Family: The Monitor Monsters

[Nurse-o-Matic]

Recently, I've had my share of family members who stare at the patient's bedside monitor looking for minute changes. Many times it's artifact or normal fluctuations but the family comes charging up to me freaking out. I immediatly do teaching regarding the monitor numbers, waveforms, etc, but it seems like this just causes them to scrutinize even more! Once, I had an art line go bad so I pulled the line and unplugged the sensor from the monitor. When the family returned to visit, they were furious that the red line was gone without thier consent--one less line for them to watch.

Does anyone have suggestions to keep visitors from becoming monitor monsters?

[Bruce RN]

"not as a teacher to the family"? That's part of our job. Your pt's families deserve more.

As a "nurse visitor" when I visit a family member I will ask EVERY question I deem necessary. They all deserve to be answered until I am comfortable with the care my loved one is being given. I do not consider this being selfish. I call it ensuring that my loved one is being given the best care possible.

I have to disagree with at least some of this.

There most definitely is such a thing as telling too much info to visitors and I must admit that I've been accused of doing it by my co-workers on occasion.

You are right in that family teaching is a part of our job, but I think that the teaching that Bahamagirl was referring to was with respect to hemodynamic monitoring. A family member being taught that this bag of medication that I'm hanging is to help maintain their loved one's blood pressure is appropriate family teaching.

Going into the details of hemodynamics, waveforms, etc. is not appropriate and can lead to a lot of trouble. You can give any family member a crash course in hemodynamics, rhythm interpretation, or what have you.

However, they are still lacking in the knowledge base and experience of a licensed nurse and their new-found skills in reading/interpreting what the monitor is saying can, and all too often does, quickly lead to very well-meaning, yet very unnecessary and inappropriate drama and worry.

Artifact on the monitor could be interpreted as V-fib to the undertrained and inexperienced family member who then starts screaming into the hallway for help. Same goes for a flat line that resulted in a lead falling off.

Both of those situations happened to me personally simply because I was telling family members way too much as a newer nurse.

As far as asking every question that one deems necessary goes, I'm not really clear as to how assertive or perhaps even agressive you may be to the staff as a visitor, it might just be how I'm interpreting your post and what I'm about to say may not be you at all, but this is a little of what I got out of it:

Badgering nurses with a multitude of questions whenever they walk into the room or while they are trying to give meds, etc. can be a very intimidating and frustrating experience. Making it known either outright or perhaps more subtly that you are an RN and are "watching" them to make sure that no errors are occurring does little more than make the staff dread your presence and therefore, dread even going into the patient's room at all.

This is not a good way to ensure that a loved one is receiving the best care possible. I believe that the quality of care actually goes down and mistakes may be even more likely, even by the most competent of nurses once they get the feeling that their every move and nursing skill/technique is being watched and questioned.

Well-meaning questions can take a lot of time and attention off the patient and instead be placed onto the visitor. This does not improve care or patient outcomes.

[bahamagirl]

I should clarify alittle. I believe that families have every right to know what is going on with their loved one. I tell families what I look for on a monitor i.e. blood pressure and heart rate and what the rationale for why we do things, but I feel that my number one priority is looking after their loved one and not educating them on interpreting abg's or lytes or hemodynamic numbers. I was a family member of a loved one in an icu for two months. I was a visitor and not there as a nurse, of course I wanted to know what was new or going on. They provided adequate updates and we felt informed and all this was done without being intimidating. It is best to respect the nurse and not badger them and make them feel intimidated because barriers go up communication fails.

[roana]

Oh, if I had a dime ! ! ! One time I had monitor monsters that frustated me so badly that I told them that it took me years to master thaose waveforms and I couldn't explain it to them in five minutes!

[blueheaven]

This one happened just today! The worst part of it is, it wasn't the patient's family...it was the patient! AAARRRRRGGGGGHHHHHH!

Mr. D. is 57 yrs old with basically end stage COPD...off and on the vent a time or two. This evening, just before my shift ended, he wrote me a note (currently on the vent again) stating that he wanted his tube out and he "knew" his ventilator numbers were better and he wanted it out NOW! He tried to argue with me earlier in the day about his respiratory meds. Had the doc come over and talk to him and turned up the propofol a bit and went I home for the evening. Will turn vent to where he can't see it tomorrow.