“I don’t think we should continue heroic measures.”
“I want a third opinion!”
“That’s not the way the last nurse did it.”
“My sister needs more water, more pain medication, and clean sheets…now!”
“How long does my son have to live?”

Questions. Capricious emotions. Absurd demands. More questions. And plain cold criticism. Often serving families of patients is more taxing than treating the patients. Kathy Quan, a veteran nurse who blogs regularly about nursing issues and author of The Everything New Nurse Book, recently spoke with RealityRN about how to handle difficult families:

What surprises new nurses most in working with patients?

Kathy Quan: Coping with the difficult family members.

Student nurses get used to most family members being delighted that the patient is receiving extra attention. They love student nurses (except when the patient needs a procedure and they lack confidence in the student).

But new nurses see the other side. Families are frightened and often uninformed about their loved one’s condition. Everyone wants to be your first priority, and they don’t want to share “their” nurse. They want information--and if the patient needs something, they don’t want to wait.

Families sometimes don’t want the patient to be told his/her prognosis or diagnosis—how should a nurse respond?

First of all, follow any orders or lead from the physician, and always keep the physician informed and involved in the process. Also make sure you are following HIPAA guidelines.

Also, consider the patient by asking a series of questions:

What is the patient asking for? What has the physician said to thxe patient about his/her condition? What does he or she understand about their condition? How does the patient feel the disease is impacting his/her life? (Are they obviously disabled, or have they lost a tremendous amount of weight, or have secondary effects set in, etc?) How is the diagnosis/prognosis going to affect his/her safety after leaving the hospital? What impact will not knowing have on the patient?

If a patient’s safety and well-being will be jeopardized by not saying anything, then the nurse needs to advocate for the patient. The nurse, physician, and family members together must develop a plan for handling the issue.

How does a nurse respond when family members are overly needy?

When you come into the room let them know you’re here to do such-and-such a task but will be back to answer any questions after you make rounds, pass your meds, or whatever else you must get done at that moment. Show them where they can get basic items themselves, such as more linens, ice, or water. Try and anticipate the patient’s needs and set limits.

Another way to make sure you’re not peppered with questions all day is to ask them to write down their questions. That way you can address them all at once. And if the family has many dominant personalities—who all seem to be asking the same questions over and over--have them appoint a spokesperson. Have all communication go through that person.
Also let them know what time the doctor usually comes in so they can plan to be there to talk to him/her. Or explain how to contact the physician by phone and have him/her return their call after office hours.

And if they still have issues?

Sometimes the only thing you can do is listen and validate their concerns and fears. They’ll often work out their own issues. Let them know that you understand their needs, and you’re going to do what you can to fulfill them. Being patient with them, and asking them to be patient with you, will go a long way in showing families that you care and are there to meet the patient’s needs.

How do you comfort families who are obviously distraught?

Let them vent their feelings. Validate them. Say something like, “I would be so angry if that was my father in there. Let me see what I can do to make this better.” Or, “You have every right to be upset; let me see how we can fix this situation.”

But don’t say, “I understand exactly how you feel.” That upsets people more.

Families expressing emotions over the death of a loved one should be taken to a private area. Sit with them and hold their hands, or hug them if it’s appropriate. Let them talk and cry—and it’s okay to cry with them. You might even begin to talk about why the person was special to you. Or ask them to tell you more about this person. This will help them to know that the person will always be with them through their memories.

Related: Boundaries, Caregivers, Caring, Communication, Compassion, Confidentiality, Doctor-Nurse Relationships, New Nurse Tips, Patient Advocate, Patients, Prioritizing