Tolerating Abuse from Grieving Families

[evelynkarirn]

Hi Everyone,

I've been working as an on-call hospice nurse (Fri 5p - Mon 8a, 63 consecutive hours) for just four months and had a real crisis this past weekend on two death visits. The previous weekend I handled six without incident.

Last Saturday I was treated disrespectfully (abusively?) by two separate families, one family verbally ganging up on me, throwing my bag across the room, yelling, complaining about the case manager, not answering questions about desired post-mortem care, and finally escorting me out of the house in a huff stating they never should have called me and refusing to make arrangements for body release. The other yelling/screaming, telling me to stop calling (it was my only call to the son of a SNF patient to inform him of his mother's passing), refusing to respond to questions concerning mortuary wishes, and hanging up on me without saying if he would be coming to say good-bye.

I was probably emotionally fragile this day having just returned from seeing my terminally ill father, BUT, after the visit when they threw my bag and verbally harassed me for almost an hour, I cried all the way home (short drive, but still...).

Hospice nurses know people are at their best/worst while grieving, but are there limits? How much is excusable? If they call you names? Tell you your agency must only employ idiots? Physically push you out of the way while you are caring for the body (I was d/cing a foley)? Tell you to get out of the house before you've completed providing care for the deceased and managing the logistics of the death?

Would love to hear from others if they take everything short of physical abuse and how they keep it from breaking their spirits. And where does your agency stand in terms of supporting you? Would especially love to hear from on-call nurses from med-large organizations since I fall into this group and am often unfamiliar with the deceased - wondering if families are more harsh with "unknown" RNs (aka on-call).

Thanks!

[Brightideas9]

The other side of the coin we don't think about is the financial hardship someone's death can bring about. I have encountered this many times where the person dying is supporting the entire household and their death will bring about catastrophe (ie., homelessness). When SW is barred from the house, it's hard to get a complete picture of everything, too. But I will say this, if anyone family member/friend throws you out of a house BEFORE you have finished processing the body (clearing through the ME's office, calling the funeral home, etc.), call the police, PERIOD. As nurses, we are in charge of that body until the funeral home takes possession. I have stayed in homes just to protect the body from overly grieved family members. We have to be allowed to complete our work. One day, people will understand our work better and this is why I encourage people to support HR 3119, the bill is stuck in the House of Representatives. Lord, if you are up there, please help get that bill passed! : )

[evelynkarirn, BSN, MSN, RN]

One day, people will understand our work better and this is why I encourage people to support HR 3119, the bill is stuck in the House of Representatives. Lord, if you are up there, please help get that bill passed! : )

Considering what a "growth" industry palliative care is, it makes sense that more education should be available in this field. The company I work for is growing at an astonishing pace and can't find/keep enough qualified RNs to serve the patients: Many of the hospice nurses formerly worked at SNFs versus having specialized palliative care experience/knowledge. All have the heart to do the job, the experience to manage the myriad issues that arise when caring for patients with extensive co-morbidities, but few have the advanced pharmacological and pathophysiological knowledge allowing them to determine root causes and the most effective interventions when "standard" pain interventions are ineffective.

Didn't realize HR 3119 was introduced almost two years ago. Hope it gets the attention and funds it needs and deserves to properly care for the growing population opting for hospice care (and often passing at home). YES on HR 3119!

[jeannepaul, BSN]

I am on call weekends also. I have had large families gang up around me throwing questions at me, thinking I was going to kill the pt. with medicine.in 15 years of hospice, only once did I call the police. They were gang members talking about drive by shooting someone so the social worker and I went to my van, called the police and waited until they got there and took over.

The case manager should have been preparing them as soon as pt came on services. Sorry you had to through that.

[Brightideas9]

When people get blunt with me like that I will get blunt back. I know I shouldn't but sometimes being an advocate for your pt requires something drastic to redirect their thinking. So it goes something like this: "I will tell you that whether I am here or not, your loved one is going to pass. Whether they do that in comfort or in agonizing pain and respiratory distress is literally up to you. Because whether or not they have one dose of morphine, 10 doses, 50, it doesn't matter. They will go when they are ready and not likely a minute before that." Hospice is 90% teaching, remember that. Redirect thinking and you become a great advocate for your patient.

[Mom22g1b, LVN]

On 6/30/2017 at 9:42 AM, Brightideas9 said:

"There is a labor coming into the world, there is a labor going out."

That's so true and exactly what I explain to my families as well. It helps them understand and accept what's happening. It completely changes their perception and brings them a measure of comfort and relief, though they are still sad. 

I also like to give the family a poem by St. Augustine titled Love Never Disappears. That poem serves as a reminder that at some level, their loved one continues on.  In my own life, it certainly has comforted me many times since cancer took my Dad in 2004.  In addition, I make double sure to educate the family on the use of hospice bereavement team should they feel the need and to not wait for the chaplain to do his follow-up communications after the death; they can call them anytime and get help if they're finding it too difficult to get through period of bereavement  or are experiencing complicated grief. 

[amoLucia]

Just reading this older post at this time. Much wisdom provided by those  who responded.

But something from the orig post has me surprised. Why wasn't the decision re mortuary preferences pre-decided??? I know from LTC, that is usually covered by the Social Worker on the opening visit (or by the next). Families could always make a change later on if desired.

When a death occurred, I would just gently bring it up to the next-of-kin that XYZ Funeral Home had been previously designated. And were they OK with that so I could make that phone call for them. Never a problem.

It is NOT the best-est of times to catch the family off-guard at the time of death for a decision that should have been made already.

I was just surprised that OP had issues twice.

 

 

[Peachpit]

It is absolutely not OK as others have pointed out already that family or patients behave in an aggressive/abusive manner. PERIOD. Most everyone has lost a loved one and yes, I know people react to illness/death/dying is a variety of ways but some people are just a-holes too. 

You should not be expected (nor expect it of yourself) to accept someone throwing your items, screaming etc. and please, please, in the future if something like this happens again, just leave. Call your supervisor and let him/her know what happened, it's not a safe environment for you and let them deal with it. That sends a message to your management and the family/patient that there ARE limits and while they don't have to like you, they DO need to respect you.

Shame on them and your employer for later asking about negative feedback.

Nurses are not handmaids nor punching bags. Jesus.

[ZenLover, MSN, RN, NP]

I work in the ICU and with COVID we see a lot more of this than ever before because many of our patients are unvaccinated and come from families that didn't really believe COVID was real.  As a result we have been screamed at, one patient's family ran up and down hallways screaming we were killing everyone for the Govt agenda.  

Death is stressful.  Pandemic is stressful.  People get into these emotional binds and then lose it because they have no control.  Acknowledge the lack of control.  Then acknowledge what you can give them control of.  Let them tell how they feel about that.  This is team effort and they have to feel they are a part of it.  The lack of education in healthcare is tough.  Most of these people have had providers telling them and their loved one that they are doing "okay" for decades and then the 11th hour comes as a surprise.  It is often hard for us to imagine the deficit in knowledge because we live this life....but people outside of healthcare know NOTHING and often worse than knowing nothing they think they know and it is all wrong.  You are essentially watching the blind be blinded by the truth/light at a hard time.  When you understand that and understand the response you will probably get that can be NORMAL you will better understand what your boundaries should be with them as well.

Don't call the police unless you have NO OTHER choice, it is not a good move to be vindictive and most officers won't appreciate responding to that kind of call.  There is a time and a place, but you should be able to recognize an emergency and remove yourself long before getting to that place if you truly are listening to them and not just expecting people to hear you.

Good luck! xoxo

[summertx]

I believe a steady call to the police would have been appropriate. It is  because you are a woman that they think they can get away with it. Maintain your composure, call the police, explain the incident, just so the legal portion of it can be take care of (the body exiting the residence), and go home. They think because your a nurse you have to put up with abuse. Way I see it be calm but do your job.