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What is your policy of telling the family the pt's disease progress

Posted

Is it allowed to share some details such as increased PTT, decrease creatinine with the family?

if the family is a ACNP herself, worrying her mother to death, what would you do? Especially, after her mother being treated badly and now the pt is getting worse and incubated.

Biffbradford

Specializes in ICU.

I don't know what the policy is, but if a family member knows enough medical to ask about BUN/Creat, then I'll tell 'em. I've seen worse (MUCH WORSE) things held from family, this is no big deal in my book.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

On admission I ask who is the family spokesperson and I hand them a business card for our unit. I say we can only have one family contact who can share information with the rest of the family to prevent any misunderstandings.

I tell the family that your family spokesperson can ask for those test results from the MD.

I do not give any info to the nurses, nurse wannabees, nursing students NPs etc. No way. It snowballs into having multiple family members making constant phone calls demanding to know every test result. I do not have time for that. Most of all, the pt and his spokesperson have a right to privacy with protected health information.

I had two physicians and a med student as family members at the bedside. I was very sorry that I shared an ABG result , HUGE mistake, they then wanted to take over and manage the pt and even tried to give me orders even though they were not on staff and were from out of state.

In the am the intensivist transferred that unfortunate pt to a Level one hospital at 0705 mainly because they family was so out of control with their attempts to run the show.

I have learned the hard way to have "medical professionals" write down their questions and present them to the intensivist.

Edited by icuRNmaggie

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

I had two physicians and a med student as family members at the bedside. I was very sorry that I shared an ABG result , HUGE mistake, they then wanted to take over and manage the pt and even tried to give me orders even though they were not on staff and were from out of state.

In the am the intensivist transferred that unfortunate pt to a Level one hospital at 0705 mainly because they family was so out of control with their attempts to run the show.

I have learned the hard way to have "medical professionals" write down their questions and present them to the intensivist.

Was the patient able to make their own decisions?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

No. Young woman with severe neurologic damage, intubated, in cooling phase of therapeutic hypothermia.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Were any of these family members the decision maker for the patient?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

no. Mother and Father were not fluent in English.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Who was the decision maker?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

the parents.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

It sounds like the patient was transferred based on the wishes of the three family members with medical backgrounds, so it would seem the parents were deferring at least some decision making involvement to those three?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Exactly. One ER physician, one was an Internist, one a medical student. I see where you are going with this. As surrogate decision makers they had a legal standing to request protected health information.

I had the intensivist speak to them two or three times during the night for various reasons. They were understandably very emotional. I can not say more in a public forum. In retrospect I should have put them in contact with the physician for all of their questions.

Edited by icuRNmaggie

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

If the official decision makers, the parents, want to include those three in the decision making process, then why would information be withheld from them?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

It was not withheld, in fact I volunteered an ABG result showing improvement and answered every question completely and truthfully. After that, they wanted to give orders. It was an awkward situation as they wanted to apply their expertise in desperation to save their loved one. The MDs were reluctant to talk with them and I don't know why.

I would handle it differently now. I would let the intensivist provide all of the test results, answer their questions and order what they suggested rather than being the messenger and middle man.

Edited by icuRNmaggie

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Back to the OP's question, I've never worked anywhere that had a specific policy on this since it's usually covered in states' nurse practice acts, which typically define that it is the nurse's responsibility to ensure that the patient is kept up-to-date on their plan of care, lab results, medication changes, etc. Nurse's are not only allowed, but expected to ensure that patient's are aware of and understand their test/lab results. In situations where the nurse doesn't adequately understand the test or result to be able to communicate and educate about the results then they are expected to defer to someone who does, but for the most part nurse's should be able to explain the results themselves.

For instance, let's say you have a new admit who just had a CT result positive for a PE, the doc has now ordered a heparin drip. When going in to start the heparin drip, the nurse is required to explain the purpose of the medication, which would include explaining to the patient what the CT showed (as diagnosed by the radiologist).

In teaching hospitals much of that responsibility gets transferred to residents who need the experience with patient communication, but it's still the overall responsibility of the nurse to ensure it's getting done.