WORK
September 30, 2015

Dealing with Difficult Patients

Just like any profession that involves dealing with the public, nursing can mean working with people that are difficult in a manner of ways. You can run into all reactions including defensiveness, anger, fear, demandingness, hysteria and a whole list of other things And that’s just the patients, not the families that you need to work with and work around.

Add in medications or diseases that can cause confusion, drowsiness or agitation, and it’s a whole new ball game of trying to give the best care, professionalism and empathy. But there are useful strategies in handling the unrelenting, frustrated, unpleasant or uncooperative patients.

“Sometimes, those working in the health care industry get desensitized. You do things over and over again. But you need to really look at how you are interacting with those around you,” said Kathleen Bonvicini, executive director of the Institute for Healthcare Communication in New Haven, Conn.

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The organization offers the workshop “Difficult Clinician-Patient Relationships” to help all types of health care professionals a chance to understand how to improve these sticky relationships.

“We all have our internal biases. We all have those moments that the hair on the back of our neck goes up because of certain patients,” she says. “Or we might have come to work after having a fight with our spouse, or we haven’t had our morning coffee before we have to see a patient. It can be anything, and that leaks out sometimes in our body language.”

For whatever is going on and whatever type of patient you are dealing with, there is a way to handle the situation. Here are what the experts say to do with certain patients and situations:

Is it Them or You? -- Figure out if it really is the patient or something that is coming from within yourself and your life.

“It’s not always about the patient. There might be a lot of things going on at work that create a perfect storm,” says Bonvicini. “It could be something about a patient that reminds you of someone you don’t care for in your person life.” She suggests you excuse yourself for a moment. Take a deep breath, and think to yourself, “What am I bringing to the table?”

Read tips on reducing workplace stress as a nurse here .

Acknowledge the situation – Sometimes, you just have to speak out loud about the tension. Say something like -- “I feel like we are getting off on the wrong foot.”

Ground Yourself – Whether it’s yoga, running or some other exercise, nurses need to ground themselves and have better self-care.

“Whatever you do outside of your job for stress release can help keep you more centered and more together mentally,” Bonvicini says.

Look through a Patient’s Perspective – If a patient is screaming at you or getting angry, it might just be their fears coming out, says Charlene Berube, chair of the undergraduate nursing program at Simmons School of Nursing and Health Sciences in Boston.

“My belief for many people is that either their best or worst self presents itself at that time of a health concern. You have to remember that this is their experience that is the focus and not your own,” she says. “By having a conversation about their temperament and where it is coming from can help.”

Let Them Tell Their Story – Providing an opportunity and the time for a patient to tell their story and delving into how they have come to this point can help their distress, Berube adds. If they are emotionally distraught, console them and give them the time and space to express their psychological and emotional needs.

Avoid Defensive Posture – “It’s not about me. It’s about the patient,” says Berube. “This kind of thinking has helped me through many situations. Refrain from thinking about your feelings.”

Don’t blow up at them because of your own frustrations.

Find Opportunities for Empathy – “The most powerful skill a clinician can have is genuine empathy,” Bonvicini states. “If their eyes are tearing up, you hand them a tissue. It can go a long way. It makes the patient feel as if you are really trying to understand them and that you care.”

Set Boundaries – If someone is using profanity at you or screaming at the top of their lungs, you should set limits, Bonvicini explains. Say something like, “There are certain things that we allow here, and in order to continue to talk to you, you cannot use that language. I will step out of the room for a while to give you time to calm down.”

Realign Your Body Language – “When I start to get frustrated because I’m not making progress with a patient, I take little breaths,” Barube says. “We both need to refocus at that time. If the patient is becoming demanding, and I’m getting frazzled, those energies need to be refocused. And when you do that, your body language realigns.”

Find Extended Help for Patient – If you feel something else is needed to help this patient through their anger, emotional breakdowns or other difficulties, you can suggest finding a social worker, hospital chaplain or someone else for them to talk to. This needs to be handled very gracefully and sensitively so they don’t feel abandoned by you, Bonvicini says.

“Remember that you can’t be all things to all people,” she adds. “There will always be difficult patients.

Patients come to nurses with mental health issues, mood disorders, depressions, anxiety and a host of other complications. They have lives or lifestyles that you may not understand or even agree with.  But none of that matters.  Each patient deserves the best nursing care you can give them. Remember that you need to find the calm in yourself, be objective and be honest with them. Showing empathy and giving them your undivided attention and time could make a big difference in their attitude and soften those hard edges.

Had enough with your current position?  Ready to find a nursing opportunity better suited for your personality? Start your search now on the nation's largest job board for nurses .

Lee Nelson of the Chicago area writes for national and regional magazines, websites, and business journals. Her work has recently appeared in Realtor.org, Nurse.org, Yahoo! Homes, ChicagoStyle Weddings, and a bi-weekly blog in Unigo.com.

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