How do you deal with overbearing family members?

umcRN, BSN, RN · Sep 18, 2012

No matter where you work there is always going to be a "difficult" patient, family etc. And often times it is true that the family does know the patient better than we would and they are looking out for their loved ones. Then there are the families who have severe cases of "googleitis" & "web MD dependence"

I work in peds so for the former families (the ones who really do know the patients best) I try to start my day by asking them how they feel their child is doing that morning, what kinds of things I should look for that may indicate they are uncomfortable and try to get a general understanding of what the families understand about their current situation. I work in an ICU so we also have very large rounds on each patient each day and parents are invited to participate so whatever questions they may have about meds, plan of care, changes etc they can voice. I also typically make every effort to contact an MD if the parents have concerns. Families should be able to direct those questions to a doctor but if time is an issue suggest they write the questions down so that when the doctor has a moment to stop by they can answer all the questions rather than be barraged with multiple issues throughout the day.

Now for the chronic internet families sometimes the only thing you can do for them is to refocus them back on the current situation and assure them that all the necessary tests/procedures are being done and tell them to bring up any concerns they have with the doctor

Good Morning, Gil · Sep 18, 2012

You educate them to the best of your ability, educating them on the meds themselves, tell them why the meds were changed if you know, but obviously, don't guess as to why. PP had good points. I always inquire as to when the family last talked with the doctor, what they've been told (good to hear what the families know; sometimes it's a misunderstanding, and the family doesn't really understand what the doctor has told them). This is your opportunity to educate the families or reinforce what the doctor has already told them.

If the family tells you that they just talked to the doctor 2 hours ago, and there's not really an issue at hand, suggest they write all of their questions down, and schedule a time when the family can talk with the doctor. However, they do have a right to talk to a doctor, so if they say, "I want to talk to a doctor now" or are not amenable to talking with the doctor when he/she makes his next rounds, then you call the doctor. Always ask them "would you like to speak with the doctor now?" if they seem disgruntled, etc.

Doctors have to deal with difficult families sometimes, too. Part of the job. But, we can do our best to mitigate the situation first. This gets easier with experience. I had trouble at first, too....not really with not knowing what to say, but how to get the families off my back so I could take care of the patients. Sometimes, you have to say, "I'll be back to address your other questions, but I need to check on my other patient." Or you can address their concerns while you're caring for your patient. So, if you're in the room hanging an IV med or helping your pt up to the bathroom, talk with the family while you're doing those tasks. Will help with time mgmt, too, because really, the difficult part about difficult families is that they suck a lot of your time up, so you have to learn to be both helpful, but assertive, because you can't let them interfere with patient care.

Sounds like you did the right thing by calling. Just be glad you were going home lol. The night shift nurse probably was just unhappy because she has to deal with it now, but that's part of the job, and it shouldn't be taken out on you. You can't make overly needy people less needy lol.

PunkBenRN · Sep 18, 2012

Bring someone else into it.

This sounds like a lazy answer, but it works. Find a supervisor, or even a colleague; there are power in numbers, and it is much easier to diffuse a situation when you aren't backed into a corner by yourself. Also, find out who does the "customer service" side of things. Every where I have worked, they generally sent complaints to a specific person or department.

If the family is overbearing, it is interfering with Pt care. Be assertive.

liveyourlife747 · Sep 18, 2012

Thanks guys! Lots of great tips

Esme12, ASN, BSN, RN · Sep 18, 2012

Make sure the family KNOWS you are listening AND interested. I would offer to call the MD so they could talk to them....I would call the supervisor to speak with them. I would tell the family they need to set up a meeting with the MD to discuss these things as I don't want to give any misinformation and give them paper to write their questions down so they don't forget tomorrow when they see the MD. In report I would make sure it is a part of the care plan...and pass on what the family concerns are and that a plan was developed so all the shifts are on the same page. Consistency is comforting to the family.

ElizaW · Sep 18, 2012

Overbearing family member here. Last week my sister was told (by her surgeon) that her gallbladder was, "Rotten. Not only did this scare her, but it also made her feel as if she was something to be hauled out and thrown away.

She was put on 02 several times during her hospital stay because her sats were low. She was not given an incentive spirometer to use after her abdominal surgey. She was not taught to splint herself when she coughs. This afternoon she called me up (from several states away - I wasn't there during her surgery) and said, "I can't cough hard enough to clear the gunk out of my lungs because it hurts too much. And oh, buy the way, is it normal not to be able to take a deep breath and feel like the air won't go all the way down in your lungs after surgery?"

Hooray for "overbearing" family members who look out for their loved ones. I wish I had been with my sister last week to protect her from the professionals providing her care.

That Guy, BSN, RN, EMT-B · Sep 18, 2012

Eliza,

there is a massive difference between overbearing and interested/concerned.

Honestly when the family gets that way, I just hope they get tired and leave. Seriously it sucks but it is the truth. You can educate til you are blue in the face and try to get them to talk to the doc, charge nurse, whatever but it doesnt help. Yes I am speaking in general and not to a specific for all patients, I know there are people out there that will take this as such. I try, I really do. There really is only so much you can do to get the information to the family. Heck, I have even had a family member sit in the room, write down every med I gave, then proceed to look it up on WebMD :banghead: and then question every single iota of the med. What good does that do? What benefit does that serve?

JMBnurse · Sep 19, 2012

Try to be careful about frequently calling the doctor to "talk to the family". I would recommend using that option sparingly. There are some doctors who are willing at most any time to talk to their patients or the family members and may even prefer you to call them to let them know if there is a problem, others- not so much.

Doctors make rounds and many of them expect that the patients or family members will discuss their needs or concerns at those times. If it is an urgent or emergency situation, then it should be fine. If it is an annoying family member who is questioning every little thing, I would use caution. Sometimes I might tell them that I will call and ask the physician and then when I am on the phone with the doc, ask him if he would like to talk to the family. If he says no, then I haven't told them ahead of time that they will get to speak with the doctor and then be faced with returning to tell them that they cannot.

I know that it's their job and it's what they get paid the big bucks for and all that, but remember, if this family is driving you nuts, they are probably driving him nuts, too. Also, sometimes after being very defiant and demanding with you, they get on the phone with the doc and all of a sudden, "Oh, it was nothing". Now, you feel like an idiot. This has happened to me before on several occasions. If it was not an emergency or critical situation, I would try to educate them and handle it to the best of my ability and then tell them very matter of fact that this is something we can discuss with the doctor when he makes his rounds in the morning or later today, etc... You can also tell them, I will leave a note on the chart with your questions and he will address it when he makes his next rounds.

I guess I always tried to decide on a case-by-case basis. If it's really important, then by all means, call the doctor. If not, try to encourage them to discuss issues with the doctor during rounds.

liveyourlife747 · Sep 19, 2012

Thank you all! It is great to feel like I handled the situation as best as I was able in all my hospital newness. Thankfully got the family out this morning. I wasn't to thrilled to have the same group again but when the discharge popped up I couldn't wait to get them out! (gosh I sound awful! Lol) what got to me the most was that the pt was competent and mentally with it but allowed her daughter to step on everyone's toes. Honestly I didn't think she really needed a hospital stay for her dx but I think the family was pushy about it so they let them stay.

Thanks again for all the great advice. :)

jadelpn, LPN, EMT-B · Sep 19, 2012

In the future just be mindful and careful on what you discuss with the family. Adult patients who are A&O have a right to privacy, therefore, the family asking questions of you could be questions that the patient could choose to answer themselves or not.

I usually say something along the lines of "the doctor will be making rounds today. If, Tom, you have questions of any kind that are not answered by the medication information forms and other education that we did, perhaps you would like to write them down to discuss with him when he comes in." When I was alone with the patient,(even at the close of the morning assessment or even with the bedside report as a question) I would say to him that I cared about his privacy and if he would like his family to be involved in his decision and education process or not. If he does, CYA and get releases signed. If he does not, then make sure that you go in with your charge nurse to explain the hospital's privacy policy to the family. Once you explain that to them, be sure to ask that they excuse themselves when you go in to assess the patient. If it is a pedi patient, the family has to be involved, and give them as much patient education as you need to, and have them write down questions for the doctor when he makes his rounds.

nekozuki, LPN · Sep 19, 2012

Overbearing family members, annoying as they are, usually have the best of intentions. I try to remind myself of how frustrating it can be having no control and not understanding the process.My strategy is to make the patient and family understand and believe that I am an advocate for THEM. Everything I do, I explain and give rationales for, because education can help them feel more comfortable with you and build trust. Family members have needs to be met (questions, concerns, fear, confusion) that must be met to. Of course, occasionally you get the total control freaks who demand all your time and energy, in which case I kill them with kindness, explain my patient load but check in constantly to keep them from mashing the call light.Working in the service industry my entire life was an unexpected advantage going into nursing. I feel like a waitress sometimes