Can a family be too involved?

July 17, 2008 at 10:31 pm 11 comments

One thing that I have always observed while working in the hospital setting is that the patients who have family and friends that come to visit tend to fare better when it comes to physical rehabilitation and overall attitude towards the outcome.  They are better able to laugh through their hospital stay and they have a strong support system.  The patients who are alone during their entire hospital stay tend to be more depressed, less motivated to participate in therapy, and have a poorer affect.

As a result, I have always advocated that when possible, patients should encourage family and friends to visit.  I recently had a situation where I questioned this for the first time.  The patient was an older person who was completely independent with all her activities of daily living and participating in the community.  She suffered a fall, fracturing some bones and having aches all over.

Once stable, therapy was called in to see the patient.  On a typical patient, we would normally ask if the patient would be willing to get up, and work towards getting her out of bed and to a chair, at least for the first time in therapy.  Patients usually complain of pain, but we try to coordinate with the nursing staff so that the patients can be fully medicated and ready to go.  Usually, this is enough, and we can proceed with therapy.

However, with this patient, we saw that there would be problems from the start.  Upon arrival, the patient’s son was in the room.  Right away, he told us that she was sleeping and that he doesn’t think she should have therapy so that she could rest.  If a patient is alert and oriented, I like to at least ask the patient their opinion on participating in therapy, which is what I did.  The patient was quick to say that she would welcome sitting at the edge of the bed, so I’m happy I asked.

Then, when approaching the bed and reaching out to shake her hand and introduce myself, the son audibly gasped, worried that my touch would cause more pain.  This went on throughout the entire 40-minute long evaluation.  Any time I touched the patient in any way, the son could be seen and heard wincing and gasping, as if my touching the patient was actually hurting him!

Now as an aside, I completely empathize with the son, and I fully understand that his mom is in pain.  I could not even begin to imagine what it would be like if that were my own mother.  However, the son took this to an extreme that I had never seen before.

In moving the head of the bed upwards, the son demanded that we be “gentle” several times.  Unfortunately, there is no gentle button, just an up and down button, but I managed to get the head of the bed situated in a way that was agreeable to everyone.  Before removing the patients waffle boots (used to prevent heel sores), the son made us wait and ask the patient to make sure that it was ok to remove them, as her legs were very sore.

With literally every single movement, the son was involved, asking his mom to tell us to stop when it became too much.  To get to the edge of the bed, we have to move one leg, then the other, adjust the shoulders and hips, move both legs again, adjust the shoulders and hips, sit her forward, etc. until she can sit at the edge of bed appropriately.  Even then, we had to manage her sitting balance and control her dangling legs.  Imagine for a moment getting stopped by the family member for each and every single one of those movements!  I’m honestly quite surprised that we completed the evaluation in only 40 minutes.  We had to reassure the son over and over again that we were being as gentle as possible, explaining exactly what we were doing, and why we were doing it.

Take note that I have spent most of this post discussing the son, and not the patient.  When a family member gets so involved that we can barely pay attention to the patient, I think that there is something wrong.  When the son asks the patient repeatedly to tell therapy to stop if it becomes too painful is absolutely detrimental to the patients ability to recuperate.  Patients need to be encouraged to do more so that they can get stronger and healthier.

Once again, I empathize with the son and I think he is the greatest son a mother could have for his ability to be at her bedside throughout the day and worry about her.  But there comes a time when it can be too much.  I had actually heard rumors that when the patient was in the ICU (where they have very specific visiting hours), the patients heart rate and blood pressure was noted to be higher when family members were present!  So, while I normally advoate for patients to welcome family members and friends to visit, I also think that there is a time when they need to step back and let the patient get therapy so that they can get well and go back to being independent.


Entry filed under: acute care, Ethics, hospital, occupational therapy, Open Questions, OT, phys dys. Tags: , , , , , .

Fundamentals of Clinical Instruction Making assumptions

11 Comments Add your own

  • 1. Melody  |  July 28, 2008 at 7:17 pm

    I totally agree with you here. I had a similar experience on a placement I had in the North Island (NZ). At the hospital where I was at sometimes patients were encouraged to do arrange a time to separate family visiting from therapy. Mind you we were always adapting when we saw clients.
    Its interesting how we can often pick up family dynamcs and using that positively in consultation so long as we dont make assumptions I suppose.
    Tell me, is this continuing to happen? What was the discharge planning like? Did you have to confront them or have the patient do something?

  • 2. Pam  |  August 18, 2008 at 11:36 pm

    You know, its totally appropriate to politely ask the family to leave… I have been in that situation before and you have every right to diplomatically explain that you want to limit distraction, or maximize the space in a small hospital room in order to make the most of your limited time with the patient. It can be hard to muster up the nerve to say something, but I have never had a family challenge me when I asked them nicely and gave a reason.

  • 3. Reba  |  January 18, 2009 at 11:18 am

    I agree it’s appropriate for the patient’s safety – especially if it’s affecting her blood pressure! – as well as respectful of her confidentiality and autonomy, to ask the family member to leave the bedside. If it’s difficult to find a way to simply ask the family member to step away, for example if the family member appears particularly challenging in demeanor, during my introductory remarks i sometimes have scanned the bedside for something that could reasonably be needed, such as a clean cup or gown to be used to cover the patient’s back, and enlisted the family member’s help in going out to the clerk’s desk to seek it on the patient’s behalf. Sometimes this act of giving the family member something useful to do, while removing them long enough for the patient to express any concerns they may have, has been very beneficial for all involved. It must also be remembered that those few moments away from the family member may be the only chance the patient has to confide an abusive or neglectful situation, or some other information that the patient doesn’t want to share in front of the family member.

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  • 8. Jill  |  October 3, 2010 at 6:30 pm

    I enjoyed your post and totally can see your point. My question to you is, how was the patient reacting to her son acting like that? Do you think it was stressing her out more or helping her to have his support there with her? Please let me know your thoughts, I am very interested to know. Thanks!

  • 9. hmelgoza  |  October 30, 2010 at 2:37 pm

    As a future OT and current service provider in mental health, I’ve often encountered situations such as this one where a family member may seem too involved. When conducting an assessment, the patient may not feel comfortable disclosing certain information. Sometimes, having the family member can be helpful as they can provide additional input, but the truth is that the patient should have the opportunity to provide their perspective on how they are feeling, what their goals are, any concerns they may have, etc.

    I’ve had situations where I have asked a family member to allow me some one on one time with the client/patient be able to conduct an assessment. I think this is completely reasonable and the family member will understand if you approach this with a good/friendly attitude. Giving the patient some privacy such as this sometimes really does make a significant difference since they may open up about things that they are embarrassed to have their family member know about. This can be true for when it’s someone of the opposite sex and you’re discussing intimate or personal questions as well as when the family member is not a close one.

    When asking the family member to allow us some private time with the patient, it’s also beneficial to help them be at ease by telling them that you would also like their input right after as to any concerns that they may have. As with any type of care, the family can be helpful when the patient is not fully conscious or aware.

  • 10. Caitlin C  |  November 4, 2010 at 8:44 am

    I think it is completely appropriate to ask the patient if it is okay for their family member to stay during the evaluation. I think sometimes it is easier said than done to be assertive but in an instance like this it is completely appropriate to ask the family member nicely to please step out of the room or refrain from comments as they are taking away from the effectiveness of your therapy. His distraction probably caused you to take longer time with the patient. I think redirecting the evaluation back toward the patient by asking are you doing okay? or are you in any pain? everytime the son had a comment may have given him some insight into her feelings.

    I know its always so frustrating being in the moment and not doing much but when you look back on it thinking why didnt I do this or that. Hopefully our ideas will help you for the next time you’re in this sticky situation!

  • 11. Nadia Kuzmich  |  November 10, 2010 at 2:21 pm

    As a future Occupational therapist …
    I guess my question is what is the appropriate way to ask a family member to step out of the room without being assertive or being offensive?
    I have to say I’ve only had positive experiences with family members through-out my fieldwork experience. Personally I would feel offended If I was asked to step out of the room when my mother was evaluated. I almost feel like it’s up to the family member to make that decision depending upon the relationship they have among each other and take the initiative to ask their family member to step out. But then again It depends on the situation. If I was to sense that a child is avoiding disclosure of information, I would take a different approach.


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