Problem patient and family

DusktilDawn · Aug 10, 2005

It sounds like your doing a good job documenting, which is ALWAYS important to CYA. I would continue having 2 people around while caring for this woman. The daughter has shall we say "issues". Also document incidents concerning the daughter and provide a copy to your supervisor. If the daughter honestly feels her mother is not receiving proper care or is being assaulted, you are correct in assuming she would not have allowed her to return to your facility. The staff should not have to tolerate verbal abuse in the form of yelling & swearing. Have you discussed this situation with your supervisor? It may be a good idea to talk to your supervisor conerning setting rules of conduct for this woman. Unfortunately you cannot stop this person from making complaints to the state board.

Best of luck with this situation.

Nascar nurse, ASN, RN · Aug 11, 2005

We have had some luck in our facilities holding weekly interdicipinary (nursing, social service, dietary, activities, therapy if appropriate) careplans with "tough" families. We present it as kind of "We are holding this meeting because we all want the same thing for Mom/Dad. We all want to him/her to have the best possible care. In order to provide this effectively we all need to be on the same team" From there we state our plan of care and goals for the resident. Then request family input of their goals for Mom/Dad. It seems to work the best if you can get them to put it in writing. It "forces" them to really focus on their important issues and serves as a good follow up for the next weeks meeting. You can pull out their own note that for example said "Mom is sitting in urine for hours at a time" You can then state, "we started her 2 hours toileting program for such and such times, she has remain free of all skin excoriation this week, etc, etc. Sometimes is really does make a difference to "kill them with kindness" and bring them in to the WHOLE decision making process. Now I realize this doesn't always work and thankfully our admin. does get to the point, when desperately needed, to inform families "We are no longer able to meet Mom/Dad's needs and we will assist you with seeking alternative placement within the next 30 days". Hope this helps. Good luck

dinkymouse · Aug 11, 2005

Sorry but she is. She bitches about the problems this person causes but then doesn't back anyone up. I like the idea about the care conference. I will see what they say about it. I do know the kill them with kindness routine used it on many a patient and family.

Daytonite, BSN, RN · Aug 13, 2005

We had a very similar situation in the LTC that I last worked. It sounds like your facility is doing the same as we did. There were care conferences in which the patient's family was requested to attend. They were recommended and set up by a state ombudsman in respond to the overwhelming complaints the state was getting from this family. I should also mention that lawyers for both sides were also involved in setting this up. A plan of care and approach to care was discussed, outlined and clearly laid out for the family, agreed to by them and put into writing. Whenever, the family would complain about something the staff merely had to refer to this plan of care and the family stepped back or went to the DON and sometimes the administrator to request it be changed. I attended one of these conferences when things got really heated up and the daughter requested the plan be changed. She was very interesting to observe in this meeting. She didn't look like she was paying attention and eventually she walked out. She was obviously a very manipulative person who had a hissy fit when she couldn't get her way. This written contact of care was our salvation.

We also required all care on the patient to be done with two staff members present. The daughter would often try to entice an occassional aide to "just ignore that, I'll help you" which almost always turned into an incident if something didn't go the way the daughter wanted. The staff was told again and again what the rules were with this patient so every one was on the same page with it. It got so bad that the daughter who used to stay with the patient 24 hours a day set an alarm clock to go off every two hours to make sure the patient got turned. In the end, talk about Karma, the daughter insisted on taking the patient home one afternoon for a visit where he passed away while sitting in his wheelchair. She was talking with him at the time until someone else pointed out to her that he didn't "look right". It's a sad thing to say, but it was a big relief to all of the staff when this man died and we didn't have to put up with his family anymore.

dekatn · Aug 16, 2005

We had a very similar situation in the LTC that I last worked. It sounds like your facility is doing the same as we did. There were care conferences in which the patient's family was requested to attend. They were recommended and set up by a state ombudsman in respond to the overwhelming complaints the state was getting from this family. I should also mention that lawyers for both sides were also involved in setting this up. A plan of care and approach to care was discussed, outlined and clearly laid out for the family, agreed to by them and put into writing. Whenever, the family would complain about something the staff merely had to refer to this plan of care and the family stepped back or went to the DON and sometimes the administrator to request it be changed. I attended one of these conferences when things got really heated up and the daughter requested the plan be changed. She was very interesting to observe in this meeting. She didn't look like she was paying attention and eventually she walked out. She was obviously a very manipulative person who had a hissy fit when she couldn't get her way. This written contact of care was our salvation.
We also required all care on the patient to be done with two staff members present. The daughter would often try to entice an occassional aide to "just ignore that, I'll help you" which almost always turned into an incident if something didn't go the way the daughter wanted. The staff was told again and again what the rules were with this patient so every one was on the same page with it. It got so bad that the daughter who used to stay with the patient 24 hours a day set an alarm clock to go off every two hours to make sure the patient got turned. In the end, talk about Karma, the daughter insisted on taking the patient home one afternoon for a visit where he passed away while sitting in his wheelchair. She was talking with him at the time until someone else pointed out to her that he didn't "look right". It's a sad thing to say, but it was a big relief to all of the staff when this man died and we didn't have to put up with his family anymore.

Please no flaming, this is just one of those corny thoughts that I probably shouldn't write, but, you know, sometimes I just gotta vent and think of silly, goofy stuff that I would never really do. I just got home from work and can sooooo relate to this, right now my sense of humor is in overdrive! Wouldn't it have been fun to have called Social Services and had the daughter investigated for elder abuse/neglect in relation to the death of her "loved one". Kinda give her a dose of her own medicine. I know, I know, some how some way it would have backfired, but it's just one of those evil thoughts you have every now and again. Families!!!! You gotta love 'em!!!!! or go nuts hating them!!!!!

Daytonite, BSN, RN · Aug 17, 2005

please no flaming, this is just one of those corny thoughts that i probably shouldn't write, but, you know, sometimes i just gotta vent and think of silly, goofy stuff that i would never really do. i just got home from work and can sooooo relate to this, right now my sense of humor is in overdrive! wouldn't it have been fun to have called social services and had the daughter investigated for elder abuse/neglect in relation to the death of her "loved one". kinda give her a dose of her own medicine. i know, i know, some how some way it would have backfired, but it's just one of those evil thoughts you have every now and again. families!!!! you gotta love 'em!!!!! or go nuts hating them!!!!!

no flaming. . .i hear 'ya. well, at the risk of opening myself up to a lot of criticism. . .i was relieved to hear that the dude finally passed on and a nasty part of me hopes the daughter has a lot guilt about it for the rest of her life. as for the abuse and neglect. . .this daughter had called the dept. of health and the state dept. on aging so many times they recognized her by name when she called in a complaint. they've probably been sitting around their office wondering why they haven't heard from her lately and, yet, conflicted as to whether or not to follow up on her. :rotfl: i've often thought that there's great stories that could be told in these experiences, but (1) would anyone believe them? and (2) could you write a story or book that would be such a page-turner that it would be a best seller making the nurse very wealthy so she would never have to put on a uniform again?!

it's an interesting idea. . .turning her in for abuse. i guess it would have had to be the paramedics because none of us at the facility actually saw what went on at the home.

just want to redeem myself here and say that most of the patients and families i've worked with over the years were reasonable people. a few were memorable, a few were obnoxious, and a lot many more i can't remember because they behaved so normally. it's these few that have a knack to push everyone's buttons and test our patience that we never forget because they make our work so difficult, tie us up catering to them and taking our time away from other patients who need us just as much. ever had a "gypsy queen" as a patient? don't get me started on that. :rotfl:

Sis123 · Aug 17, 2005

Never had a gypsy queen as a patient yet (I am still doing pre-req.s) but when I was a patient in the hospital couple years ago, I had the Romanian circus going on around the patient in the bed next to mine.....

Daytonite, BSN, RN · Aug 17, 2005

Never had a gypsy queen as a patient yet (I am still doing pre-req.s) but when I was a patient in the hospital couple years ago, I had the Romanian circus going on around the patient in the bed next to mine.....

I think that would qualify! :chuckle Bet you heard and saw a lot! At least as a employee you only have to put up with it for 8 or 12 hours. I can't imagine what it must be like to deal with it 24 hours a day.

dinkymouse · Aug 19, 2005

The patient I described in the beginning of the thread told a STATE INSPECTOR to "f" off yesterday! :roll The patient was on one of her rolls and had taken her pants off. When the nurse took the inspector in to introduce her the pt said "f" no. The inspector said, "Did she say what I think she just said?" Our nurse said, "Yes". She asked our pt if she would talk to her again and the patient said, "F" off. The latest state report was dismissed immediately. We doubt we will have any more problems with state because of her. We all laughed cuz this is her normal behavior. By the way, even though I hate medicating I was able to get an order for haldol IM prn for when she is trying to knock my staff around.:cheers:

Daytonite, BSN, RN · Aug 19, 2005

Oh, I almost fell off my bench here at the computer reading your post! :chuckle It brings back such memories. Why do we love it so much when the state gets to see the "real" stuff? And cusses them out, to boot! :chuckle

Do you guys have an Alzheimer's unit where you work? It sounds like that would be the perfect place for this lady.

I remember having a male patient who was just mean. There were one or two female CNAs that he would let work with him. Everybody else was "fair game" and he would just double up his fist at an opportune moment and haul off and hit you, so we always figured that he probably knew what he was doing. He was another one where there needed to be two nurses at a time when with him for any reason. A lot of times he refused his meds and he was on Coumadin. I was told by the social services person and the DON that we were the only facility that would take him because of his behavior, but we were a Jewish home, he was a holocaust survivor and had no other family, so they wanted to care for him.

DusktilDawn · Aug 19, 2005

The patient I described in the beginning of the thread told a STATE INSPECTOR to "f" off yesterday! :roll The patient was on one of her rolls and had taken her pants off. When the nurse took the inspector in to introduce her the pt said "f" no. The inspector said, "Did she say what I think she just said?" Our nurse said, "Yes". She asked our pt if she would talk to her again and the patient said, "F" off. The latest state report was dismissed immediately. We doubt we will have any more problems with state because of her. We all laughed cuz this is her normal behavior. By the way, even though I hate medicating I was able to get an order for haldol IM prn for when she is trying to knock my staff around.:cheers:

:rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl:

Don't you love it when you don't have to say a thing!!!!

She said it all for you!!!