A nurse will care for hundreds, maybe even thousands, of patients in his or her career. Some of these patients and their family members will be such a joy to work with. They will leave a positive, long-lasting effect on you. There will also be a fair number of patients and family members who appear to make it their personal mission to make your life a living hell. Some individuals may become so belligerent that they threaten your personal safety.
What is a nurse to do in these types of situations?
The best approach to dealing with difficult and possibly aggressive patients and/or family members is to nip the problem in the bud before the situation escalates; “consider their perspective”, “check your bias”, and “therapeutic communication” will discuss tactics to avoid an escalation in the patient or family members aggression. It can be very taxing dealing with these types of patients so “recruit help” and “ignore unnecessary remarks” will cover coping mechanisms for a nurse dealing with these patients. Finally, “aggressive patients” will briefly cover what to do if a patient becomes aggressive and threatens your safety.
Situation Dependent:
This is a disclaimer of sorts to say that the actions you take when dealing with difficult individuals will heavily depend on the situation. There is not a one size fits all solution. If at any point you feel your personal safety is at risk, you should call for reinforcements and remove yourself from the vicinity of the individual.
Consider their perspective:
This is important but can be difficult to implement. However, I firmly believe if you practice this frame of mind you will dramatically improve your attitude and quality of nursing care. In all honesty, this is something all nurses should practice with all their patients on a regular basis.
Take a moment and consider the perspective of your patients and their family members.
Imagine how they are feeling during this difficult time in their lives.
When an individual is in the hospital they often feel as if they have no control.
Patients who are hospitalized are told what they can eat and when they can eat it.
If they require assistance with toileting, they must rely on nursing staff to help.
They are given medications they have never heard of and may not fully understand.
They are being poked and prodded at all times of the day and night.
They may have tests run (such as an x-ray or MRI) and will have to wait for what feels like an eternity to find out if they have any abnormalities.
In more serious cases, individuals may be facing a terminal illness or the possibility of death during a major surgery.
All of this causes many individuals to feel stressed, scared, angry, anxious, etc. These intense feelings often cause these individuals to act out in ways that they normally wouldn’t.
If you can consider why it is that patients or family members are acting “crazy”, then you will have an easier time managing them.
Considering their perspective does not mean you are letting them off the hook for being rude or inappropriate. However, it will allow you insight on how to better handle them on an individual basis as opposed to using a general approach.
Check your bias:
This is another important yet difficult to implement tactic that nurses should practice with all patients.
All of us have biases that can affect how we interact with people. Some of these biases can create a more meaningful relationship with some patients (for instance, you and a patient may bond over your mutual bias that right Twix are better than left Twix). However, often times biases can lead to strain on the nurse-patient relationship.
I have witnessed many nurses who perceived a patient or family member as being difficult and overbearing when the reality was quite different. We can not always control our gut reaction to certain situations or requests; however, we can evaluate our reaction and act accordingly.
For instance, a nurse may believe that a patient and their family is being “difficult” or “needy” because they continue to call the nurse for little things such as new linens, fresh ice chips, a new gown, a cup of pudding, “can you move my pillow a little to the right? No… a little more to the left”, pain medicine, nausea medicine, etc.
This nurse may be willing to do these tasks for a patient who they jive with (the aforementioned patient who also enjoys right Twix) but may dread doing these tasks for another patient who they don’t get along with (a patient who *gasp* likes left Twix). In this situation it would be best for the nurse to evaluate why she is feeling so peeved with the “needy” patient and their family and aim to improve her outlook on the situation.
It is especially important to check our biases as nurses whenever a difficult patient is being confrontational in order to avoid further escalating the situation. When a patient is being belligerent you will need to focus on the issue at hand and avoid letting your biases get in the way of finding a solution to the problem.
Therapeutic communication:
One of the biggest mistakes you can make during a confrontational situation with a disgruntled patient or family member is to become defensive, rude, or aggressive. I know you may be screaming on the inside and want to give someone a big ole sucker punch…but don’t do it! Also, avoid starting a yelling match. Try to remain calm and use these tactics instead.
If a patient or family member is upset about something, then let them express how they are feeling about it. Obviously, they need to remain respectful during the conversation but allow them to vent a little. Use this time to listen to what they have to say and limit any interruptions or rebuttals.
Allow the patient or family member to vent and listen to their concerns. Attempt to avoid brushing off certain concerns because you believe they are being irrational. Remember, their outbursts may be coming from a place of fear.
It is also helpful for individuals to feel that their feelings are being acknowledged. You can achieve this by saying things such as “I can see that you are upset about having to wait all morning for a bath. That must have been very frustrating for you.”
Doing this allows the patient to see that you understand and acknowledge their situation. It may also be appropriate to offer a sincere apology if the patient has experienced an unfortunate event. It can be as simple as saying “I’m sorry you had to experience [insert unfortunate event].”
In order to work towards a solution, you will have to consider the individual needs of the patient and their family. Include the patient in the decision-making process so they are an active participant in finding a solution and feel as though they have some control.
Recruit help:
If you find that you are becoming exhausted from continuing to appease a patient or family member, then it may be time to call in some backup. Hopefully you have a CNA or fellow RN or LVN who can help ease the burden of the overbearing individual.
A good approach would be to coordinate with your CNA and delegate tasks that they can complete in order to prevent you from having to handle all the patient’s requests. If you have a buddy that is willing to help with RN tasks, then you could also ask them for help.
You can also consult your charge nurse if you feel the situation is continuing to escalate and feel that you need them to help facilitate a conversation.
You don’t have to deal with these difficult patients or family members on your own. In fact, if a patient appears to exhibit any sort of aggressive tendencies, I would highly recommend getting higher management involved and notify security of the issue.
Ignore unnecessary remarks:
If you try all the previous tactics and still find that a patient or family member is continuing to be the bane of your existence, then it may be time to turn on your “selective hearing” ears. This does not mean it is time to ignore requests from your patient; we still have a duty to provide nursing care to patients despite their attitude.
What I am referring to is the practice of ignoring comments from patients and family members that do not provide any value to the situation or that are rude and inappropriate.
With your “selective hearing” ears you choose to not acknowledge a patient saying, “It took you long enough” or “You’re not doing that right” or “Do you even know what you’re doing?” or “I bet your husband doesn’t like you” (that last one is a personal favorite of mine from a patient I took care of years ago). These comments could really continue to nag at you if you choose to acknowledge them.
However, you are choosing to focus our attention elsewhere and essentially let these comments roll of your back. You do not have to have a response to every little thing that your patient or their family says. You can choose to turn the other cheek and focus on providing adequate and appropriate care for your patients.
Aggressive patients:
It is important to note that not all difficult or rude patients will become aggressive. You may have a patient or family member who yells obscenities at you but would be appalled at the idea of physically harming you. However, there are an increasing amount of healthcare workers who are experiencing abuse from a patient or family member, so I wanted to take some time to touch on the subject.
An important factor in handling aggressive patients is recognizing when a patient is becoming aggressive. Individuals will often show signs that they are becoming increasingly aggressive so pay close attention to non-verbal cue.
In this type of situation, it is suggested to use “de-escalation techniques” in order to diffuse the situation and find a solution. Vivid Learning Systems Inc. has a good training page on how to handle these types of situations so go check out their information if you want more information on how to act in this type of situation.
It is not easy to deal with difficult patients…that’s why they are deemed difficult. However, with a little bit of practice and experience you will learn how to navigate these situations a little bit easier; I hope this information helps you along in that process.
Happy Nursing!