Along with communicating with patients, it can be easy to talk to a patient’s immediate family. From spouses to parents, it helps to only have a few people that you have to manage. However, most patients have families and friends in far larger numbers than this. This means that you may, very quickly, find yourself entrenched in interfamily politics, put into ethically untenable positions, and generally spending a great deal of time turning people down in their hunt for information. Although it should be the job of the immediate family to manage the others, this responsibility often falls to the nurse.
Privacy, HIPPA and Families
Technically, the only one with the rights to patient information is the next of kin. Large families, though, pose a problem as there may be a number of next of kin. Even some friends of the family can call in, make a nuisance of themselves and attempt to get information. Despite being US centric, the Health Insurance Portability and Accountability Act (HIPPA)—a piece of US legislation—offers advice and guidance that may be useful for health professionals practicing globally. One example is the privacy number concept—something that many US facilities now employ. Think of a privacy number as an access PIN for patient information. If you don’t have the number, then you don’t get any information on the patient. It is simple and easy to turn someone down under those circumstances.
This isn’t always a total fix, though. That number can very easily be disseminated to numerous people, and this means the nurse has to spend a great deal of time explaining the same information to ten or twelve different people. It takes time to make non-medical persons understand the situation, and the problem can get quickly out of hand. You are there for the patients, not to answer the same questions from a multitude of concerned relatives.
Managing Large Families
In large family situations, someone should be appointed the main contact. This way the nurse only has to explain the situation once. Ideally, it should be the next of kin; but some families may want a member with a medical background to handle updates and check-ins. You don’t need to get into the politics of who becomes the main contact, but you do have to strongly insist that only one person can get the information from the nurse on duty.
Another possible management tool is to tell the next of kin to guard the privacy number closely. Explain to them that it takes away from the care of their family member to have several people with the privacy number. Even though you are not in charge of the family, you will have to step in and make suggestions that they may or may not comply with. If they don’t comply, it may be necessary to call a family meeting and explain the importance of a contact person. However, even in the best of situations, it may be difficult to get the amount of contacts down to one.
Mrs. Jones is an 89-year-old woman who has come into the intensive care unit with an acute stroke. She is the proud mother of five children, all of whom are married, and a grandmother of ten. Some of these grandchildren are old enough to have spouses of their own. Unfortunately, Mrs. Jones’ husband died four years ago and her care has been transferred to her eldest daughter, Lisa. The relationship between Lisa and her siblings is complicated, and all of them have insisted on obtaining the security code for themselves. Lisa, not wanting to start an argument, has given it to her brothers and sisters, who in turn who gave it to a few grandchildren.
Every day on the unit, the nurse assigned to Mrs. Jones receives at least five phone calls about their family member’s status. Although the nurse tries to be concise, often these conversations can take up to twenty minutes. After a few days of this, the day nurse brings the family together and explains the difficulties in handling so many calls when their mother’s care is so critical. It is decided that all information will flow through Lisa, although this does not make everyone happy. The plan is agreed to however, and now the nurse need only field one update call per shift and continue to communicate with her elderly patient, Mrs. Jones.
Juggling Bad Feelings
In the end, you will inevitably engender bad feelings, even in small families. No one wants to be told that they don’t have a right to information about their loved ones. Even those without the privacy code may try to bully you into telling them something, and your assertiveness as a nurse has to override that impulse to please. Some families may even go to your manager, so be sure to keep them abreast of the situation and what you are doing to protect the patient’s privacy.
There are no easy answers in cases like this, and the nurse has to make a judgment on a case-by-case basis. You can help minimise bad feelings by actively listening, keeping your cool and assuring callers that you understand they are concerned about the patient. If you have someone who is angry with you, that may be necessary for the good of the patient. If that person goes to your manager, be sure to back up your actions so that you can prove you are merely respecting privacy laws and protecting your ability to care for the patient.
What to Do When Things Escalate
Sometimes, despite our best intentions, things can get a little out of hand and patients may demand to speak to a higher authority—your nurse manager for example. If this does happen, it’s best to calmly accept the patient’s request and inform them that you will organise a meeting. The video below provides an overview of how an experienced manager is likely to conduct such a meeting.
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