Home Care Peds when Parents don't agree with each other on treatment

[Kitiger, RN]

How do you deal with parents who have different goals and expectations?

In one home, the dad wanted comfort care while the mom was fighting to get her child healthy enough to grow up. They agreed on what care I should give. I listened to both, and was truthful with both when asked about their child's health. There were some awkward moments.

In another home, chest percussion was ordered QID & PRN. At bedtime, while I was doing the chest percussion, the mom told me to do it in the middle of the night, too, to keep the secretions loose. Then she went to bed. An hour later, the dad stopped in the bedroom to tell me to "let his boy sleep, and don't bother him with all that percussion when it isn't necessary." Then he went to bed.

After 4 hours, when I assessed the child, I felt percussion wasn't needed at this point. Then mom got up, asking if I had been doing the extra percussion. When I said no, dad didn't want it done unless it was really necessary, she wanted to know WHY I hadn't done what she had TOLD me to do ...

Ouch.

The next day, I caught them together, and told them that I would follow my assessment first, and I would also try to follow the most recent instruction from them. So, if the most recent instruction was to let him sleep - and I felt I could safely do that - then I would let him sleep.

That home was a challenge.

How would you have handled it?

[caliotter3]

You handled it well. If the bickering gets to be too much and you just can't get the parents on the same sheet of music, ultimately you can leave the case. I found that when the parents or other caregivers contradict each other like this, they usually are able to see eye to eye when they are giving the agency an earful about the nurse(s). Usually, at some point, it becomes necessary to leave the case. Can't remember any where things smoothed out over time.