Hygiene issues, behavior issues, a much older boyfriend, etc...what would you do?

[flashpoint]

I've been spending a lot of time working in ER lately and we have a family of patients that is just driving the ER staff a little over the edge. There is a mother, 12 year old girl, 16 year old girl, a 23 year old daughter, and the 23 year old's husband. They have always been people that we see alot, but in the past month, I have seen one or more of them (at least daily...sometimes they will come in two or three times in one day) in the ER for things that are not really considered emergent...broken fingernails, pregnancy tests, throwing up once, etc...but that isn't the problem...just laying some groundwork here.

Anyway, these people have the most horrible hygiene I have ever seen...they literally stink so bad that after they leave, we have to have housekeeping come in and clean the room, and even after that, the room usually smells so bad that we consider it closed for the rest of the night. They also never really "act sick." Usually all five of them come in no matter who is sick and they laugh and giggle and tell loud and crude jokes that everyone in the ER can hear. Also a bit more ground work here...

I know there are also some mental issues here...they all have a lot of trouble reading, the mother and 23 year old cannot read cursive writing, so we have to print all of their discharge instrutions. We have to be very specific, yet simple with their instructions or they will call back a dozen times trying to understand them...we have to say things like "Swallow one pill at breakfast. Swallow another pill at supper. Do this until you swallow every pill in the bottle" rather than our usual, "Take one tablet twice daily until gone." We also have to go over things very step-by-step, or again, they are calling with questions...can't just tell them to change their bandaid, clean the site, and apply neosporin twice daily, have to tell them to take the old bandage off, wash with soap and water, dry well, apply frech neosporin, and put on a new, clean bandage.

They leave a mess in the exam rooms...food everywhere, kleenex on the floor, food on the wall, entire boxes of gloves pulled out and thrown all over the floor, supplies in cupboards and drawers gone through...

I am trying not to sound judgemental here, but it isn't working.

So...the problem is...I go to church with the 23 year old and her husband. A couple of weeks ago, she asked me why I am so standoffish to them when they come in to the ER. I told her that I honestly try to stay very neutral with patients in the ER and that while I will give the best nursing care that I can, I am not there to be my patient's friend...I will take care of their needs, but I am not their buddy. Not very nice of me, I know, but a lot of times I just don't have the time to be all happy and friendly with them...I also hate the idea of reiforcing to them that coming to the ER is a fun and good idea...sure I will help them with whatever they need, but I am not going to make it a good time for them....not going to make it a bad time, but I sure don't want it to be fun. Honestly, I am also not really sure if I want people I work with to know that I know these people socially...

Also...because of the hygiene issues, one of our doctors often talks about turning the mother in to social services for neglect. He doesn't believe the younger girls need to be removed from the home or anything, but he does think that there needs to be some sort of intervention, parenting classes, hygiene assessment, etc. I would never let anyone in the family know this is about to go down because they would probably clean up their act until they are investigated and then go back to status quo...also it is just not my place and would be inappropriate for me to do so. He also has concerns that even with very detailed instructions that often the discharge instructions are just not being carried out...they will often come in with a seven or eight days worth of antibiotics from two months ago wondering why they didn't work...the husband once left stitches in for 21 days because he didn't understand that he had to have them removed.

But...would it be wrong for me to invite the 23 year old over for lunch someday and talk to her about some of my concerns? She and her husband have the same hygiene issues and I honestly think that neither of them were ever really taught that you have to bathe, shampoo your hair, wear antipersperant, brush your teeth, etc. I think they must bathe on Sunday morning, because I really don't notice the hygiene thing at church. Would it be inappropriate to talk to her about their behavior in the ER as well? I don't want to step over any lines, but I really think that if she was told how inappropriate their behavior was, they would cool down, at least for a while.

Also, I happen to know that the 16 year old has a 23 year old boyfriend and I am about 99% sure that the mother doesn't know. I know because I have caught them making out in the hospital lobby after hours and because a friend of mine works with the boyfriend and he was asking me what I know about the girl...she looks way older than 16...and my friend acted pretty shocked when I told him that is how old she is.

So...I'm not sure if I am just venting here or being a judgemental witch or what...if I ever smelled that badly and behaved that badly, I would want someone to tell me. If I do say anything to the young lady from church, I doubt it will go over very well, but...just don't know what to do.

Also...any ideas on how the ER staff can better deal with this? I really feel like we have contributed to the making of this mess and a lot of us are really frustrated right now.

Also, please forgive me for rambling on and on...

[flashpoint]

I can't seem to type or proofread today...please forgive my mess!

[cjog]

From what it sounds like this family is very poor - so I wonder how it is that they can keep making all these visits to the ER for ridiculous reasons. This infuriates me because I, at the moment, can barely afford health insurance that will only cover me if I am lucky, and I'd still have to end up paying a huge percentage of it. These people using the ER like that is one reason why health insurance is so ridiculously unaffordable.

I do not think that you are being judgmental at all. If people act dirty, look dirty and smell dirty, it's pretty safe to say they're dirty. Perhaps I am being a bit harsh, but I'm just trying to tell it like it is. When a persons hygeine is so bad that you have to clean a room after they've been in it, something needs to be done. I'm not sure what would be the best way to counsel this family reagding their behavior and hygeine, but I probably would advise against inviting the woman to your house. Keep things strictly professional and get the help of your colleauges and superiors. These people are simply clogging up the ER when there are real emergencies to be handled. Yes, they need help, but not the kind offered in an ER.

[flashpoint]

I know they don't have a lot of money, but I also know they live in some pretty nice subsidized housing...our ambulance goes to the other houses in their complex a lot and they have all of the comforts of home...running water, heat, electricity, etc. I will never understand how people can go without bathing...

I do have a bit of a personal realtionship with the 23 year old...she sits in front of me in church every Sunday and we do lunch after services once in a while...but...if I didn't see her in the ER so often, I guess I wouldn't really know about the hygiene thing, so...

[SmilingBluEyes]

Gee if they live in a HOUSE I would assume they have access to a shower/bath? The rest, you can't help.........it's sounding very complicated and yes, lots of mental issues abound here.

[JBudd, MSN]

I think your doctor should report them for neglect. Not teaching your chldren basic hygeine, whether from ignorance or not, is neglect. Not giving medications properly is neglect. Poor hygeine likely means poor nutrition as well, because they are not likely to keep their food prep any cleaner than the rest of their lives. This also keeps you from being the "bad guy", not that I think there is anything wrong with reporting.

How involved do you want to be with the 23 year old? As a fellow church member (I can sympathise, having been the pastor's wife), it isn't so easy to turn your back on someone who obviously needs help. She gave you an opening when she asked about being standoffish: she may be very lonely. Being the good samaritin isn't easy, the question becomes, are you willling or able to get that involved with her, and if there is fall out do you want to have to deal with it? They certainly need help, you may be the one God put in their lives to do it: but only you and God can know.

God bless, and guide your decisions.:icon_hug:

[Marie_LPN, RN, LPN, RN]

But...would it be wrong for me to invite the 23 year old over for lunch someday and talk to her about some of my concerns?

I wouldn't think so, because it would be combining personal and business.

I'd keep the two separate as possible.

Think of it this way, if this were a total stranger, would you do the same?

[Bipley]

Whatever your involvement today will likely increase in the future. Meaning, have lunch with one of them today and bank on a bit of a 'needy' relationship forming in the future. Can you handle that? Are you willing to accept that responsibility? It's much easier to prevent a relationship vs. ending one at a later time.

If the kids are suffering it is your duty as a nurse and a human being to turn them in. I have to admit, for the rest of it while I was reading your post I was thinking that I'd send an anonymous letter to them! LOL

As for the ER overuse, can you get together with their PCP and do a contract of sorts? The ER is to be used for "X" and not "Y"? Or would that likely be too difficult for them?

[flashpoint]

Dear Mom...

I am worried because your hygiene and that of your family is very poor. It concerns me that after you leave the ER, the rooms smells so bad that housekeeping has to go in and to a thorough cleaning and we cannot use the room for the rest of the night. If you need assistance with your water bill, buying hygiene supplies, etc, please call out social services director...she would be happy to help you.

BTW...I caught your 16 year old making out with a 23 year old construction worker in the hospital lobby. The hospital, while a public place, is not a good place to go on a date. The 23 year old construction worker's coworkers say he is an ass.

Hugs and Kisses

Me

[JentheRN05, RN]

LOL Cute :)

[canoehead, BSN, RN]

If you have issues about the hygiene I don't think its fair to have them reported without being very clear about what you expect. Add this to your discharge teaching, and gently explain about how not washing regularly affects healing, and how it puts people off that might otherwise be kind. Get on their side and see if they make small changes.

[NurseyBaby'05, BSN, RN]

Psych and social services consults are in order for these guys. While they may indeed be just trashy, there might be some underlying issues that need addressed. Also, why are these people allowed to tear up and trash things in your hospital. If limits aren't set, you all are doing yourselves no favors. There's nothing wrong with asking the family members that aren't being treated to leave if their behavior is unacceptable. You also have an obligation to notify child services of the condition these people show up in. The children in this home that are obviously neglected. Maybe it will be the needed jolt to get through to this family.