Family Matters - Part 1

I recently had a situation with a co-worker that I found particularly disturbing yet very eye opening. Let me explain... I recently took care of a man who was dying from end stage renal disease (kidney failure) at the young age of 57. He had 2 daughters ages 21 and 23 and a very large extended family. If you have had any experience working in or being in the ICU, you have probably noticed that the visiting hours are between certain hours, are usually limited to 2 visitors at a time and they never let anyone spend the night in the room. I have never really understood the rationale behind all of these regulations but you know how nursing is, once someone's done it a certain way for a certain time, God forbid you try to change it. I have never been a fan of limiting visiting hours or visitors so I have always just managed my visitors on my own; I usually just pull the curtain so the charge nurse can't see in my room (especially if you have one of those charge nurses who likes to micromanage you); anyway, so I asked my co-worker to come help me pull my patient up in bed. I had allowed 5 visitors in my room because the poor man was dying and they were very polite people so I had no problem with it. As my co-worker entered the room, in a very rude manner, she proceeded to tell my visitors they had to leave the room for privacy purposes, and then when they called her out on her rudeness, she threatened to call security on them!!!! I was absolutely disgusted at her behavior and shortly after had a conversation with her and the charge nurse regarding the situation. What I realized during that discussion is that the culture in the ICU surrounding the importance of family and healing was very negative and in desperate need of change.
I do understand where my co-worker was coming from. I use to work in a place where that mindset was the norm. I believe that culture was created as a result partially because of the patient population and because of learned behavior. Hospitals located in certain neighborhoods bring in a lot of drug overdoses, alcoholics, gang violence, and family drama. I know what its like to not want to deal with someone's personal family drama or have your unit on lock down because a patient's family members are holding you responsible for their loved one's death. I get it. I have had compassion fatigue before. Our job as nurses is emotionally and physically draining. Often times we don't feel respected by our leadership, co-workers or our patients so I can see how we become this way. In 12 hours it is highly unlikely that we will change our patient's family situation or even their physical condition, but what we can change is our mindset and this patient or family's experience.
Each time we fail to treat a patient or their family as individual or apply them to some standard, we lose the ability to be personable. We have to treat each patient situation as its own entity. Here are a few tips:

• Allow your fellow nurses to manage their own visiting hours. If he/she has multiple visitors in his/her room then mind your own business; your co-workers are perfectly capable of managing the situation. 
• If you have to ask a family member to step out of the room so you can turn them or clean them up that is fine, just make sure you say please and thank you and explain your rationale. 
• If you have those family members who like to stare at the monitor and ask a lot of questions, then answer them to the best of your ability. If you don't have time at that moment, then politely say that you can't explain it now but that you will get back to them if you can or give the short version.
• Avoid becoming defensive by becoming curious instead. If someone comes out to notify you that they think that there is a problem with their loved one's IV simply say "really?" "let me take a look at it". You can seriously use this response for everything. 
• If a family member wants to cover up their loved one and this patient has a fever, it is okay to cover them with a sheet, I promise you it's not going to hurt anything. Most people are pretty modest. 
• If someone is dying then do everything you can to accommodate this family. You can single handedly change the way this patient and their family experiences death. I know in healthcare we have become numb to death, but just so you know this is not normal, the rest of the world still thinks its a big deal. 
• If you are dealing with a nurse who you notice does not provide respect and decency to patient's family members, then either bring it up to them or tell your manager. I think in most cases that these nurses aren't even aware that they are doing it.
• Do your best to put yourself in this family member's shoes. Being in the hospital is difficult for both patients and families. How would you expect your mother, father, son or daughter to be treated?

The old mindset in the ICU is that we are too busy saving people's lives to stop and answer questions or get you a warm blanket, but the fact of the matter is that providing a quality patient and family experience and treating people with respect and common decency  is much more powerful than medicine alone.