Bizarre family member behavior

1 I had this patient in an ICU setting a couple days ago. Patient background -- approx. 70 YO M had an open nephrectomy about 3 weeks ago. He went out to the ward POD 1 and came back to the unit on POD 3 after vomiting and a severe aspiration event requiring intubation. He was very ill initially (hard to oxygenate, in ARDS) and this persisted for about 3 days or so after the aspiration. Since that time, he has remained ventilator dependent although in stable condition. Very lethargic/deconditioned, being tube fed, etc.

I took care of this patient the second and third day after he came back to the ICU after aspirating. The only family that decided to show up at the hospital after all these complications was his sister and his niece on the 3rd day. Patient has a wife and 4 children. Sister/niece were understandably very worried. I explained to them the severity of the situation and that he had made some improvements over the last 24 hours (true by the third day.) Sister/niece were concerned that none of his immediate family had shown up and wondered if they needed to call them in right away. I told them that this wasn't necessary and that he was in stable (although serious) condition, and then they asked me for my opinion on what I would be doing if this was my family member. I hesitated to answer, but I told them the truth, and that was that I would be at the hospital every single day if that was my dad. I think they took that to heart and talked to the rest of their family (patient's wife/children), although I can't verify this.

Fast forward two weeks. I haven't cared for the patient since. I get him a couple of days ago and the son I never heard a word from during that initial period calls wanting lab values. Apparently he had been doing this on a daily basis, and it had been ok'ed, so I gave him all the info he wanted (from other staff that have done this, son is NOT medical. No idea how he is interpreting this information.) He then told me he had been in over the past weekend for a 1/2 hour and took issue because apparently the patient's leg had slipped out of the side of the bed and he was too weak to put it back in himself...worried that his dad was in pain with that, etc. He asked me if I could get a bed that had rails that go all the way down to the end of the bed so this wouldn't happen again. I told him that no bed that I know of like that was available and generally we keep our patients on our ICU beds unless contraindicated because of the mattress having some protective affects for their skin, etc. and I would make sure that he had all the rails up and was adequately watched so he wouldn't slip out of bed. Also went on to detail that patient was in an ICU and had 2:1 staffing, we looked at him frequently, etc. so he didn't need to worry that the patient wasn't being taken care of. Also explained that the patient was very lethargic and didn't move much on his own (and indeed, for my entire 12 hour shift, patient did not have his legs out of the bed. They stayed exactly where I repositioned them.) He was very adamant that we get him a new bed or completely pad the patient in the bed with pillows so the leg that he observed being out of the bed for a very short period of time 2 days prior, when I wasn't even taking care of the patient, wouldn't fall out again. He was like, "Well, I saw it, and it did happen, so can you just do that so it doesn't happen again?" ....like trying to place blame for something. And, something very minor in my estimation. I really didn't know how to respond after I gave my lengthy explanations as to how I would ensure that the patient was adequately cared for. I was pretty bewildered at his behavior and just let him talk at me some more and then let him say goodbye.

What IS this? Is this guilt, at not having been there before, or not being there often enough? Is he a control freak? How do you explain this weirdness? And a better question -- how do you deal with it?
I see this all the time- patient family members getting upset over minor things. I write it off to anxiety over having a severely ill family member. In this case, it probably is a degree of guilt, as well, as you mentioned. If they're requesting something fairly innocuous, I'll generally comply with their request, if it makes them feel better, though this can start a slippery slope to further future bizarre demands.

First I would like to say, please be careful putting all four siderails up. Having all four siderails up is a restraint, an order is usually needed. Some family members are very concern about the patient well being. We probably be the same way if it was our parent or child. It was very mannerable and polite of you to decrease some of the son anxiety. To me this behavior is not unusual sometime the family is the problem. Most of the time the patients are calm, cool, and collected. It just dealing with the family sometimes can make it very hard to handle. I think you did a good job of handling the situation.

Quote from lkwashingtonFirst I would like to say, please be careful putting all four siderails up. Having all four siderails up is a restraint, an order is usually needed. Some family members are very concern about the patient well being. We probably be the same way if it was our parent or child. It was very mannerable and polite of you to decrease some of the son anxiety. To me this behavior is not unusual sometime the family is the problem. Most of the time the patients are calm, cool, and collected. It just dealing with the family sometimes can make it very hard to handle. I think you did a good job of handling the situation.

Quote from CNL2BThank you for being complimentary. I am not entirely sure that I handled it well at all -- I felt weirded out. FYI in my state in an ICU it is ok to keep all 4 rails up for patient safety without an order and it is not considered a restraint.

I think that sometimes family members are unable to process the medical side of things so instead focus on things that they can relate to. While this pt's son may not understand the critical nature of his father's illness and what the labs mean or what as a fellow nurse I might ask you to do for him, provide adequate pain management, turn frequently, monitor vitals, etc. he can relate to the fact his dad might be uncomfortable with his leg hanging off the bed, and has even developed his own version of a solution for you (get a bed with a longer rail). I would take this only as genuine concern for the pt and put a pillow between the side rail and foot board and tell the son that you have ensured that there is a pillow there to prevent his leg from falling out of bed again. It may seem weird to us, but not understanding the situation or how to help fix it it might be all this family member could think of to help his dad.I went through this with my own family before my father passed away, he was in the ICU after having a hemorrhagic stroke due to metastasis of lung cancer to the brain, their greatest concern that the bed wasn't long enough. While as a nurse I understand what a grave position my father was in and what issues needed to be focused on, their concern was only for his comfort. My sister is a nuclear operator and incredibly intelligent, yet even she was most concerned about his basic needs. I think this truly shows just that the son is concerned. I would try not to judge his absence as a lack of caring, he might have had his reasons for staying away or just the inability to come.

People are inundated these days by the news, Readers Digest and other sources about the importance of advocating for yourself or your loved one during times of illness. It is very popular in the press right now to point out the falability of medical personnel as well. It has been my interpretation of these kinds of experiences of bizarre demands focusing on the mundane that it is the family member's attempt to be an "advocate" for their family member, that they seem to feel it equates to doing their part to help their loved one get better and that it equates to showing love and concern for that individual. When there is nothing really to advocate for, they struggle to create (more subconsciously than consciously) something because in their minds that is their job in this scenario. Add in a touch of guilt and they can get quite adamant about things that ultimately do not matter.

His only way to control the situation. Pad the bed. J

I have theorized there are three subgroups of family members. The first group are the guilty about one thing or another regarding their loved one and feel that by somehow raising dozens of minor issues they are somehow redeeming themself, the second group of people genuinely do care about their loved one ( they seem to be the ones who recocognize the nurse for their medical knowledge, they say things like- It's no rush, when you get time can you look into this for me, even once in a while the rarely heard "thank you"!!! etc) then there are the people who completely despise the person you are caring for and seem to want them to suffer as long as humanly possible. I also think a lot of people use the internet for medical info and the next thing you now they are always making these oddball requests. I call them "web md'ers"

i peeked at your profile and see that you've been a nurse for sev'l yrs.i mention this because i was a bit surprised at the perplexity of family members not being at bedside.the posts previous to mine, are all right on...in that everyone has different coping/defense mechanisms to trauma.i've been doing hospice for many yrs, and you'd be stunned to learn how many families aren't present.i believe this too, is part of one's coping strategies, that sometimes (often?) it is 'easier' to care from a distance.whether it is r/t feeling frightened, overwhelmed, anxious...catastrophy tends to bring out our most vulnerable qualities.i definitely agree with that it'd be helpful if you could placate the son.every little act of love, can only be therapeutic.now, when they start imploring for you to give that dilaudid q 10 mins, perhaps some limit-setting may be in order.but as it stands, it is certainly a benign request that'll definitely keep dad safe, and the son at ease.heck, you could even suggest that he do prom on dad.again, win-win.leslie

It's not that I was weirded out that he wasn't there -- it was the attempting to control the situation from afar that I was weirded out by. Families do indeed run the gamut, from being totally overbearing and there 100% of the time on one end of the spectrum to never being there and never calling on the other. This guy seemed to be some weird combination of the two. It just makes you smile a little bit, in a funny sort of a way -- the guy essentially wants his dad to be placed in an adult crib, when he isn't even there to visualize whether or not he really needs one. Ohhhhh---kay???? Sure. Like so many other things in nursing, it's "whatever you want", isn't it?

Working in ICU, some families will get very worked up over things that seem trivial to us, like your example of his leg having slipped. It goes back to what we learning in nursing school about people experiencing a loss of control and trying to regain it. It doesn't make him a "control freak". He's just in an unfamiliar and frightening situation and his dad's leg slipping out is one thing he can understand and focus on.I've had family members become very fixated on their loved one not having enough blankets, who can't understand why I don't drop everything to get another blanket when I'm trying to manage 2 labile patients with multiple drips.I try to explain that there's three things I can worry about. Things that will kill my patients quickly, things that will kill them slowly, and things that won't kill them, in that order. They usually get the message that a blanket's not going to kill anyone, and cut me a little slack for taking care of more pressing matters first.

I am writing an article for AMN Healthcare about how nurses can help families become assets instead of liabilities in patients regaining their health. Deadline is end of day, this Wednesday. I really need tips you might have used or you share with new nurses on making families' bedside behavior "healthy" for the person in the bed. I can do a phone interview which would only take 10 minutes tops! Or you can share your tips here...downside is I need your name, credentials (RN, etc) and the hospital or organization you work for and I am not sure how to get that without sharing "Identifying information." Any chance any of you would be able to help me? Any ideas on how to get your info to me?