help oh help

[pedspnp]

I am seeing a new family in clinic, she is not new to our clinic but is new too me, the grandmother has gaurdianship of the grandson and has her own child. I just started seeing them on tuesday and so far she has been back everyday and calling 2-3 times a day about a sick child.( so far the exams have been negative for all the complaints, ranging from cough to diarheaa) I can see she is overwhelmed by the 8 month old and taking care of her own child, so today when she came back in i saw the child and then tried to talk to the guardian about how people can feel overwhelmed when overloaded. She got very upset and yelled at me that I had no right to make judgements about her I calmly pointed out this was just my observation that she was over whelmed and I was not judging her. she continued to carry on and ruminating for 20 minutes about her daughter and everything that is going on in her life. I can see the children are well taken care of, the gaurdian has anxiety and depression issues. She states there is no one to help her out. She was really out of control but calmed down. Until she got to the receptionist to schedule another appt and started all ove again about taking care of the 2 children and all she does is take care of them never leaves the house. at this point my main concern is the 2 children I am worried that she is going to snap. I am calling DCFS in the morning with my concerns, but she has already let my nurse know that if DCFS show up she will know it was me. This woman has a history of being vindictive so how do I protect my self and staff from this women,

[traumaRUs, MSN, APRN]

I'll be honest here - DCFS won't do anything.

What about continuing to keep the lines of communication open so that she continues to bring the kids in. Keep the visits low - key, make positive comments that its obvious the kids are well taken care of, refer her to a grandparents raising grandchildren support group (if one exists in your areas) and just continue as you are doing.

[linearthinker, DNP, RN]

I think by showing up with minor complaints so often she is crying out for help. The defensiveness is just a protective mechanism. I think she will come around and confide in you one of these next times. I wouldn't bother with child services, they aren't going to do anything but **** her off and ruin the relationship.

[Wile E Coyote, ASN, RN]

Snip

I can see the children are well taken care of

May I suggest asking DCFS for a list of helpful resources that may give this family break? Based upon what you've shared, I see no red flags to warrant a formal complaint (assuming that was your intent), as "she may snap" could honestly apply to most any parent/guardian at one time or another, eh? I agree that continuing contact with the family using low-key, encouraging tactics should eventually net better results for all involved.

Of course if the bad vibes worsen, then by all means summon the demons,,,,er I mean DCFS.

[traumaRUs, MSN, APRN]

Believe me, in IL you don't want to contact DCFS "for a list of resources." Our state is flat broke - it takes days (yes days) for them to even return a call for emergency removal from the home even when you have documented (as in current ER visits) for non-accidental trauma.

Good idea though to ask for resources: contact a peds social worker at your hospital, call around yourself (I have a current list of local adult/peds help in my area), contact one of the school's social workers.