Disruptive families in acute care settings

Nurses General Nursing

Published

I have been trying to search out information on a topic and am coming up dry. So, I'm turning to my on-line nursing community. Maybe I'm the only one that's had this experience. OR it's something that is negative in nature and not reported.

Here's the deal:

Adult med-surg patient. Nurse and patient getting along OK. But then... some family member/significant other comes into the room, and inserts themselves between the nurse and the patient. This is usually like a twisted sort of advocacy role.

Example: Older lady involved in MVA. Has a non-surgical back, burst fracture at T-12, being managed conservatively with a "turtle-shell" type brace, pain management, PT/OT. Has a daughter that lives about 50 miles away who has been calling the floor multiple times per shift telling us what mom wants and needs and demanding information. Finally, shows up. Sits down on mom's bed literally between patient and nurse, picks up my rounding log and states categorically that I was not in the room at any of the times noted, that the log is a complete fabrication and that her mother was ignored all day. The patient was passive. Didn't correct her daughter.

Another example: Mother of a 45 year old patient tells us we are not medicating her daughter with enough opiate. Then tells us we're giving the daughter too much ("she'll never get off that stuff if you keep giving it to her like that...") on and on. We are incompetent, we are ignoring her, we're giving her too much or not the right medication. Again, the daughter is passive, allows mom to drive all the action.

Another example: Chronically ill middle age woman, brought up from PACU with a lot of co-morbidities. From the jump her sister is taking the pulse ox off the patient because the alarm was disturbing the her (the patient). I explain purpose of pulse ox. Sister says I'm full of it and she doesn't see any reason for the alarm to go off until her sister is in the mid-70's range and if I can't make the alarm fit those parameters, she doesn't want it on at all. (No, the family member has no medical/physiological understanding, is clearly picking a number out of thin air.) Again, the patient is passive.

Common features:

1. There is nothing inherently defective in the nurse-patient relationship.

2. Objections of family member not rational, and are resistant to any explanation or education. (In fact, in my experience any attempt to educate or inform is taken by the disruptive family member as self-defensive excuses by the nurse and validates their complaints.)

3. This behavior places a barrier between nurse and patient that is poisonous, inhibits continuous assessment, treatment and evaluation. Basically short circuits the entire nursing process.

4. It is not directed at any particular nurse, since none of the nurses are competent in the family member's eyes.

5. Lots of threats and implied threats : "I'll contact my lawyer." "Who is the CEO of this place?" "Wait till I tell the newspaper how awful you all are."

Please help me NAME THAT BEHAVIOR? What mesh-heads can I use to search the literature? Is it just me? Do all nurses see this occur? If it's not in the literature, why not?

ANYTHING you can tell me would be appreciated!!!

Specializes in CDI Supervisor; Formerly NICU.

Please help me NAME THAT BEHAVIOR? What mesh-heads can I use to search the literature? Is it just me? Do all nurses see this occur? If it's not in the literature, why not?

ANYTHING you can tell me would be appreciated!!!

Starts with 'A', ends with 'hole'.

I think what you're missing here is the reason that these disruptive family members aren't coming from a rational place is because they're coming from an emotional place. That's why they aren't being rational and it doesn't make sense to you. They are just "reacting" because they are in "crisis".

I would suggest that you not take these things personally, I myself, had to deal with a family member (more specifically my father) in hospital on and off throughout my teens with a brain tumor. And it's a very stressful and emotional place to feel out of control.

When you feel out of control, it's natural to try and find that control somewhere, be it criticizing a nurse, or just trying to make sense out of a situation that doesn't make sense to you, so it must be the fault of someone else (i.e. the reason my mom is in such poor health is because she's not being cared for properly, and if she was then she wouldn't be sick. ect ect) (btw we are all guilty of this at some point, even outside the hospital)

The reason your pt doesn't correct the family member is most likely due to the fact that they don't want to upset their family members further (many times the pt feels responsible or guilty for their family's stress due their hospitalization). So they don't want to make any more waves by "undermining" a family member's concern.

I think the TERM for the BEHAVIOR you're looking for is called "grief", "stress", or just "being human".

I know it's frustrating to deal with at times, but try to put yourself in their position, and remember the place they're coming from. Have grace for them and when all else fails pray.

Seriously, sometimes we just need to ask God to give us hearts of compassion when we're faced with "difficult people".

Specializes in CDI Supervisor; Formerly NICU.

I think a lot of what the poster above me says is true, for some people. I fear, however, that some people just get their jollies by making other people miserable. It's the same people that drive waitresses crazy over every little perceived misjustice involved with their getting mayo instead of mustard.

We should pray for those people too! Because they're looking for that same control!

Specializes in med-surg, psych, ER, school nurse-CRNP.

I'm with Bortaz. I swear, if one more NM had told me to let a family member's AH behavior slide, to the point of physical abuse towards the nursing staff, because they were "upset" or "grieving", I'd have had a come apart. I settled for telling them that if I got hit, I was hitting back, job be danged. Last I looked "nurse" and "punching bag" were not synonymous.

I have had ill family members, some that died, some that did not, but you can bet your bippy I never behaved like the OP described. It's called self-control and good manners. When I was the patient, 400 miles from home with no one but DH with me, and had to have a blood transfusion, and he acted like a turkey, I DID step in. I nearly DIED, and I mediated. So, I'm not buying it. Then again, not everyone is as assertive as me, and I realize that. I just was raised to believe there was no excuse for bad behavior, no matter how you try to explain it away.

Specializes in ICU/Critical Care.

If my patient's 02 sats were in the 70s and the family kept taking the pulse ox off, I would have to ask them to leave because they are interfering with care. That's what I tell family, I have no problem with them being at bedside, I will answer their questions, but once they start interfering with my care then they got to go.

Specializes in Management, Emergency, Psych, Med Surg.

As the charge nurse I am usually the one that has to step up in this situation. I try to talk to these people and see if we can work out a plan that will be satisfactory to everyone. When the person is drunk I explain to them that if they don't calm down that they will be escorted out of the building. When they threaten to call their lawyer I hand them a phone. If they make any type of threat toward a staff member, out they go.

When the family is concerned about the medication the pt is or is not getting I try to sit with them and the mar and try to explain it. Many times these family members are so overbearing that there is no consideration of what the patient wants. The patient won't even speak up for what they want. Once I work out a plan I bring the nurse in, introduce her/him again and we again review what the plan is. I write it on the kardex so we can carry it through from shift to shift. I also try to educate them about their illness and give them reference/ educational materials when ever I can. My worst problem is when you have family members that hate each other trying to control the situation. These, for me are the most difficult situations to deal with. There are lots of reasons that these people act the way they do and you can't know what the reason is for everyone. When each new patient arrives to my floor I try to go into the room and introduce myself and give them one of my business cards (all the charge nurses have these). I let them know who will be taking care of them and discuss pain issues with them. I try to get a feel as to what the mood is and I find that when I do this first it starts the stay off right. It seems to be working well for us because we have the best patient satisfaction scores in our hospital. But we are lucky, we have great nurse staffing ratios so our patients get prompt attention most of the time. By the way, I work in a small, county hospital just outside of Seattle. We serve a specific community of patients and this hospital has had some real PR problems in the past but over the past three years with new administration and great managers, we have turned it around. I want my patients and families to be happy. If they are happy, it makes it so much easier for the staff to take care of them.

There has to be bondaries set as to what is acceptable behavior and what isn't. I'm with TN07 in that if they touch the patient's equipment and don't stop removing it when explained why the patient needs it they will be asked to leave. Period. Thankfully I've never had it come to that.

If the patient is conscious and of sound mind I always direct my questions directly towards the patient not the family members. I find this helps them to express their wants, needs, etc.

I do take time to let the family know why things are being done and multiple times when needed so they feel involved. I also give the families little jobs when I feel it will help. Have the help their loved one soak their feet, give them lotion to rub on legs, etc. to let them feel like they have a purpose. I feel that helps as well.

On the flip side I will not put up with physical or verbal abuse. If you hit me I'm calling the cops and pressing charges. If you verbally abuse me you will be asked to leave until you can control yourself. These things are non-negotiable. Their foul mood, stress, etc. don't trump my right to feel safe on the job.

I'm with Bortaz. I swear, if one more NM had told me to let a family member's AH behavior slide, to the point of physical abuse towards the nursing staff, because they were "upset" or "grieving", I'd have had a come apart. I settled for telling them that if I got hit, I was hitting back, job be danged. Last I looked "nurse" and "punching bag" were not synonymous.

I have had ill family members, some that died, some that did not, but you can bet your bippy I never behaved like the OP described. It's called self-control and good manners. When I was the patient, 400 miles from home with no one but DH with me, and had to have a blood transfusion, and he acted like a turkey, I DID step in. I nearly DIED, and I mediated. So, I'm not buying it. Then again, not everyone is as assertive as me, and I realize that. I just was raised to believe there was no excuse for bad behavior, no matter how you try to explain it away.

I'm with you Angelfire.

When did being upset, grieving etc become excuses for adults to revert to childish behaviors, or worse?

Regardless of the reasons, and regardless of the nursing response, the behaviors mentioned by the OP are apt to result in needless stress on the Pt, which stands in the way of healing.

It also takes control away from the Pt by substituting the judgment or emotion of the family member for that of the Pt.

Certainly, family members should complain stridently about substandard care. But they should also have to make a reasonable case, and that means presenting verifiable facts, not simply feelings that the care is indeed substandard.

Specializes in dialysis (mostly) some L&D, Rehab/LTC.

In Texas...we can shoot people...:smokin:

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i think what you're missing here is the reason that these disruptive family members aren't coming from a rational place is because they're coming from an emotional place. that's why they aren't being rational and it doesn't make sense to you. they are just "reacting" because they are in "crisis".

i would suggest that you not take these things personally, i myself, had to deal with a family member (more specifically my father) in hospital on and off throughout my teens with a brain tumor. and it's a very stressful and emotional place to feel out of control.

when you feel out of control, it's natural to try and find that control somewhere, be it criticizing a nurse, or just trying to make sense out of a situation that doesn't make sense to you, so it must be the fault of someone else (i.e. the reason my mom is in such poor health is because she's not being cared for properly, and if she was then she wouldn't be sick. ect ect) (btw we are all guilty of this at some point, even outside the hospital)

the reason your pt doesn't correct the family member is most likely due to the fact that they don't want to upset their family members further (many times the pt feels responsible or guilty for their family's stress due their hospitalization). so they don't want to make any more waves by "undermining" a family member's concern.

i think the term for the behavior you're looking for is called "grief", "stress", or just "being human".

i know it's frustrating to deal with at times, but try to put yourself in their position, and remember the place they're coming from. have grace for them and when all else fails pray.

seriously, sometimes we just need to ask god to give us hearts of compassion when we're faced with "difficult people".

sorry, but i'm not buying it. stress is one thing, but being disruptive, verbally abusive and interfering with care has very little to do with stress. people act that way because they feel entitled to act that way. so the term would be "entitled" behavior.

grief, stress and "being human" don't entitle one to act like the north end of a southbound mule.

ruby, whose father died two weeks ago and whose mother has alzheimers and is currently experiencing both grief and stress and (hopefully) is not acting like a horse's patoot.

+ Add a Comment