How do you handle family members who want to impose their will on oriented patients?

[RNdynamic]

Frequently I will be caring for a patient in their 60s or 70s, totally alert and oriented, who has an adult son or daughter who who calls asking for updates about the status of the mom or dad, their illness, their treatments, and so forth. Often they want a rundown of everything that has already been explained to the patient themselves. Or they want a doctor to talk to them after the doctor already saw the patient that day. Very generally I tell them I will transfer them to the patients room so that the patient can explain to them what is going on or what the doctor told them. Even if they have a HIPAA password and the patient has given permission for information to be given out, I don't feel that either the doctor or I should be obliged to explain everything all over again to absent family members, when the patient is perfectly able to do so. More than that, I feel that a lot of things are for the patient to say, not me.

Second issue: one time I had a lady get mad at me because I gave her oriented 90 something year old mother a xanax overnight, which the patient had asked for. It made her very lethargic in the morning when her daughter came. She didn't say it outright but I got the sense that the daughter thought that we should have gotten her permission to give the xanax, just because her mother was old. I explained to her that the patient wanted it, and my concern was primarily for what the patient wanted.

Has anyone experienced this sort of thing before? Do adult children have the right to impose their will on their parents when they are patients? Do they have a right to updates from nurses and doctors that their parents could provide them just as easily?

[Nurse SMS, MSN, RN]

I am pretty blunt. I tell them since their loved one is of sound mind and judgement, they will be making their own healthcare decisions and that if they disagree with those decisions they need to take it up with the patient, as legally and ethically I cannot circumvent the patient's choices.

I also transfer update calls to the patient themselves for out of town relatives. I only talk to the relatives if the patient asks me to and then I phrase everything in a way that lets them know the patient's wishes and choices are being followed. "Your dad elected to forego surgery....your dad refused dialysis....." Etc. If they squawk, I remind them that their dad is oriented and able to choose for themselves. If they ask how we can "let" them choose to refuse things, I tell them ethically we have to. Then I transfer them to "Dad" to try to cajole him into different choices rather than attempting to intimidate or bully me into something against the patient's will.

I get very little flack for these practices. I can be quite firm when I have to be. No way am I going to waste what little time I have to care for people listening to an absent family member trying to manipulate things. Ain't nobody got time for that.

[toomuchbaloney]

I wouldn't get too worked up about stuff like this because we cannot really change the family dynamics at play with our patients.

Having said that, simply being mindful of the real HIPAA issues will keep you on the right track. If the family members do not have the "password" or similar just transfer them to the alert/oriented patient. If the daughter is upset about giving the Xanax that is ordered, suggest that she could speak to the prescribing provider about it. Just remember that many geriatricians do not approve of the use of benzo's in the very elderly.

[ArtClassRN, ADN, RN]

I've hung up on them. They call back and yell at the charge nurse, which saves me a lot of time.

[jadelpn, LPN, EMT-B]

You are absolutely correct, OP in that you limit information that you give to adult children. Sounds as if you are doing everything right in that regard. Good for you for protecting a patient's right to privacy.

In the Xanax situation, I would have not told the daughter a thing. If the patient was lethargic and daughter had an issue with that, it is up to her to discuss with her mother. Or, she could make an appointment with the MD in their office for a "consultation" in which the MD would say the same thing.

And that brings me to point 2. Should a family member want a rundown on the course of care, they can either make an appointment with the MD during normal business hours for a consultation, or speak with social work about a family meeting to discuss the plan of care.

Don't ever get yourself into a place where a family member can say "Nurse RNdynamic told me, Mom, that you are taking xanax!! OMG you will have an ADDICTION!! I am not going to come over and give you your DRUGS....." you get the picture.

Keep doing what you are doing. Use your resources as far as "more information" and they can set up a meeting if they are concerned, interested, micro-managing.....

[TheCommuter, BSN, RN]

I've hung up on them. They call back and yell at the charge nurse, which saves me a lot of time.

Yep. I'm the night shift house supervisor and in the past I have not hesitated to hang up on family members who are belligerent, hollering, cursing or are otherwise being disrespectful.

My favorite conversation ender is, "Talk to the dial tone."

[CrunchRN, ADN, RN]

You have to set limits. In the past in the office I would tell people the oriented person is my boss and what they say goes. Period.

If they are belligerent then I give them 1 warning that if they continue I will hang up. And then I do.

[BillyTheKind]

I am pretty blunt. I tell them since their loved one is of sound mind and judgement, they will be making their own healthcare decisions and that if they disagree with those decisions they need to take it up with the patient, as legally and ethically I cannot circumvent the patient's choices.

I agree. I can be blunt as well but most times I am nice about explaining that their loved one is the patient and in full control of themselves. They in essence are our bosses not some stupid wanna be web MD doctor. I am nice about it though.