Unfortunately, difficult patients are a reality for professional nurses. Dealing with them is part of everyday life and is a conflicting issue because the needs of patients are the main priority. Many nurses display negativity when their every effort is met with a harrowing ordeal. While this is completely understandable, it is not acceptable and should be viewed in an entirely different light. Nurses that have the most success with ‘taming’ challenging patients see them as a fantastic opportunity to improve their nursing skills.
Nursing is an extremely complex profession that requires far more than just the call of duty. Empathy is imperative, along with compassion, intuition, understanding, honesty, helpfulness and insight. A vast reserve of communication skills is compulsory, as well as interpersonal, diplomatic, social, persuasive and critical thinking excellence. A well honed sixth sense is immensely helpful in surviving the worst cases. There are many ways that patients prove troublesome, through verbal abuse, neediness, criticism, uncooperativeness, screaming, crying, wandering, over-talkativeness, gossiping, physical aggression and the all too familiar call button. Some are welcomed over others, but they all prove trying indeed.
The important thing to remember is that all of these difficult behaviors stem from fear in all its nasty forms. Pain, discomfort, confusion and disorientation are other factors, as well as any personal issues the patient may be facing (such as perhaps losing a loved one in the same car crash). Each patient is unique and they bring their own set of behaviors that must be dealt with – and this must be done in the most professional manner. There is no place for reactionary attitudes that include frustration, gossiping, rejection, bad language, forcefulness, fighting with patients or anything that contradicts your nursing integrity or gets you or your employer sued. So what do you do when confronted with a troublesome patient?
Acknowledging your patient means being fully aware of their frustrations, fears, emotional state, needs and desires relating to their hospital stay and interaction with you. Letting them know that you have acknowledged them as individuals is a sure way to gain their trust.
Be honest with them
Be heartfelt and honest with your patient at all times. Do not lie or sugarcoat anything when dealing with them. If pain is imminent, tell them. If medication will make them sick or drowsy, then make sure they know it. If they must lie still in order to accomplish a task, then explain why their cooperation is needed. Honesty is the key to good relations with your patient.
Clarify their concerns
Many patients are confused when receiving treatment. They do not always understand what is wrong with them, what is required of them or what is going on around them. In order to put them at ease, it is important to clarify what you are doing and clearly answer any questions they may have. Although nurses are not doctors and may not discuss certain aspects of treatment and prognosis, there is much a gentle nurse can do to put a troubled mind to rest.
Nurses are more objective and able to resolve issues when they do not take things personally.
Offer some time alone
Sometimes, time alone is both helpful and unavoidable – for both you and your patient. Time to calm down should not be necessary if you have taken steps to win your patient over, but it is essential to avoid a massive incident. Some of the most difficult patients respond well to a direct approach when given time alone to absorb the information afterwards.
Give them choices
There is a strong feeling of helplessness when patients are being treated. They have little to no control over their diagnosis, prognosis or ability to get out of the hospital. It is often helpful for nurses to give them options to alleviate this feeling. Giving them small technical choices to make not only empowers them, but gives them confidence in you. Would you like to go to the toilet before or after your meal?
Setting personal boundaries is absolutely imperative. It must be clear that you are a professional nurse and not the domestic at home. Sexual innuendos and even advances must be firmly refused. Your personal integrity should not be questioned in order to satisfy manipulative or nasty patients. The trick with setting boundaries is to do so unmistakably, yet with inherent kindness and understanding.
Identify the problem
Often the underlying reason for problem behavior is not immediately obvious. Finding the root cause of a patient’s anxiety will usually solve the problem. This involves subtle investigation on your part and requires you to ask innovative questions. There are frequently practical reasons for demanding or excessive behavior. Once you know what they are, you will be able to alleviate many issues.
Provide special attention
Giving a patient a little extra attention can go a long way in easing relations. Take an additional fifteen minutes to talk with your patient and ask questions. Any attempt at trying to understand where they are coming from will relax some of the tension the patient is feeling. Of course, this must not become the norm or a new set of problems will arise.
It is not enough to simply hear what your patient is saying. It gives the impression of clinical cold heartedness and may result in an icy situation. You need to listen… really listen. Listening involves both understanding and action. Treating a patient as if they are the only person relevant to you at that moment will inspire gratitude and trust – instantly diffusing any tensions or misunderstandings.
Keep your promises
Never make promises that you will not be able to keep. You may be busy, but your patient is likely bored and seeking a bond with you (however unbelievable that may seem). If you promise something, ensure that you make it happen – pronto. Do not be forgetful as this really does not make the patient feel important in any way and will likely make them more unruly or downright disrespectful.
Routine is critically important when dealing with patients. Be methodical and thorough when treating them. Do not overlook small aspects of care and use the same techniques every time you work with them. Patients learn to expect a certain amount of pain and what is required of them during a particular procedure. Changing even the smallest aspect of it has the potential to totally disorient them and create bitter mistrust in you.
Rather respond to your patient, instead of reacting to them.
Watch your body language
The importance of body language must be stressed. When a patient is being difficult, they are usually vulnerable and creating scenarios that reflect their inner turmoil. Crossed arms, rolling eyes, grimacing, twisting your lips, tapping your foot – these are all signs that your words are not sincere. They make you look flustered, angry or simply uninterested. While that may be the rise the patient is seeking from you, it conflicts with what you are saying to diffuse a situation and affects your ability to get a clear message across. Remain calm, smile and keep open, honest eye contact with your patient.
It is frequently essential for nurses to stand back and assess themselves in a challenging situation. Often the manner in which you approach your patient, speak to them, administer treatment or understand them is a cause of conflict. This is completely unintentional and directly related to their experiences, but it still needs to be addressed. In addition to this, self assessment is also a fantastic tool for figuring out what approach to take next. Take a prolonged breath and reevaluate the underlying needs of your patient.
If none of the above methods stop troublesome patients in their tracks and the situation continues to escalate, then it is safe to say that all else has failed. The protection of yourself and those around you is of paramount concern and violent or abusive behavior is not excusable under any circumstances. Immediately report any such incidents and handle them appropriately. It is imperative that you adhere to HIPAA (Health Insurance Portability and Accountability Act) standards in order to ensure all parties are protected from risk. Here is a guide on what to do when a situation with a patient spirals out of control:
- Record Events
Any and all adverse events that have occurred with a patient must be perfectly documented in either their patient record or the healthcare facility incident report, according to the required policy. It is critically important that there are no oversights in these records and that objective documentation is practiced. Should litigation become reality, these records will stand in your favor.
- Pay Close Attention
All threats that a patient may make regarding lawsuits must be taken very seriously, particularly if they claim to have previously sued a healthcare professional. Contact your nursing supervisor immediately and make sure that your risk manager is aware of this threat. Preventative measures will be taken to resolve the conflict and avoid the risk of a lawsuit.
- Seek Help
If treating a patient has become undeniably unbearable, then seek help. It is not wise to treat a patient who makes you truly uncomfortable physically, emotionally or mentally. Nurses rarely find themselves in untenable situations, but your supervisor will reassign patients if necessary.
Taming the most harrowing of patients can be challenging, but it is possible once you understand their motives. Having a few helpful tricks in your arsenal will warm them up in no time, provided you remain genuine and professional. Arming yourself with the knowledge that they are afraid and uncertain is an advantage that will help uncover their underlying needs. Remember, patients are not ‘difficult’; they are human. By caring for them the same way that you would care for your own family, you can rest assured that half the battle is already won.