Tips on dealing with difficult parents

I, too, avoid them as much as possible. I try to perform as much care as I can when they aren't present. When they are present, I keep myself busy charting.

If they try to invoke me in their family drama, I normally flat out tell them that it's none of my business.

Any drama, yelling, etc. that affects the pt is well documented.

I try to start out friendly, but firm so that they know where I stand from the beginning.

I go by the book

do exactly what's on the 485 - no less, no more

as gimme coffee said, unless it pertains to the care of the pt,

i don't want to know

I do document verbatim a lot, but tell them that's what i'm doing

"i will document this exactly the way you said it so that everyone can know

and we're all on the same page"

Currently, I'm working with the know it all parent in denial of their kids illness. Example: PT comes to work with kid. Parent stands in room telling kid what exercises to do, how many times, etc all while PT is trying to work. PT can't do her job because the parent is stepping over her. Same parent says the Dr doesn't know what they are doing and the parent then says they are going to just test the kid off the vent and maybe even cover the trach. While changing a vent circuit, parent starts instructing me until I show a dirty filter to the parent. Parent states they don't know what it is, so it can't be important. Parent teaching is impossible because it goes in one ear and out the other. Told parent today not to let formula go down the tube til air gets in because it will make the kid gassy. Same parent keeps doing it anyway and says it won't hurt the kid. Kid has been passing gas one way or the other all morning and usually isn't gassy. Kid complains of gas pain this morning. Parents deny kid has diagnosis that the experts gave. Then the parents go on to say the kid will be weaned off the vent when the illness is, sadly, a death sentence. Past history from parents include cussing out hospital staff and doctors, letting good therapists go over trivial things, etc. basically burning bridges. Parents have asked that we don't discuss life threatening events with the Dr because then they will want to do more tests. Then to top it all off, they have started the game of nurse vs nurse vs therapist vs : insert specialty here:. Every day when I leave, I get drilled asking if I did specific nursing tasks and when and it goes on and on. It's made worse by the fact that they show up right at the end of the shift and then want a 30 min report. They haven't missed a day of nursing due to a reliable team of nurses on the case. But they have made threats if the agency doesn't cover a call out. I dread that day. We are human and need days off too! Just trying to find ways to deal with this difficult set of parents without losing my mind. So thought it would be great for us all to share tips/tricks we use.

They need counseling. I am in no way defending their crappy behavior but it seems to me like they have no coping skills and are stuck in the denial part of the grieving process. I think they are also craving control over a situation that they can't control. They can't control their child's impending death but they are trying to control everything having to do with their child to make up for their inability to stave off death.

If the agency doesn't cover a call out, it means one thing: the parents will have to parent, which sadly sounds like the child will suffer more for it.

They need counseling. I am in no way defending their crappy behavior but it seems to me like they have no coping skills and are stuck in the denial part of the grieving process. I think they are also craving control over a situation that they can't control. They can't control their child's impending death but they are trying to control everything having to do with their child to make up for their inability to stave off death.

If the agency doesn't cover a call out, it means one thing: the parents will have to parent, which sadly sounds like the child will suffer more for it.

I think all parents in this situation need counseling...except the amazing ventmommy. But the majority really do need it and it's overlooked.

I think there is a fundamental difference between adoptive parents of MFTD children and birth parents of MFTD children.

My husband and I absolutely know what we are getting involved with before we bring a child home. We don't have nine months of expectations of a perfect birth and a perfect baby and a perfect childhood and high school dances and graduation and college and weddings. We knew that we were adopting a profoundly disabled little boy who likely wouldn't live to be 10. We knew everything or almost everything about all our other children before they came home.

A birth parent has all of their dreams and hopes crushed in one brutal day. Their baby is born, sometimes traumatically, sometimes not but at some point they realize something is wrong and the doctors tell them "well, yes, your baby will never say I love you, will never eat from a spoon, will never kick a ball and will need a feeding tube (or TPN or trach or vent or whatever) to survive and it will be a hard, hard life and she might not live past 2 or 12 or 22 or she might outlive you and you'll have to live with the constant worry of "who will care for her when we are gone?"

And for some people that's too much. A lot of people don't know how to accept dying or process grief. I am sure if you post in the hospice care forum, there are families that are very similar to this one. They haven't accepted the diagnosis and they rail against anyone they can and try to control the situation in the most inane ways.

I don't think the hospitals do enough with getting social work and psych services to see these families before they are discharged and there is little to no follow-up after discharge. I saw a family that was new to vent-dependency when my son was in the hospital once. This family cried their eyes out for days but I never saw a counselor come talk to them. I spoke to them casually but that's not the same as a trained professional with a lot of professional connections.

I don't think you really can "deal" with them, because one way or another they are going to find *something* to focus on besides all the stuff that ventmommy mentioned. It's a matter of providing the best care you can, maintaining your professionalism, and knowing that one day either they or you will not be able to take it anymore. I have lived through this already. It's not fun at all to watch and in the end the kid is the one that suffers for it.

Over the years, I've worked with many family members who struggled with

poor prognoses or imminent death. I find it quite normal to reject such prognoses

and have a harder time with families who react in a stoic fashion.

However, the use of profanity, as in cussing out hospital staff and doctors, is never

acceptable.

Lots of great responses for a super timely topic. I made a list recently- all the families I've ever worked with for PDN. Even if it was just a few shifts subbing. It was like, 25 families and I'd say 75% of them have been more than moderately difficult.

So. I've learned a lot. Lol.

I guess my biggest tip would be don't talk to the difficult parents too much.

If they are difficult, the more you engage in ANY sort of conversation with them; the more you open yourself up to trouble. (Agency calls, "Parent X said that you said this..."

Hmmm...difficult parents? NEVER let them have your phone number. Ever.

I'll come back in after work with more tips.