Things You'd Like To Tell Visitors . . . . and get away with it

pyrazen · Jun 29, 2009

Please follow me to this little office here & we will get you that psych eval you so obviously need.

LaurenBoog · Jun 29, 2009

To family members who actually "help out" with a patient:

Thank you. I know it's not your job to take your loved one to the bathroom, feed her lunch, or stay the night to ensure that she doesn't fall. I don't expect your help, and I would never ask for your help, because that would give the impression that we're "short-staffed." Don't get me wrong, your loved one would still be cared for if you weren't here, but I so appreciate you helping her so that I can give some extra TLC to a patient who doesn't have any family members who are as caring as you.

rachelgeorgina · Jul 1, 2009

I'm a student nurse/nurse assistant and currently, also a family member/visitor. I'd really like to know - how to be a good and respectful visitor whilst concerned about a family member and totally void of info.

My great aunt has CHF, CAD, unstable AF, two leaky valves, COPD and acute pulmonary oedema. Two months ago I took her to ER with severe symptoms of unstable AF. She was admitted, on 2L O2 for 7 days, taken off her Imdur (for CHF) and started on dig - and discharged. She immediately began experiencing breathlessness again and developed pulmonary oedema. Three weeks ago I took her to a DIFFERENT hospital where ER spent no time screwing around (as done previously, they wanted to send her home) and she was almost immediately admitted to CCU where she still is now, very sick, including 3 days in ICU.

It was discovered that the previous hospital did nothing expect disguise her symptoms - including never getting her dig to a therapeutic level (i.e. she wasn't on anything for her heart at all) or diagnosing two major valve leaks. This was a major teaching hospital and world renowned, so I was surprised, to say the least. & it means I'm more than a little wary about how she is being treated in this hospital - though for the most part her treatment has been exceptional. They're even making plans to send her to rehab once they stabilize her cardiac condition!

However, this evening while I was visiting with my mum, my aunt became increasingly short of breath, gasping and gulping for air, using accessory muscles of breathing excessively, holding her head - almost as if she had a headache, was making small moans of pain, couldn't get comfortable (& was insisting that she was fine, in usual fashion - she doesn't like to be a burden & it isn't in her nature to speak up or ask for help, which i've tried to make staff aware of.)

I buzzed for a nurse who put 1L of O2 (she's restricted to max 2L as a CO2 retainer). Half an hour later she continued to deteriorate, which I pointed out to the nurse several times as I was concerned about the distress and discomfort she was experiencing. The nurse told me that he had cared for my aunt on several occasions and that "this was normal for her".

& I dont want to sound awful but I care for my great aunt and my grandma at home and I really do know what is "normal" for them - and this wasn't it! She'd been deteriorating all evening (over about 3hr) and her symptoms were beginning to mimic what she presented with in ER and what had her transfered from CCU to ICU. This nurse told me that there was nothing more he could do to help with the breathing issues or make her more comfortable and that visiting hours were over so I'd just have to leave and 'leave it to him'. I don't know if you can imagine, but that didn't instill a lot of faith in me.

Same nurse administered my aunt's eye drops while I was there. Her opthamologist was very clear - 1 drop in each eye every night else you'll go blind, fast. For the drops to end up in the right part of the eye, you need to press on the tear duct after you drop them in. (On Dr's instructors + I administer these drops at home for her.) I noticed that the nurse didn't do this for the first eye and explained the correct procedure to him. He ignored me and didn't change tact for the second eye. I asked politely if maybe a note could be left for pharmacy to add these instructions to the chart (because that couldn't hurt, right?) Again, I got a no.

Where did I go wrong? How can I advocate for the best care for my aunt without being one of the horrible family members described in this thread?

GiGiOm · Jul 1, 2009

Here's mine: "No, a hamburger does not qualify as a "snack", especially when the cafeteria is closed (it's midnight, HELLO!). BTW, pt just got finished eating a full supper tray at 9:00 p.m.

nerdtonurse?, BSN, RN · Jul 1, 2009

Okay, if I was your aunt's nurse, here's what you wouldn't see.

What's her O2 sat currently, last several readings, and ***important*** what do her VS usually do at night at the hospital? You said this was in the evening, and since visiting hours were up, I'd guess about 2100? What I'd probably see as a nurse is that her 2100 meds are due and she's a little symptomatic because her prior doses of her meds are running out. Now, if she's looking like she has air hunger/hypoxia, but her O2 sats are okay for a CO2 retainer, reasonable capillary refill, etc., then I'm not going to going to mess with the O2 (except to put it on to calm nerves). If her pulse and BP are okay, I'd give her a PRN xanax (we have those on our telemetry protocol orders), but if she's about to get heart meds that can drive down BP, I'd probably wait until her scheduled meds are on board and see if she feels better. A lot of our end stage COPDers and CHFer have a scheduled "nerve pill' and it's better to give the pt the 0.5mg scheduled Xanax than the 0.25 PRN and not be able to give them the scheduled dose they're used to getting.

Eye drops. First, you don't plug the tear duct to make the drop go to the right part of the eye -- that's done by surface tension. You're plugging the tear duct to prevent someone from getting the drops into their nose and the mucus membranes (read: blood stream). Depending on what's going on -- glaucoma getting a betablocker eye drop like timoptic or CAIs like trusopt -- I've called the docs when we got an admission to tell them the pt didn't have their meds. We don't have access to them when pharmacy's closed down, and the docs will tell me that one day missed won't hurt; yes they need them, but I've never had a doc tell me to call a pharmacist back in to get a pt their drops for one night. Never.

Finally....a caring family member is a good thing. However, you don't see a lot of the "behind the scenes" things. I know I've had the same situation you describe with family members. The family is concerned because they think they see a change, I assess and don't see a clinically significant change, or if I do, I know the meds that I'm about to give will resolve the issues. So I tell them the same thing the nurse told you -- I've looked after this pt for 3 nights, they do this every night, I give them their night time meds, and the pt feels better. The pt can also pick up the worry of the family members, and that actually stresses the pt. If I have a family member saying, "mom doesn't look good, she's not acting right, the last time she acted like this she ended up in ICU/tubed/lifeflighted out" -- what's that doing for the family member but scaring them to death? If you have concerns, express them outside the room -- you probably did, but it's easy to forget.

If she really had been deterioriating, what you'd probably have seen was the pt going on a nitro paste, maybe a shot of morphine to reduce both the pain/anxiety and the O2 requirements for the heart. RTs would have come in and performed a stat ABG, I'd have been on the phone with the doc if the results came back iffy getting an order for a BIPAP to get the CO2 off of her, maybe starting her on a low volume (40cc/hr) IV fluid with HCO3 in it if she was having respiratory acidosis to hurry up and knock it down (some docs here do that, some don't).

When you think somethings up, talk to the nurse outside the room, but listen to what they say. If it was me, you'd have probably heard this.

"Ma'am, I've looked after Ms. X for the last 3 nights. Her meds are due, and once she gets them, she'll feel better. Her blood has plenty of oxygen, and her fingers and lips are pink. I know you're worried about the eye drops, but a single drop once a day is really a very low dose -- I've seen 2 drops, both eyes, three times a day, with 3 different medicines for people with advanced glaucoma. Please don't worry, I treat my patients like I do my own family, and if I was concerned about anything I saw, I'd be on the phone with the doc right now." -- now, that's if I had the time. If I didn't, had 7 patients, getting an admission, having another pt trying to crawl out of bed and fall, etc., you'd have probably gotten, "She's fine, I've had her before, please excuse me."

WYDiceDancer · Jul 1, 2009

To an inmate's mother:
He's lying to you, he likes to make you suffer.
Why do you listen to his BS?
No, he doesn't have cancer. When did you last visit? 6 months ago??? He's lying to make you feel sorry and guilty so you will come visit him.
He's a sociopath and he's lying.
Go ahead and call the Governor.

Love those "concerned" family members. The best part of correctional nursing is no call lights and ALMOST no families!!! "Calling the Governor" is my favorite, like the Governor would do anything.

Trishalishus, PhD, CNS · Jul 2, 2009

In my experience the type of reactions from relatives you are describing are caused by fear and feeling inadequate - as is most bluster, anger, etc. I can see that you are really upset by it, but don't retaliate because it will only escalate the problem (and make you feel worse). Take control rather than buy-in. Here's how: try to defuse their fear: give them your full attention - eye to eye; stop what you're doing, listen wholeheartedly to them and respond to their feelings not their words; calmly paraphrase back to them as a question to show you have understood/are listening and to clarify your understanding - (part of their frustration and fear has to do with the fact that nobody is listening to them); give them an answer that explains/clarifies/clears their confusion and offer them an alternative solution (for example - "I can't give your mum more pain meds right now because it would be dangerous and might stop her from breathing. I know you want to help her and I can see how upset you are that she is hurting. You can help her right now by distracting her from the pain. Massaging lotion into her hands/feet/wherever would be really helpful to her.")

Remember that we are trying to develop our person-centred practice by using all means available. One of the best, cheapest and most rewarding means available is to enlist family. 1) They stop being pains in the neck and start being co-carers/helpers who thereby 2) enable you to do more with less and thereby feel better about yourself and your practice. Most importantly, 3) health and wellbeing is tied up in our connectedness to others. Therefore, the more loved ones help, the better off your patient will be.

DolceVita, ADN, BSN, RN · Jul 2, 2009

In my experience the type of reactions from relatives you are describing are caused by fear and feeling inadequate - as is most bluster, anger, etc. I can see that you are really upset by it, but don't retaliate because it will only escalate the problem (and make you feel worse). Take control rather than buy-in. Here's how: try to defuse their fear: give them your full attention - eye to eye; stop what you're doing, listen wholeheartedly to them and respond to their feelings not their words; calmly paraphrase back to them as a question to show you have understood/are listening and to clarify your understanding - (part of their frustration and fear has to do with the fact that nobody is listening to them); give them an answer that explains/clarifies/clears their confusion and offer them an alternative solution (for example - "I can't give your mum more pain meds right now because it would be dangerous and might stop her from breathing. I know you want to help her and I can see how upset you are that she is hurting. You can help her right now by distracting her from the pain. Massaging lotion into her hands/feet/wherever would be really helpful to her.")
Remember that we are trying to develop our person-centred practice by using all means available. One of the best, cheapest and most rewarding means available is to enlist family. 1) They stop being pains in the neck and start being co-carers/helpers who thereby 2) enable you to do more with less and thereby feel better about yourself and your practice. Most importantly, 3) health and wellbeing is tied up in our connectedness to others. Therefore, the more loved ones help, the better off your patient will be.

Bless you. I think you are mistaking this for an advice thread. Cute though. :lol2:

Trishalishus, PhD, CNS · Jul 2, 2009

Visiting hours are over. Please leave the building, we release the attack dogs in 3 minutes.

love it!

WYDiceDancer · Jul 2, 2009

In my experience the type of reactions from relatives you are describing are caused by fear and feeling inadequate - as is most bluster, anger, etc. I can see that you are really upset by it, but don't retaliate because it will only escalate the problem (and make you feel worse). Take control rather than buy-in. Here's how: try to defuse their fear: give them your full attention - eye to eye; stop what you're doing, listen wholeheartedly to them and respond to their feelings not their words; calmly paraphrase back to them as a question to show you have understood/are listening and to clarify your understanding - (part of their frustration and fear has to do with the fact that nobody is listening to them); give them an answer that explains/clarifies/clears their confusion and offer them an alternative solution (for example - "I can't give your mum more pain meds right now because it would be dangerous and might stop her from breathing. I know you want to help her and I can see how upset you are that she is hurting. You can help her right now by distracting her from the pain. Massaging lotion into her hands/feet/wherever would be really helpful to her.")
Remember that we are trying to develop our person-centred practice by using all means available. One of the best, cheapest and most rewarding means available is to enlist family. 1) They stop being pains in the neck and start being co-carers/helpers who thereby 2) enable you to do more with less and thereby feel better about yourself and your practice. Most importantly, 3) health and wellbeing is tied up in our connectedness to others. Therefore, the more loved ones help, the better off your patient will be.

How nice for you that this works. Unfortunatly, most of the patients that came into my hospital (before I went back to corrections) were full of entitlement. There is nothing like worrying about "customer service" when the "customers" are drunks and drug addicts. Nothing in their world is right, and they do their best to make the rest of humanity around them miserable, cause you know, their problems are SOCIETY'S fault. :angryfire Let me rant, doing so in a safe environment such as this is what keep me from working at Mini-Mart. :bugeyes:

Trishalishus, PhD, CNS · Jul 2, 2009

brilliant post NY Dreamer regarding your sadness about loved ones reactions to dementia - really moved me. By the way - where did you get that superb avatar? I want one!!!!

DolceVita, ADN, BSN, RN · Jul 2, 2009

How nice for you that this works. Unfortunatly, most of the patients that came into my hospital (before I went back to corrections) were full of entitlement. There is nothing like worrying about "customer service" when the "customers" are drunks and drug addicts. Nothing in their world is right, and they do their best to make the rest of humanity around them miserable, cause you know, their problems are SOCIETY'S fault. :angryfire Let me rant, doing so in a safe environment such as this is what keep me from working at Mini-Mart.

I don't think that poster is a nurse, student nurse or aide. Psych major w/hons in fact.