Can we add "Biting the family" to the Nursing Process?? - page 2

:( Funny question, but a very serious one.... Scenario: Last night, LTC patient is at death's door. Family has not seen her in about 8 months. Priest came in for last rites, family at... Read More

  1. by   JennieBSN
    I frequently want to inflict bodily harm on the families that come with my patients in labor. Gotta love the ones who sit glued to the t.v.while the patient moans and cries, then they start yelling when you ask them to leave...'this is my sister!!! i ain' leavin'!!' Blah, blah, blah. Yeah, if she's so damned important to you, why are you more interested in what's on the WB than your beloved sis who's in labor? Gimme a break. Then there are the families that come in with the patient who's SOOOOOOOO not in labor, but insist she needs drugs. I tell the docs, 'her mother/father/sister/neighbor is in labor, not her.'

    Yeah, it's nothing like the stuff y'all deal with in ICUs and on the floors, but man...same concept....wanting to BEAT THE SNOT out of the annoying FAMILY!! Screw psychoanalysis...just gimme a HAMMER.
  2. by   MRed94
    So many times I find myself in the med room or the linen room, attempting to sort out my feelings.

    Sometimes I yell, and sometimes I cry like there is no tomorrow. I know that there is nothing more I can do beyond keeping the family comfortable, and keeping the patient comfortable.

    I try to approach the family in the way that I would want to be treated, but at the same time, we all must face reality.

    I attempt to get the family to say their goodbyes and ALLOW the patient to die, with the dignity that they deserve.

    Soemtimes you can tell the patient is waiting for something, and when that happens, I try to convince the family that the patient wants to be reassured that all will be well with the family if the patient goes.

    When the family finally sees that there is no more to be done, and the patient wants to die, they usually come around, and they tell the patient that they will be ok if the patient dies. In this case, more than once, I have seen the patient relax enough to go ahead and take that final step.

    I always tell them that the patient will be in better and bigger hands than ours, and that it is the best thing.

    The families don't want to accept it, but most of the time they do, when they can tell it is inevitable. They are always so glad that they did what they should have done.

    I NEVER leave a patient alone to die, to me that is the cruelest thing that anybody could do to someone. If it takes me longer to take care of my other patients, usually I tell the others that there is someone dying, and they usually understand.

    But then again, there are the families that bicker and fight with you over what is happening, and they are the ones I really cry over. If they could just see that what is happening ISN'T just for them......................

    I grit my teeth more than I would like. But I attempt to remain cheerful and helpful, because that is part of my job.

    Doesn't mean I can't fantasize about biting them, tho!!

  3. by   canoehead
    Just to clarify what someone else said about it only taking a half hour to take extra care of a family needing TLC. If a nurse is missing her lunch and breaks for that 12 hour shift of course it is stressful, but the family is in crisis, and as a compassionate person he/she needs to put their needs first. However...on every shift there is a family or two in crisis- sincerely needing the same help. But if the nurse misses all breaks, and has to play catch up all day, hoping that no one else crumps into the bargain; and then ends up missing breaks EVERY shift, and working under that much stress every shift that means he/she is either in emergency mode or recovering from a crisis mode shift for half his/her working life. That is the prescription for mental breakdown and burnout if I have ever seen one. Not to mention the nutritional/urinary issues that come with neglecting themselves for 12h at a stretch. So we need to support coworkers who have decided that they will take 15 minutes to eat NO MATTER WHAT, every shift. And those that say they HAVE to leave the floor for 5 minutes for a "respiratory treatment" (Yuck). Even if their patients need them.

    That is NOT the view I had coming out of nursing school or for the first 5 years of practise even, but if you don't take care of yourself you will crash. And when nurses burn out like that it is usually the most caring and self sacrificing ones, I think nursing as a profession deserves better.

    Of course if a patient is crying in pain while the nurse sits yapping at the station I would agree they need a kick in the can. And there are lots of those too.
  4. by   chermor6
    Biting the family? Come on! Supportive enviroment aside, I would be afraid to have someone with this attitude caring for my family member. I am sure you don't really mean it. We all have patients/family members like this at some time. it takes maturity and fortitude to rise above the frustration. Besides, we never truly know what others are going through when a terminal/sudden illness strikes. The only thing you can change is your own reaction.
  5. by   ucavalpn
    i know exactly how you feel . one gentleman's wife was so anxious / scared .she had spent the past 10 years taking care of this man . he was her whole life . if i managed to get out of the room , pt's wife would follow me . to other pt's rooms , to break , even followed me to the bathroom once or twice . after several days of this a co-worker asked me , how do you manage to deal with that woman and still smile? i said , i'm not smiling i'm grittin' my teeth . a couple of months after the pt. had passed away , his wife wrote a letter to our hospital . she had nothing but praise for me . made me sound a lot nicer than i really am .
    so don't feel bad , grit your teeth if you need .
  6. by   RNforLongTime
    Dear Mspurp and Hoolahan,

    Thanks so very much for your words of encouragement. When I originally posted the scenario, I was just looking to vent. We as nurses need to be able to do that and who better than to vent with as another nurse.

    I have just purchased "Chicken Soup for the Nurses Soul". I recommend that every nurse and nursing student purchase this book for themselves. It makes you feel a lot better about being a nurse.

    Essarge, I can understand your point. And, I'll say it again, when you have 6 or 8 patients and family members to deal with, sometimes you tend to become impatient. I never mean to be that way but when you run yourself ragged for 8 and a half hours a day it sometimes cannot be helped.

    Luckily, I have had a mask on when talking to the wife as the pt is on MRSA precautions so she cannot see most of my facial expressions.

    This is why I am switching to night shift. I am a night owl by habit and there will probably NOT be many family members hanging around at the nurses station at 3 am. I do not mind answering family questions but a lot of times I ask them. Well did you speak with the doctor? More often than not they will say no.

    As for my "team"? Most of the RN's I work with are of no help unless forced and then they act like it is a big deal. I consider myself a big teamplayer and when I am not busy, I ask my fellow nurses if there is anything I can do to help them. Very rarely does someone offer to help me when I am busy.

    But enough of me complaining. Sometimes you can't win no matter what you do!
    Last edit by RNforLongTime on Sep 3, '01
  7. by   hoolahan
    Ain't it the truth!

    One thing that annoys me is when I am working in the CT ICU and a family calls every 5 minutes. I love talking to pt's and families, and I understand the need for everyone to know what is going on, but I have a limit. After the fourth call from a different family member, I say, you need to speak to your brother who just called. I am trying to take care of your (insert mom, dad, bro, sis, etc) but every time I get into the room, I have been getting a call from a family member. I say it very nicely, and I have never had a problem, most people understand. The only time I make an exception if I can is when people are calling from out of state.

    The last time that happened however, there were seven sibs, and we had no secretary, no aide, and I seriously could not get anything done with the pt for all the calls, so I asked them to call sister sally in Arizona or brother pete in pittsburgh for more info, and even these guys were nice about it. I wouldn't mind if they wanted to call at 2 am when things have settled a little, but all the calls come between 7p and 10 pm, when I am trying to get my assessments done, etc... I always tell visitors when they are leaving, if they wake up in the middle of the night and feel an urge to call, I will be happy to speak to them. I think it just makes them hapy to know they can, b/c I rarely get a 3 am phone call!
  8. by   MRed94
    Like most everybody else, I come HERE to vent.... If we aren't comfortable venting on these pages, we wouldn't come here.

    Of course, I have NEVER bitten a family member, but that doesn't prevent me from thinking it sometimes.

    With as many years of family/patient care under my belt as I have, I have learned which face to present to the family and which face to wear in private.

    No matter how I am feeling, or what reaction I have to the family/patient, I keep control when I am within sight of anyone....

    Venting is what keeps most of us going....

  9. by   frustratedRN
    are you saying that nurses shouldnt get frustrated with family members?
    you would be "afraid"? reaction to family members is not the same thing as patient care. while its certainly a part of it, its not the whole thing.
    i can take excellent care of the patient while still disliking the family. of course i dont show that but face it...some families are unreasonable and a royal pain.
  10. by   Over-the-hill-Nurse
    I just finished reading alot of response to your question "Can we bite the family"? I work in CCU and there have been times when I would have liked to bite the family but.... would never dream of doing it. I do love taking care of the patient, family, and extended family. I try to give all of them 110% of my time. I work 12 hour shifts. Usually I am there 13 or 14 hours. The paperwork waits. For me giving the family what I can is very important. Usually, I don't have to say anything, just be there. I have never let a patient die alone, I am right there with the family, I cry the same as they do... most of the time we stay with the same patients each day we work... continuity of care. And it really works, the family gets to know who you are, what you are like, and what they can expect from you. I do think you did a terrific job with this particular family. It is hard not to grit your teeth in privacy. I do however try not to influence another nurse on my reaction of the family members. I have seen where others reactions is passed on and the patient and the family are labeled as "pests, pain in the arse, mean, demanding, etc...." Which in turn gives the oncoming nurse a bad view already before she has even taken care of the patient. I do sympathize with you and have been in your shoes a million times. Keep up the good work, and know that you are making a difference in this families lives.
  11. by   MRed94
  12. by   RNforLongTime
    The pt's wife said to me today (yes I was assigned to him again) that she is glad when I am taking care of her husband.

    And like Marla said, I too have learned which face to "wear" when in the presence of family and which face to "wear" around my fellow nurses.

    Sadly, though, he will be leaving our unit soon and yes I will probably miss taking care of him and his wife.

    And also as Marla said, I come here to vent! As do a lot of other people.

    Thank you.

  13. by   res04lly
    I can understand your frustration on this subject-but i know how it feels from the other side of the bed also and it is an eye opening experience. You feel everything the staff's body language is giving off, posture to the tone of voice. I watched how my mother's anxiety increased as staff began with the nonverbals and tone of voice that really didn't need to be there. Do you think it is easy to give up a husband or a wife of 40 -60 years so easily? when they have shared so many things together? Do think that maybe it is hard for the children who remember them for who they were and see what is happening now?? I can tell you it is Hard as Hell to watch it and experience it and whether you visited once or 60 times don't you think it has to something to do with the individual's coping skills in this situation. I can tell you first hand as a nurse i was horrified to see how my father was treated and my aunt but most of all my mom, it really ticked me off ,to be blunt about it ,so little compassion, so little caring, so little professionalism and to much nonverbal junk. I have worked in ltc and in hospital situation with the dying for 17 years and i hope i never ever made a family member feel as we were made to feel. I have always allowed the family their privacy, offered my best cna, provided coffee, and tried to give my best care to that individual Yes i have been buzy but if you let the family know that you will attempt to met the need whether they are a no code or not it helps lessen the loss and the families pain. You also need to be careful how you vent in the breakroom also, a family member could be in ear shot as i was and the nurse was taken aside by me and told to Chill out and put herself in my mom's shoes. She got my understanding real quick. After my father died i sent a letter to the head of the hospital thanking those who helped my mom but what was interesting about the whole situation was that the compassion mom received was not from the Nurses but from a wonderful Cna who had the compassion to offer her a cot 24 hours before dad died so she could be with him and to say her good byes. It was not nursing, or social work, but someone who was in tune with what was going on and reached out. That is what your families really want is for you to stop for 5 minutes and reach out them and let them know you care. Is this not what nursing is about??