Ever Had a “Difficult” Patient or Family?

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If you have been in nursing for longer than two days, the answer to that question is a resounding, “Yes!” I think my first encounter with a patient that could be labeled (a bad thing to do, by the way) as “difficult” was in my second day on a nursing unit. Fortunately, he was my only patient (remember that about nursing school clinicals) and I had lots of time to address his many issues. Unfortunately, I didn’t have the skills to set boundaries and attend to his concerns as professionally as I would have liked.

Since then, I hope I have learned some things and gained some skills in dealing with “difficult” patients and families. I believe Dale Carnegie summed it up quite nicely. “When dealing with people, remember you are not dealing with creatures of logic, but creatures of emotion.” I think this is especially true when interacting with patients who are not feeling their best and families that are under stress because their loved one is not feeling his/her best.

There are some tips that can help nurses provide compassionate care to patients and families that are having difficulties in dealing with their health challenges.

  1. Remember the patient is probably not at his/her best. He/she is sick, in pain, and may be dealing with a drastic life change.
  1. The family is under stress. They are facing changes as well. What do we have to do about this situation? What is really going one with our loved one? Who is going to take care of the patient after the hospitalization? So many issues.
  1. Actively listen and critically observe. Lots of times patients and families just need additional information. They may not understand what the doctor told them, what is involved with treatment options, etc. Observe for behaviors that indicate stress. This may include threats, physical as well as legal, the staff or the hospital.
  1. Give the patient/family some control. Ask the patient and family to write down questions and tell them you will come back and try to answer them or get answers for them. Allow the patient to set up his “space” in a way that allows him as much independence as possible.
  1. Act in a caring, compassionate, professional manner. Nurses have many roles—they provide support, information, as well as care. It may be necessary to set boundaries so other patients are not deprived of needed care.
  1. Document relevant events, interactions, or observations. This is protection for both the hospital and the nurse.
  1. Seek assistance from supervisors or nurse managers—especially if things seem to be getting out of hand. It is always appropriate to ask for help when a nurse believes a situation has gone beyond his/her capacity to manage the problem.

Hopefully, the encounters a nurse has with “difficult” patients and families are minimal. But, it is better to be prepared than not. If you want to travel with a company that really cares for its nurses, contact us at www.pprtravelnursing.com. We would love to talk to you.

Ruth R. Stiehl, Ph.D., R.N.

Vice President, Clinical Quality