Your worst nightmare scenarios, part 4: Patient/family edition

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We shoulder a great deal of responsibility for our patients, but sometimes the best medical care just isn’t enough. Read these scenarios for advice on how to handle tricky patient care situations.


Your worst nightmare scenarios, part 4: Patient/family edition

1. Patient Y, an elderly patient with mild dementia, is a complex case requiring frequent nursing care with privacy. His numerous family members question the nursing and support staff about interventions and patient progress. They insist on staying at the patient’s bedside during procedures, and one family member keeps a written record of what happens with the patient. Rumors circulate that this family is looking for a lawsuit. No one on the nursing staff wants to care for this patient because of the family. What should you do?

The keys to handling this situation are diplomacy and consistency. Getting everyone on the same page about patient care can be tricky, but necessary. Often, a family just needs to know that their opinions and concerns are valued.

Patient privacy is essential, regardless of diagnosis. Unit staff should meet with the manager to debrief, review unit policy on family visitation, clarify any infection risks and plan for privacy issues. The unit manager should also meet personally with the family and primary doctor to discuss concerns of both family and staff and to review unit policies on visitation and privacy. Determinations from these meetings should be communicated to all staff, and copies kept for future reference of the family and staff.

2. You wake Mr. R, who is a frequent flyer alcoholic in your ER, to let him know you will be drawing blood and starting an IV. He interrupts his heavy snoring briefly to mumble “Okay,” then resumes snoring. As you insert the needle into a vein, his other hand jerks across his body and forces the needle through his skin, through your double-layered gloves and deep into your thumb. You know from previous records that Mr. R is both HIV and Hep C positive. What should you do?

Time is a factor, but don’t drop everything and run away. Call for help and quickly place a bandage on the patient’s wound first. The CDC advises workers to wash needlesticks and cuts with soap and water and immediately seek medical treatment. You should report the incident to your charge nurse, who should be aware of immediate protocol for needlestick injuries. DO get help from your hospital resources; just “hoping” nothing will happen and you’ll be okay is a mistake, even if the chances of acquiring a bloodborne disease are slim.

Find more occupational hazard information at the CDC website here.

3. Baby A requires a surgical procedure to keep the tongue from occluding the airway when the infant lies supine. Other options have been exhausted, including tracheostomy. This will be the third surgery for this child, and the father refuses to sign consent after hearing the child could eventually grow out of this condition. The mother is not involved. Insurance has stated that they will not pay to keep the infant in the ICU any longer unless the tongue surgery is completed and the infant moved to a stepdown unit eventually. What should you do?

This father is in a catch-22 situation, and has no good options left. Yes, it seems the insurance company has already made the decision for him, but forcing the father into a course of action may make him feel he is being bullied, and may lead to lawsuits later on. The best approach is to project empathy for the difficult decision and emphasize that the child’s medical history has led to very limited options. Be a good listener,and gently correct any lingering misconceptions that may be preventing the father from signing. This father should be heavily involved with social work, case management and counseling if available.

4. You are unable to locate one of your patients with Alzheimer’s, who is a resident at an independent long-term care facility. What should you do?

Alert all staff members to be on the lookout for the missing resident. Notify the police.

I’m reminded of a phrase: The best offense is a good defense. Take every measure to prevent this situation ahead of time. However, when this does occur, your facility should have a protocol. If not, consider leading a committee to form a protocol. If you deal with outpatient Alzheimer’s patients and families, caregivers may be interested in the Alzheimer’s Association Safe Return program.

Have more scenarios you would like to see discussed? Send them to us here.

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