How do you handle patients/relatives?

[NewlyGradBSN]

It's my first month as a licensed nurse and I have learned a lot. I am currently rotated in the post op ward. This one time I experience a relative of a patient stating that they want their IV infusion to be removed. She kept on stating that the patient doesn't want it anymore. So what I stated was that in this case she would need to sign a waver indicating her refusal. I dont know if it's the number of patients or that I was so busy that day but somehow they received my comment as disrespectful when all I did was say it in my most polite way. Then, the relative stated that she's a nurse in some well-renowned hospital and that she knows the rules. I was bothered that she said that I was disrespectful when I answered them that they need to sign a waver. I felt that she might have misunderstood me. I was so sad because my motto as a nurse IS no matter how busy, I should always be smiling (if appropriate) when I am with a patient. Any advice please? I know should grow a pair and be stronger. These are the lessons NOT taught in nursing school.

[SolaireSolstice, BSN, RN]

I'm probably not the best one to be answering this, because I tend to be rather blunt, but no one else has replied, and I too have had these issues with family. However, I don't usually say it with a smile. I just say the issue straight and to the point. "Just the facts, ma'am." However, I have never (knocking on wood) had someone complain that I was rude. "She is receiving *whatever treatment* for *whatever reason* and per *whatever MD's* orders. I would be happy to pass the concern over to the MD during rounds." Sometimes I will ask directly "What is it that you are concerned about *this treatment*?" and if it's something I can answer I do so, or find the information to help them. And if the patient voices the refusal to me directly, I will remove *whatever is offending them* and document. Patients are allowed to refuse treatment, and I always state this. But until the patient tells me they don't want it, or it's not safe, or the MD orders it DCd, I am to continue *the treatment*, unless that family member is medical POA and the patient is unable to voice their wishes. The ones who puff up and state they are *whatever medical profession* will understand your need to document about patient's refusing treatment, unless they are not actually that profession. Which has happened more often than I care to comment.

A simple example: A patient had come to us from a stay in ICU with a peripheral still intact and within date. The peripheral was not needed for current treatment, all medications were po, but still flushed well and after a day even still had blood return. A family member asked why the pt still had "that IV" and why didn't I remove it after I had checked it's viability. I said I would check if we needed it, but that it was still a good IV. I checked with the MD (he happened to be at the desk) and asked how he felt about me removing the peripheral. He told me and I explained (speaking both to the fully alert and oriented pt and the family member) that while the patient was better and no longer needed the higher level of care that the ICU offered, the pt was still medically fragile, and if an emergency happened, starting an IV would take needed time and definitely an additional hole, if not more since she was a difficult stick. (Actually what the MD answered was "if she crashes again, how fast could you start an IV on her?" I didn't state it in quite those terms to the pt.) "This is a good IV, still within date. Until it's no longer viable, it's safer to keep it intact." The patient understood, and once the pt understood, I no longer needed to discuss the matter w/ the family.

[talaxandra]

I tend to take advantage of disclosures about relatives' health care background - in this case I'd have said something like "I'm so glad to hear that! Now I know you understand that, however annoying, I have to follow hospital policy about this. So many laypeople don't understand why I can't just stop X, instead of going through the proscribed process."

[carolmaccas66, BSN, RN]

I'm a bit confused: is the patient not able to speak, or perhaps can't speak properly? Even then unless the relative has power of attorney or something similar, you don't need to pay any attention to them. You should not be discussing the patients' status with a relative unless they are a carer (even be careful then), or it is general information. Just state that it is confidential and it is ONLY the patient's wishes you can listen to.

I don't understand either why the patient would have to sign a waver. In Aust we can't force treatment on someone. Some patients have pulled their IVs out, so we just put them on oral med's (if possible), or they may get a PICC line, then they're usually happier.

Tell them they must discuss anything like this with the treating Dr. Or report it to the shift coordinator/NM, whoever is in charge when ur on. Don't take the brunt of complaints. It's not up to you to explain why for this and that treatment. And document everything.

Yep you will have to be firm but polite as possible, but I wouldn't be discussing anyone's medical treatment with any relative - remember, that is confidential info and you can explain that to them.

[aerorunner80, ADN, BSN, MSN, APRN]

We had this problem when I was a tech in a SAC unit. Pt's would ask all the time if I could take their IV out (d/c IV's was in my scope of practice as a tech but it wasn't my decision) because they weren't getting any meds through them.

I always told them that it was our policy that if the person was sick enough to be monitored, as all of our SAC beds are, it was required for them to have an IV. I would follow this up with, if the person did not have an IV and were to code, life saving treatment could be delayed.

Once I told them that, they typically wouldn't ask again.

Educating our patients and families is SO important!!

[netglow, ASN, RN]

Another thing. Family and friends of patients who tell you they are RNs, or whatever, often are not. I've always doubted when someone pipes up with this information. Same with "My so, and so, is an MD". So?!... they don't work here, I do. Of course I won't say that, but really, all you can do is ignore that info as it should not begin to govern your practice.

[shoegalRN, RN]

Here's how I would have responded to the family member who states she is a nurse:

Are you the pt's DPOA? If not, then you understand the PATIENT has a right to refuse any medical care as long as he is alert and oriented. If you are not the DPOA, then the pt has a right to make his own medical decisions.

If you are a nurse, you do understand this right? You also understand I will also be documenting this.

I am no longer intimidated by those family members who throw around "I'm a nurse" or "such and such in my family is a doctor". As a nurse, she should be well aware of DPOA and pt refusal issues so she should have known what to expect.

[evolvingrn, BSN, RN]

... no need to ever be aggressive.........even though you probably didn't mean to going right to you will need to sign a waiver.........is not a good first step in the conversation. i find a little education goes a long way. "this is why we are keeping the iv in , this pt has just undergone this procedure and received medications that they could still potentially react to. We need to keep access for that reason, I know how frustrating that is and how uncomfortable it can be, I would be happy to pass on to the dr that as soon as it is safe it is a priority to have the iv d/c "

I also totally agree with using the background of the family member is a great tool.

i find education is everything, there is only one family that i have not been able to educate to making reasonable choices (spouse was a former nurse......lol, we can be PIA ) and i didn't take it personally. i simply passed onto the dr their choice and we accommodated that...