Overbearing family members

Tait, MSN, RN · Mar 4, 2013

It really depends on the scenario. Parents for children there isn't much one can do. Children for elderly parents can be related to so many things, guilt, frustration, over-protection, or they may simply be the POA of health care. There are also cultural considerations as well.

Usually what I will do is try to ascertain how the patient feels about it. Asking them when the family leaves to get lunch, or go to the bathroom, if they feel they are being heard.

Also sometimes getting the family out of the room and talking to them privately, asking them how they are doing, if they have additional stressors, or anxieties. Don't be afraid to gently remind family that you are there to take care of their family member, and part of that care is making sure their wishes are being heard.

It is a delicate dance, and when things get really rough I would also call in a co-worker with more experience or a chaplain (if you have one).

Tait

turnforthenurse, MSN, NP · Mar 4, 2013

Also sometimes getting the family out of the room and talking to them privately, asking them how they are doing, if they have additional stressors, or anxieties. Don't be afraid to gently remind family that you are there to take care of their family member, and part of that care is making sure their wishes are being heard.

After I have developed a rapport with the patient and the family, I have actually had family members stop me and talk to me in the hallway about their feelings and frustrations...sometimes they break down in tears..."I'm so scared of what's going to happen," etc. This helps them and afterwards I feel like they aren't jumping in as much and dictating the care for their family member.

And as Tait mentioned, asking the patient about their feelings when a family member steps out is a good idea, too.

Poochiewoochie · Mar 5, 2013

From one of those "overbearing" family members that you are talking about.

When my Mom was alive she had dementia. It was very hard for her to answer all the questions that were thrown at her when she went to the doctor or hospital. Plus, IMO most medical professionals have no clue how to treat a dementia patient when they come in. No, she could not comprehend how to use a call light, No, she could not comprehend how to call up and order her food since she lost the ability to use a telephone a long time ago. She could not answer when you asked her the 5 rights-right patient and so on. I was not POA but I had no problem advocating for my Mom since she could not do it herself and trusted me. I had to tell each and every person who treated her that she had dementia because somehow that little fact always seemed to get lost whenever someone told the next person about her.

Instead of being annoyed by family members who do this why not try to understand that maybe there is a reason behind it. I don't think most of them are doing it to be controlling or annoy you. They know their family member that is being treated and maybe, just maybe, there is a reason as to why they are doing it.

Kunzieo · Mar 5, 2013

Instead of being annoyed by a nurse's vent thread- consider the situation.

I don't think she was talking about cases where the pt is clearly unable to speak for themselves.

In my opinion, dementia patients still have the right to "participate" in their own care. I WILL ask a dementia pt questions about how they feel/do they hurt/ do they want the blood pressure cuff on their right arm or left. They can still often answer these questions, and if I seem to be distressing them by offering a choice (as sometimes happens) then I drop the question and move on.

Nurses have NO problem with families that are helpful by pushing the call light when needed, or ordering a meal. That is actually appreciated as we assume you know more about your loved one than we do. But when asking subjective questions (are you in pain? How are you today? Etc) it's much more helpful to have the actual PATIENT'S response if they are able.

Me- I have NO problem asking family members to let the pt answer the question. I usually say "I would like to hear your opinion, (daughter) but right now I would like (patient) to answer the next few questions.

redhead_NURSE98!, ADN, BSN · Mar 5, 2013

From one of those "overbearing" family members that you are talking about.
When my Mom was alive she had dementia. It was very hard for her to answer all the questions that were thrown at her when she went to the doctor or hospital. Plus, IMO most medical professionals have no clue how to treat a dementia patient when they come in. No, she could not comprehend how to use a call light, No, she could not comprehend how to call up and order her food since she lost the ability to use a telephone a long time ago. She could not answer when you asked her the 5 rights-right patient and so on. I was not POA but I had no problem advocating for my Mom since she could not do it herself and trusted me. I had to tell each and every person who treated her that she had dementia because somehow that little fact always seemed to get lost whenever someone told the next person about her.

I feel like the nurse still must assess the patient. Just because the patient is being asked the year even though the nurse knows there's probably no way in Hades they're going to get the right answer doesn't mean anyone lost the fact that the patient has dementia. I recently had a severe dementia patient who only said "Yeah! Yeah! Yeah!" no matter what the question. That's all he knew to say. I went in to see the patient for the first time and said "Hi! What is your name?" And the daughter was on me like white on rice saying "He can't ANSWER you, he has DEMENTIA." I just said "I know, I still have to do an assessment on him." Just because I know someone has dementia doesn't mean I don't have to ask the questions and at least attempt to get a response. You never know. How would anyone like to be the one to say a patient is oriented X1 because "that's what ER told me" and the next nurse comes in and says "They answered all orientation question properly and carried on full conversations with me for 12 hours" ?

redhead_NURSE98!, ADN, BSN · Mar 5, 2013

What is the best way to deal with family members that are doing all the talking for the patient, as if they are deciding what is the best care for the patient?

I do so enjoy someone who whips out a health care POA with great flair and announces "Well I'M her POWER OF ATTORNEY," in front of their 75 year old alert and oriented, living-independently mother. That's lovely, you hold in your hands a document that is quite worthless at the moment. It does not require me to speak to you, nor does screeching "WELL I'M THE POA" into the phone at 3am negate the fact that you didn't stick around the ER long enough to get the patient's HIPAA "privacy code" so that anyone can discuss anything with you.

I simply tell the family that I need to hear the patient's answers to my questions, and they can tell me if they have anything to add later. If they want to throw out opinions on what they think their family member needs instead of the current plan, they are invited to speak to the case manager or the physician, depending on the subject.

Working2beRN2014 · Mar 5, 2013

I read this and find myself feeling as if I may have been overbearing on occasion. but then as a nursing student and someone who resides with my mother and has helped care for her through her MANY ups and downs, it is easy to start speaking on my loved one's behalf. I forget to shut up and just let my mom talk. Of course I also know my mother who will downplay her pain levels, and then she will wait until she is in near excruciating pain to call for her PRN meds... I have educated my mother on this many times, not only as a daughter but also from the perspective of a student nurse.

That said I applaud the direct approach, just reminding the family that you want to hear what the patient has to say does wonders.

Orange Tree · Mar 5, 2013

My strategy is to get on their side- and fast. After that, the rest is easy.

SaoirseRN · Mar 5, 2013

From one of those "overbearing" family members that you are talking about.
When my Mom was alive she had dementia. It was very hard for her to answer all the questions that were thrown at her when she went to the doctor or hospital. Plus, IMO most medical professionals have no clue how to treat a dementia patient when they come in. No, she could not comprehend how to use a call light, No, she could not comprehend how to call up and order her food since she lost the ability to use a telephone a long time ago. She could not answer when you asked her the 5 rights-right patient and so on. I was not POA but I had no problem advocating for my Mom since she could not do it herself and trusted me. I had to tell each and every person who treated her that she had dementia because somehow that little fact always seemed to get lost whenever someone told the next person about her.
Instead of being annoyed by family members who do this why not try to understand that maybe there is a reason behind it. I don't think most of them are doing it to be controlling or annoy you. They know their family member that is being treated and maybe, just maybe, there is a reason as to why they are doing it.

We are never annoyed by family members who advocate for their loved ones, or provide much help as you did with your mother.

Someone else mentioned that, even with dementia, we still need to treat our patients. I will always ask my patient questions, especially if I am meeting them for the first time, because I need to see for myself where they are at. I know they have dementia, but that can take many forms and stages and if I'm going to get a sense of the person, I need to talk with them. So what you may have taken for a lack of knowledge was in fact an assessment. We learn a lot by talking with our patients. If they clearly become overwhelmed, or are unable to answer, then I know more about how to work with them.

I am the first to admit that sometimes we don't have the resources in a hospital setting to provide as much support for people as we would like, so I am always glad for daughters (sons, grandchildren, etc) who are able to help with those tasks such as helping at mealtimes (where I work, nobody has to 'order' meals, but for those who need help eating, it's nice knowing there is somebody to do that). It gives me more time to help those who don't have the family support.

There is a difference between people who are there for their relatives and people who are overbearing. I see both types on a regular bases and some families are more difficult to work with than others. Some are just not willing to trust the staff no matter what, which makes caring for their loved one more difficult, the exact opposite of what they are trying to achieve.

I looked after a very competant woman in her nineties, whose granddaughters insisted on speaking for her, over her, and making plans for her care without her consultation. This case is vastly different from that of you and your mother. She wasn't able to speak for herself, so of course you needed to. My patient could, but her granddaughters felt they knew better. I would like to think this second scenario is closer to what the OP was referencing.

Poochiewoochie, your mother was lucky to have you to advocate for her.

EDIT: I say "we are never annoyed", though I suppose that is a statement of an ideal world. We SHOULD NOT BE, is closer to the truth. I can't speak for everyone, but I do try to understand where everyone is coming from. A family member who is truly advocating for their loved one is a good thing. Sometimes, though, people really are challenging to work with, and it's only human to feel annoyance. It's how we handle the situation that makes the difference.

SoldierNurse22, BSN, RN · Mar 5, 2013

If the patient is A&Ox3 and in charge of their own care AND it appears that they are being overshadowed by their family member, I will say "OK, thanks" to the family and address the patient with the same question.

If family member keeps butting in, I will ask them to leave the room for my assessment.