ICU experience - question from a student

[Multicollinearity, BSN, RN]

My grandfather died a few days ago in an ICU. His ventilator was removed in accordance with his DNI/DNR. He was 82. My huge family was in the ICU room and their behavior shocked me. I'm not too familiar with them, as I only see them once every few years. Seven adult children and their spouses were in the room. About 9 grandchildren were in the room. They were lined up against the walls and sitting on the floor.

Now, Grandpa obviously wasn't conscious. The family was lined up like sardines jam-packed in the ICU room waiting for him to pass away after the ventilator was removed. They were talking loudly like it was a family party. Nobody paid any attention to him, or talked about him. They were all talking over each other with small-talk, laughing, etc. Once another RN (not Grandpa's) asked them to please keep it down, that they were disturbing patients in other rooms.

I am so shocked at their behavior. Yes, Grandpa was a difficult man and caused many pain. Still, I cannot fathom being so disrespectful of his dying experience. Who knows if he had some level of consciousness? Maybe he did? Maybe he didn't. Thing is, they did the same thing at the funeral home, and I was still horrified. The funeral director had to ask them to please keep their laughter and 'loud banter' down because it was disturbing another family on the other side of the funeral home in another viewing room!

So thinking of this from a student's perspective, here's what I'm wondering and would like feedback on. Wouldn't many ICU nurses advocate for the patient and ask the family to be mindful of his last hours, meaning quiet down? Of course I also then think of when I worked in an ER and we were mindful of those d&^! customer service rating scores. Grandpa cannot return a satisfaction survey but the family can. UGH. Any input? Have any of you seen anything like this, my horrid extended family? I am shocked.

[ZASHAGALKA, RN]

Any input? Have any of you seen anything like this, my horrid extended family? I am shocked.

Generally speaking, people grieve in different ways and it's not my place to comment or detract from that, (indeed, in many ways, it's my job to facilitate that), except to the extent that it disturbs other pts/families.

In addition, very shortly after 'terminally extubating' someone, if they don't immediately stop breathing (and it is common that they don't), we move those pts into private rooms on the medical floors so that family CAN have more access.

I don't really think that the behavior you witnessed is so shocking. As I said, people grieve in different ways. I've seen enough to know that wearing black and blurring your mascara to everybody that watches isn't necessarily grieving. And putting off your emotions and acting 'casual' isn't necessarily NOT grieving.

Don't be so hard on your family.

~faith,

Timothy.

[Multicollinearity, BSN, RN]

Thing is, they weren't talking loudly and laughing as a coping mechanism. They really didn't like him, and resented more time dealing with him. I'll be the first to say he caused alot of pain and sent many people into therapy for years. Even so, shouldn't he have had death with dignity? Good Lord - at the funeral home someone leaned up against the casket while laughing and telling jokes. During the 2 hour viewing I never heard a single person mention him in any way.

Back to my question though. Would some ICU nurses ask them to be more quiet and mindful of his dying experience?

[caroladybelle, BSN, RN]

Let's see:

As a nurse, I have had people complain that I looked: too sad, too tired, too happy, too smiley, too friendly, too unfriendly, too involved, too uninvolved, etc, etc.

Because as a nurse, I know that every single family in the world handles death differently. And as a "culturally sensitive" provider, I have to accept that their ways, though rude to me, may be perfectly acceptable to them. And unless it is dangerous, GROSSLY inappropriate, impinging on another's rights, or illegal, I really don't have any business imposing what I think is the "appropriate" death scene a family that is not doing anything drastically wrong.

If they were being verbally abusive in his presence, or harmful, that is one thing and the nurse has a right to step in. Merely chatting oblivious to his dying presence in a fashion that a few others in the room found disrespectful, is not the sort of behavior that nurses should or need to govern. And obviously, the behavior was not offensive to some others, as there were others participating in the activity and continuing in it.

And the question, did YOU, or any other offended person ask the family to stop behaving in that manner. Nurses aren't psychic, nor are suitable to judge others' benign traditions. YOU know what is acceptable to your family customs and you were the offended party...why did you not step in and say something?

It is much easier to be angry at others for not stepping in (even though they may have had no reason to do so), than to accept that you as the offended should have done so, if it was of such great importance to you.

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I think that maybe you are displacing your anger that you feel towards your family/and perhaps unresolved family issues involving the deceased, and directing that anger onto others (the nursing staff) that are "easier" to be angry at, as they are not family. And you asking us to sanction that.

Sorry, but we cannot sanction that. We have plenty of duties above and beyond micromanaging benign behavior. If the behavior had been harmful, dangerous or abusive, certainly we should step in. But it does not sound like it was, merely offensive to your feelings at the time.

Nurses get alot of abuse dumped on them during death and dying scenes, that has nothing to do with them and everything to do with problematic family relationships. And as far as I have seen, management does not include that in acuity levels, when parceling out staff. When families start having difficulty maintaining "reasonable" control, at times, family representation at the bedside gets limited...and no one is happy. It provides a basis for the"no more than two at a time, 15 minutes only"rule......which may be necessitated by family members bickering.

And what would you prefer, not being able to freely visit your dying loved one, or handling issues politely amongst yourselves. Because if nurses are required to figure who in the family is "right", "respectful", "acceptable", etc., chances are everyone but 1-2 next of kin are going out of the room.

[caroladybelle, BSN, RN]

PS.

This isn't the worst but:

Very athletic, relatively healthy, forty something male, in his second marriage to a moneyminded young thing. Admitted for nonresolving pneumonia for a work, patient is jogging about the facility awaiting test results. Blood work comes, bone marrow BX is done, patient is told that he has CML.

Wife immediately tells everyone that he is on his death bed, even though many CMLers (especially in his excellent condition) live 10-20 years with only symptomatic treatment. She darkens the room curtains, bars his kids (from the first marriage) from getting information, and discourages them from visiting and "tiring" him out. He takes to the bed, like the reaper is at the door.

After a few days of the preacher coming by, and wife going over the will, and his insurance so that everything "is ready", he continues to do just fine and we give him the standard chemo with decadron. He starts feeling that steriod high, whereupon, she keeps knocking him down, with how gonna die.

One day, I walk in to hear him talking about sick he is with the leukemia, and she is on the phone. And after a couple of minutes, I hear her spelling names out and realize....SHE IS DICTATING HIS OBITUARY...ON THE PHONE-RIGHT BESIDE HIM!!!!!!!!!!!!!!!!

[nightingale, RN]

and realize....SHE IS DICTATING HIS OBITUARY...ON THE PHONE-RIGHT BESIDE HIM!!!!!!!!!!!!!!!!

:trout: Frightening

[Multicollinearity, BSN, RN]

Caroladybelle,

I was not at the hospital. I was at the funeral home. I agree with what you said. Thank you. I was too emotional to look at the situation objectively. I have to admit I am still surprised at how LOUD they were. I tend to think some nurses *might* have asked them to at least keep it down - out of concern for Grandpa. But I know you are right in what you said. No - I wasn't upset with the nurse. I was upset with my family and a tad surprised that Grandpa's nurse didn't tell them to at least keep the volume at a level where people weren't raising their voices. I did say something at the funeral home. I just don't understand these people.

I do know you are correct. Thank you for saying it.

[caroladybelle, BSN, RN]

It is rough at times. We do not get to choose our relatives. And sometimes you really wonder if you are actually blood kin to them.

After nursing for years, I find that I have to be careful about my judgements. When the local church has a "sing them to the Lord" group in, they get highly irate, if we tell them tell to be a little quieter.

You would think that G-d was deaf as a post, since they insist in singing loud enough to be heard to the next County...at 2300 at night. That others may want to sleep is a bit foreign and not of concern to them. And the nurse that objects to the noise is accused of being pagan or rascist or heartless and lacking in "compassion".

I have dealt with families (10 or more at a time) that spent a week or two at a time, with the " MD comes in, everyone has to hear, and then they all proceed to have loud crying jags, and fainting spells in the hall" episode.

My sympathies to you. It is a hard thing to deal with. My prayers and thoughts are with you at this difficult time.

(when my father died, his family was of the type - Aunt Dot threw herself in the casket, bawling......he died of terminal emphysema, after 40 years of smoking. He was 74 inches tall, weighed 78 lbs at his death from the effects of the disease and was the youngest/first to die in his family of 9 brothers and sisters.

And do you think that there was EVEN one that was not smoking like a chimney at the viewing, the funeral or the cemetary. It was like a forest fire out there.)

[Mags4711, RN]

...SHE IS DICTATING HIS OBITUARY...ON THE PHONE-RIGHT BESIDE HIM!!!!!!!!!!!!!!!!

And I'd have walked out to the desk, looked up the name and number of a good divorce attorney, and went back in and handed it to him. :)