F is for Family!

Dealing with the *very* involved patient family is a nursing rite of passage, like being hit with [insert mystery body fluid], your first code, and holding your pee for 10+ hours. Welcome to nursing!

We’ve got the note-takers, the second opinioners, the ones that ask each and every person who comes in the room the same questions to see if they get the same response. Sometimes they consult Dr. Google. Sometimes they’re actual medical professionals. Which is better or worse? Debatable. The outcome is the same. Your every move is questioned and it seems despite the daily family conference, they “haven’t heard from the doctor in a week”. 

First of all, understand this: neediness is tied to feelings of helplessness. At the end of the day, despite the countless demands, they know their loved one’s decline is ultimately out of their control. There could be other layers: feelings of guilt, financial dependence, stages of grief, hopes for a miracle, etc. But at the base of it all, they want to feel as if they’re doing something and not just “giving up.” Through gritted teeth, I can understand that. 

But how do we deal with it? How do you stay professional and actually care for your patient with that constant pull in another direction? Let’s talk about it!

1. Identify a spokesperson. If you’re dealing with a large family, answering the same questions over and over is time-consuming and let’s be honest- annoying. Most importantly, it takes time away from the patient. The more you get behind and scramble to catch up, the higher chance of missing something or making a mistake. I would explain this to the family in a very diplomatic way. For example: “In order to provide the best possible care to [insert name], it would be very helpful to choose a spokesperson who can share updates with the rest of the family. I want to make sure I am providing safe care and have time to attend to his/her needs. I would really appreciate your help with this.” Any reasonable person would understand this, plus it gives the chosen spokesperson a job to do which often provides a distraction.
2. This brings me to my second point. Use the patient’s name. Remind family members you view their loved one as a person and not just “the patient” or “room 12.” Additionally, I believe using his/her name subliminally reinforces that the situation is about [patient name] and not them. 
3. Give them a job to do. Remember, neediness is tied to feelings of helplessness. So let them help! Give the family member a simple but helpful job to do. For example, instruct the family member how to do incentive spirometry with their loved one. Watch a TV show together then every commercial break, do 5 leg exercises. Read to your family member to decrease anxiety. Help him/her with morning hygiene. Be clear about what they are allowed to do to avoid harm and so they have guidance. 
4. Set boundaries. It is not appropriate for family members to ask what you would do or if you feel the situation is fair. You may likely have different beliefs and even if you don’t, its simply not your job to offer opinions. Frankly, it’s asking for trouble if you recommend a course of action that causes discourse between the family. For example, if some family members want DNR status and others don’t. It is your job to explain what the term “DNR” means and the medical implications, but not to say “if this was my mom, I would…” You can, of course, politely decline to answer or try tip number.
5. Deflect and reflect. Whenever I get asked those types of questions, I reflect it back on them. I say “You know [patient name] best. How would you describe his/her personality? What types of things does he/she like to do?” These questions do a few things. First, it shows interest and caring on your part. Second, it evades giving your own opinion. Third and most importantly, it allows the family member to come to their own conclusion about the way their loved one would want to live based on their own knowledge of that person (not our assumptions as strangers basically). Perhaps the patient was very physically active and wouldn’t want to be vent dependent. Perhaps his/her religion stipulates trying all measures to sustain life. The point is that you allow the family member to guide themself to their own conclusion. 
6. Involve management. If family is impeding your ability to give care or simply taking a toll on your emotional health (which in turn, impedes your ability to give care), get your charge nurse. Find a private spot and have a chat with your charge nurse or manager. Explain the situation first so you can be on the same page. Provide some clear examples so they too can formulate their stance. It’s part of their job to support staff and there’s no shame in asking for help. It all boils down to safe patient care. Sometimes, because they are “family” they don’t see how they could possibly cause an unsafe situation. It may just require a person with a leadership title to have your back and lay down the law. 
7. When you do reach those last shreds of patience, think back to the mantra. Neediness is tied to feelings of helplessness. In their mind, you are the last resort keeping their loved one alive. You are doing a job they cannot do. Your presence or even phone call represents complicated feelings of hope, reality checks, despair, uncertainty- all depending on what kind of info you bring. And well... that’s tough for both parties involved. When I take a moment to be understanding, my patience level gets a little reboot too. 

I hope this has given you some helpful tips and maybe even helped you see the other side of things. As with most things human, there’s no one-size-fits-all solution. And let me tell you- compassion is easier said than done! This blog is a key example of what makes our job uniquely different and difficult at times. But don’t let it overshadow your wins. Do the best you can and realize it’s not personal. You got this nurse!