How to deal with the families of ICU patients

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How many times have you felt the frustration of patients’ family members who camp out in the waiting room for days on end?

They get someone to bring their meals to the waiting room unless there is a “no food” policy and someone to enforce it. They live and sleep in the same clothes and do not bathe, they compare notes with other family members (so much for privacy and HIPPA rules!) and they bring in expensive treats for the staff. I once had a patient whose son brought in three boxes of Godiva chocolates for each shift (this is part of the “bargaining” stage of coping).

There was a family member who had a cooler with her in the “camping area,” which we later discovered contained a half-gallon bottle of gin. In the middle of the night she got VERY drunk and a “cat fight” ensued with security finally removing the woman. For some reason they brought the bottle of hooch back to me in the unit. As if any of us could drink on duty! (Kind of like the family who brought in the jars of moonshine–but that is another story.)

What you notice after a few days or even weeks is that these family members have begun to exhibit signs of deterioration mentally, physically and spiritually. They are already going through the stages of grief as defined by E. Kubler-Ross, which most of us learned about in school.

In their most vulnerable moments, they’ll begin to nit-pick about small details and practically stalk the doctors. The blame game will ensue among family members, an acute phenomenon in the first few hours or days.

So what do you do to help yourself AND your patient’s family?

I used to tell my patients’ families: “Now is the time for you to take care of yourself and let us do the work. Do something that is part of a regular lifestyle. Sleep at home, go and get your hair done, eat a real dinner at a nice restaurant, etc. Because you will need your strength when Mama gets out of ICU. If something should happen while you are not here, know that there is nothing you could have done if you were here. In an emergency, no one is allowed to come in and we will do everything possible to take care of the problem.”

Be certain you have all of the correct cell and home phone numbers for the family and be sure to call them, as you have promised to do, with any new changes or developments.

Sometimes a patient will pass away when his or her family leaves. When that happens, you will have to explain the unexplainable as best as you can.

Sometimes nothing that you do or say will change a situation like this. In the end, you must respect that the family members have the right to stay or go as long as they are not being disruptive or violating the rights of others.

There is no doubt that it is around the family and the home that all the greatest virtues, the most dominating virtues of human society, are created, strengthened and maintained (Winston Churchill).

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Nurse Rene

Nurse Rene has been an RN since 1978; CCRN since 1989 and attained a BSN in 2010. She has worked in virtually every specialty from Neonatology to Neurosurgery and is a Member of Sigma Theta Tau International Nursing Honor Society with a particular interest in helping students and new grads develop to their full potential. She's been married for 33 years and has a keen interest in history and in current issues as nursing continues to develop as a Real Profession. When not spoiling the grandchildren, she enjoys sewing, cooking, kayaking, camping and travel. She likes all music which does not hurt her ears, watching NCIS, Leverage, Top Gear and Criminal Minds and reads books written by Clive Cussler, Miss Manners, Erma Bombeck and Tom Clancy. She enjoys collecting Quotations for use in her writings.

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3 Responses to How to deal with the families of ICU patients

  1. Rxnurse1955 LPN

    Right now I am a nurse AND the wife of a neuro-ICU patient. My husband had a cerebral aneurysm rupture. The nurse part of me understands the procedures and the need for the rules of the ICU. But the wife part of me is terrified that if I leave the hospital that is when they will page me to come upstairs as something has happened, good or bad. The nurse part of me wants to make sure that they are doing everything the way I would do it! I didn’t leave the ICU waiting room for the first 9 days. Our local hospital has a wonderful waiting room with large recliners to sleep in, showers and a break room to eat in. I have spent the last 21 days sharing information of the rules why’s and wherefores of an ICU with my fellow family members. Yes, we share information of our loved ones condition, because we are all living the same nightmare. Yes, I brought the nurses a box of special cookies, but that is because I understand the stress they are under and I want them to know that I appreciate their wonderful work. It was not me bargaining with anyone or trying to bribe them to take better care of my husband. I know that they do everything they can for every patient in their care, just as I have done for the last 27 years! Try to remember that the family has lost all control over everything happening to their loved one and their own life. Put yourself on the other side of that door and remember, this could be you someday.

  2. Nurse Rene RN

    Yep. Been there, done that, know EXACTLY what it feels like and what can happen when families live at the hospital for weeks on end.
    It was my hope that the comparisons to Dr. Kubler-Ross’ monumental work would assist other nurses in understanding the processes which take place. They have been well documented by researchers on grief, anxiety and all of the other emotions which come in to play when humans live in unnatural environments under high levels of stress where the outcome is usually not predictable.
    Unfortunately my own experience as both Nurse and Family Member seemed to be somehow Insufficient for quite a few of the responders. I suppose that NO ONE else is ever allowed to tell a family member that it is OK to leave the hospital for awhile to go and do something Normal, like a 40 minute hair appointment which just MIGHT make them feel better when nerves have reached the breaking point.
    I hope that I will someday read where someone else has ‘cracked the code’ and has all of the correct answers!

    • Rxnurse1955 LPN

      The best thing about being a nurse is that we know how to continue our education. In our professional and personal lives. And we learn from our experience. We share our knowledge and experience with others. And it did feel good when I finally went home and took care of myself for a while. My husband is in rehab now and I am trying to get through the grieving process of losing our former life and relationship. I appreciate this forum for sharing.