethoscope, pen light, and did a full head-to-toe assessment. He then proceeded to take off all of the pt's dressings and look at what was under there.
I'm suprised he didn't attempt to look at the pt's chart. When I saw him doing this, I was speechless. I didn't know what to say to him. He comes in the room, asks different nurses the same questions to "test our knowledge"...which is what I heard his say under his breath to the other visitor.
Am I just over reacting...or should I have just let him do what he wanted to do??
I posted earlier about the brother-in-law. Now I want to post again about US.
So many of the responses sounded angry, even enraged. This might be an initial reaction, but it shouldn't stay at that level. If we leap to take offense and then respond in kind, what does that accomplish?
Yes, there are family members who can be a real pain in the patoot, but they may not be like this under better circumstances. People act weird when they're scared. Skewed family dynamics don't improve with a crisis. Some of these folks have been engaging in power struggles for decades. In a small, over-crowded ICU cubicle it's easy to get caught in the crossfire.
First and foremost, do not take the bad behavior personally. That doesn't mean you ignore it. It just means that you make the effort to understand that if it wasn't you getting the flak it would be someone else. It isn't about you.
Second, try to read between the lines. What is the real need? Most likely, it isn't to challenge you or to make you look stupid. Rather, it's an attempt to discharge fear and tension, or to try to grasp some form of control in an out-of-control situation. It could even be a ploy for an insecure person to try to be a hero and gain some security with other family members.
You don't have to play armchair psychiatrist. Just understand that the more you can figure out the real agenda, the easier time you will have meeting the actual needs and setting limits on the false ones.
This will also allow you to set aside the anger and find ways to connect that don't compromise patient care.
If you have a unit plan, you can then calmly take a persistent offender aside and explain the limits. You can also offer positive outlets to direct the energy and soothe some of the intense emotions.
For example: Mr. Blake, I can't allow you to remove or alter your brother-in-law's dressings. If you do that again, we'll have to ask you to leave for the day. I can let you take a look when I do the dressing changes. You can ask me any questions you have at that time, and if I don't know the answer, I'll do what I can to find out. Please consider how protective you feel of your own patients. That's how I feel about your brother-in-law. We really are on the same team, you know. I hope you'll respect the fact that I have a job to do and we can support each other and your brother-in-law.
Not everyone will respond to this, but many will. And of those who do, not all will fall in line right away, but they may settle down and back off in time.
It's useless to flare up and take offense when the conflict really isn't about you. And that kind of anger only complicates an already challenging situation. If you need to take a few minutes to blow off steam or vent to a co-worker or manager, do it. Then calm yourself down and try to meet the difficult people where they are without adding your own negative energy to the mix.
Sometimes when people are charged up and they know they will probably get a harsh response, the most effective way to defuse the tension is to do or say something kind. I have seen folks burst into tears with this approach because it's unexpected, it's undeserved, and it's healing, like balm on a wound.
If none of these measures work and you still have someone who is over the top, you may have to invite them to leave or even call security if things get ugly. But once again, remember it isn't personal, so don't make it personal back at them.
"I'm sorry, Mr. Anderson. This isn't working out very well right now, and I have to put your brother-in-law's needs first. You need to leave now, but you can try again tomorrow. If it's okay with your sister, you may call once during the night and I'll let you know how he's doing. I hope you can get some sleep."
No animosity. No power struggle. Just clear limits with a bit of kindness thrown in for good measure.
When you have a critical patient, the whole family suffers. Try to separate them from their needy, rude and scared behavior. Care for them even as you set limits for their actions.
Then, even if you have to ask them to leave, you can do so with a calm spirit and a peaceful heart.
This takes practice, but, boy, is it ever worth the effort to build this skill. And it's one that carries over into other parts of your life.
Blessings on all who strive to learn and practice this approach.
I understand when it's an emergent situation...and we need to temper our responses with kindness and the understand that the additonal stress of an illness and everything else will bring other family dynamics to light....
HOWEVER, I do NOT agree that the family member should have touched the dressings...cause guess what, now you just exposed them unnessaraily.....Also, stripping a patient down in front of other family, and who isn't your patient...is a violation of their rights.....
Clearly, that bro in law needs to understand that you have an RN license same as him, and you are trained to take care of him....If you have questions, feel free to ask, but if you are trying to trip other nurses up after what I've told you....we have a problem...everyone has a different interpretation....not all of us are out to kill your bro in law, dude..so chill out.
Specializes in pedi, pedi psych,dd, school ,home health.
yes what this man did is very out of line.
however, there definitely may be a lot more to the family dynamics than you know. maybe he felt some kind of pressure as "the medical person" in the family during this time of crisis. he is afterall the brother in law - maybe this is his time to get in good with the in-laws who previously did not care for him much. just playing devil's advocate here.
regardless, he should have known better as a nurse.
perhaps the family had asked for this from bil; and he was complying with their request.
my step-father, who was for the most part my father, was recently in the icu. i admit that i did do a mini-assessment (had tucked my stethoscope into my purse). however, i did this on the sly - no one knew that i did this other than my mom. i would never want to interfere with a fellow nurse's care of my family member, let along be "one of those" family members.
i really just did that so that i could get a more clear picture of his status/prognosis. goodness knows, i definitely would not've removed his large abdominal dressing!!
and that whole "test their knowledge" stuff. i'll bet this doofus would not have pulled that with the md!
i think we all need to listen to rn/ writer on this. unless you have been in this horrible position ( yes, those who know my story know that i have been in a similar situation) you shouldnt judge this man's actions without speaking with him first . i am not quite so intrusive, but when sil was in the hospital i did "check out " his injuries; as we were quite overwhelmed with the extent of them . we also were shuffled between many parts of the treatment team and everyone had something to add, causing great angst and anxiety with my dd and his mother. so, lets have a little compassion for this family as well before we jump the gun and start the :angryfire. just my mary
Had the brother-in-law addressed any concerns he had re. the patient's care or progress with the nursinng staff or physicians? I am sorry, he was not acting in a reasonable or acceptable way. You do not even know how close the patient is to this brother in law or if the patient himself would be okay w/ the exam. I would not want or consent to any of my in laws examining me while I was in the hospital. The patient has nurses. This guy needs to be a family member and love and support the patient. This butting in on care is ridiculous. I know the wife or mother, etc. may have asked for this BUT unless the patient himslef gives consent that his nurses clearly understand, then the BIL needs to keep his stethoscope to himself. If he were a walking, talking guy and told BIL to do it, then (I still think it is out of line) I guess it would not be a problem. I don't know if I'd call security, unless he was adjusting the ET tube or IV pump. but the charge nurse or manager needs to talk to this family ASAP.
I would have called security immediately. He went too far on that one....
I probably would have even went as far as having the police called, having a trespass warning issued. Not that I would not allow him not to visit, but he would not be allowed beyond the waiting room without an escort, and with the warning if he touches so much as a piece of toilet tissue it off to jail.
I wonder if it was a HIPAA violation if the patient's wife was there and agreeable to the exam. We've had similar experiences in our ICU also and debated whether or not it was illegal. If the wife (or suitable hcpoa) wasn't there, then I think the circumstances are different.
but I"m not saying that I agree with what the guy did. It was wrong in many ways. Especially removing the dressings! To be honest, if a patient's family member is in the medical field and wants to listen to breath sounds or heart tones, it doesn't bother me...trying to dictate treatment or prescribe medicine based on it is a totally different story!!
What if the patient suffered some injury during the exam (like reopening a bleed)? who would be responsible?
and the "testing their knowledge" is awful but happens more often than you'd think. Whenever someone is asking me questions like that and I can tell they are being rhetorical to see if I know what I'm talking about I usually reply by asking them if I"m being graded or videotaped, ask them if they are from the NCLEX doing a knowledge-retention survey or when they describe in excruciating detail things that I"m already familiar with I thank them for an impromtu inservice and ask them if they'll sign me off for 30 min con ed credit. (only if I think they won't be offended!)
Doesn't much matter if he had the wife's permission or not, you do NOT strip a pt down when others are in the room, unless the pt is coding. Even then you try not to.
Doesn't much matter if he had the wife's permission or not, you do NOT strip a pt down when others are in the room, unless the pt is coding. Even then you try not to.[/quote
I'm not advocating violating anyone's privacy, unwarranted exposure or anything else. and if the wife or other immediate family member wanted an exam done I don't see where it's hurting anything. there are plenty of times I've stripped someone down OUTSIDE the hospital, in a traumatic situation. It had to be done, I didn't want to or gain some kind of satisfaction from it but it would have been medically negligent not to...and I'll add that I"ve found many entrance wounds that would've been missed had I not done it.
You can disagree and jump my case all you want and that's honestly fine, but I stand by my original point of view. In fact, when a hcpoa wants something done there are lots of times where we have to honor it even if it's something we wouldn't personally choose for ourselves.
I think I need lessons in communication from you, rn/writer. I wish I had that ability to talk to people and keep my cool and sound educated and in control all at the same time. For some reason I have never mastered this. I used to be very shy, which I am not now but I think I missed out on a lot of communication skills because I never used to speak to anyone. I like the way you worded your post. I truly wish I could have that ability to think like that right on the spot. Thanks for your post.
I think I need lessons in communication from you, rn/writer. I wish I had that ability to talk to people and keep my cool and sound educated and in control all at the same time. For some reason I have never mastered this. I used to be very shy, which I am not now but I think I missed out on a lot of communication skills because I never used to speak to anyone. I like the way you worded your post. I truly wish I could have that ability to think like that right on the spot. Thanks for your post.
Thank you so much for your kind words.
You have the most important qualities in cultivating good communication skills--the desire to do it and a caring spirit. What you need now is practice.
Take a few minutes every day to think through hypothetical situations. What would I say to a patient who wanted to leave the floor to smoke when doing so really isn't safe in his current condition. How would I react to a co-worker who snaps at me over something ridiculous? What can I say to a neighbor who criticizes the way I put out the garbage? Effective, caring communication is like any other skill worth learning. It takes some effort, and it's best if you work on it before you need it. Coming up with a good response on the spot is a lot more likely to take place if you've prepared a repertoire in advance.
There are two essential principles to keep in mind. The first is to separate people (who they are) from their behavior (what they do). You can be set limits and be firm as all get out with behavior and still be supportive of and kind to the person. With some it's more of a challenge than others, and believe me, I lose my patience more than I'd like to admit, but it's still a good goal.
The other principle is nothing more than the good ol' Golden Rule. Ask yourself, "What would I want if my relative was lying in this hospital bed and I was acting like a horse's behind because I'm tired and worried and I don't know who I can trust." It's a little easier to ditch the offensive defense and present a caring demeanor if you can get past the prickly exterior and put yourself on the other side of the equation.
This doesn't always have the desired effect. Some people were creepy before the crisis hit. But it will have the effect of de-stressing you and allowing you to operate out of a sense of competent strength and quiet confidence.
Practice a little each day, and pretty soon, effective, strong, confident communication will be a part of your identity, both on the job and off.
One other trick I keep up my sleeve is to ask the ranting, raving, foaming-at-the-mouth person my secret weapon question. "What do you need?" Not, "What do you want," and I think that's where the power lies. People want all kinds of things, but when you ask them what they need, it sometimes rocks them back on their heels as they themselves try to figure out what they need. And it cuts to the chase, bypassing all the hoopla that may or may not end at the real destination after all.
What do you need? How can I help you? What would make this better? With questions like these, you can sidestep side issues and identify what's really important.
Thank you again, for your encouraging words. You made my day.
Well I have no room to talk. My dad had a small heart attack less than two weeks ago prior to this story. He was having the same chest tightness (no pain, but he is diabetic) We took him to the ER there and waited and waited... I asked them several times how soon they could get his tests in and that he had a heart attack a short time ago... but they kept saying 'we'll get there soon as we can'... finally after a half an hour of being in that room and his tightness increasing I stole an EKG machine and gave him an EKG. Shortly after, my mother (who is a cardiac icu nurse) arrived and read it. It looked okay as far as she could tell, so we just continued to wait. It took almost an hour for a tech to get in there and give him a legit one. It was uncalled for. I assume they didn't think he was emergent because he didn't c/o pain, but if they would have just looked at the records they would have known I was serious that he had had a heart attack a few days earlier.
They did end up admitting him and cathing him though.
I know this was not the most legal thing to do, and some may not agree, but I'm not ashamed one bit for doing it.
I don't think you were one bit wrong on that one. Heart is muscle. That is totally different from what the looney in the ICU did. Hope your dad is ok :icon_hug:
OMG! I would be seeing red :redlight: I would have called security and then the supervisor, do an SOE and make sure everything is charted. What became of this incident? What an idiot. Gives nurses a bad name.
mary
rn/writer, RN
9 Articles; 4,168 Posts
I posted earlier about the brother-in-law. Now I want to post again about US.
So many of the responses sounded angry, even enraged. This might be an initial reaction, but it shouldn't stay at that level. If we leap to take offense and then respond in kind, what does that accomplish?
Yes, there are family members who can be a real pain in the patoot, but they may not be like this under better circumstances. People act weird when they're scared. Skewed family dynamics don't improve with a crisis. Some of these folks have been engaging in power struggles for decades. In a small, over-crowded ICU cubicle it's easy to get caught in the crossfire.
First and foremost, do not take the bad behavior personally. That doesn't mean you ignore it. It just means that you make the effort to understand that if it wasn't you getting the flak it would be someone else. It isn't about you.
Second, try to read between the lines. What is the real need? Most likely, it isn't to challenge you or to make you look stupid. Rather, it's an attempt to discharge fear and tension, or to try to grasp some form of control in an out-of-control situation. It could even be a ploy for an insecure person to try to be a hero and gain some security with other family members.
You don't have to play armchair psychiatrist. Just understand that the more you can figure out the real agenda, the easier time you will have meeting the actual needs and setting limits on the false ones.
This will also allow you to set aside the anger and find ways to connect that don't compromise patient care.
If you have a unit plan, you can then calmly take a persistent offender aside and explain the limits. You can also offer positive outlets to direct the energy and soothe some of the intense emotions.
For example: Mr. Blake, I can't allow you to remove or alter your brother-in-law's dressings. If you do that again, we'll have to ask you to leave for the day. I can let you take a look when I do the dressing changes. You can ask me any questions you have at that time, and if I don't know the answer, I'll do what I can to find out. Please consider how protective you feel of your own patients. That's how I feel about your brother-in-law. We really are on the same team, you know. I hope you'll respect the fact that I have a job to do and we can support each other and your brother-in-law.
Not everyone will respond to this, but many will. And of those who do, not all will fall in line right away, but they may settle down and back off in time.
It's useless to flare up and take offense when the conflict really isn't about you. And that kind of anger only complicates an already challenging situation. If you need to take a few minutes to blow off steam or vent to a co-worker or manager, do it. Then calm yourself down and try to meet the difficult people where they are without adding your own negative energy to the mix.
Sometimes when people are charged up and they know they will probably get a harsh response, the most effective way to defuse the tension is to do or say something kind. I have seen folks burst into tears with this approach because it's unexpected, it's undeserved, and it's healing, like balm on a wound.
If none of these measures work and you still have someone who is over the top, you may have to invite them to leave or even call security if things get ugly. But once again, remember it isn't personal, so don't make it personal back at them.
"I'm sorry, Mr. Anderson. This isn't working out very well right now, and I have to put your brother-in-law's needs first. You need to leave now, but you can try again tomorrow. If it's okay with your sister, you may call once during the night and I'll let you know how he's doing. I hope you can get some sleep."
No animosity. No power struggle. Just clear limits with a bit of kindness thrown in for good measure.
When you have a critical patient, the whole family suffers. Try to separate them from their needy, rude and scared behavior. Care for them even as you set limits for their actions.
Then, even if you have to ask them to leave, you can do so with a calm spirit and a peaceful heart.
This takes practice, but, boy, is it ever worth the effort to build this skill. And it's one that carries over into other parts of your life.
Blessings on all who strive to learn and practice this approach.