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 witness many, MANY radical behaviors on a daily basis.
my very first statement is that of limit-setting.
"i cannot allow you to...."
my second statment is empathy.
"i can see that you are feeling _______, ________ and ___________.
what can i do to help you?"
once families recognize their debilitating behaviors, as well as recognizing that others want to help them through the process, they, for the most part, become vulnerable...and teachable.
families, as well as pts, need to know they haven't lost total control of their surroundings.
once they feel informed and involved, it makes for a much smoother experience.
People act weird when they're scared. Skewed family dynamics don't improve with a crisis.
Nor should they be allowed to occur in an ICU. Which irrate family member has a gun in his pocket? If you don't think it can happen, it can. We had a father who came in the ICU and shot the stepfather of his child who he blamed for the MVA and everyone thought he was just concerned about his child until he pulled out his gun and killed someone.
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.
I'm am actually a very calm reasonable person but if my patient is being stripped down and his dressing are being removed, um...I'm not taking the time to read between the lines until he has been removed from the situation by security. I would not worry about this person trying to upstage me as a nurse. If he is that insecure then it's his issue, not mine, to deal with. I just want to be able to take good care of my patient. The family members mental issues are not my concern.
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.
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 agree that this is a life skill definately worth learning and even more so using but I don't believe an incident occuring, such as this, in an ICU is the time to figure out what issues the visitor is having at the time. I'd ask him nicely to stop and if he didn't I'd be dialing the phone for security and I would be angry.
I agree with most of the posts above mine. It does however, get very difficult when a patient's rights are being violated. If it were the spouse, mother/father or only person in the room then I am all for "What do you need?" but in an ICU setting there is too much happening to worry about the brother in law, but you can be concerned and helpful.
This reminds me of my pt's husband (she had been in an mva) who erased my name from the board and put his, followed by RN,BSN,MSN. Then he "quizzed" me "Are you an associate's nurse or do you hold a Bachelors of Science?" Families are really really really rough at times!
i agree with most of the posts above mine. it does however, get very difficult when a patient's rights are being violated. if it were the spouse, mother/father or only person in the room then i am all for "what do you need?" but in an icu setting there is too much happening to worry about the brother in law, but you can be concerned and helpful.
this reminds me of my pt's husband (she had been in an mva) who erased my name from the board and put his, followed by rn,bsn,msn. then he "quizzed" me "are you an associate's nurse or do you hold a bachelors of science?" families are really really really rough at times!
wow, he had alot of nerve and obviously an inferiority complex. i hope you erased it and proudly wrote yours back in. the amount of education one has does not a good nurse make!
wow, he had alot of nerve and obviously an inferiority complex. i hope you erased it and proudly wrote yours back in. the amount of education one has does not a good nurse make!
This reminds me of my pt's husband (she had been in an mva) who erased my name from the board and put his, followed by RN,BSN,MSN. Then he "quizzed" me "Are you an associate's nurse or do you hold a Bachelors of Science?" Families are really really really rough at times!
Whoa.
He put his name on the board in place of yours as her nurse?
First, I'd sincerely thank him for his offer to take over her total care for your shift. Whee! One less patient to worry about!
As far as his question, I'd simply tell him that although I am licensed as an RN, it's quite obvious which one of us has the BS.
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.
It appeared to me from the OP that this was the first time the bil had visited since the MVA. This bil was not known to the OP'er.
I feel he "crossed" the line when he stripped the patient and when he took off the dressings. I could deal with the stethoscope, pen light and assessment but I have to advocate for my patient first and deal with the family dynamics later.
That's exactly what I would want my nurse to do for me if I were in the same situation. I would be apalled if my sil (who really is a nurse) did this to me.
I wouldn't yell, scream, throw a fit or anything even remotely along those lines. I can be angry on the inside and calm on the outside. I would ask him to stop and if he didn't I would reach for the phone.
I feel that RNwriters post is excellent but did not address what she would do at the time of the incident. It's easy to look back later and reflect on the situation but at the time of the incident you have to act in the best interest of the patient and figure out what to do about the bil later. Just IMHO.
RNwriter, what would you have done at the time of the incident?
dutch, w/o a doubt, this guy was waaaaay out of line.
my adrenaline was pumping, just reading about his antics....esp where he removed the dressings.
i could tell you stories that would make your hair stand.
i've had families remove o2, disconnect iv's, trying to INCREASE iv narcotics (like, bolus them in)...even have had someone trying to smother the pt w/a pillow.
my immediate reaction is to firmly and physically stop them from what they're doing.
while i am imposing these limits, i also include, "while i understand that you are feeling immensely ______________, or whatever it is i think they're experiencing, i will not allow you to ________. and if i ever see this again, i will make sure you will never have the chance to visit with your ______ again."
the look on my face and the inflection of my tone, is usually sufficient.
but, i also make sure that i address these behaviors at another time.
not to chastise them- far from it.
but to let them know i understand their anguish, and the crazy things they feel driven to do.
i always get our social worker and chaplain involved, whatever is appropriate for the situation.
while i am imposing these limits, i also include, "while i understand that you are feeling immensely ______________, or whatever it is i think they're experiencing, i will not allow you to ________. and if i ever see this again, i will make sure you will never have the chance to visit with your ______ again."
leslie
I admire that, that is something I usually don't do at the time, hence you're in hospice and I'm not. We each have our niche. Thank God!
My co-workers say "if you want something done, esp if you think it can't be done, ask Joanna, it will get done".
leslie :-D
11,191 Posts
i witness many, MANY radical behaviors on a daily basis.
my very first statement is that of limit-setting.
"i cannot allow you to...."
my second statment is empathy.
"i can see that you are feeling _______, ________ and ___________.
what can i do to help you?"
once families recognize their debilitating behaviors, as well as recognizing that others want to help them through the process, they, for the most part, become vulnerable...and teachable.
families, as well as pts, need to know they haven't lost total control of their surroundings.
once they feel informed and involved, it makes for a much smoother experience.
best of everything.
leslie