Pacifying a difficult family that will not listen to reason??

[Work in Progress]

I am a new grad nurse working on a med/surg floor, and this is my second month of orientation. I have had a great orientation so far with a really supportive preceptor and everyone on the floor is very helpful. This afternoon I had a situation that has left me reeling and frustrated.

There was a patient on our floor that was awaiting placement in a nursing home. He is an octogenarian and has many co-morbidities and has been slowly decompensating.

Apparently, on a day that I was not working, he started going into respiratory failure and also had a large hematoma on his chest that was new. What happened isn't apparent. According to the CNA that was a sitter in his room and the documentation by all staff involved, there were no falls or any other incidents. He was transferred to the ICU and while there, his family decided to put him on comfort care. He was transferred back to our floor and I got him as a pt. It was confirmed that he was on comfort care and I went about making sure he was comfortable.

His family showed up and started asking questions about what happened. When I told them that I was not there and all I know is what is documented and what I was told, they just kept grilling me. They have decided that he fell and we are covering it up, and nothing can convince them otherwise. I just kept taking the tactic of empathizing with their concern and telling them I know nothing (which I do!) Then they started asking why he was not getting fluids, not being monitored, not being treated with XYZ. When I (gently) explained what comfort care is, they said "so you are just going to let him die?" I was flabbergasted. I read the note about the family meeting in which it was decided.

Then they started taking pictures of everything on his body, calling me in every 20 minutes to ask me the same questions over and over again. And new ones, about why he has bruising on his abdomen (heparin shots), so on and so on.

My preceptor just told me not to take it personally and just do the best I can for the patient and keep repeating that I just got this patient today and I have no idea. That is all well and good, but I just was wondering if anyone has any advice as to what might calm this family down enough or explain clearly enough the situation that they might cease grilling the staff and spend their time loving their father/grandfather/husband? I know that in my time with him, I did all I could to make him feel comfortable. I know that there was nothing, as a mere mortal, I could have done to ease their suspicions or their grief.

Also, what do you think about this mysterious hematoma that happened concurrently with the respiratory failure? I don't think it would be possible to cover up any falls or anything, as it would be impossible to get him back into bed without help. I also don't think anyone involved would ever in a million years do something like this. But the family persists in believing it. I told them that I understand where they are coming from and why they are concerned, but explained why I don't think that would happen.

I know that this is not something I have to worry about being at fault for, but I am worried that they are wasting their last moments with their loved one on suspicion and anger. I am worried that everything I am saying is just giving them ammo to keep being suspicious. I have the day off today and I know I am not going to be able to stop worrying about it.

Am I just being an oversensitive new grad? I know we live in a society where any sort of death is looked upon as "someone's fault" Should I just let them vent their frustration and let it go?

I know this was long and had a lot of questions and is kind of fragmented. Any thoughts would be helpful.

[Nascar nurse, ASN, RN]

1. Is the guy on Coumadin/ASA? What is his current PT/INR?

2. Can he move himself about in bed? Any chance he just landed against a siderail to hard?

3. Where is the bruise at on his chest? If it is closer to the axilla then to the center, did someone move his by yanking on his arms?

4. Even is he did fall, it would be rather unusual to bruise the chest as opposed to knees, butt, elbows, head, hip...the more usual places that people tend land.

Just my $0.02

[LVAD RN]

First I must say as a new grad myself it is hard at times not to take things personal. It is great that you have a supportive team to work with and a great preceptor.

I have noticed that when families have "lost" control of a situation they start to pick at any and everything. Sometimes it is the TV not working or the sheets not fitting the bed correctly. If you have documentation of a family meeting about comfort care and the family still does not understand, the doctors caring for the pt and a social worker should be involved.

The hematoma you spoke of should be addressed with your manager or charge nurse since the family is not convinced. I did not know families could take pictures inside the hospital or healthcare setting?

Again do what your preceptor is telling as long as it is the truth and everything is documented to standard, If the family is suspicious I would make sure to chart everything you do and who you spoke to about the issues they are having. This could be a potential court case.

Good luck

[lkwashington]

By reading this post, where did the charge nurse/nursing supervisor come in play. You have not handle this by yourself. Your preceptor was not helpful at all, in my opinion. Someone should have been in the room with you to witness what was said and done because it would be your word against theirs. It could put your job in jeopardy. Some of questions that was asked by the family should be to a doctor. Im all about covering my a$$.

The family could be going through the stages of grief. Most likely it is anger. They may not have accepted the situation with the family member.

Dont feel bad at all. Sometimes it happen. I just feel bad that you had to go through it by yourself. Just remember this will not be the last. Good luck to you and keep us posted.

[Work in Progress]

1. Is the guy on Coumadin/ASA? What is his current PT/INR?

2. Can he move himself about in bed? Any chance he just landed against a siderail to hard?

3. Where is the bruise at on his chest? If it is closer to the axilla then to the center, did someone move his by yanking on his arms?

4. Even is he did fall, it would be rather unusual to bruise the chest as opposed to knees, butt, elbows, head, hip...the more usual places that people tend land.

Just my $0.02

1. He was not on Coumadin or ASA. He was on the standard TID 5000 units heparin sub q, and no coags were being monitored.

2. He could not move himself about in bed with any force. Just small shifts.

3. His bruise was closer to his axilla and I agree that it is possible that someone did yank. This is the most likely thing in my mind. I know that it was there when the day shift came on and do not really know who was taking care of him the night before- I could see a possibility there.

4. Completely agree.

While the yanking would be terrible and I could see definite fault there, I don't see that it would be related to the respiratory failure. But the two things did happen on the same day, so the family is definitely seeing a cause and effect relationship. BTW his chest xray didn't show much of anything. Am I missing something?

[Work in Progress]

First I must say as a new grad myself it is hard at times not to take things personal. It is great that you have a supportive team to work with and a great preceptor.

I have noticed that when families have "lost" control of a situation they start to pick at any and everything. Sometimes it is the TV not working or the sheets not fitting the bed correctly. If you have documentation of a family meeting about comfort care and the family still does not understand, the doctors caring for the pt and a social worker should be involved.

The hematoma you spoke of should be addressed with your manager or charge nurse since the family is not convinced. I did not know families could take pictures inside the hospital or healthcare setting?

Again do what your preceptor is telling as long as it is the truth and everything is documented to standard, If the family is suspicious I would make sure to chart everything you do and who you spoke to about the issues they are having. This could be a potential court case.

Good luck

The doctors and social workers were both in there several times. They continued to agree that they wanted comfort care, but then still didn't seem to quite grasp what that meant. Another problem was that different family members were in and out. Once one or another family member was calmer and reasonable, another would come in and get everybody all stirred up again.

The charge nurse and my preceptor were both also in there several times on their own, reiterating things that had been said. My preceptor was also in there with me most of the time that I was, but she let me take the lead (and said I did well) Unfortunately, no one on today was there on the day in question, so none of our answers were satisfying. Apparently, this has already been addressed by the nursing sup and the patient advocate. I honestly don't know what our picture policy is, but my preceptor and the charge nurse both thought that telling them not to take pictures would make them more angry. I will look that up on my next shift to see what the P&P is.

[lkwashington]

The doctors and social workers were both in there several times. They continued to agree that they wanted comfort care, but then still didn't seem to quite grasp what that meant. Another problem was that different family members were in and out. Once one or another family member was calmer and reasonable, another would come in and get everybody all stirred up again.

The charge nurse and my preceptor were both also in there several times on their own, reiterating things that had been said. My preceptor was also in there with me most of the time that I was, but she let me take the lead (and said I did well) Unfortunately, no one on today was there on the day in question, so none of our answers were satisfying. Apparently, this has already been addressed by the nursing sup and the patient advocate. I honestly don't know what our picture policy is, but my preceptor and the charge nurse both thought that telling them not to take pictures would make them more angry. I will look that up on my next shift to see what the P&P is.

Good job!!! Inform all nursing staff to cross their T's and dot their I's. Looking up the policy would be a great idea. I truly believe in one family member be the spokesperson for the family. Things are confusing right now for everyone, especially with the family. I hope it will be handle with caution. Keep us posted and keep up with the good work.

[pcbnurse]

I actually have a friend who's mother is in ICU today, dying. She is 84 years old and is in resp failure, has C Diff, and a host of other problems. She is now a DNR. My friend called me in tears stating that her mother is receiving horrible care, the nurses are chatting at the desk not watching her, not attentive, etc, etc. Basically she is angry and "helpless" because her mom is dying! I listened to her complaints, and tried to reassure her that her mom is in good hands. That nurses generallly do "chat" at the desk and are not in a patients room unless needed.

I think the lashing out at "you" is normal and unfortunate for you. If I were you, I would ask for a different assignment tomorrow. This family does not need to target one nurse. They will be angry and find fault. In my opinion, you don't need this at this point in your career. We need you! Stay strong and know you cannot "heal" these patients and you obviously did not cause their dying condition. The bruise, easily could be explained with heparin use.

Keep us informed, but keep your distance!

[lkwashington]

I actually have a friend who's mother is in ICU today, dying. She is 84 years old and is in resp failure, has C Diff, and a host of other problems. She is now a DNR. My friend called me in tears stating that her mother is receiving horrible care, the nurses are chatting at the desk not watching her, not attentive, etc, etc. Basically she is angry and "helpless" because her mom is dying! I listened to her complaints, and tried to reassure her that her mom is in good hands. That nurses generallly do "chat" at the desk and are not in a patients room unless needed.

I think the lashing out at "you" is normal and unfortunate for you. If I were you, I would ask for a different assignment tomorrow. This family does not need to target one nurse. They will be angry and find fault. In my opinion, you don't need this at this point in your career. We need you! Stay strong and know you cannot "heal" these patients and you obviously did not cause their dying condition. The bruise, easily could be explained with heparin use.

Keep us informed, but keep your distance!

I totally agree with you pcbnurse. This would be a patient that should be rotated through all staff because it will be overwhelming for just one nurse. I truly believe in continuity of care but not this go around. This is a sticky situation.

[Work in Progress]

By reading this post, where did the charge nurse/nursing supervisor come in play. You have not handle this by yourself. Your preceptor was not helpful at all, in my opinion. Someone should have been in the room with you to witness what was said and done because it would be your word against theirs. It could put your job in jeopardy. Some of questions that was asked by the family should be to a doctor. Im all about covering my a$$.

The family could be going through the stages of grief. Most likely it is anger. They may not have accepted the situation with the family member.

Dont feel bad at all. Sometimes it happen. I just feel bad that you had to go through it by yourself. Just remember this will not be the last. Good luck to you and keep us posted.

I was not in there by myself for the most part (a couple of times). Like I said, my preceptor was in there backing me up and listening, but she didn't have a whole lot more to add that I didn't say or do. I had the doctor come in 3 times. They asked the same questions over and over. The last time I asked if they wanted to talk to the doctor, they said "we are done with doctors, I am talking to my attorney."

I documented every conversation, accusation and how I responded. I do believe some people were feeling anger, and some denial. I know logically that I did what I could do and that no one had the answers that this family was seeking. Unfortunately, my emotional side and my people pleasing side wanted to smooth it all over.

I know this case will probably go to court and that my documentation (and my preceptor's) was flawless in the short 6 hours I had him. I wish that the poor man's last few hours or days were going to be peaceful and full of his family's love, instead of yelling. I wish I could provide that for him. He was a very sweet man the one day I had him as a patient about a month ago before this all happened.

[Work in Progress]

Thankfully, I am off tomorrow. Thank you for that perspective.

[DizzyLizzyNurse]

People get angry when they feel like things are out of control. Sometimes they say and do things they wouldn't normally do. I had a woman on my floor who had been just checked by her nurse. As the nurse walked up to the nurse's station the phone rang. It was the woman's husband who wanted to talk on the phone to her. When the nurse took the phone to the woman, she was dead. Talk about unexpected! Luckily the social worker was still here. The woman's daughter and a friend came in screaming about how they were going to sue us since we obviously did something wrong. They were screaming about taking all of our licenses (they found her 20 minutes before my shift started so I walked in a couple minutes before them) and lawyers and lawsuits. We let them vent for a minute. Then we told them the truth. Sometimes that just happens. Not very often, but sometimes. She went fast, wasn't suffering, had been happy and smiling when the nurse had been in there the minute before. Stick with positives. We said we knew they must be hurting for it happen and they were angry they didn't get to say good bye. Acknowledging their feelings calmed them down. They started crying and apologized. You will learn how to talk to people in this situation. And after a while when you've had your license threatened a bunch of times for things like not bringing a cup of water fast enough or stopping to do something important before changing someone's mother's tv station for them, you'll know when you need to be worried and when you don't. Also you shouldn't have to explain things to a huge group of people. Don't they have a HCP or someone who is charge of that? Working in LTC I'm not sure about hospitals, but in LTC you can only talk to 1 or 2 people who have been appointed.