I'll try to be as descriptive as I can without going too deep, but this is a bit lengthy.
I have a patient that I am often assigned to. This patient has an order for 1:1 safety advocate(sitter) 24/7 due to behavioral issues/mental retardation (IQ<70). Current hospital stay began when mom brought in patient to ED for behavioral disturbances/aggression. Come to find out patient had been in an adult group home successfully managing patient's psychiatric issues and behavioral disturbances, when mom suddenly and without explanation removed patient from home and suddenly stopped all psych meds. Since then patient has been in and out of hospitals for primarily behavioral issues but also, per mom, various medical problems (everything from brain tumors to pancreatic cancer, all unfounded). Each time nothing is found to be wrong other than meds need to be adhered to.
As of now, mom is POA, but APS is working on a case to have that removed as MSBP is suspected due to exaggerated patient symptoms, falsifying diagnoses hx, and requesting completely unnecessary and stressful tests and operations (such as a brain biopsy). Since nothing has been done legally yet mom still gets visits, but per psychiatry visits are limited and 100% supervised. Mom can be asked (usually forced) to leave when her behavior starts aggravating patient. On several occasions mom has amped up her child's behavior to the point that the patient violently assaults staff. Several have been sent to the ED for this.
With altered medication regimen, patient's psych status has greatly improved. Behavioral outbursts are now limited to specific and very understandable triggers. However every time mom comes for a visit patient gets aggravated and mental stability declines. Always ends in either crying or assaulting staff. Usually just the former if Mom leaves before things get out of hand. Patient has voiced feeling neglected and abused by mom, has stated fear over mom's presence and control over patient's medical wishes. Despite all this mom still gets to visit.
My question is, as a sitter and the supervisory staff for her visits, at what point can I make her leave? I can tell when patient is getting worked up, but currently mom is only asked to leave when patient has gotten completely out of control and security is called to help with patient behavior. I have heard during several conversations between the two mom telling her child that she's dying, there's something seriously wrong, her meds are killing her, etc, and when Mom leaves we're stuck doing damage control. Patient clearly loves mom, fears her to a degree, but does not have the mental capacity to understand what's going on. Patient sometimes feels that we are holding patient prisoner and accusing mom of abusing patient (mom tells child that mom's being denied rights, we're stopping her from ever seeing patient again because we're evil, all to purposely get patient worked up), but patient will then acknowledge the decayed mental state of mom and how mom being around isn't good for her.
As I'm at the bottom of the totem pole I don't know where my abilities lie in controlling the situation. I personally feel like mom should have no visitation rights, but I'm in no position to be making that decision. In the least it's obvious the harm her visits are doing and it's so painful to watch the patient psychologically suffer like this. I just don't know what to do in the meantime while things are being sorted out legally.
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