Family member in the hospital

Nurses Relations

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Hey guys, it's been a while. Looking for some advice. My dad was admitted to a local hospital this weekend (thank goodness not mine!) As a nursing student preparing to take boards, I am at least minimally aware of some aspects of the "textbook" care he "should" be receiving - things like infection control, labs, (some have been wacky) mobility (major pneumonia risk,) I am also ABSOLUTELY aware that the experienced nurses are EXPONENTIALLY more knowledgeable than I am in every aspect of patient care. I trust them almost implicitly. As a daughter, I am a paranoid mess, but doing a very good job (I feel) of keeping my mouth shut and not sweating the small stuff - I don't want to be that pain in the *** family member. As an APCT (and a damn good one) for quite some time, on a busy, high acuity unit, I am well aware of the realities of hospital life - I know he is one of 23 pts, may not get mobile, cleaned up, whatever, basically the level of attention and help that we would all ideally want for ourselves and our loved ones every minute of every day - I'm realistic, and thrilled to be there to do as much as I can.

Situation: I feel that things are being...overlooked:

-Gave rapid acting insulin and didn't make him eat - next BG, at 28.

-No incentive spirometer, coughing, getting him up, even encouraging sitting up except for 10 min of PT a day (yeah, it's a respiratory issue.)

-Totally immobile in bed for DAYS, but no SCDs (yes SQ heparin)

-No foley care for 36 hours (and yes, I know for sure, one of us was here continuously)

-Intermittent S/S of confusion/delirium -- this just scares the hell out of me, and I can't seem to convince the staff that this is NOT his baseline - he's normally sharp as a razor!

Question: How do I get my concerns addressed without coming off as an *******? It drives me nuts in the ED when a mom says, "Um, you know you didn't scrub that with alcohol long enough, right? You're supposed to do it for a full minute." Hm, I don't think so. Or "OMG!! STOP!! You can't get BP on the left, he has an AV fistula!!!!" Yeah, pumpkin, I know, if you had let me fully open the door, I would have actually made it INTO the room and eventually to the other side of the bed.... Sheesh.

So how do I keep him safe without being that girl they talk about in report and say "he's a sweetheart, a little confused, but the daughter - OMG, she's a pain in the ***."

How do I get them to say "he's a sweetheart, a little confused, and the daughter is a NS, but super helpful, seriously. No really, don't roll your eyes, I know nursing students suck, but this one... you'll be glad she's here."

Specializes in Peri-op/Sub-Acute ANP.

Advocate for your father, even if they think you are a PITA. You don't have to be mean about it, but why do you care so much about what they think of you? Advocate! This patient just happens to be related to you, but the next patient will not be and you will still have to be a PITA with the docs, RTs, PTs etc at times to make sure your patient is getting the best care possible.

Specializes in Med/Surg, Academics.

Whenever I have a loved one in the hospital, I do all the basic nursing care. If I think an IS will help, I'll ask for it. If I think SCDs should be ordered, I'll ask the doc for it. I'll turn, I'll do mouth care, I'll get them up to the chair, I'll ambulate.

I need to know if you spoke up as you were noticing these things. There is a way to advocate for a loved one without sounding like an *******.

Specializes in Nephrology, Cardiology, ER, ICU.

First, I'm sorry your Father is in the hospital.

Second, how to address your concerns: discuss them calmly with the bedside nurse. It is a sad state of affairs but it is very helpful to have family members help with the care of the pt. My granddaughter spent almost 3 months in the hospital this past year, all the time in the PICU. We had someone with her 24/7 too. Ask what you can do to help. Some things we did included:

I&O - emptying foley cath bag and recording it, weighing her diapers

Turning her (with whatever needed assistance from staff)

Administering her meds as appropriate

Helping with feeding - she was tube fed for most of this time

Trach care - because she was expected to go home with trach

We did not do anything without first being cleared by staff but we readily established ourselves as a very active family who wanted to do as much as possible for her too. We were not aggressive and when we noted actions that we had concerns about, we gently mentioned it and our comments were always well received.

Hope he gets to feeling better soon. Take care.

Specializes in ICU.

My hospital uses SCD's only if sub-q heparin is contraindicated. One or the other, but usually not both. I agree you need to speak up. Smile and be sweet. Pitch in and help.

Specializes in Public Health.

My best advice is to ask if there is a reason they aren't doing something, if you can do it, ask them to teach you. What makes someone a PITA is either their insistence that the nurses know nothing or when the family/patient want everybody to drop everything for them. Even if your issue is urgent, that doesn't mean you're the most important thing right now.

Before we lost Dad, I did whatever personal I could. I bathed him, changed his sheets etc. I would ask for the supplies but make it clear that I was happy to do these things (and I was). Anything that wasn't interfering inappropriately. Well I did change his hydrocolloid once, carry them in my car stock and his was a mess. I took a pic first then redressed it and found the chatty treatment nurse (this was during his rehab stay) and let her know what I did and showed her the pic. I don't know how annoying that was to her but this was my dad and it was a simple enough thing to do and since he wasn't due for another day or so (they actually told me that) I got it done.

The stuff I took issue with were the big things. Like mom calls and says dad can't breathe if he lays down so I speak (long distance) with the nurse and ask her to check his lungs. I call back and am assured he was clear. Next day my sis (CRNA) shows up to assess him after mom called again and he's full to the nipple line and initiates hospital transfer and he was admitted with CHF. I called the facility admin and asked if family was really responsible for patient assessment and pointed out he was ill enough to be admitted and I had asked the nurse to assess him.

Overall we weren't bad to deal with, we didn't make an issue of out anything insignificant and we weren't squeaky wheelish, we know how to address things without excessive or aggressive dialogue.

In in your case I'd be all over the regular insulin given regardless of a meal, I wouldn't care who thought I was *that* family member though my style is calm but firm.

Well wishes for your dad.

Specializes in Family Nurse Practitioner.

The delirium/intermittent confusion is alarming. That should be the focus of your concern right now if there is no explanation for that. Has he had any temps? Have they done blood cultures? It could just be him reacting to being in the hospital.

"Overall we weren't bad to deal with, we didn't make an issue of out anything insignificant and we weren't squeaky wheelish, we know how to address things without excessive or aggressive dialogue.

In in your case I'd be all over the regular insulin given regardless of a meal, I wouldn't care who thought I was *that* family member though my style is calm but firm."

Libby, thank you so much. This is exactly what I am trying to emulate. I am sorry for your loss and appreciate you sharing your experience.

I agree, Lev, the confusion is really concerning. The nursing staff seems to be passing it off as a "typical?" result of fever (100.4 does NOT seem high enough to produce delirium, in my inexperienced opinion? Maybe I'm wrong.) No evidence of UTI, no med change...what am I missing? He was dx with Influenza A, but has been on Tamiflu, IVF, pain meds and ibuprofen for almost 48 hours. The BG is terrifying, but the angel... I mean nurse... promised that she will use her professional nursing judgement, rather than strict sliding scale to determine his insulin coverage. Thank goodness for confident, autonomous nurses. This MD would have him in insulin shock before I could get back there to notice...

At my hospital the provider is required to order A form a DVT prophylaxis. This can be sq heparin OR SCDs, but does not have to be both. Last time I was in the hospital my provider let me choose which I wanted during my stay.

Thank you all so much for your replies. I have come to trust you all as my best source of real world, experienced advice for guidance on nursing behavior. I am very, very new at all of this, and appreciate any guidance. I feel like a pro answering patient questions on my unit (I know I am not anywhere close to a pro) but it's hard to know where to draw the line between helpful advocate and annoying "sophomore" when it comes to family. Any other tips on therapeutic communication with staff and/or family would be appreciated.

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