Hol(yHell)istic Nursing: How to manage anxious families with compassion
There’s difficult patients, and then there’s difficult families. If you’re a seasoned nurse, you know exactly what this entails. Yet, while families are often looked at as an obstacle to overcome (or avoid), true nursing dictates that we include them in our patient care plans. After all, nursing is holistic—we go beyond treating a diagnosis to caring for the patient as a whole—and that means considering their support systems in place.
Below you will find some tips and points to consider when it comes to managing your patient’s anxious family. Here you will find a few perspective shifts, some communication technique tweaks, and how to stand up for yourself when behavior crosses the line. We can all use a little help in these areas; our goal is to get you get through those difficult shifts a little bit easier.
Hol(yHell)istic Nursing
Deep breaths and direct communication.
Let’s say you’ve just been given one of those reports. Where the outgoing nurse looks deeply into your soul and apologizes for the 12 hours you are about to have. This alone is enough to fill you with dread and anticipate a crappy shift. The problem is, this expectation sets you up to have that exact experience! When you do receive a report like this, remember to maintain your objectivity. And by that, we mean make a conscious effort to give this patient and their family a clean slate with you. This requires lots of patience, and prioritizing your care for this patient with extra time in mind.
For the majority of anxious families, their actions are fear-based. Add in the lack of control that a hospital setting strips away and you can certainly empathize with how they’re feeling. Bottom line, they need to know you care, and that their loved one matters. To communicate they matter to you, too, always interact with the patient first! Then, turn your attention to the family.
Supporting patients and their families.
Begin by acknowledging that they’ve had a rough go of it. Listen to them. Don’t interrupt if you can help it. Yes, we’re all busy, but you’ll save yourself time in the long run if you can establish a trusting rapport right off the bat. Speak clearly about the plan for the shift, write down any questions/concerns they have (even if you don’t need to, the act of writing it down will signal to them that you are on their side), and be extra clear about how you expect the shift to go. Reassure them that even if things get busy, you’re still there. For example, many families don’t know telemetry patients’ vitals are transmitted live into the nurses station! Little intuitive reassurances like this go a long way in helping them understand that you know where their fears may lie.
Inclusion, levity, and boundaries.
The foundation of fear is uncertainty. And for families, not knowing what the heck is going on the majority of the time their loved one is hospitalized is agonizing and exhausting. You’d be surprised how much simply acknowledging this will help to diffuse tension. Because as hard as it is being the one who’s sick, there’s a certain type of cruel suffering that comes from feeling helpless by their side too. That’s where patient’s families live. And all their bad behavior is just noise swirling up from that impossible position.
Including them in care decisions (at the discretion of the patient, of course), relaying information as it’s appropriately available, and keeping them up to speed on what to expect and when helps tremendously. Make sure to review plans for the shift a few times, and leave time for questions. Another communication tip is to get them talking about things other than the hospital experience. Pets, grandkids, the weather…these are all light topics, but most importantly, it gives them permission to be themselves for a few blessed minutes, and not their loved one’s warrior.
Lastly, there is a hard line to draw when bad behavior from families veers into inappropriate territory. Expressing frustration, unhappiness, or anger is one thing (and it will become easier to absorb as your skin thickens and you learn to lean on empathy), but name-calling, belittling, or cutting you down is NOT. If this does happen, take control immediately. Speak clearly and authoritatively, and keep it short. Some thing along the lines of “It is not okay to speak to me like this. I am on your side and doing my best. I’ll come back in 5 minutes after you’ve cooled down.”
Usually this type of direct confrontation stymies rudeness right away. If it persists, don’t go it alone. Bring your charge nurse along with you as back-up and document, document, document. In the rare instances when you need to drop this patient’s care—and if a family member needs to be restricted from visiting—the hospital will require sufficient evidence to back up this decision.
Lean into compassion.
A running joke in 2020 was nurses’ relief at the restriction of family members and visitors from the patient bedside. And of course, less people “in our way” means that we can complete our endless tasks more efficiently. But the flip side of this coin is how the patients experienced it.
In isolation rooms for days and weeks on end and beholden to overtaxed staff, many, MANY, patients spent the last moments of their lives like this. Alone. No nurse wants that for their patient. So much so that many of us made valiant efforts to connect families to their dying loved ones in any way possible.
2020 certainly put a new perspective on just how important family members are to our patients, didn’t it? Even the not-so-pleasant ones.
As we return to post-pandemic “normal,” let’s carry with us a spirit of holistic nursing that leads with compassion. We hope these tips help you to navigate the challenges that anxious families present!