Monday, March 05, 2007

Too much of a good thing

Ok, here's the deal. I like having a child's parents at the bedside. It's fantastic. It's the way things should be, with the parents providing care, reassurance, and valuable "insider information" on my patient.

Sometimes, though, you just need the room to yourself. (The following is heavily paraphrased.)

"So, what's that you're giving her now?"

"Nothing new, the dopamine infusion is about to run out so I'm swapping in a new one. You'll see her blood pressure go up for a bit, but it'll soon settle."

"Oh, right. Has she had a suction at all?"

"Not on my shift."

"Did she hoik?"

"I'm sorry?"

"Hoik, you know, like cough? Or was it all in the tube?"

(Struggling to keep up) "Uh, her last suction was before my shift, so I really couldn't say."

"Ah, ok." Brief pause. "What's that she's getting now?"

"This is one of her antibiotics." I check the clock. 0120 hrs. Please, please, go to sleep. Your child is sedated. She won't wake up unless... you start... to rub her feet and talk to her in a loud voice...

"So that's one of the ones to put her to sleep?"

"Yes, we don't really want her to wake up just yet, she needs to be relaxed."

Parent gets out own thermometer to check temperature. "Do you use these? These are good."

"Uh, we have some other kind." I am willing you to go to sleep. You are getting sleeepy. Sleeeeeepy...

Pointing to the monitor, where the respiratory rate has fallen slightly. "Where do you want the respiratory, boss?"

Boss? "Don't worry too much about the numbers on the screen. It's normal to pause a bit when you breathe, especially when you're in a deep sleep. You and I probably do too. If she stops for too long, the ventilator will kick in."

"Right, right. So what's that she's getting now?"

Poison. I'm giving her poison, IV stat. "This is another antibiotic. I'm just adding it into the line in a different place."

"Why's that?"

And on, and on. Don't get me wrong, I'll answer questions with the best of 'em. However, some parents feel obliged to do the heroic guardian bit and stay up all night, completely exhausting themselves and adding to their family's already significant stress levels.

Plus, on night shift the bedside nurse's patience is less abundant.
Posted by PaedsRN at 4:37 AM

Anonymous Sean, at 12:52 PM  

I laughed out loud on this post! I've been in that situation SO many times.

Do you ever wish it was like the old days...and people never ever ever ever questioned doctors/nurses...and there were very strict visiting hour rules?

I find that family members fall into two categories. A blessing or a terror!

There's nothing like walking into the room at the start of your shift to see a family member there(usually a wife) and she says, "I already washed him and made the bed and took him for a walk..."

But some families just make you want to scream bloody murder...and they don't realize the negative impact they're having on the patient.

Anyway...awesome post!


Blogger running wildly, at 3:37 PM  

Thanks for the giggle. Beautifully written. Soooooo sooo true.

Anonymous msquoted, at 5:07 PM  

Sometimes when it gets out of control, I say to the family, "I love answering your questions but I need to be focused for just a little while so I am ensure I am providing the best care possible for your loved one. Here is a piece of paper and write all your questions down on it and when I am finished my nursing care, we can go over them if you wish." It gives me some breathing space and empowers them at the same time! I also tell them that if they are tired and not focused because of lack of sleep that they won't be of good use either. They sometimes still get defensive and upset but mostly they pause and actually go and rest!

Any more tips out there?

Blogger HypnoKitten, at 6:44 PM  

Poison. IV Stat.

Made me actually laugh out loud - loudly! OMG that is SO like something I would think.

My extremely irritable, psychotic, unreasonable, non-directable patient today: "I DON"T WANT ANY M----- F------ CRAZY PEOPLE IN MY ROOM!!!"

I'm thinking: "Then you'll have to go out in the hall"

Anonymous Scott, at 7:09 PM  

The other night at around 3am (I work in an adult ICU) I phoned a collegue's bedside phone, a few cubicles up to get her to press the emergency button. This allowed me to usher the realtives out of the ICU and insist they go home because there was a medical emergency within the unit.

My collegue (once they were gone) then appologised profusely and declared she pressed the wrong button.

Blogger Betsy Baumgartner, at 7:10 PM  

I have to say I think it's worse during the daytime with adults!! That's when the doting daughter or son who has a friend's-sister's-niece call because they are a nurse and want to ask questions.

Anonymous S. R., at 8:45 AM  

I wrote about this on my own blog. Sucks.

Anonymous msquoted, at 1:31 PM  

Scott! I am in an adult ICU as well. Interesting technique!

I have heard of a nurse doing her Master's thesis on Post Trauma Syndrome for Families of Patients in ICU. I am not sure how to deal with families who are in that shocked state. Giving information is important but sometimes there seems to be a point when they need to take a break. It will be interesting to find out if the study actually produces practical solutions on how to deal with families to reduce the tramatic effects and ensure safe nursing care.

Blogger beajerry, at 6:52 AM  

It's not just a child's parents that can annoy like that, sometimes it's a 30 year-old's parent! That makes it much harder to stand.

Blogger The Angry Medic, at 7:32 PM  


And heh, this post made me laugh. I can sympathise. Sad thing is, when I graduate I'll prolly have to deal with the same thing. I'll be thinking of you to help keep myself sane :)

And what Sean said up there: Do you ever wish it was like the old days...and people never ever ever ever questioned doctors/nurses...and there were very strict visiting hour rules? Sigh...there's prolly nothing I'd like better...damn you Google!

Blogger Student Nurse Jack, at 3:24 PM  

Choked on my Diet Coke while laughing and reading "Poison. IV. Stat."

I can only imagine how annoying that can be. And now I'm wondering if I've ever been that parent the nurses hate. I must say, I've never called a nurse "boss", so maybe I'm not that bad.

Blogger unsinkablemb, at 6:51 PM  

Stories like that make me glad that I'm in the OR where patient families would not want to witness the play-by-play of what goes on in there!

Anonymous, at 6:47 PM  

You might like my Blog as well. Not as funny but hopefully as informative for other nurses.

Blogger NurseWilliam, at 1:01 PM  

PaedsRN and Hypnokitten, I have tageed you two for the Thinking Blogger Award Meme. You two are great, and deserve this award. Thanks for your insightful posts.

Blogger Linda M., at 7:03 PM  

Thanks for the great posts! Ahh yes, those parents. You're invited to my blogsite about being a LPN and a professional photographer. Somehow the two can be related.

Blogger Jocelyn, at 12:14 PM  

Yes, parents can be a help, and a hinderance! But I agree during night shifts no matter where you work patiences is a very difficult thing to keep. I know my patience's goes out the window when I'm working a night.

Exhibit A: I'm work at a nursing home to put myself through nursing school, and the last night shift I worked a resident just wouldn't go to sleep, and asked, I swear 10x in a row where her room was. By the end of it, I wanted to scream. Imagine "Where's my room?" "Down the hall, #158, your name's on the door". I would then bring her back to her room, but 2 minutes later she would be up again. I spent a good 30 minutes doing this. How it finally resolved: She fell asleep!

So you see it's not only family members that can ask the questions, patients can too. But I guess it's what we do, and this times make us learn to have more patience.

Blogger Nurse M, at 2:36 AM  

Haha.. good post!

Anonymous Anonymous, at 12:14 PM  

I thought your post was funny, to an extent. I am not a nurse, nor would I want to be as I don't have the emotional stability (read: I cry WAY to much over stuff)but nurses can be a great blessing or down right nasty too. For some reason every time I have given birth the day shift nurses are sweet as can be and the middle of the night nurses are too but the nurses that come in at around 9pm would always be short with me. I wondered why since it seemed to happen at every birth (I have had 5). What is it with that shift? Please let me know so I can bring those nurses some Pepsi and whatever else they need. I think it is hard on patients who are really nice to have a mean nurse. It does ruin the experience for me sometimes.

Mom of 5

Blogger Working Girl, at 10:29 PM  

great site. I'm hoping you wont mind if I put your super cool logo on my blog.

Blogger Nurse Practitioners Save Lives, at 4:47 AM  

This is often a problem during the day shift as well. There are often WAY more people to field questions to and they don't seem to get the hint that the patient needs their rest. Sometimes I will insist that one person become the family spokesperson and then they can dole out the info to the others. Great post!

Blogger nursemanager, at 12:35 AM  

Very good indeed...and lets remember that tragedy and comedy are but two aspects of what is real, and whether we see the tragic or the humorous is a matter of perspective ...and at some point we too become the family on the receiving end.

Robert Dilts has some really good stuff on perceptual positions (Meta Mirrors) and Martin Buber "I and Thou" ...

Anonymous Su, at 10:15 AM  

Thanks for a great story (and an eye-opener). It is always a difficult one with children in hospital... also for parents!

Blogger BillyBob, at 9:00 AM  

I wonder how many times Sean has been in that position as the parent ? I'm writing this comment as I wait for my daughter to wake from her nap. We're
getting her up today. Four days ago
the doctor removed 150 cm of her small intestine. Necrotic. Gangrene. Nurses who thought I was being too demanding, saying "everything looks fine, coffeeground emitus, we see that all the time. She just has a kidney infection. The even put me in the nursing report saying that I was 'demanding'. Maybe they'd have been
demanding, too if it was their
daughter dying in the bed,all the while they downplayed the elephant
standing in the room. bobby

Anonymous Anonymous, at 8:26 PM  

And the LPN when my son was in the hospital--"Oh, a 40 degree Celsius temp is nothing to worry about. Mine is 37!"

I just looked at her and said, "Get. The. RN. Now."

Later I heard someone getting reamed because she had injected a child with a drug. The parents asked what it was and she said, "I don't know."

I would have gone apesh*t. Yes, we know people are human and make mistakes...THAT'S WHY WE CHECK. To you, it's a job. To us, it's our children. Not to say that you guys don't care, but you are human, you can err. If we didn't care you'd be saying "I can't believe, if it was my kid, blah blah."

Thanks for all you do, BTW. Like the blog.

Anonymous Anna, at 3:54 AM  

I can only imagine how often you all have to put up with that. I hope I was NEVER like that when my child was in the hospital!

Thanks for the laugh!

Blogger Nick's Blog, at 8:08 PM  

Well, as a mother whose child just got released from a PICU, I can relate to all of the questions asked. My son aspirated after surgery due to an incompetant anesthesiologist, so naturally, I was very concerned about who was treating him with what and why afterwards. He developed ARDS and was on a vent for 12 days. He nearly died and "ECMO" was a word tossed around. That said, parents who have children in ICU are very stressed and do need their rest, but I know for me, rest was not a real option. Especially when I was having to worry about whether my son WOULD take his next breath (vent or no vent) and ESPECIALLY after he aspirated due to error.

I did ask, "why are you taking out that IV for another?" "Why does he need MORE Reglan when he is pooping fine?" "Please make sure you talk to him when you change his diaper or move him because he is an anxious child (much like mom) and needs to know what you're doing."

And yeah...I needed some PTSD counseling, some wellbutrin and could have probably benefited from a 3-day psych stay when it was all over.

So be a little patient with the patients parents. :) We're in a really bad I wouldn't wish on ANY parent and I had the occasional sarcastic and nasty nurse (mostly night ones) that *I* wanted to smack...but for the most part, they took excellent care of my baby and he was in a great hospital. :o)

Blogger ..., at 1:51 AM  

ROFL! I can relate to this blog. haha. thanks!

Blogger florid nightingale, at 1:48 PM  

I was a clinical nurse specialist (MSN) when my Dad had a pulmonary embolism and a bowel nick after surgery for a bowl obstruction. I played the role of the demanding daughter from out of town. After seeing the incentive spirometer across the room, fever & chills going treated, pulse ox in the low 80s, 6-day old IV tubing, and cognitive decline, I think a bit of bitchin' was justified! Still, the surgeon himself had the audacity to admonish me for "alienating the staff!"

This was truly bad care, but even when my patients' family members get demanding, I try to remember that all our psychological "stuff" comes forward under stress. They are frightened and they look to nurses to comfort them. Talking comforts a lot of people - and talking means asking questions when there's nothing else to say.

Of course, every family member has a right to advocate for their loved ones. But I think almost all of it comes from genuine concern for the person lying in the bed.

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