Difficult family members and friends, what do yo do?

leslie :-D · Aug 3, 2008

restrict any visitors that are not complying with orders.

you remind the pt why these orders were implemented and the consequences in not following them...

which would include prohibiting those who are smuggling in the smokes, drinks, etc.

the nurse's role is to optimize pt's well being, and whatever that takes...

especially when there's a fetus:twocents: involved.

leslie

nrsang97, BSN, RN · Aug 3, 2008

I do have to agree with Leslie. Also DOCUMENT EVERYTHING!!

SoundofMusic · Aug 3, 2008

When I was just off orientation I would get all mad and irritated about things like that. Now, I ENCOURAGE AND EDUCATE, remind them it's "doctor's orders" - and if they know all of that, acknowledge it, and yet still go off the path, all I can do is document that I provided the info and the patient and/or family refused to cooperate. Then it's on them, not me.

I actually TELL them that I'm "going to document that I provided you this info" and that it's their choice not to comply. Then they know . ..they will be held accountable, not me.

It's still all about their free will and their patient "rights." I dont' understand why some of them present themselves to the ER with all their problems, and then get into the hospital and refuse to comply with everything -- I don't get it. Most of them fight us from the minute they get there to leave.

I'd just assume they did leave and leave room for those who truly want and need treatment . . . .but it never seems to go that way.

But, document, document.

santhony44, MSN, RN, NP · Aug 3, 2008

I agree with document, document, document. Also, be sure that the physician is well aware of what's going on, so that he or she can do education and documentation as well.

This is a situation where a provider might even consider "firing" the patient. Not likely, in a pregnancy, but the provider will certainly want to document very very very well.

I would not be a bit surprised if, in this situation, any adverse outcome would be blamed on the physician, the hospital, or both. In some states, it's possible to sue for malpractice related to childbirth until the child is 21 years old, so very good documentation of careful education and continued willful noncompliance is critical.

It's a shame they can't think of the baby's welfare.

cutehumor · Aug 3, 2008

I threaten to call security. :chuckle

psalm, RN · Aug 3, 2008

In the case of smoking, are you a smoke-free campus? As far as going into the bathroom to smoke and having a lookout...I feel for you. We are smoke-free and some of our frequent flyers who are on oxygen, sneak smokes in their bathroom. I think a hospital somewhere will have to suffer an explosion before something is like this is taken seriously (smoking near O2). Sorry I don't have an answer, but as stated before, document and make sure the attending knows.

BaRNs · Aug 3, 2008

restrict any visitors that are not complying with orders.
you remind the pt why these orders were implemented and the consequences in not following them...
which would include prohibiting those who are smuggling in the smokes, drinks, etc.
the nurse's role is to optimize pt's well being, and whatever that takes...
especially when there's a fetus:twocents: involved.
leslie

This is a great answer. Reinforce pt/family education with why these orders are in place. Restrict visitors (or even have them removed from the premises in some instances) that don't comply. Be sure to establish a VERY good therapeutic relationship with this pt and family in order to gain their trust. Lastly, establish some sort of scheduled rounds to check this pt's room. You can delegate this to a CNA, LPN, and/or check yourself as often as you can. I would recommend every 15 minutes for the first 4-6 hours and every half hour after that until you are sure these orders are being followed.

Also try to understand that with many smokers, not smoking can raise blood pressure more through stress than smoking will. Smoking in a hospital is against the law in every state and they should be made aware of this fact too.

If you ever have a pt/family that persists after your education it is a smart move to bring in an outside source such as another RN or charge to reiterate things. Maybe they will have better luck.

CHATSDALE · Aug 3, 2008

in the case of an expectant mom i would go along with cute and call security and tell them that as they are causing harm to the baby they can be charged with abuse

knew a mom who couldn't stay off drugs and they put her in jail until baby was delivered and they put her two y/o in with his father who didn't have the parenting skills to take care of a stuffed bear but that is another story

BBFRN, BSN, PhD · Aug 3, 2008

You could also inform them that the next time someone smokes in the room, that the fire marshall will have to be called, resulting in a hefty fine for smoking in a hospital. Works like a charm.

I used to work in a hospital where this was a common problem. We also had a fire marshall that was more than willing to come in and write a citation ($1000 fine). Nipped that problem in the bud pretty quickly.

Thankful RN,BSN · Aug 3, 2008

inform the visiter's that their behavior is threatening the health of the pt, document this, inform the charge nurse & the nurse supervisor. if the visiter's continue to put the pt at risk. threaten to call security. and if they continue to do as they wish. call security and get them kicked out.

bagladyrn, RN · Aug 4, 2008

I am wondering what do you do when family members give the patient things they are on doctors orders not to have. Example: NPO , bedrest only, no stimulation, 32 week pregnant preeclamptic mom. Family member and friends giving her cigerettes, drinks, and watching for the nursin while the pt goes to the bathroom to smoke. How does your facitlity handle this? What is the nurses role?

Had a family like this not long ago. What I did was sit the family members down away from the patient and lay out for them EXACTLY what the worst case scenario could be from PIH - seizures, abruption, death of fetus and/or mother, stroke, etc. Related to them that I have actually seen these things occur. I backed this all up with written material. Then I documented exactly what I had educated the family on and their responses.

Feedback on this came several weeks after the discharge of the patient with a good outcome: I heard from someone who knew I had cared for the patient (very small town) that the family said "We thought at first that she was going to be a really mean nurse, but she took such good care of (patient)!" Every once in a while you feel vindicated.

As for the smoking in the bathroom, I'd document teaching, explanation of hospital policy and call security and notify MD if it continued to happen. Covering yourself is the best you can do here.