Every nurse has them—the difficult patients that, no matter what good is happening in their lives, are just really negative with their attitudes all the time. So what can you do to help them and to help yourself, as it’s not easy to deal with so much negativity?
Dr. Jodi De Luca is a licensed clinical psychologist who has been working in hospitals for years and currently works in an Emergency Department at Boulder Community Hospital in Colorado. She’s the “go-to” person, especially when patients are negative or challenging to work with.
“In-patient hospitalization or a visit to the ER can be a threatening and stressful experience,” De Luca explains. “From an emotional and psychological perspective, the visit can be overwhelming.” She says that everything from the loss of control, fear of procedures, fear of death, and the like can terrify patients. “Nurses in particular bear the brunt of the negative behavior.”
It’s important to know how to deal with these patients because they can cause nurse burnout, increase anger and resentment toward the patient, and other patients suffer or can be neglected because all the nurse’s time is spent on this particular patient.
De Luca has some tips for nurses on dealing with these kinds of patients:
1. Setting structure and limits are key.
Be direct when clarifying limitations, particularly in explaining to the patient what is unacceptable and disrespectful behavior.
2. Eliminate the unknown whenever possible.
Knowledge gives the patients power and control.
3. Whenever possible, offer the patient realistic options of care.
By doing so, the patient feels empowered in his/her decision making and may feel validated and more in control. As a result, the behavioral manifestations may be reduced.
4. Ask questions that elicit a sense of control for the patient.
Ask questions such as: What would make things better? What options do you propose? If this option is not possible because of (the reason), but these options are available, which do you think would be best for you?
5. If possible, have nursing and medical staff alternate work load with a negative patient.
This gives everyone a chance to mentally recharge and prevents the negative patient from monopolizing all of your time.
6. Find out what the patient’s expectations are.
Are they realistic? Can they be accommodated? Are there options?
7. Explain to them how their behavior negatively affects their overall well-being and treatment.
When patients are under duress, particularly in a hospital setting, they are often unaware of their own behavior.
8. If possible, have a third party present when you are dealing with difficult patients.
Document not only behavior, but also what the patient states verbatim. Documentation and third-party witness is our best defense particularly with regards to future potential repercussions, complaints, and litigation.
9. Consider engaging the assistance of the Behavioral Health Team at the hospital.
Psychologists, psychiatrists, case management, and social workers can help provide treatment recommendations for the staff as well as the patient and to rule out any other potential contributors to the behavioral disruption and negativity (such as medication reaction, delirium 2nd to metabolic insufficiency, infections, etc.).
After Pamela D. Toler’s book Heroines of Mercy Street: The Real Nurses in the Civil War was published, she began giving talks about nurses during the Civil War as a spin-off. Toler, a freelance writer with a PhD in history and, as she says, “a large bump of curiosity,” is currently working on a global history of women warriors. She took some time to talk with us about Civil War Nurses.
You give talks about nurses in the Civil War. How did you get into doing this?
In some ways, I just fell into the project. PBS was looking for a writer to produce a work of historical non-fiction as a companion for their historical drama, Mercy Street. I had the right skills and was in the right place at the right time.
At the same time, the subject was made for me. I was that nerdy kid who hung out at the local Civil War battlefield on the weekends, learned to shoot a muzzle-loading rifle, participated in living history programs, and read and re-read the biographies of women like Clara Barton, Julia Ward Howe, and Harriet Beecher Stowe. Writing Heroines of Mercy Street allowed me to return to my first historical love: the Civil War in general and the involvement of women in the war effort in particular.
Today, nursing is female dominated. But back then, women had to try and crack into nursing because men were doing it. How did they go about it? How did they break through the male-dominated war and get accepted? Who were the key players?
In the mid-nineteenth century, nursing as a skilled profession barely existed and most people didn’t consider it a job for a respectable woman. Before the Civil War, the Army’s Medical Bureau depended on convalescent enlisted men who were not yet well enough to return to their duties to work as nurses.
Even after Congress approved the formation of the army nursing corps, women experienced a great deal of resistance from Army doctors. They argued that women didn’t have the upper body strength to do the job. They complained women didn’t have the training to do the job—not that convalescent soldiers had any training. They were worried that women would suffer indignities in the rough atmosphere of the military hospitals. And some of them thought that the only women who would volunteer would be husband-hunters.
Civil War nurses won acceptance the only way women have ever won acceptance in male dominated fields: by changing the opinions of one man at a time. The longer a nurse was on the job, the more likely she was to conquer the prejudices of the doctors she worked with. By the end of the war, most army doctors had come to believe that the nurses they worked with were indispensable.
What are some of the most surprising things that everyday people don’t know about these nurses?
At some level, the question is what isn’t surprising about these nurses?
The most important thing is that there were no nursing schools in the United States before the Civil War. With a few exceptions, these women had no formal training as nurses. Most women of the period had some experience nursing a relative or neighbor, but taking care of someone with measles or a broken leg was no preparation for working in military hospital. When you read the letters and memoirs written by women who served as nurses, their first experiences of hospital work often made them ill and sometimes caused them to faint. They learned how to take care of patients on the job.
Every year during the third full week in May, the American Association of Neuroscience Nurses (AANN) celebrates Neuroscience Nurses Week (NNW) to honor all nurses who work in the field. To get more insight, we contacted Allison Begezda, MPS, senior marketing manager of the AANN. What follows is an edited version of our Q&A.
Why was NNW started?
Neuroscience Nurses Week was started to celebrate the nurses who care for the most vulnerable patients and their families. During NNW, AANN thanks our nurses for providing the highest level of quality care to their patients. The week is all about highlighting neuroscience nurses’ influence on patient care to hospital administrators, allied health professionals, and the community.
What kind of celebrations/recognition are held for this week? Why?
AANN encourages hospital administrators to celebrate their neuroscience nurses by providing lunch, cake, a party, or other recognition. We provide an activity planning guide on our website with tips and ideas for planning a NNW celebration. We also have a NNW logo and poster hospitals can print and use.
Additionally, we offer a proclamation template that hospitals can use to alert the media or that their local officials can use to endorse the observance of NNW. Our journal, the Journal of Neuroscience Nursing (JNN), also offers the current issue for free.
AANN has partnered with Jim Coleman Ltd. to offer branded neuroscience nurses week merchandise for sale. Hospital administrators can purchase pens, tote bags, t-shirts, and more for their nurses as a NNW gift. Learn more at www.AANN.org/NNW.
What are the various kinds of neuroscience nurses? What kinds of training or education do they need to have in order to hold this position?
Neuroscience nurses assist patients with brain and nervous system disorders. They work to understand and treat illnesses and injuries that affect the nervous system. Neuroscience nurses work in diverse, challenging, and rewarding environments, such as hospitals, health care clinics, brain injury units, and intensive rehabilitation units.
As for their education, neuroscience nurses have a nursing diploma such as an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) and then must pass the National Council Licensure Examination (NCLEX). After two years of practice (candidate must have at least two years of full-time experience or 4,160 hours in either direct or indirect neuroscience nursing practice during the past 5 years), nurses are eligible to sit for the Certified Neuroscience Registered Nurse (CNRN) exam and upon passing become a CNRN.
While Catherine Browning, DNP, RN, PMHNP-BC, now works at the Arthur Center Community Health in Mexico—well, in Mexico, Missouri, that is—there was a time when she worked overseas. In honor of International Nurses Day, we asked her about her experiences. Here’s what she had to say (what follows is an edited version of our Q&A):
Catherine Browning, DNP, RN, PMHNP-BC, graduate of Chamberlain’s Doctor of Nursing Practice (DNP) degree program
When you worked as an International Nurse, where did you work? When? What did your job entail?
I worked at a Psychiatric Nursing Faculty in Kuwait from 2001 – 2009. I worked at Kuwait University and I worked at the Public Authority for Applied Education and Training’s College of Nursing. My job entailed teaching BSN and ASN students, both Kuwaitis and Arab and African students of varying nationalities. I taught in the classroom, and I accompanied my students to their clinical settings in medical hospitals, clinics, and the state psychiatric hospital. I provided counseling to many people over the years, including many war victims.
Why did you choose to go overseas to work as a nurse?
For as long as I can remember, I always wanted to live and work on the other side of the world. As a child, I dreamed of being a nurse in Africa. Later, I had fantasies of being in the Middle East. I wanted to help people, especially those of other cultures. I knew I could learn so much from them and I wanted to offer what help I could. Though I dreamed of going there someday, that dream seemed far away for many years and almost unlikely to be achieved.
Was I in for a huge culture shock. Not only was the flight a grueling 17-plus hours, but once I arrived to the Kuwait airport, security questioned and detained me for hours. There were signs of military and security presence everywhere. After all, Saddam Hussein had only invaded Kuwait during the Gulf War 10 years previously.
Kuwait University had a rigorous schedule for me to follow during the week of visiting hospitals, meeting with colleagues and students, giving talks and interviews, and touring the psychiatric hospital. I was totally overwhelmed by the language, the heat, the intimidating men in flowing gowns and headdresses, and the somewhat antiquated hospitals. I almost talked myself out of working there and then the second to last day I toured the psychiatric hospital. I was terrified. I kept thinking, “How can I do this? I don’t understand the language. I am not familiar with the culture. How do I know who to trust and how can patients know it’s safe to trust me?” And then I stepped foot on the women’s psychiatric ward, and after that the men’s psychiatric ward, and suddenly I knew everything would be OK. I recognized the client’s symptoms and immediately knew how to interact with them non-verbally. I learned to ask for help, and I felt a great connection with the patients.
By the time I arrived back to America a few days later, there was an email awaiting me saying I was offered the job.
How was working as a nurse different there? What were the biggest challenges of your job?
Working as a nurse in the Middle East didn’t take all that much adjusting. I learned right away that nursing is nursing and the patients we serve and the professional nursing values we uphold are the same everywhere. As long as I remained true to what I know and believe about nursing, I was confident and comfortable in my nursing and teaching roles. The biggest challenge was learning to maneuver through the complex bureaucracy to finally get my housing and my salary and my health insurance set up. Those things took months and that was a stressful time.
What were the greatest rewards?
My greatest rewards of working in Kuwait were:
- Forming amazing, life-giving bonds with my students, their families, and new friends I grew to know and greatly respect and love. The Arab people were so kind and hospitable to me. They appreciated the wisdom and learning I had to share and so often I felt like I really made a big difference in someone’s life.
- Having whole new cultural and travel opportunities in that part of the world. I studied Arabic, listened to lots of Arab music, wore Arab perfume, burned Arab incense, grew to love Arab food, and shaped my life to be more and more like those living in the culture. I loved the hot, dry climate and my health was better than ever before. I traveled during my vacation time to most of the Arab countries. I was so excited to spend time in Egypt, Turkey, Syria, Jordan, Lebanon, Palestine/Israel, and the Gulf countries. I also got to know really well people from Africa and India, and I even traveled to India, which was another dream come true.
- The job provided more holiday time and greater income than I was accustomed to and that was very beneficial for my mental health. Having lengthy holiday and vacation time, in particular, really taught me the importance of resting, renewing, and enjoying life.
As part of National Nurses Week, we wanted to share some stories with you about how nurses have changed lives and gone beyond what some people stereotypically think: that nurses just take temperatures, clean bedpans, and give shots.
Nothing could be further from the truth…
“Healing Touch is an energy healing therapy used by trained nurses to balance the patient’s mind, body, and spirit, which assists the patient in self-healing. Healing touch was very successful on a patient who was screaming in fear and could not fall asleep. The nurse asked me to help the patient. Not only did the patient need sleep, but other patients in close proximity to his room would benefit too. After five minutes of healing touch, the patient was resting comfortably. Within 30 minutes, the patient was sleeping. No shot was needed.”
—Alissa Perrigo, RN, MSN, Largo Medical Center
A Different Perspective
“One of the best ways to connect with an infant is to get down on all fours yourself and see the world from your little one’s perspective. This empathetic response helps connect a young mom to a child’s early developmental processes, especially visual development. Even physically, when you’re on the floor yourself, it is much easier to imagine the strength that is needed for an infant to hold his head up, turn over, or begin to crawl and pull up.”
—Adelmis Granoderoro, RN, Visiting Nurses Service of New York, who helps first-time Suffolk County moms plan for and navigate the first year of their babies lives
Going Above and Beyond
“I recently began working with a nurse who partners with my office through our Accountable Care Organizations (ACO). She was working diligently to arrange home care services for our patient. The patient was discharged from a sub-acute facility and is currently living with her sister in a room. When visiting the patient at her home, the nurse noticed that the patient was unable to clean herself and her sister was unable to assist. The nurse asked if she could assist the patient, but the patient refused. The nurse knew the patient may develop skin breakdown and pleaded with the patient to let her help. The patient still refused.
“The nurse continued to work to arrange for home services for the patient. Each day, the nurse asked if she could come to help the patient until the services began. Finally, the patient agreed. The nurse, along with a colleague, went to the patient’s home to clean the patient. Upon arriving to the apartment, the patient was found lying in her waste. While maintaining the patient’s dignity, the nurse worked for an hour and a half cleaning the patient, as well as changing the linen and the patient’s clothes. Unfortunately, the patient had skin breakdown on several areas of her body. During the visit, the nurse spoke kindly to the patient educating her on what she can do to prevent further skin breakdown. Eventually, the patient received home care.
‘Christine’ went above and beyond the call of duty for our patient, during her critical transition from sub-acute to home care.”
—Melissa Richardson, DNP, RN, FNP-BD, nurse practitioner/nurse manager at Somerset Family Practice, part of Robert Wood Johnson University Hospital and clinical site supervisor at Monmouth University