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Discussion

The frustration of the Functionally Dysfunctional... aka family members.

I am at my wits end. It's been one hell of a week and sometimes what I do is run in circles while directed by family to do so only to be shot down pretty much seeing that NOTHING that I did mattered... nor was appreciated. Welcome to the world of hospice. It's plagued with functional dysfunctional like every aspect of the world, but we know emotions are at an all time high giving the circumstances we usually understand.

Crazies Amongst Us. There be definitely.

The sign below I need on my steering wheel on my car. ( says please bang head here ) The ONLY challenging and frustrating part of my job is dealing with the functionally dysfunctional within my patient families. I am a hospice nurse I can not make your loved one "better" or cure them what makes you think I can "fix" your messed up family? My powers are limited to aggressive symptom control and interaction with a multidisciplinary hospice team. True, I may have a direct hotline to the doctor that most family members or patients themselves do not have. I have the ability to call in orders for extremely strong medications, narcotics and other necessities to facilitate prompt treatments. I can not cure your funked up family. What I can do is help you and yours understand what is happening, course of action and what we may see as things progress. I am not a psychotherapist who can cure years of issues.

Yesterday I received a call from a patient's daughter who I call weekly and update her on multiple things. This week, she is calling and asking for a visit for her loved one. I get there and sure enough there is a big change and its' not good. I spend 15 minutes with the patient, 45 with the daughter who insists on revisiting her family issues not directly related to my patient. I listen, I listen I listen. I tell her I must call the MD and get orders, it's New Years Eve and we need a few new medications in place to help curb symptoms and get medications delivered. "Ok" I hear.

I am asked at the end of my visit. Can you please call my brother "Billy Jr" and update him on our loved one? I just got off the phone and he isn't coming to see our loved one tonight. I think he needs to hear from you. I had to say to this daughter... yes, I will call him. But, I need to alert you that I have also called him two other times this week and left messages for him and he never called me back. I feel my attempts are futile. Oh, he said you never called. I asked. who is Susie? Oh, she is his wife. Well, she is the one I have left the messages with. So in fact I have called, multiple times. I will call again, but it is not my place to tell family they need to come to see their loved one, but I will alert him to his change.

( phone call done, no answer, left message.... )

Later that night our after hours gets a call from this daughter. She claims she had a change of heart. She wants us to stop all the comfort medications we worked so hard getting in place for her loved one on New Years Eve. She knows he is going to go, but "doesn't want to medicate for symptoms"

People, choose your power of attorney's for health care very very carefully.

Excuse me while I go bang my head on the wall, spending 2+ hours tending to a patient only to have all the work which was agreed upon by a fickle individual to be changed last minute.. whirlwind.

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    I should also state, that the after hours team was shocked to find out the daughter is indeed a RN...

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    Sounds like you need to use your chaplain and social worker as resources the minute family dynamics disintegrate. When i was a hospice case manager i would often get tied up with needy family members. A visit that should have taken one hour would take 2-3 hours and, invariably, even though i paid close attention and allowed them to vent as much as they wanted, the family members would lodge a complaint and i would be to blame. My manager would always tell me, the minute they start acting nuts call the office and we will have the chaplain or social worker relieve you. And, actually it does not surprise me that the daughter is a nurse in your scenario; some medical professionals lose all rationality when a loved one is dying. There is also a control issue when it comes to medical professionals. They don't want to admit defeat. Now i work for a hospice as an on call nurse mon-fri 40 hours per week, which is a breeze compared to case management. Even still, if family members or unreasonable or just not coping well, and their dying relatives symptoms are unrelieved because of their behavior, i call telecare to have the chaplain or social worker on call to come to assist me. A nurse does not have to handle everything her/himself.

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    The Chaplain and SW were involed in this case.. obviously NOT enough. I am thinking this is more of an employer issue.. as our staffis so stretched out beyond. I have already given my two weeks notice as i have noticed much more nutters in this agency then ever before and the pysch soc support is lacking on a whole.

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    We have a family on service, the son wanted not one, but two comfort kits (his request was met with a second ekit being delivered)-he is ocd and was "afraid" they would run out over the holiday weekend (christmas)....as of today he has used 1 ativan and 10mg roxanol......he asked the nurse on call yesterday for a 3rd ekit-with was emphatically refused by the nurse because there is 990mg roxanol and 9 ativan left (in addition to double all the other meds that are in the ekit.

    Also, yesterday, son requested an "emergency intervention team" to come to his home because he and his sister got into a squabble over how to use the comfort kit medication. The nurse on call asked what the problem was, spoke with the sister....who verbalized an understanding of the use of the comfort kit, med by med. When son got back on the phone, he went off on nurse "oh, for YOU, she shows respect, but for me, she shows no respect...." Social worker called later that night, and everything was found to be normal for this family unit.

    Yes, we have some messed up dysfunctional families, add a life limiting illness on top of that, and all *ell breaks loose.....What can we do but roll with it. One of our nurses will ask families "what did you do before hospice was involved......" usually that calms things down, because yes we treat the whole family unit, but we are not miracle workers...

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    i too am an on call nurse....i have found that i'm not sucked into the craziness like the m-f case managers are.

    I tell people my job is to fix a problem, and move on to the next visit.....

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    I have to remember that this is #3 family this week like this. I am constantly on the line with our SW. What I find her doing is having family meetings and including me. Ideally this week it didn't happen because I was called out to family fires.

    I have had one to many families suck every ounce of life out of me. From now on. One family member is contact. I will not call family members who are not invovled and show no interests. My time is valuable, and I can't let this one case like the other two this week use up my time. I only have 8 hour days. Its not fair that some of these hours are 2-3 at a time. Watching functional dysfunction and playing coach. I will draw the line when I see this again in the future, insist the SW and Chap involve themselves more. Dunky Ducked up families are NOT my specialty,and I need help when one like this or in this case 3 show up.

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    establish strong boundaries, use your IDT members, and focus on the plan of care...

    we are not miracle workers and we have no ability to fix families...only to walk with them for a short time.

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