tips for working with *difficult* families

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How do you all do this? Any suggestions? I was caring for a baby last week, mom was very young (18), hx of domestic violence, dad had been intercepted by security for verbally abusing mom...then verbally abused security, then was escorted away by the police. Paternal grandmother is threatening to come to the hospital and take the baby...meanwhile, mom is bringing in HEAPS of visitors, after she's been told several times she can only have two at the bedside, and only those on her list can come in without her. Still no luck...and the maternal grandmother isn't too happy either when she was told they couldn't have that many at the bedside (4-5+), got upset and walked off.

Another one was a new mom of twins who was also upset that she couldn't have tons of visitors all at once, and said she didn't want Nurse X (who had to explain the rules & rationales) caring for her kids anymore...

Any suggestions for families like this?

~J

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Specializes in Critical Care, Cardiothoracics, VADs.

The only thing I can say is that the staff should support each other and the unit rules, including the nurse manager. Someone needs to explain the rules politely but firmly and reinforce that no matter which nurse looks after them, the rules aren't changing.

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I guess first, realize that sometimes there is nothing you can do, and people come in with issues that sometimes have little to do with us.

The second thing is to really emphasize when parents come in why we do these things (i.e. more visitors mean more chance of infection, etc.) and that we do what's best for the baby, period.

I also concur that everyone should be consistent when they enforce rules.

hope this helps, t.

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Specializes in NICU.

We call in our social worker (the hospital has one in the building until 0200). That can help to defuse a situation. Managers go home in the afternoon, and that's not much use to us. We had two problem families last week, kept him busy, but it gave our staff time to deal with their patients.

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Specializes in NICU, Infection Control.

Make sure you give each parent written rules(in the language of choice); some places make them sign a copy and put it in the chart--like a contract. We really crack down during the winter/flu/cold season--no siblings!

As has been said, everyone must give the same answers and permit the same thing. If the family cannot follow the directions (which are in place to protect the health of ALL of the babies), then they lose the priviledge for a period of time. (you could do a 1st offense, 4hrs, 2nd, 8hrs, etc)

The social worker is a big help in reinforcing the visiting rules. And, of course, security is a last resort. If security has to be called, they shouldn't be allowed to visit for 24 hrs.

Any exceptions need to be based on the needs of the baby and be cleared thru the charge nurse (or other honchos). I once allowed 2 sets of grandparents and the parents to come in all together because the priest was there to baptize the baby.

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Specializes in NICU- now learning OR!.
Another one was a new mom of twins who was also upset that she couldn't have tons of visitors all at once, and said she didn't want Nurse X (who had to explain the rules & rationales) caring for her kids anymore...

Any suggestions for families like this?

~J

This happens all the time in our unit...it is the nurse who follows the rules that suddenly is the "bad nurse". I have noticed the nurses are either firm and state the rules matter-of-factly or they state the rules and also mention that the "next shift" might not be so flexible with the rules...it is a major cop out but it can sometimes avoid a fight.

Parents and visitors must stop at the secretarys desk to sign in before they scrub and come to the bedside. The secretarys are supposed to be stating the rules and stopping a whole herd of people from even coming to the bedside....but that is probably a whole different thread.... sigh.

I have noticed that with the very young parents, you really have to build their trust and establish some sort of rapport or you are just going to constantly feel like you are talking to a brick wall!

Jenny

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