How to handle particularly pushy/picky/questioning family members

[RNLaborNurse4U]

I have noticed, from time to time, there will be that *one* family member who will question your each and every move with a client. They question --- EVERYTHING. They challenge you on EVERYTHING.

I had this one particular person come visit a client I was taking care of recently. I work on L&D, and we get the s/p surgical pregnant patients. This particular patient was s/p open appy, post op day #1. She was 30+ weeks gestation, baby #1. No complications from the surgery, and no OB complications. Most especially - no preterm labor/preterm contractions. Thus, why she was being cared for on L&D on continuous EFM.

Her pain was under relatively good control with Percocet. She was taking in p.o. fluids well. She was up to the BR with minimal assistance several times. IV converted to hep well. On colace and mylicon. Doing cough/turn/deep breathing to help reduce atelectasis. Basically, all things that can be done at home (other than the continuous EFM, which in my nursing opinion should have been d/c'd by this point, but I digress.)

I was just there to fluff, buff, ensure that everything was staying status quo and she was getting better. Enough for d/c to home the next day.

Then the family member know-it-all graces us with her presence.

"What is her status?" she asks me outside of the patient's room. I explain that I cannot comment on her health status without getting consent from the patient, so I suggest we go into the patient's room. We do, and the patient is fine with discussing her status and plan of care.

I once again, reinforce all of the normal healing functions that are going on - off of IV fluids, oral pain meds, taking fluids and can move up to solids now, urinating normally, bedrest with bathroom priv + MD orders to ambulate TID and prn, use of cough/turn/DB to clear lung secretions. And that she's more than likely going home the next day since she was doing so well.

"What?!? Go home?! But she's on bedrest! She can't go home!"

Last I looked, she's not on bedrest (strict), but rather, she needs to actually get up and walk more than she's doing (other than going to the BR and back), and walking actually helps promote healing. In other words: it's GOOD FOR HER TO TAKE SHORT WALKS. --sigh--

"Oh my God! Why is this fan on!? She can't have air blowing on her!"

Really? Tell that to her, when that fan was placed there per her request because she was feeling hot and wanted the air blowing on her for COMFORT.

"She can't go home!"

Why not? Everything she is getting here is the same things that family members can help her with at home, or she can do herself. Such as, swallowing her pain medication, taking colace and mylicon, walking to the bathroom, etc.

"What about a bowel movement! She needs to have one!"

Really? I do believe that if she has an urge to have one, she can get a little one person assist to the BR to do it. (To patient - when did you have your last BM? Yesterday? Ok, so you're ok, and right on track. Sometimes the next BM after surgery is a little delayed, but that's why we have you taking over the counter colace to help make it easier to go when you do have to have a BM.)

"But, you can't seriously think she can go home tomorrow? What if this was you?"

I have had several abdominal surgeries, and trust me when I say - home is better than a hospital. Yes, it's normal to go home on post op day #2..........or even the same day. She's not an invalid.

No --- I didn't say these things word for word. Some where thought in my head...........while I verbally was giving the absolutely best patient/family education for health promotion and good post op healing as I possibly could.

[Elvish, BSN, DNP, RN, NP]

I hear your frustration loud and clear. Most people don't believe it when I say that 95% of the time I can deal with my patient(s) just fine....it's their flipping crazy, irritating families that make me want to stab myself in the eye.

[merlee]

You don't say who this person is - - the main caregiver? pt's mom? Someone who is just being annoying?

I would have deflected some of the questions unless this was the most likely caregiver and she (or he) was just very anxious.

[RNLaborNurse4U]

She never stated who she was, nor did I ask. She was about the same age at the patient, so I was assuming she was either a sister, cousin, or friend.

[ProgressiveActivist, BSN, RN]

The surgeon surely spoke to the next of kin post-op. I would refer this PIA to the surgeon.

"What did Dr Smith tell you?"

"you'll have to take that up with Dr Smith."

"No, I am not going to call him because you don't agree with his orders."

"Your mother will be just fine under my capable nursing care."

"It took me 25 years to learn all of this and I don't have time to go every little thing right now.

Clearly this is attention seeking control freak behavior. Cut her off at the knees.

[VICEDRN, BSN, RN]

Libby liberal took the words out of my mouth...answer questions once then refer the family member to md. I have found myself defending md's discharge order only to have him or her relent and admit the patient just to shut them up. Of course, by then, I was seething. So now I let the md deal with it!

[opossum]

Sounds like you handled it very well; I'm always looking for tips/suggestions on how to deal with family members like this. I think they are just stressed out and trying to make sure we're not making any mistakes...unfortunately, they ask questions that they don't even know *why* they are asking. Here's an example I recently had:

Family member: "How is their pH level?"

Me: "Well, it's going up, and-"

Family member: "-what, it's going up? Still?!"

Me: "That's good. That's what we want it to do right now..."

While it's good to keep family and caregivers informed, sometimes it becomes too exhausting and complicated. And I'm all for keeping family involved and informed, etc. But sometimes I think it becomes more of a burden, even for them. I was discussing this once with an MD who advised me to "just say 'labs'" when a family asks how we know their kidneys are getting better, or how we know if they had an MI...but then that seems

sort of condescending to simply say "labs"...you can tell the family wants to know more.

[Double-Helix, BSN, RN]

It's definately annoying to have a family member who questions your every move and every medical decision. I hate working feeling like every nursing intervention, IV push med, BP cuff application, etc. is being scrutinized.

I find that the best thing is to just give the person the accurate information.

"She can't go home!"

"Yes, she can. Almost all of our patient who have this procedure go home the next day."

"Why is this fan blowing on her? She can't have air on her!"

"She wanted the air on her. There is no reason why she can't."

Just be honest, but short and to the point. Make it clear, while being polite, that the visitor's opinions are false.

It also can be really helpful to give the person something to do. Many people who behave this way are doing so out of helplessness. They feel powerless when their loved one is in the hospital and assert themselves in an attempt to feel useful. So when you have a family member that is acting like that, give them direction. Ask them to feed the patient (if it's a child or person needing assistance). Allow them to get more ice water from the kitchen area. Ask them to do gentle range of motion with patient's fingers, or apply lotion to the arms and legs.

If all else fails, tell the visitor, "I understand that you have some concerns, but I have to check on my other patients. Why don't you make a list of the important things and I'll look at it when I come back."

[RNLaborNurse4U]

So help me, sometimes I just want to smack the family/friends who are more of a nuisance than anything else. But I hold back on that urge. I'm a professional, after all! :-)

[JeneraterRN]

I hear you. Last shift, I had a patient's wife follow me for 2.5 hours asking for DC orders after telling her multiple times I'd come to the patient's room when I had them. Meanwhile, they had decided he needed to stay, so when I did have them, they told me he wasn't going home. He went home-I win.

[locolorenzo22, BSN, RN]

I try to go see those PITA family members if I know they have been driving the previous shift crazy asap. Usually if I spend the 10-15 minutes at the start explaining what is going on, the plan for the night, the plan for tomorrow, etc. they seem a little better. If they ask me for results, I always explain that the doctor has to go over test results, but I will look and see if there is anything found that must be addressed tonight. If so, I will be contacting the physician.

I get sick of the people who refuse to give patients water when they ask, (you're sitting next to her, you can't hand her water?) when they want me to feed the patient right away(well she doesn't need to be fed, we're actually trying to get her to do more, let's go ahead and cut her meat, get her situated/setup, in the chair/higher in bed, etc.). I explain that A)I will get mom/dad/wife/hubby situated as best I can now, if they need to be fed, I will certainly be in to do that shortly or my CNA will be shortly as well. (if they are not a serious swallowing issue, I will suggest the family can do this if they would like. "well, you can start, and one of us will be back shortly."

I have issues with family members who want to stay the night when the patient has a roommate. NOT happening! or if the patient is stable, and has been there 2-3 days. First night, depending, I may let them stay. Otherwise, they're ok.

Best advice? Kill em with kindness. When you stay calm professional, and polite, it's tough for someone to get after you.

And some people are just nuts.

[talaxandra]

I love working in the public system and in a country that's yet to hear of Press-Gainey.

"Discharge decisions are made based on a combination of medical and social consideration. In this case there's no medical or social need for her to stay here after tomorrow, and every unnecessary day in hospital increases the the risk of her developing an admission-related complication. In any case, this is not your call."