How to Handle Difficult Patients
Published on the 05 October 2016
Published on the 05 October 2016
Most nurses live for their patients (see Communicating with patients). It is usually the patients that make the sore feet, paperwork, and hours without a bathroom break worth it. However, not all patients are rosy, happy people, and sometimes they can truly test a nurse’s compassion, patience, and communication skills.
If difficult patients are not managed properly, it can make it increasingly difficult to communicate with a patient’s friends and family about the patient’s actual care needs as well.
Whether you encounter a patient who is angry, manipulative, demanding, or downright nasty, sometimes these patients can make you question why you became a nurse in the first place. All it takes, though, is that one patient who sincerely says thank you, for you to remember why you are there. You can handle the difficult patients with a little forethought and tactics.
It just takes another step of education to diffuse these tense situations and come out of the encounter with your compassion intact.
Someone who is acting angry may simply be frightened, defensive or resistant to what is going on around them. It is important for a nurse to take a step back from the patient who is angry and ask themselves what is really going on. If the patient is actually frightened, then you will have to approach them differently than if they are truly angry over something, such as a long wait time. Even anger over a long wait time can mask a fear of not knowing what is wrong with them. The best course of action is to carefully interview the patient to draw out what they are feeling. Use reflective statements, such as “I can understand why you feel that way,” and try to discuss possible solutions with them.
Manipulative patients are the ones who threaten, cajole, cry, or throw temper tantrums in an attempt to get their way. These are patients that you cannot talk to. They simply are stuck on their version of events and will not budge from their beliefs. A manipulative patient will do all they can to convince you to call the doctor for more pain medicine, give them special treatment, or otherwise do what they demand. It is important for the nurse to calmly recognise their own feelings when dealing with this type of patient and not let emotions overwhelm them. Manipulative patients are often looking to engage you in a heated argument.
When dealing with difficult patients, it helps to watch your language as closely as possible to prevent the situation from escalating. Usually difficult, angry and manipulative patients will attempt to draw you into a shouting match, pull on your own angry emotions, and attempt to bait you into becoming verbally aggressive. You have to first calm yourself and take stock of your own emotions. Then you need to address them calmly, avoiding so-called “negative language”. This is language that makes the patient seem careless, such as, “You neglected to,” which indicates they are lying, “You say that,” which makes the person seem less intelligent, “I fail to understand how,” and demanding phrases such as, “You should.” These language gambits can lead to an escalation.
A more appropriate approach would be positive language, to deescalate and defuse the situation, and give the patient no opportunity to overreact.
For instance, you could say, “It seems you have a different viewpoint on this situation. Let me explain our position”. This statement allows the patient to be heard and allows you to state your side of the argument. Another good positive response is, “Might we suggest to you…” or, “An option open to you is…” This allows the patient to know what their options are in a non-threatening manner.
Your body will tell the story of your emotions far better than your words do. If you are seething with anger and attempt to use the above positive responses, yet you are wound tighter than a drum, the patient will notice. They are more likely to respond to the message that is coming from your body cues than your voice cues, and that is why it is important to relax and control your body in a heated situation. Eye contact is important, and it conveys honesty and openness.
However, don’t stare down the patient, as this may seem aggressive. Aim for eye contact around 60 per cent of the time. Cool your facial expression to keep from grimacing, twisting your lips, pursing your lips, lifting your eyebrows, or scowling. All of these will be read by the patient as a sign of dishonesty. Keep your hands and arms placed in front of your body, but not crossed as this can seem confrontational. Finally, don’t get too close to the patient because that can be interpreted as invading their space and instigating aggression.
We have all had those patients. Nearly every nurse has experienced a patient shouting at them, berating them, and telling them where to go.
Occasionally, those moments escalate into pure aggression on the part of the patient. Your patient may throw things at you, spit at you, or physically try to attack you. It doesn’t do much for a nurse’s morale to face this sort of patient, but if you are in nursing long enough, you will find a patient who becomes aggressive with you.
You can deal with aggressive patients by remembering some simple rules, but you should also consider how an aggressive patient impacts you emotionally. Nurses are harder on themselves than anyone should be, and you may expect yourself to “roll with” the abuse you regularly take from patients. This isn’t actually the case, and it can be quite detrimental over time.
Let’s face it, nursing is already stressful. You have to worry about patients, getting all of your documentation done on time, and not making a crucial mistake when a patient needs you. It almost seems unfair to add on defence against aggression to a nurse’s already full plate. Worrying about a patient who is going to yell at you – or worse, hit you – makes nursing seem like a much more difficult job than it is. Some nurses may feel that they have personally failed when a patient acts out against them. It isn’t a reflection of the nurse or their skill in handling patients. It is merely another symptom of the patient’s disease that requires medical attention.
Sometimes, a nurse can feel like it is too much. When patients are demanding and descend into aggression, it just may be a breaking point for some nurses. In these situations, it is important to express your feelings to a trusted supervisor, and possibly consider using the employee mental health services provided by most facilities. Your fear of an aggressive patient can colour the way you care for certain patient types. For instance, maybe an older woman lashed out at you, and now you feel that all older women are going to be difficult. This is not fair to you or the patient, and you should seek out help to sort through your feelings when you encounter aggressive patients on a frequent basis.
Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions.