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.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
You will be in this situation more times than you will ever know. The most important thing to remember is that YOU are not at fault, and families cope how they cope. YOU cannot change them. YOU have to change how it will affect you.
So many good responses on here! As mentioned by JoPACU, you will encounter this many times over. My response in the past to families has been "I can only account for the time I have been xyz's nurse". It may seem a poor explanation for things but sometimes family members will grill you as mentioned about many things including other nurses. Boundaries must be set and maintained.
I have encountered many similar instances, one of which the legal department of the hospital was involved in by writing up a contract the FAMILY had to follow (since they had "fired" every nurse on the floor).
Another poster mentioned they have only one point of contact that information is dispersed through. I encourage this because it cuts down on the amount of phone calls that come in as well as as information coming from one person, so there are not numersous "versions" of the same information. Good job making sure everyone is involved, docs, manager, SW etc. The more people and specialties documenting, the better.
I used to work for a case management dept of a hospital (nonnursing position) and saw what happened when families had to face loved ones whose health was declining and/or they could not be placed safely back home and needed LT care.
#1 problem is denial. Many family members want to believe the pt will get better with time, or that the family can meet their needs at home (even though explained that pt needs 24/7 care) or that a "better" doctor or hospital can help. We had families virtually turn the hospital upside down trying to find a way to save their loved one when nothing more could be done than what we were doing.
Anger was another problem. Frustrated people feeling helpless will lash out at anyone, nothing personal. We had one mother suing virtually everyone who came into contact with her son -he had extensive brain damage from meningitis and his long term prognosis was poor. She was clearly grieving the loss of her son's health. No one could talk sense to her, and as a result she created more problems for herself because healthcare providers were afraid of getting sued. She ended up limiting her son's options to a scant few.
Re-familiarize the stages of grieving. People grieve loss of life, health, function, independence, family role, etc. I think it's a huge part of nursing - for both patients and families.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
i doubt very much that this family became totally implacable and unreasonable overnight. this is probably the way they deal with problems on a regular basis. what you're seeing may actually be "his family's love." it doesn't look like anything you or i might consider loving, but maybe that's what they consider to be demonstrating their love. my in-laws view throwing a fit of some kind as expressing love. if you don't care enough to scream, carry on, make threats, etc., you don't care. that may be the case in your patient's family as well.
In situations like that I tend to cover my a$$ by getting the patient advocate or nursing supervisor in there to diffuse the situation.
I have learned the hard way to keep my mouth shut in ugly situations. Only talk about what happened on your shift and nursing related things, vital signs, pain, etc. Play dumb "I don't know but can have the doctor get in touch with you". "I have no idea what the test results are, but the doctor does". Don't go out of your scope.
When there may be a lawsuit I call in the reinforcements and watch what I say.
The family may repeat what you said out of context and then you'll be in hot water. Not worth it.
try not to take it personally. the family is just going through the stages of grief...anger, denial, blame, etc. perhaps you could suggest that they speak with the doctor or case manager if they don't understand what comfort care consists of. as far as them thinking the hospital is covering up a fall, let them think it. just document everything. cover your butt.
I could have written your post, as I just had a similar situation two weeks back. I am also a new nurse, only a month off orientation. I had a patient with overwhelming issues, (family agreed to 'comfort care measures', had visits with docs, NM and palliative care team), who then decided they wanted to go ahead with the surgeries on 99 year old daddy on the chance he may survive.
*sigh.
They tried all week to get this man stable enough for the first surgery; as more and more problems sprang to light via diagnostics and the endless battery of tests, the family only became angrier and angrier. By the time I had them, you had to wade through the family members at the bedside, who questioned you about every intervention, med, visit and team member and wrote all of your answers in their respective notebooks.
Like other posters already suggested, document everything. State only what you saw and did; perhaps involve your charge, NM and risk management to defuse the finger pointing and interrogation. I know you feel badly, but there will always be people you can't reach, no matter how glaringly obvious their bad behavior and poor choices are to you. Forest for the trees, and all.
Hang in there and don't blame yourself; you are there for the patient and his best interests. Hopefully he is rotated through the other staff so no one has to become a consistent target for this.
Oye. I'm the nurse in the LTC that will be getting this pt and the family.
Trust. Grief. Denial.
The family is dealing with the grief/ denial issues and lost trust with the nursing staff. Could have been over something really stupid and things could have snowballed.
Logically everybody knows that we all die someday. Logically we all know that over time our body's function declines. Logically we know there is a limit to medical intervention. Logically we all know that every medical intervention has risks and adverse affects.
Logic goes out the window more often than not when families deal with these issues. Handling their questions, accusations, anger etc. is an art. You are just being initiated into this now, so just do your best with what you know and utilize support from experienced nurses that you know do well with these issues, utilize the quality management department, utilize case managers and social workers. And even when you're a seasoned pro, these families can still just sap your energy and spirit. You'll bounce back.
Something that I would suggest is that when I am asked a question more than once I say, "Well ... LIKE I SAID ..." The more they ask the same question, the longer I draw out the "Well ... LIKE I SAID ........." They usually get the hint. Please be aware if they are asking questions repeatedly like this, that it is a red flag that they're trying to get a different answer they have already gotten out of you. Please make sure they're given all the information that is available at that time, but do NOT offer any opinions, "possible options", etc. Don't give them false hope if none exists. I'm sure you haven't, but it's just a suggestion. Finally, when they ask you questions like they have been, make DARN sure you think at LEAST twice about what you're saying to them. You do NOT want to given them ammunition for later.
If they continually are saying Comfort Care is what they want, then this is what they want. Make them comfortable, give them pain medication if said person is groaning or gurgling, suction as needed, supplement O2 if indicated, and by all means put the bedside monitoring on COMFORT CARE so they aren't able to hear every desat, brady HR, etc.
Specializes in LTC, home health, critical care, pulmonary nursing.
I work in a SNF where we do a lot of comfort care, and I see this ALL THE TIME. For some families, they feel helpless and are grieving, and you're there, so you're who they lash out at. Your concern that they are spending the last bit of their loved one's life being snarky instead of loving on him is perhaps one that could be gently brought to their attention. I have done that in the past with good results. Depends entirely on the situation though, these people may not be reasonable enough. Good luck.
I can smell a future lawsuit. It seems that these days people (family members) are less genuinely concerned about their family, but are more concerned about gathering enough info to get a payday from the hospital.
I had a PT in a LTC that was brought to us with an extensive history of falls and related injuries. His wheelchair that was supplied to us by the family and a Velcro seatbelt (not restraint) that he was easily able to get out of. He had the ability to communicate his needs. On many occasions he was found with his belt off or in the process of taking it off. Well as was expected he fell. I was standing at the nurses station, facing away from him when he fell, forehead first. He was sent out to the ER and had sustained a minor concussion with no new breaks. His x-ray report did show that numerous old breaks in various stages of healing. Well he later did from complications related to hospital-acquired pneumonia (not from our LTC). The family hired a lawyer and suing for a LARGE sum of money. Approximately 5 months later (and after I no longer worked there) I get a call from FL Dept of Children and Family services asking a bunch of questions. I was told that the complaint against the facility was recently filed.
Sorry for the rant, but why do families feel the need to sue when a relative dies of unknown etiology or causes related to their illness? Stop trying to get paid and move on with life...
PostOpPrincess, BSN, RN
2,211 Posts
You will be in this situation more times than you will ever know. The most important thing to remember is that YOU are not at fault, and families cope how they cope. YOU cannot change them. YOU have to change how it will affect you.