If you are a nurse you’ve likely experienced stress now and again. Long hours, sicker patients, staffing issues, and other specifics tied to the job can torpedo the joy of doing it. But what happens when families of your patients add their own unique dynamics to the mix? Your stress levels likely surge even higher!

Most relatives want the best for their loved ones, but uncertainties of all shapes and sizes can provoke tension even in the most loving families. And people who let past disputes, present rivalries, or even personal demons overshadow the problem at hand can quickly disrupt the flow of quality care, not to mention cause angst for nurses.

The unfortunate reality is that you may not have time to process what’s occurring, even though doing so can be a safety valve for your own mental health. As Teresa Conte, PhD, CRNP, assistant professor of nursing at the University of Scranton, notes: “There’s always a patient in the next room to think of so you never get to pause and deal with it. So you’ll either start crying in the car or you’ll push it off and push it off without realizing the small effects it’s having on you until you yell at the dog or get really annoyed when your child spills the milk.”

A Proactive Pact

As a nursing professional, you’ve likely found ways to center yourself after an untoward event or other encounter. Perhaps you talk with your colleagues or even debrief as a unit. Yet taking steps at the first simmering signs of tension or an issue can go a long way in helping you advocate for your patients and their families. By establishing rapport, setting boundaries, and knowing your limits, you can calm agitated nerves—both theirs and yours!

Establish Rapport

Even though you’ll likely have an admitting diagnosis and impressions from colleagues during report, you probably won’t get a true sense of what’s going on with the patient and family until your first assessment. That’s why it’s important to establish common ground when you enter the room: Acknowledge the players, explain what you’re doing, and ask for any questions or concerns. From that point forward, your goal is to keep people in the loop by delivering information in ways that either empower or soothe. Also, always remember that being a patient or the family of the patient is a difficult place to be under any circumstances.

“What nurses do best is to educate patients and families,” says Leslie G. Oleck, MSN, PMHCNS-BC, LMFT, a psychiatric clinical nurse specialist and a graduate instructor at the Indiana University School of Nursing. “When people feel like they have a better understanding of what’s going on, they’re able to cope better. They don’t get short with each other or the patient as frequently—and the patient doesn’t get short with them.”

For instance, although obstetrics is usually a happy specialty for Lexi Dunn, MSN, APRN, CNM, a midwife and doctoral candidate at Emory University School of Nursing, sometimes she has to deal with the inevitable tension that arises when expectant parents have to make tough medical choices. Whatever the issue, the fact that events can turn on a dime can be a “shocker for people,” she says. “There’s high emotion and a lot of tension because of the nature of the situation.”

Dunn admits that while disagreeing with the parents about their choices can make her feel sad or even helpless, she stays focused on her mission—to educate and empower them so they’re comfortable with the decision. “Most of the time when you have conflict it’s because there’s so much going on that people miss important information,” she says. “So I want to reassure them that I’m here for them, that I want to know what’s bothering them, and that I’m giving them all of the perspectives to come to an agreement.”

Set Boundaries

Even though illness can bring out the worst behavior, you likely don’t want to wait for an unruly family member to erupt before taking action. Outlining your rules at the first sign of a problem not only tells people what’s acceptable and what won’t be tolerated, but it also may keep security at bay.

For instance, when the wife of a heart transplant recipient made it clear that his adult children couldn’t see their father, Christy Hogue, BSN, RN, CCRN, was equally frank. As the supervisor and day shift charge nurse in the cardiovascular intensive care unit at the Medical City Dallas Hospital in Texas, she not only let it be known that she’d do whatever was best for her patient, but they’d have to either put their differences aside or stay away if they couldn’t be civil. “We’re not counselors or the police,” she says. “As nurses, we’re just trying to do the best for the patient. Sometimes we need to set acceptable boundaries with families so we can provide that quiet, healing environment.”

Know Your Limits

As a caregiver, solving every issue that’s sucking the energy out of the room might be an appealing notion. Yet it’s not your job to deal with the bigger, entrenched problems haunting a family—even if circumstances have pulled you into the drama. Resisting whatever urge you have to fix what you likely can’t fix helps you stay focused, even though you might have to leave your ego aside to do so.

For instance, when one mother’s abusive behavior toward her child’s pediatric oncology nurses started affecting unit morale, Conte’s administrative colleagues arranged for volunteers to sit with the boy multiple times a day. They were concerned that the woman’s off-putting antics were not only stressing the nurses, but also jeopardizing his care. Giving her multiple breaks admittedly didn’t change her personality, but it allowed the nurses to work without fear of entering the room. “People have issues that are not going away just because a loved one is sick,” Conte says. “If anything, that compounds the situation. We may wonder why they can’t get it together, but it’s their reality. You can’t change it.”

But you can be effective in redirecting the course of events by putting your ego aside and being mindful of your words and delivery.

For instance, when a combative father went Papa Bear ballistic on an emergency room nurse trying to test his 18-year-old daughter for brain function, Lourdes Lorenz, DHA(c), MSN-IH, RN, NEA-BC, AHN-BC, swooped in immediately. The founding CEO of International Integrative Health Institute in Ashville, North Carolina, was rightly concerned about protecting her then-hospital colleague. She also knew that she needed to clear up the man’s confusion about the prognosis. Even though the girl was non-responsive after aspirating from a roofie-laced drink, her father misread a cardiologist’s assurances that her heart was stable as a sign that she was getting better.

Lorenz immediately legitimized the dad’s concerns by suggesting that anybody in his position could be similarly confused. But she also provided the parents with a full picture of what was occurring before circling back to the doctors to make sure that they’d be better at coordinating their messaging in the future. “Before you can control the situation you need to be very mindful of what you’re thinking and let your ego out of it,” Lorenz says. “If you don’t do that it can become a bigger conflict.”

Final Thoughts: Safety First

Whatever you do to keep everyone on an emotional even keel, it always comes back to safety. Your institution likely has protocols in place to deal with progressively difficult or challenging situations.

Calling security is clearly a front-and-center option if people are threatening or nasty. But it may not come to that if you can move family members to a quiet place for a heart-to-heart with a social worker, chaplain, or yourself. Beyond an actual face-to-face meeting, however, instituting a behavioral or visitation contract further cements the fact that you mean business about someone’s menacing attitudes or verbal abuse.

You may be fortunate in that you won’t need to put your rules in writing. Then again, putting them to paper may be the best way to clip the wings of potential troublemakers and give you much needed stress relief. “Sometimes when you lay it out for people,” says Conte, “it kind of jars them into realizing, ‘Oh my gosh, I need to make some changes.’”

Chris Hinz

Chris Hinz is a freelance writer based in Milwaukee, Wisconsin.

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