How do you deal with irrate family members?

[dbsn00]

So, how do you deal with irrate family members of patients? I work LTC, I know a lot of families feel guilt about their relative having to be there, they're scared of the relative's worsening condition, etc. But many of these families are on the defensive immediately & without justification. I don't want to feel bullied nor do I want to fan the flames (sometimes explaining yourself just digs you in deeper!) but it's hard not to get defensive when every question has an accusory tone. Any advice/opinions to share?

[pricklypear]

I find it very difficult, too. I think you have to develop a thick skin, and learn to keep your own irritation under the surface. Just answer the questions they ask, in simple terms, and try to keep a sympathetic attitude. I work in ICU so if things get out of control, I can have family removed. I've never had to do that, but in some situations, the family nagging can remove my focus from the patient.

Sometimes it all comes down to trust. The family is stressed, and they kind of feel you out to see if they can trust you. If you can remain calm, they may be more at ease. I'm pretty willing to let a lot of things go when it comes to stressed families, but I would never put up with outright rudeness.

I try my best to make the family feel better, but sometimes everything you do will be wrong. If you have a good supervisor, it may be worth it to involve them in the situation. Sometimes having someone in "authority" backing you up will take care of the situation once and for all.

Then, on your way home in your car, you respond to their rudeness the way you REALLY wanted to at the time!!! I do it all the time!:rotfl:

[leslie :-D]

it's something you cannot take personally- their feelings are extremely displaced.

yes, there's much guilt when a loved one is placed in a ltc facility with alot of other negative feelings. so we, the nsg staff, are the targets of their anger.

one time a dtr placed her mum in the place where i worked in hospice (the snf was attached) and she was demanding and aggressive. after listening to her complaints and demands, i finally told her that we were doing everything we could for her mom and her outbursts were not only unacceptable, but were disruptive to the other pts and visitors. at first she was taken aback but her attitude softened considerably.

another time, a son of a pt. was SO irate because we were not ambulating his mother. i tried to tell him she was non-ambulatory and he refused to believe us and that we were negligent, threatening to sue. so i pulled the bull by the horns and we walked to where his mom was, in a geri-chair and said, "come on bob, help me stand your mom up".....as we tried to assist her to an upright condition, she just could not grasp the concept of what we were trying to do (late stage alzheimer's with contracted foot) so when we got her upright, she was total dead weight. we placed her back in the gc and that's when the reality of his mom's condition hit him, and he started to weep.

so just keep in mind, that often anger is a mask for pain, denial and mere frustration. it has nothing to do with you.

leslie

[CoffeeRTC, BSN, RN]

Gosh I see this alot. One of our biggest problems is keeping the family informed/ updated on thier loved ones condition. I will call them (and we should) with everything! They respect this and see that we are taking care of thier loved ones and staying on top of things.

Anther way is get them involved in care..maybe not the actuall physical care (unless they are willing) but in decision making.

What I'm trying to say is get to them first..don't let them walk around angry. If I know we have a difficult family coming in, I will normally get to them right at the door and say Hi...Moms doing good today....etc...How are you?

Letting them vent also helps..just listening to them.

Remember tho that no matter what you do, some families will always be angry/ mad/ miserable.

Ohh I just wanted to add....always stay in control of the situation. I refuse to argue with a family member. I have much better things to do.

[ATLRN]

Don't take it personally. Try to remember that families may be dealing with emotional issues that are a result of things that you have no control over. Many times these issues stem from things that occurred a long time ago. There may even be some internal turmoil within the family going on. I have just about seen it all. The most important thing that you can do is LISTEN and COMMUNICATE. They may have a valid reason to be upset with the facility or staff. If they do, fix it. Keep them informed. And something that has worked well for me is find something positive to say to them. For example if this is a new admission, "I can tell you have done a great job in caring for your Mother" or "This has got to be really tough on you. I can tell how much you love your Dad" or "What can I do to make this easier for you?" People want to be recognized. Call it "kissing up" or whatever. It usually works for me. And remember, there are those people in this world you aren't going to be able to make happy, no matter what. Continue to be kind and do your best.

[Gompers, BSN, RN]

It seems to be one way or another. Some families need to be spoken to softly and reassured that we are doing everything we can for the patient. With these families, calming them down and then doing a little hand-holding makes a big difference.

BUT...usually I have to take a different approach.

If a family is very upset, I'll break things down for them. First, I'll explain what the problem is with the patient. Then I'll explain what we're doing to fix that problem. I'll physically point out all the interventions that we are doing so they can see them with their own eyes. I'll offer to have the doctor come and speak with them. I'll ask them if they have any questions for me, and if so, I answer them as best I can using the most simple terms possible. Sometimes that little step makes a huge difference - a lot of that anger may be due to frustration and confusion. If you break down exactly what is going on with the patient in a way they can understand, it really helps. The family feels like they understand what is going on, and they feel more confident in your abilities. It's really easy to talk to someone using all kinds of medical terms. But to be able to explain it in your own words, words that make sense to non-medical folks - this is very important.

We get a lot of very upset parents in the NICU, and that is completely understandable. But I find that with the above techniques, nine times out of ten, I am able to calm the family down without needing to involve the docs or my charge nurse. I've taken care of babies whose families were just livid, and by the end of their visit, I've gotten them calmed down and they thank me when they leave. I even had one family refuse to speak with anyone BUT me on the phone one night when their baby was going downhill fast. That was a very extreme case and I wish it hadn't been that way, but at least they were calm enough to listen to me explain all that we were doing.

And sometimes, I just lay it on the line...

"We are doing everything we can to help your baby. This entire staff has devoted their professional lives to caring for these babies. This is what we do, and you are going to have to trust us when we say that what we are doing is the best thing for your baby right now."

I swear, sometimes saying this out loud does wonders.