Don't you just LOVE families and visitors that try to tell us what we should and should not be doing? I had to deal with one yesterday that takes the cake.She has 2 loved ones in our LTC and calls the MD directly to make demands and (problem number 2) the MD does whatever she asks! She must be notifed prior to any change in meds (which we do always do that but sometimes it may be the next shift if we get swamped) But SHE decides if her loved one will receive the med...She called one evening recently and told the nurse on duty that she decided that a particular med had to be dc'd-and insisted the nurse call the doc right away The doc just blew it off " Whatever-do it" So her loved one has been having problems ever since.I went through the nurse's notes and reviewed the sequence of events with her-she is more focused on BEING right and having the last word then what is best for her family.I could have smacked the crap out of her!
She KNOWS it ALL because SHE took the med one time and SHE -..fill in the blanks...
or SHE talked to. ..- fill in the blanks...
or SHE read that ... -fill in the blanks...
After I mustered my courage and informed her that independently gathering info from places like the internet and the friendly neighborhood pharmacist is NOT in her loved one's best interests and that decisions regarding administering meds and making diagnosis' is best left to the MD,NOT to her or we nurses and that she can not compare her health history and experiences with theirs then she wanted to argue with me about when the particular set of symptoms began.I had it right in front of me in black and white but SHE wasn't having it...WHAT A WITCH!!! The WORST PART is her loved ones suffer needlessly because of her stubborn controlling manipulative behaviors.Ssomeone needs to make one of those anonymous calls to the ombusdman:lol2:.The state decreed sometime ago that LTC's need to consider the residents NEED ahead of the FAMILY'S demand...I wonder what they would say about this situation?
Many LOs feel a loss of control because they can no longer take care of their relative, and unfortunatly, they tend to micro-manage. I have run into family members like this even in Case Management. I currently have an elderly patient whose EMT daughter thinks she has a medical degree. She thinks because she has a "Power of Attorney" for her mom, who is perfectly capable of making her own decisions, she can insist that I "check with her" before asking the doc for anything. I had a sit-down with her and gave her a "reality check": her mother is my patient, and until I make the assessment that she is not capable of participating in her own care, I will continue to deal directly with my patient. I did agree to keep her in the loop by advising her of what I am doing, but that is a courtesy that I give to all my patients' LOs. The PCP, who has been dealing with this daughter for years, thinks I walk on water now. This should have been his job a long time ago, but I also understand his concern that he needs to maintain a good relationship with the family in order to keep this patient, so I will be the "bad cop".
Sorry but I think that family member is right to advocate for her loved one. I think we all know that doctors do not always know best. Neither do nurses or pharmacists. And it is very good for people to try increasing their knowledge via the internet. The net is the great equalizer.
This person should not be comparing her experiences to her loved one's but I think she is doing some things very correctly. I think maybe you and your colleagues find it inconvenient to have to clear things with her and that is why you don't like what she does. Sorry if I'm wrong. I mean no offense, just that I have experienced this before - where staff do not want to bother calling family due to busyness or a perceived insult. Doctors forget, doctors are not available, nurses get swamped, as you stated, and you have lots of patients. She has only one and she loves her. I hope she continues to go to bat for her loved one.
Lots of families are very knowledgeable about medical things and know too much to just be accepting of all that nurses, docs, and the whole lot of us hospital types tell them. This harks back to the days of paternalism on the part of doctors toward all the rest of the world.
Still, if you think the patient is suffering because of her, I guess you have to contact someone on the patient's behalf.
What is an LO? And in what way is the patient suffering? Is management of any assistance to you?
Oh, I just realized - is that loved one?
Yes, I think a loss of control, fear of the loved one's death, guilt, pain at seeing their loved one dependent and at the end of his or her life, and related emotions might play a large role. I once had to speak with a woman about how she and her children were causing upset on the part of staff because they would come in and do everything for the mother/grandmother (patient). I sort of liked that they were so close to her and so devoted and I liked that they fed her, cleaned her, turned her, did her hair, mouth, nails, and just about everything for the better part of 24 hours per day. Lord knows we were busy enough that their being there was a tremendous help to us and the patient had her family nearby, which seemed to be a good thing for her. This family did not question us or pester us with their views, they just were there all the time. The grandson took a turn, too, and seemed very uncomfortable and awkward, not knowing how to care for her.
Some staff, though, felt the family did not trust them. As Charge, I spoke with the daughter. Turned out that she did NOT trust us to quickly and correctly be there for her mom. In my view, she was partly right. We could definitely not be there as quickly as she could. I just mentioned to her that some staff felt she didn't trust them and assured her that we would take good care of her mom, feed her, clean her, etc. so she and her kids could get some rest. She checked her mom out the next day, moved her to another facility.
I guess it takes all kinds but I don't think that it is necessarily a bad thing for family to question or opine or help with caring for the loved ones. Again, though, if the OP thinks some abuse is occurring, she should contact whoever can help.
I have run across this type of family member and it's maddening because they reject appropriate courses of medication, tests, and treatments for less desirable kinds. When, after all is said and done, we wind up back at Square One and have wasted time and dollars doing things their way, they will still insist they were right, despite all evidence to the contrary.
A couple of times I've really wanted to put in a consult with Psych -- for the family.
Specializes in LTC,Hospice/palliative care,acute care.
Thanks all-when I said that maybe someone should make an anonymous call to the state I had my tongue firmly in my cheek.I know the phone number and I have lived up to my responsibility as a nurse caring for this patient.I'll let you know what happens when the dust settles.In my experience the DOH feels we must "consider resident's need beforethe family's demands" but on the other hand when we have a problem like this they are reluctant to step in.
This particular case is not simply about a caring LO advocating for their family-it goes way beyond that.It's also not about us not wanting to "be bothered" Our POLICY states we must notify LO's within 24 hours of any change in the resident's condition/plan of care.This is about someone with NO background in medicine at all gathering info from every Joe Scmoe she knows and every stupid website where anyone can claim to be an "expert" and then demanding meds be admin or dc'd at her whim.She also spends a limited amount of time with the residents weekly and then assumes that the behaviors she sees during her visits are typical and will not accept that they are not.The big problem really is the doc letting her do this...I can't get into too much detail without giving away too many identifying factors-she has gotten the doc to dc meds in the past that were of benefit to her LO and will NOT listen to reason. She refuses to permit her mom to take a statin (s/p cva,sky high cho) yet makes her stay on a NO salt diet due to her HTN and made her give up her 2 cigs a day .. It's clearly about controlling her loved one...and it's too her LO's detriment at this time...It's sad,really
Since she likes the internet so much, you can guide her to the above site for dietary ed. The TLC diet is what we (I'm a disease manager for people with chronic conditions) recommend to our patients with HTN coupled with hyperlipidemia. It's evidence based practice, and is endorsed by the AHA, NIH, Nat'l Heart, Lung, & Blood Institute, etc.
I find that when I have patients who are internet 'research' oriented, it helps to guide them to established websites, where they can see for themselves why certain diets, exercise regimens, meds, etc. are recommended. I've had good results with this, because it helps them to feel more in control over the information they're receiving, while at the same time educating them in the direction we think they need to go in. Maybe this approach would work for a family member as well? It may be worth a try.
I've been on the other side of the fence before. My grandpa spent his last 2 yrs in LTC. If we (my family) weren't right on top of things, he didn't get the care he needed. Many times he didn't get bathed for days. He sat in poo for hours until a family member came in and changed him. He didn't get help with meals if we weren't there to help. His meds were always being "missed". We would find him too puffed up to fit in his clothes and realize that he hadn't received his Lasix for days. When he had new symptoms/probs come up, it was up to us to call his Doc and try to get something done.
There was a time when healthcare providers were never questioned. Everyone assumed they were educated and therefore correct. Now, we know that is just not true.
I can't blame anyone who really pushes to stay informed and involoved about their LO's care, especially if that loved one named them their POA. A family member who scoures the net to try to understand what is happening to their LO is trying desperately to give them their best care.
It may seem annoying or pushy to the staff, but it isn't their beloved family member at the center of it.
I've been on the other side of the fence before. My grandpa spent his last 2 yrs in LTC. If we (my family) weren't right on top of things, he didn't get the care he needed. Many times he didn't get bathed for days. He sat in poo for hours until a family member came in and changed him. He didn't get help with meals if we weren't there to help. His meds were always being "missed". We would find him too puffed up to fit in his clothes and realize that he hadn't received his Lasix for days. When he had new symptoms/probs come up, it was up to us to call his Doc and try to get something done.
There was a time when healthcare providers were never questioned. Everyone assumed they were educated and therefore correct. Now, we know that is just not true.
I can't blame anyone who really pushes to stay informed and involoved about their LO's care, especially if that loved one named them their POA. A family member who scoures the net to try to understand what is happening to their LO is trying desperately to give them their best care.
It may seem annoying or pushy to the staff, but it isn't their beloved family member at the center of it.
It sounds like your granpa was in a not so good facility and they neglected him. I hope they got reported.
An informed family member advocated for their loved one isn't necessarily annoying. The annoying ones would be the ones that are on the call bell all the time demanding service from the nurse "right now", and taking the nurses time (or trying to), when the nurse has a lot of more important things to do than to fetch the family member coffee. They are the "entitled" ones who think that what they want is more important than the sudden onset chest pain/difficulty breathing in another room that the nurse needs to take care of ASAP.
Reading this thread turned a little light bulb on over my head. Now y'all roll this idea around in your minds and see if it fits some situations you've been in. Maybe sometimes family members can become jealous, even destructively jealous, of how rapidly we establish a trusting relationship with "their" patient?
Specializes in LTC,Hospice/palliative care,acute care.
that's a good point-I've often had family members say their loved ones referred to us as "family" I can see where that could have been a factor in a few situations I have been involved in--but-How to negate it? Re-assure and validate I guess...
Does the woman have POA over the patient?! What a shame that people meant to protect their loved ones often hurt them. I would get a social worker involved if the doctor isn't willing to set them straight. Make the call ASAP. This woman is hurting a patient under your care all because of their own ego. How tragic and sad.
We have a surgeon like that where I work. We had a difficult loved one that insisted her husband wasn't ready to come home. Although by our standards he was fine. She just couldn't stand to see him post-surgically. One time I told her he was doing pretty well. She brushed me off, saying, "I don't think you understand, he is a very very very sick man."
This guy was not really that bad off at all, was finished with PT/OT, vital signs were great, was doing everything independently, and was more or less completely ready to be discharged except for his wife. The guy would be up walking, smiling, eating, etc. The minute his wife would walk in her attitude was like, "OMG what do you think you are up doing walking around?!?!? You can't do that!!" So he'd just lay in the hospital bed like a lump. She'd hit the call light/coming up to the desk saying he was in extreme pain, etc. She was also very accusatory to the staff, saying stuff like, "If I wasn't here he'd NEVER get medicated! If I wasn't here no one would help him eat his sandwich!" Mind you, this guy was completely A+O and had no reason to have someone feed him. She was complaining about everything and at one point was threatening to call the chairman of the hospital's office. I offered to let her talk to the unit manager, but she said, "No, I want to talk to the HEAD GUY. Whoever it is that signs your paychecks." (yea lady, the executive of this triple million digit corporation will be here shortly to hear your complaint). The only people she ever ended up talking to were the risk management/hospital lawyers because I think they smelled a law suit coming. I documented the crap out of the situation at the time. I call it the McDonaldization of our society. many people think that they can immediately have access to complain to a manager and they will automatically get their way. But at the hospital it's not like we screwed up their hamburger or forgot their fries or something - it can be pretty serious business to even acknowledge a complaint. I don't think they realize that complaints can easily translate into lawsuits.
Anyways, the surgeon just went along with the wife and let the guy stay an extra 4 days with her being a major pain in the neck the entire time. She'd sleep in his room, convinced the guy was dying and "it might happen tonight and I want to be here!" Mostly I think the surgeon just completely avoided the situation - didn't even visit on his rounds or anything most days. Of course the wife was like, "Why didn't Dr. X come and see us??? I have lots of questions!!!" But she didn't want to hear the answers that nursing had to her questions, and she'd completely disagree with anything the doctor said. The wife was insisting the guy get put in a nursing home (he did NOT need to be in an ECF). Thank god the discharge planner finally put her foot down and put a stop to that crap or else he'd probably still be a pt.
Specializes in LTC,Hospice/palliative care,acute care.
Does the woman have POA over the patient?! What a shame that people meant to protect their loved ones often hurt them. I would get a social worker involved if the doctor isn't willing to set them straight. Make the call ASAP. This woman is hurting a patient under your care all because of their own ego. How tragic and sad.
yes-she is dpoa.She attends team meetings regularly and is like a little kid with her eyes squeezed shut,hands over her ears and yelling "na-na-na I can't hear you" She just steam rolls over everyone.I think I mentioned that the doc takes her orders (lol) so until he gets some cajones this situation will not change.
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Katie82, RN
642 Posts
Many LOs feel a loss of control because they can no longer take care of their relative, and unfortunatly, they tend to micro-manage. I have run into family members like this even in Case Management. I currently have an elderly patient whose EMT daughter thinks she has a medical degree. She thinks because she has a "Power of Attorney" for her mom, who is perfectly capable of making her own decisions, she can insist that I "check with her" before asking the doc for anything. I had a sit-down with her and gave her a "reality check": her mother is my patient, and until I make the assessment that she is not capable of participating in her own care, I will continue to deal directly with my patient. I did agree to keep her in the loop by advising her of what I am doing, but that is a courtesy that I give to all my patients' LOs. The PCP, who has been dealing with this daughter for years, thinks I walk on water now. This should have been his job a long time ago, but I also understand his concern that he needs to maintain a good relationship with the family in order to keep this patient, so I will be the "bad cop".