Upset Family

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Hello, I am a somewhat new nurse. I have been a nurse for 2.5 years and only worked in the one hospital I worked at now.

I learned a lot of different opinions and thoughts and made changes in my practice from reading this site. One included getting over new nurse burn out and knowing I am not alone.

I had a recent event done that upset me and looking back, perhaps I was wrong in my encounter.

i discharged a 70 y/o female and her daughter helps care for her. She did not had a stroke but came in for potential TIA. Her workup included (CT head, MRI/MRA head no contrast, US carotid were negative except for potential brain bleed that was ruled out by EEG awake and sleeping).

Physicians said was clear to go home and her daughter asked for prescriptions for her mom (muscle relaxant). Most of the time her daughter call on the phone and I tell her, your mom is fine, she shows no signs of stroke, she had her tests done. Told her mom was going home and follow up with neurology and pick up prescription downstairs. All so far so good.

six hours discharge she calls me and demanded answers about a TIA discharge diagnosis and and kidney disease. I told her that your mom was not diagnosed with a stroke from the physicians note (both neuro and primary), and that a lot of the times, the paperwork includes differential diagnoses so they know what to look out for.

She was nice about it though, but asked me "why didn't anyone say anything about this, you say that she didn't have a stroke but this paper says she does!" Told her that I cannot diagnose as it is out of my scope of practice and that there is a follow up with Neuro.

she asked also about medications in which during the medication reconciliation both muscle relaxant and aspirin over the counter was written; I told her that no one gave me a prescription for those (except for the muscle relaxant, which was the one I asked for earlier per patient family member request) and that she needs to call neuro for further answers, esp because she was not in to speak to any physicians.

says I was no help and going to complain to the hospital. I spoke to my mom who was also a nurse and she said that next time I needed to handle the situation with more grace....

Any advice/what is your thought/opinions on this? I cried a lot feeling like I disappointed and was not a help to this mom that I cared for two days... Thanks.

jennylee321

412 Posts

Doesn't sound like you did anything wrong here

Crush

462 Posts

Specializes in Case manager, float pool, and more. Has 13 years experience.

Does not sound like you did anything wrong. You explained nicely what you were able to do or not do. Sometimes families complain for various reasons that have nothing to do with us as nurses.

I am not sure what your mom meant by "more grace"? Maybe the rephrasing some things but overall, if you did the best you could at the time then no need to feel disappointed. Maybe just reflect in order to provide better answers next time?

Specializes in Neuroscience. Has 4 years experience.

You provided good care, and you did the best you could with the family. Whereas your mother's comment of handling the situation with more grace is dependent on your ability to reflect on the conversation. Could you have stated things a little differently, were you being defensive in the care you had given when explaining it to the daughter, and could you have changed anything?

Granted, I don't know exactly how the conversation went, but it does come off as a little defensive. So, perhaps next time a few key things to do is to acknowledge the family member's feelings:

"This must be frightening to be told one thing at the hospital, and read the discharge papers that state "stroke"." Give them time to explain.

"Can you tell me what the doctor told you before she was discharged?" Help her understand what it means.

Explain the general information given to patients based on the service. "Because your mother was on neurology and presented with stroke-like symptoms, the information in the discharge paper is there to help you understand the signs and symptoms of a stroke, like when we discussed FAST, we want you to feel equipped to handle a stroke situation."

Let her know it's auto-populated from the chart. "She was entered into the system as a stroke alert, and that unofficial diagnosis was pulled from her chart to her discharge summary. I am so sorry for the confusion. What questions do you have for me at this time?"

Finally, thank her for calling, and remind her if she has any questions at all, to not hesitate to call. Remind of the appointment time with the neurologist, and to write down questions prior to the appointment because it's not uncommon to forget things while talking with the doctor.

It's not that you handled it wrong, but that perhaps you could've handled it better. Don't get defensive, they aren't upset with you, it's not your fault, but they just need clarification. It's okay to apologize and help them understand the issue. It's okay to reflect back on the conversation and think if you could've said anything different for a better outcome. That's how we grow! Best wishes!

JKL33

6,587 Posts

i discharged a 70 y/o female and her daughter helps care for her. She did not had a stroke but came in for potential TIA. Her workup included (CT head, MRI/MRA head no contrast, US carotid were negative except for potential brain bleed that was ruled out by EEG awake and sleeping).

Physicians said was clear to go home and her daughter asked for prescriptions for her mom (muscle relaxant). Most of the time her daughter call on the phone and I tell her, your mom is fine, she shows no signs of stroke, she had her tests done. Told her mom was going home and follow up with neurology and pick up prescription downstairs. All so far so good.

six hours discharge she calls me and demanded answers about a TIA discharge diagnosis and and kidney disease. I told her that your mom was not diagnosed with a stroke from the physicians note (both neuro and primary), and that a lot of the times, the paperwork includes differential diagnoses so they know what to look out for.

She was nice about it though, but asked me "why didn't anyone say anything about this, you say that she didn't have a stroke but this paper says she does!" Told her that I cannot diagnose as it is out of my scope of practice and that there is a follow up with Neuro.

she asked also about medications in which during the medication reconciliation both muscle relaxant and aspirin over the counter was written; I told her that no one gave me a prescription for those (except for the muscle relaxant, which was the one I asked for earlier per patient family member request) and that she needs to call neuro for further answers, esp because she was not in to speak to any physicians.

says I was no help and going to complain to the hospital. I spoke to my mom who was also a nurse and she said that next time I needed to handle the situation with more grace....

Any advice/what is your thought/opinions on this? I cried a lot feeling like I disappointed and was not a help to this mom that I cared for two days... Thanks.

I'm going to agree with your Mom based on what you've written here. :) Hear me out...

It does stink when people are not present for important points in care and then become upset later because they don't have information. But sometimes they have conflicting responsibilities, are physically unable to come, or perhaps just need respite while the patient is away from home. Whatever the reason, if they are a caretaker of the patient (and if the patient wants them to be informed) than it is in the patient's best interest that they understand the information.

Discharge information is a huge, huge deal - both for patient risk reduction and continuity of care, and for legal reasons and readmission rates. Even when a condition has been ruled out.

She was nice about it though, but asked me "why didn't anyone say anything about this, you say that she didn't have a stroke but this paper says she does!" Told her that I cannot diagnose as it is out of my scope of practice and that there is a follow up with Neuro.

This response ^ was not appropriate. (For the sake of discussion I will assume the patient consents to the information-sharing). Talking about what was diagnosed and what wasn't diagnosed is not, in itself, "diagnosing." It is well within your scope of practice to answer the question she asked. Conversely, if the patient was diagnosed with neither CVA nor TIA, but they wanted her to have the TIA instructions in order to be aware of risks and "when to seek care" - then you can explain that very clearly and alleviate everyone's concerns and make sure the patient knows what to do in the coming days if she has trouble.

she asked also about medications in which during the medication reconciliation both muscle relaxant and aspirin over the counter was written; I told her that no one gave me a prescription for those (except for the muscle relaxant, which was the one I asked for earlier per patient family member request) and that she needs to call neuro for further answers, esp because she was not in to speak to any physicians.

I'm not sure I'm completely following, but one way or another she has questions about the medications. If the patient was just discharged from your facility hours earlier and then doesn't understand the medication instructions, then "call neuro" is not the answer. Ask yourself this - do you think someone who has just been discharged should know whether or not the physician recommends that they take aspirin?

This doesn't have anything to do with the daughter not being there. You can't punish the patient for that. Get the patient on the phone and see if the patient understands the answer (but I doubt she does, since her discharging nurse doesn't!) - and if she doesn't, you need to get the answer.

Honestly, some situations simply require finesse when dealing with interesting family members - - but I have to say this kind of sounds like it missed the mark a little more than that - unless the patient knows all the information and this is simply a wacky call from a random family member.

Learn from it what you can. If you have specific questions about your role, you can post them here and we'll try to help. :)