Conflict w/ a patient or family member?

Repat · Oct 28, 2003

You know, I try to look at these situations not as conflicts, but as people who are finding themselves unable to control the direction of their lives in a time of stress. I always support their desire to ask questions (one of the ways for people to get better is to know about their condition), and I always try to make the hospital situation as much like home as possible. For example, an elderly patient who has been able to coordinate her multiple medications at home takes them on a schedule that helps her to remember what to take, and what the med is for. I change med times often to suit home schedules. Also, people often resist something because they don't understand the reasoning behind a treatment, etc. Once explained to their level of knowledge, the often become compliant with treatment. Put yourself in their shoes - it usually helps with the frustration of multiple questions!

purplemania, BSN, RN · Oct 28, 2003

While I agree with Repat that every effort should be made to consider the family's stress, I have to say that some people are just plain mean and expect way more than can be delivered. Pay attention in school to the lectures on therapeutic communication. Smile and try to be helpful. But get someone else involved, as a witness if nothing else, if things get out of hand. This is probably a major contribution to nurse burn out---dealing with fractious people. Don't let it get you down. You will also get flowers and candy and hugs from some families.

CoffeeRTC, BSN, RN · Oct 28, 2003

I've been called an idiot, stupid, stupid idiot.. too young to know anything and everything else but a white girl. When family members are sick most families feel overwhelmed and confused. Working in LTC I see a lot of control issues. Some feel like they lost control of their parents. They want to do everything or make you do it just like they would and if you don't follow the same pattern watch out. What works for me is establish trust, determine how much involvement the family wants or can handle in their loved ones care. Yes is is very difficult to take care of someone when being name called and being told "your too young .." to know what you're doing....where did you go to school but eventually some come around. I was having such a hard time with one family member questioning on everything I did that I made and printed out some info and research on their mothers condition and explained everything to them. After reading and reviewing everything with them, I just kept refering to the current standards of practice and info that I gave them. Eventually they got the picture..

Just to reiterate (sp) what everyone else said... It is very diffucult to be a patient or a family member of a sick loved one, put your self in their position and sometimes you'll see where they are coming from. And if all else fails, just remember "Sticks and stones may break my bones, but names will never hurt me!"

ktwlpn, LPN · Oct 28, 2003

Great topic-great posts.......My mantra is "Don't take it personally.....the "customer" is always right" It's so hard for me as I have a natural tendency to always have the LAST WORD......

barefootlady, ADN, RN · Oct 28, 2003

After you have done everything humanly possible for their sick loved one, remember some family members will still distrust you and see you as "not doing enough for their loved one. I agree this is one of the most trying issues with nurses and contributes to burnout. Since administrations take the stand,"the customer is always right" a nurse is often left dangling in the wind with only coworkers a support. I know that is why nurses love night shift and do weekends only too.

jnette, ASN, EMT-I · Oct 28, 2003

Originally posted by ktwlpn
It's hard for me as I have a natural tendency to always have the LAST WORD......

shew !!! me too... :imbar

But I CAN say what I have to say with a smile !!!

Barefootlady... good post. Don't get this much in dialysis, but I sure have experienced it already these past two weeks in M/S !

Burnt Out, ASN, RN · Oct 28, 2003

Where I work, we do have our share of "conflicts" with patients and family members. We see a lot of families that want us to do 1:1 care with mom or dad...and you just have to try to be polite and of course take care of immediate needs and tell them you must make rounds and you will come back.

We also get the families that question us a lot about everything we do...I just try to grit my teeth and answer or I really pour out the sweetness.

I have had loved ones in the hospital and it is stressful...sometimes the families need a little TLC too.

I also try to treat them as I would want myself or my family treated.

I agree with Barefootlady....even if you do all that you can for this patient and their family...if you hung upside down from the moon, it would still not be enough....

chad75 · Oct 28, 2003

When I have "difficult" family to deal with I usually try to put things in to perspective, what if that was my mom/dad and I didn't understand why the nurse had to wake them up at 2400 to give them medication etc.

That helps me cope and "tolerate" difficult families. Sometimes people are just mean asses, in that case I set limits. If you are interfering with me taking care of your loved one, or being verbally abusive to me or the support staff I am going to tell you your behaviour is inappropriate and why it is in a very calm rationale manner.

After I do the above they either behave or get even more beligerent in which case they demand to see my superior or I just go ahead and call the NM/house superivsor :).

Not everyone is suited to confront difficult families in the manner in which I do as they tend to get emotional or take things personally in that case I would suggest reporting to your charge nurse/NM etc. to see if they could help relieve the situation. Always remember to chart the objective facts and be "theraputic" in your communication with the family since more then likely you will be defending your actions to your superiors.

cannoli · Oct 28, 2003

I've had people "quiz" me which can be insulting, if they are hostile about it, it makes me want to spend as little time as possible in the room. I think they get that from the media.

Sometimes you will have a problem, personality clash or whatever, and they will just not want you as the nurse and request another. If that occurs, with extreme anger on their part or not, it's best just to say fine and stay away from all of them. Usually it's a family member and not the patient.

That has happened to me and to other nurses that I know. That does not make me a bad nurse, I know I am a good nurse and professional, and have been told so many times by other nurses and doc.

Sometimes trying to smooth things over, etc, just makes things worse, you can't placate them once they've already gotten like that. I always give a heads up to the supervisor or whoever to let them know what happened so that they can do PR if they want, or in case they get a complaint later they will know what it is about.

One problem I have, is that I come from the northeast with the accent, manner of speaking, etc. from that area and I work and live in the southeast and the manner of speaking is different and things are interpreted differently, seen as being abrupt, etc when that is just the manner of speaking, nothing is meant by it. Some people here don't like Yankees anyway, so that you are already at a disadvantage if you are from the north.

It does occur and try to deal with it therapeutically and if you can't just try not to let it bother you, and try to learn something from it and just go on. Don't take it personally, probably a lot of it is their baggage, their problem, and yes, they are under stress.

Good luck.

nurseygrrl, LPN · Oct 29, 2003

These types of confrontations happen on a daily basis in LTC, especially now that LTC is being exposed by the media as mainly...shoddy. I deal with a lot of people who have massive guilt due to putting their loved one in an SNF. This guilt is compounded since I work on a very young floor and my patients aren't really 'supposed' to be in one. My advice if someone confronts you is to be very professional. If you do not have the answers they are seeking, tell them you will gather the info and give them a call or talk to them during their next visit. You can also call your supervisor if someone is getting 'over the top'. I personally have had to tell family members: "You are being verbally abusive and/or unreasonable. I care very much about your loved one so when you are ready to treat me with respect, I will be here to talk with you". Most times, family members are very apologetic after I say that because they realize that they are out of line. When it comes to my patients, they can be very manipulative...so I am sure to gently and professionally make sure that they know who's boss (me:D) and that they need to treat me with respect as I do them. It's funny...when there is a float nurse assigned to my residents they get away with MURDER. It's like children with a substitute teacher!! :roll

I have even caught residents outright LYING to float nurses thinking I have left, yet I'm right outside the door. "Yes, I'm on aspiration precautions, but I CAN have a donut and coffee. The doc said so." They even throw around terms like "barium swallow study" to convince these poor floats...hehe

Anyhow...now that I've gotten totally off the topic, good luck and don't sweat it, it gets easier dealing with these types of situations each time.

wayover20 · Oct 29, 2003

Happens daily in a busy ER. I usually try to contain the paitient/family to one are, say their room if they've come out into the hallway, I gently close the door and ask how I can help. After several seconds of shouting or cursing, they see I am not interested in a verbal fight and really want to help.....they calm down and we're usually able to settle it. I know it sounds corny, but nowadays management is apt to reprimand US if we don't do everything we can to answer their question/complaint as it occurs. We used to be able to call security if someone was cursing/shouting at us (verbal abuse!!) and have them sent out immediately. Now we have to show we tried to answer their needs. Then if the verbal abuse continues we can ask for security. I've found many times they apologize for their behavior.....remember their scared. Don't worry, after several years of this you get pretty thick skinned and it won't phase you.