What do you do with families who think badly of you?

[hazyblue]

I know that ways to handle a family differs by case. To be honest, I'm probably here to unload rather than ask for advice.

Let me tell it chronologically. One of my patients is on mechanical ventilation and the alarm for his tidal volume kept ringing. I did everything my untrained self knew when it comes to intervention. When I couldn't fix it, I immediately asked for the team leader's help. She said that that's just the way it is with that patient. Sometimes it just happens to be go off like that. She even reprimanded me when I tried promoting lung expansion by repositioning.

Later in the day, we eventually consulted with our head nurse with the attending physician within earshot. The plan was to change the tubings with a "disclaimer" that nothing would probably change. I was advised to just monitor the patiens status.

Now, it's policy not to mute mechanical ventilators and that's where the problem is. The patient is sharing a room with another patient whose family came later in the day. Naturally, they were worried and bothered. I said my apologies. I even said that I've referred the situation. Apparently that went through their heads. It didn't help that therapists were making a fuss about it nearby. What? Was I supposed to explain to them the status of the patient who's not related to them?

I couldn't just stand there forever. The patient's vital were fine. No loss of consciousness and such. I had 20+ other people to take care off. I left and later I found one of the relatives roaming around looking for my leader.

The moment was quite upsetting for me. I didn't like this idea that I wasn't doing my job. That I don't care about the patients. I got really sad. If I was in my early 20's, I would have cried. I respond to alarms not coming from my patients even if other nurses simply ignore mine...

I'm the one who found the leader first. Funny, before I could even finish my referral, she told me to stop minding the alarm. I told her that the family on he next bed seems to think that I'm not doing my job. She went to troubleshoot for me and the alarm stopped... for a while. Just like it sometimes does. But, in that short while, I could hear one family member, the one who went roaming around, saying things, one of which is, "It's good that I reported it."

=_= FYI, the consultation with our head nurse happened when I bypassed our leader.

It's just so upsetting. I wanted to defend myself but I also feel stupid for doing what I was told to do/not to do. I mean I would be worried to if I were the family... Maybe I should habe broken the policy and kept the machine on mute... I don't know.

Anyway, they were considering the respiration problem to be time-related　body-clock wise.

[iluvivt, BSN, RN]

This reminds me of the quintessential little old lady screaming ..HELP me...HELP...me and visitors coming up to the nurses station to report it.I always found this odd as if we would all ignore pleas for help.As an aside I find it odd that a tidal volume alarm can't be fixed..was it a low tidal volume alarm? Maybe a wonderful respiratory therapist will chime in and tell us how to troubleshoot this alarm.With that said it would not bother me one bit if a visitor that I owe nothing to thinks I am not doing my job and they think they are the savior.If you are I see nothing wrong with either telling them the staff is aware of the alarm and it does not indicate a problem.If said visitor patted herself on the back and made the comment you indicated I would have approached her and said,"Thank you for your concern but your report was not necessary as we are aware of the alarm and we are handling it.Don't violate a policy ever for convenience especially one as critical as ventilator alarms.

[Wuzzie]

If I hadn't done anything wrong I wouldn't do a darn thing, including caring about it.

[hppygr8ful, ASN, RN, EMT-I]

Honestly I don't give them a second thought.

[Triddin]

Try suctioning or checking the tube for kinks. Make sure the alarms are appropriate for the patient and change them if need be. Did you have an RT to consult with?

[brownbook]

What the family thinks of you is not the problem.

I know as a nurse it drives me crazy to hear alarms going off frequently. I can't blame the family. If I were the family or patient I'd complain also.

You, your charge nurse, the DON, someone needs to get the vent fixed or figure out the problem. The patient should not have a roommate until the vent alarm problem is fixed. To say nothing of staff learning to ignore the alarm is the perfect example of the boy who cried wolf, eventually the alarm is not going to be false and the patient may die.

[psu_213, BSN, RN]

When a non medical person questions my judgment, and I know I'm in the right, I am not going to give a 2nd thought to what they say or think, nor am I going to address it with them if it does not directly deal with the care of them or their family member. In this circumstance, the first time the family directly asks about this, I might say something like "respiratory therapy has come up and assessed this. Unfortunately it cannot be muted. I apologize if the noise is bothersome."

Now, I was never is a position where I dealt with vents very often, so you can take this with a grain of salt; but I think more needs to be done to get this alarm to stop (other than muting the alarm) before alarm fatigue sets in and a true danger alarm goes off.

[Kooky Korky, BSN, RN]

Get the RT in there and get the alarm fixed. Or get a different ventilator. What a ridiculous situation - an alarm that has to be ignored. Surely this is a violation of basic common sense.

I think the visitor was not wrong to report it. You could have told her, when she brought it up to you, that you have checked with your Supervisor about it and the Sp is looking into it.

I would be driven mad by a non-stop alarm, especially if staff seem to be ignoring it. Imagine the poor patients and their visitors who can't get away from it.

[Rosie_one]

Sorry you were put in a very difficult situation and it's completely normal to take this to heart when you're doing the best you can to care for their loved one. It generally haopens when you're busting your butt to do all you can.

It's a different situation in Australia to the US m, as we don't have respirstory techs so do ventilation as well. Tidal volume alarms will go off for several reasons.

*pt. not getting satisfactory volumes for several reasons. Could sputum load, which another nurse mentioned earlier which requires suctioning.

A pt. biting the ETT would also cause a low tidal volume alarm, which is disrupting ventilation is usually fixed by boluses sedation to stop biting and/or a bite block.

*Tidal volumes are large, which could mean that the pressure support that set on can be reduced as satisfactory volumes are being made.

*Minute volume alarms couldbe triggered, as they are increasing their respiratory rate. Minute volume is RR × Vt= Mv

*Also mentioned earlier, the alarms could be too tight, or patient's situation has changed and requires alarms to be altered.

*They could just be coughing or starting to breath up, about the set alarm limits, so vent often alarms it's a machine and doesn't like humans breathing haha...in certain respiratory modes.

It's not uncommon for family members to get distressed when alarms are constantly going off despite you letting them know. You did the appropriate thing to go to team leader etc.

I actually find it quite poor that a manager of an ICU not have an understanding of ventilation, even at a basic level would allow to trouble shoot. Surely a resp tech from another pt. Could have helped fix the issue. Not safe to keep vent alarming I agree.