Working with Family as a Nurse

Working with Family as a Nurse As a nurse, if a family member becomes ill, you could end up visiting them while you are at work. Most hospitals have rules against treating family, but you may still offer input and serve as an advocate for your family member.

The most important people in the lives of most physicians and nurses are their spouses, children, parents, and siblings—their immediate families.

These are the very people who have every reason to benefit from the medical knowledge and expertise of their physician family member.

Twenty-two percent of physicians and nurses in the study fulfilled a family member's request about which they felt uncomfortable.

But should physicians and nurses treat family members? Interestingly, the American Medical Association in its initial, 1847, "Code of Medical Ethics" addressed treatment of physicians' families when it said of the physician, "the natural anxiety and solicitude which he experiences at the sickness of a wife, a child, or anyone who by the ties of consanguinity is rendered peculiarly dear to him, tend to obscure his judgment and produce timidity and irresolution in his practice."

The physicians and nurses of today certainly experiences the same anxiety and solicitude at the sickness of one "dear to him" -- or her -- as did his/her counterpart a century and a half ago. In our current AMA "Code of Medical Ethics.

Related: How to handle Patients with Cerebral Palsy The opinion goes on to warn that professional objectivity may be compromised when treating family or self and thus affect the medical care being given.

There is often a dynamic tension between physicians' and nurses personal and professional roles when it comes to the medical care of a family member. Just last year, authors of an Annals of Internal Medicine article reviewed instances from their own experiences and concluded that in some cases involvement was not helpful and was possibly harmful, while in others it was beneficial. In none of their cases did the physician act as the primary physician for the patient-relative.

The authors also suggest that there are potential problems with physicians' and nurses participation in loved ones' care to any degree -- whether low risk (explaining medical information to a family member), medium risk (refilling a medication previously prescribed by the primary physician) or high risk (ordering tests or doing procedures).

Some physicians and nurses may omit sensitive or intimate areas in history taking or aspects of physical examination. Likewise, the patient may be hesitant to submit to parts of the physical examination or to disclose

personal information.

Finally, when treating family members, physicians and nurses may be tempted to address problems that are beyond their expertise or outside their training, when doing so can cause them discomfort and potentially harm the patient.

Ethical tenets of autonomy and informed consent are likely to be easily compromised. Family members may feel as though they are offending the physician, nurse-relative, if, for example, they refuse a particular recommendation. And the physician or nurse may be hard-pressed to respect the right of a patient-relative to refuse when, in his or her professional judgment, the recommendation is in the patient's best interest.

Example: Family members of physicians and nurses have the same rights as any patient, including the right to informed consent, meaning that the patient must hear all appropriate information about the nature of a procedure, its risks, benefits and side effects and reasonable alternatives to the suggested treatment. Any patient, even a family member, then has the right to ask questions, to refuse the physician's or nurse's recommendation and to understand the consequences of his or her choices. The informed consent dialogue might very likely be nonexistent or subpar if a physician or nurse were to treat a family member.

Related: Why get your Master’s in Nursing?

Deciding whether to treat family members and, for that matter, self or colleagues, is not a new dilemma for physicians and nurses. Yet these aspects of medical practice are not often taught or discussed in medical venues. Such discussions should be part of formal medical training for students, house staff, and practicing physicians. The ethical, emotional, and competency concerns those treating relatives raises should be talked about during such training. The AMA Council on Ethical and Judicial Affairs soon will issue an opinion on peers as patients. Watch the online Policy Finder and the next print edition of the "Code of Medical Ethics" for this opinion.

Although it may seem impossible to separate ourselves from the physicians and nurses we have become, at times it may be more helpful for us to be a good spouse, parent, child, sibling, grandparent, aunt, uncle, niece, nephew, cousin or in-law to the patient rather than a great nurse.

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