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Patient and Family Involvement



When family members have a loved one hospitalized, it's only natural that they want to be involved in the care of their family member.  Many facilities now offer a code to the patient, who can then provide it to anyone that has permission to discuss their condition.  If a family member or anyone calls to check on the patient, without prior approval, they will be disappointed. HIPAA rules prevent it.  So, the first thing to do when speaking with a newly admitted patient is to determine who they want to have information regarding their condition. 

Families can get very involved, which is understandable, as their loved one is their top priority. There does however need to be some boundaries regarding family involvement, since too many family demands can take your time away from the patient, and that is unacceptable. 

A new Nurse’s Dilemma

All stories are told by Susan, a retired nurse.

Lela was a great Nurse; she had a very warm personality that easily won the hearts of her patients and coworker's alike.  As Lela’s supervisor, I was able to evaluate her as doing great in all areas, until she encountered a patient, and their family.  The patient was a 55 year old female that was very obese and diabetic.  She was admitted so that her blood glucose could be regulated.  This patient had a husband,  3 kids, all adults, a mom, and a very involved sister.  Lela was assigned to work with the patient for the duration of her stay, however it appeared she was taking orders from the patient's sister.   Lela explained to the patient's sister at least 15 times in a two day period, what the plans were to adjust the medication for the patient.  While Lela was in the hall explaining things to the patient's sister, the patient's mother took food into her.  The doctor ordered a high protein, low carb diet, so the 2 double cheese burgers, large fries and large shake her mom brought, was not exactly on her diet plan.  As Lela got back to her room, the patient was finishing up her very large meal, and Lela spent another 15 minutes explaining to the mom about following doctor's orders.  Needless to say, after 3 days Lela was ready to quit.  Lela’s personality made it difficult for her to say no, and to confront the family, however, as a nurse, it is sometimes a part of the job.  After meeting with Lela and educating her on setting boundaries, she took the lead, and advised the family that things would change, effective immediately.  Surprisingly, the family went along with the new plan,  and I would have to say, even developed a new respect for Lela.  A very good Nurse became a great Nurse, as she learned to draw the line when needed, to interact with families. 

It's always nice when you encounter a family that is concerned for their loved one, and visits often, however, when the family begins to occupy too much of your time, and appear to be breaking hospital rules regarding the patient you are caring for, it's time to set the appropriate boundaries.

Patient's Privacy

When you are going to a patient's room for any type of what would be considered a private procedure, it is appropriate to ask family members to step outside the room.  The family member may try to assume the role of caretaker even within the hospital, and that should be monitored closely.  If a family member tries to assist a patient to the restroom, and is not familiar with assisting a fall risk person, it could create an accident for both patient and family member.  You may find it necessary to remind family that here, hospital staff will tend to the patient's needs, however do so in a respectful manner.  Consider from the family member's perspective, they see their loved one in pain or sick, and they have a strong, loving desire to help in some way, it's only natural.  By directing families to visit, and spend time, however, leaving the patient's physical needs to hospital staff, will ensure unnecessary risks are not taken.  It's also a good idea to remind family members they need to care for themselves.  It's all too common that family members  become  stressed trying to care for sick loved ones, so just a friendly reminder to take care of themselves too.

It's great to develop a good rapport with family as well as with patients, but just be sure to follow those all-important boundaries. 


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