Family member's disrupting treatment sessions

Hi everyone,

This is my final post for this placement, hope you are all satisfied with your performance in this prac and are looking forward to our third last one ever!!

This blog relates to a situation I had during my final assessment for my respiratory placement. After reading the notes of my selected patient, it became aware to me that this patient may be very complicated given that she is under 50yrs and dying of COPD due to her extensive smoking history, has suffered ETOH abuse in the past, has anxiety issues (related to her poor relationships with her children) and is living in a shared hostel with minial support. On entry to the room my initial concerns were hightened when the patient began complaining about being kicked out of other hospitals, "just because they don't like her because she's a smoker". Half-way through my exercise program that I was prescibing (mobilisation was not indictaed due to a massive migraine and intense shortness of breath), her only 'supportive' son entered the room he: a) began ranting about his run in with the police due to a brawl he'd had earlier, b) about how he shouldn't have gotten 'high' on drugs that morning, c) about his issues with his girlfriend, d) began rolling cigarettes (NOTE: in a respiratory ward whereby most of the patients are admitted due to smoking-related causes!!!). As expected, my patient lost all interest in the exercises, her breathing began to get worse and her headache progresses so much so that she no longer wished to continue treatment.

I felt very confronted in this situation. My supervisor and I had already established that in order for this patient to comply with our treatment now and in the future (she is to attend COPD linkage services on discharge) a good relationship needed to be formed and therefor, by sending her son out of the room would have caused resentment towards instead. I was very upset that while I am educating the patient in regards to the benefits of quitting smoking, her son averts attention towards his habit which I'm sure has an influence on her ability to quit herself. My relaxtion techniques went out the door when her anxiety levels increased due to her sons ranting and I felt that my treatment session was not as effective as it could have been without the presense of her son. In future with this patient, I will time my session for times when the son is not present ans provide some education regarding the importance of reducing stress levels to assist with relaxed breathing.

Do you guys think it is the patient's due right to have any person they want in the room with them during our treatment sessions and how do you think I should broach the topic with the patient about how passive smoking and temptation to smoke are only making her condition worse?

Kate.