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.).
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