Sunday, November 15, 2009

Advocate 24 /7?

I recently gave a presentation at a Midwestern hospital to a group of nurses. The topic was critical and compassionate communication. I was prepared with some role play to use following some brief training in listening skills and recognizing the feelings and needs of the patient and / or patient’s family. The idea is to connect with what is happening with the patient and family and not concentrate so much on the words being said but more how they are being said.

A family member who sounds angry and spews hurtful words at a nurse who is already tired and also anxious may be coming from a place of fear and not anger at all. A search for those feelings and recognizing that the words are not actually meant to hurt the listener, but instead a call for understanding and acknowledgement that the patient is scared and feels lonely.

We addressed briefly family members who insist on staying over night which often causes communication problems. I suggest, in my family centered patient advocacy training that the advocate or family advocate learns ahead of time the policy for overnight guests. Usually, I have found there is not a set policy but it is left open so the hospital can ask a family member to leave when their stay is not benefitting the patient.

The nurses at this hospital, in the Midwest brought out that they do not allow family to stay overnight. It is privacy issue to the patient in the same room.

If I were the patient in the room I would not want the husband or another family member in there. But, then I had to question; what is the point of the “advocate”?

Are errors not made at night or early in the morning? Does the roommate not need privacy during the day?

I don’t have the answers, but sometimes, only more questions.


Kathleen Clark said...

I thought that allowing family to stay overnight was pretty common these days. When my son had thyroid cancer surgery in Oct, 08, I said I'd like to stay overnight. The only reason I couldn't is because they ran out of chairs that recline so there was no place for me to sleep. They had so many other people staying overnight that, by the time I even thought of it, all the recliners were taken. He was in a private room, though. I hadn't thought about situations involving roommates but agree with Ilene that staying with a loved one to make sure they are getting what they need doesn't seem to violate the roommate's privacy any more than being there during the day. That is, as long as the family member/advocate is quiet.

Just thinking that that is a question I'd certainly ask next time before my son or a loved one checked into the hospital, and ask, if the response is no, why the policy doesn't permit family members/advocates; then, I'd follow up with a letter to the hospital and the physician encouraging a policy change.

I think, often, rules such as no sleeping overnight with patient are rules that have been in effect for years and don't get reexamined unless and until someone asks for a change.

Doug Hall said...

Good point. An advocate who is refused access to their loved-one or client for half the day can't do much in the way of protecting the patient. There are plenty of opportunities for medical error, patient injury or worse at night.
Plus, hospitals are 24 hour operations and care doesn't stop just because it's dark outside. Their excuse to keep you out of the room is weak.
A Patient Safety Advocate needs to be creative to work within the hospital system. A brief meeting with the administrator or director of nursing to explain your desire to be the eyes, ears and voice for the patient may make your efforts easier. Otherwise, request a private room or a transfer to a double room that is currently empty or get the approval of the other occupant for your presence.
Advice for all patients: make every effort to never, ever be in a hospital or other healthcare facility without an advocate at your side 24/7.
The hazards of healthcare speak for themselves.
Doug Hall
PULSE of Florida

Anonymous said...

I think the patient and family and hospital staff should try to figure out the best solution considering all aspects.
The family member or advocate may need a break and rest.
The patient might need the same.
The other person in the room might not care, so long as the advocate is quiet and doesn't talk all night. Can't be any less private than having the advocate or family member there in the day.
And the nurse may recognize things that the patient and advocate may not.

When the other bed in my room opened up after a patient went home, the nurse actually consulted with me on whether I wanted to move into another room, or the other person would move into my room. Amazing. I know that's not about the advocate staying the night, but the concern was for my comfort.

Medical Safety said...

This is something I hear about frequently. First of all, the angry family member might well be tired or frustrated. Too bad there is not a universal policy in place where the attitude of the party in question is addressed in house by independent advocates not employed by the hospital or patients. On the other side of the coin, there are also clinicians who are not very friendly to the family member either. I have many times heard that busy clinicians are rude and do not respond appropriately to the family member. On this side of the issue, the same problems exist where the staff member might be tired or stressed for reasons having nothing to do with the patient or family member.
An easy remedy for this would be signs in all patient rooms and hospital hallways that cause everyone to stop and think. A sign like, "Tired, frustrated or just having a bad day? Why not take five, breathe deep, and think about how you want to be treated".

Regarding overnight stays, I have have heard that patients who have family members or advocates with them most of the time fare better then those who do not. Does any one have data available about this? Hospital policies that prohibit such options might be reevaluated by boards and perhaps a portion of a wing might be set up to accommodate patients who welcome this option. That would make everyone happy.

amy said...

My 16 year old son, died due to medical negelct. The Doctors at both hospitals knew what they had to do but they didn't. That was to send my son to Boston to get a transplant. Instead they opted to keep him at the hospital for another year while he just waited in pain and died. The hosptial did not even give him pain medication when he needed it.

The arrogance of these doctors caused me to lose my son. I was his only advocate, I fought hard to keep him well and alive. I have since filed lawsuits against the hospitals for neglect. I also started a non profit to make sure no other parent has to go through what I did.