Tips On Handling Unruly Dialysis Patients
Disruptive patients can wreak havoc at freestanding dialysis centers while placing the staff members and other patients at risk. The intended purpose of this article is to discuss techniques on managing unruly dialysis patients.
Due to the rapidly exploding incidence and prevalence of disease processes that harm the kidneys such as hypertension and diabetes mellitus, the patient population at freestanding dialysis centers is growing by leaps and bounds. Unfortunately, some of these individuals behave in ways that sometimes endanger their caregivers and other patients on the unit.
Dealing with unruly patients in a freestanding dialysis center is nothing short of difficult and mentally perplexing for staff and other clients. The dialysis patient can display any number of behaviors that interrupt the flow of operations at the dialysis center, including purposely arriving late for scheduled appointments or failing to show up at all, making false allegations against staff, engaging in verbal abuse, expressing aggression, using illegal substances prior to treatments, and committing physical violence.
According to Hashmi and Moss (2008), healthcare professionals have a moral obligation to deal with the difficult or disruptive patient in a broader context of protecting and promoting the patient's rights and well-being. Moreover, these patients still need dialysis treatments in order to remain alive, so the staff at these freestanding centers must find techniques to effectively deal with this challenging population while maintaining the safety and order on the unit. After all, unruly dialysis patients are not going away anytime soon. In fact, the number of these types of patients will likely continue to increase.
Fortunately, a handful of tips and techniques are available to assist in managing potentially disruptive dialysis patients. First and foremost, handling difficult behavior in dialysis patients needs to be done with the utmost empathy. Staff must place themselves in the shoes of each individual and be cognizant of their personal frustrations over the lifestyle changes that follow dialysis such as strict diet adjustments, fluid restrictions, medication schedules, and the many hours spent on the chair at the center.
Therapeutic communication techniques can go a long way because they let the patient know that staff is hearing them out. Techniques such as restating what patient says and openly seeking clarification of any statements made can be greatly helpful. According to Hashmi and Moss (2008), negotiate a behavioral contract that specifies what is to be done by the patient and the renal team and when. Always be firm and professional when managing a disruptive patient to maintain limits and promote safety for other staff and patients at the dialysis center.
If the patient repeatedly arrives late or demands extra treatments, use a nonjudgmental tone of voice to make him or her aware that this behavior is unacceptable and encourage him/her to formulate a plan of action to prevent future occurrences. Under no circumstances should staff tolerate verbal abuse, threats, or physical violence from unruly patients. If the patient commits an act of physical violence, do not hesitate to contact the local police department. Most importantly, learn about the patient's background and make him/her aware that you are attempting to understand the situation from his/her viewpoint. Show the patient that you care.
We do not provide care to patients because they are nice people, friendly, or make our shifts easier. Conversely, we provide care because we have sick patients who require the skill of healthcare professionals. Recognizing unruly patients, implementing techniques to manage their disruptive behaviors, and reassuring these individuals in a calm and professional manner can improve care while keeping staff and other patients in the dialysis center safe.Last edit by Joe V on Aug 3, '12
About TheCommuter, BSN, RN Moderator
TheCommuter is a moderator of allnurses.com and has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a registered nurse.
Joined: Feb '05; Posts: 38,035; Likes: 69,308
CRRN, now a case management RN
11 year(s) of experience in Case mgmt., rehab, (CRRN), LTC & psychAug 1, '12The problems sometimes arise when the nursing staff does not get any backup from the medical staff, who are rarely there to witness the awful behaviour. Most of these patients put on their 'happy face' when the docs are around.
I worked in 2 units that were backup units for prisons. Sometimes that meant that when these people were released we had to accept them because no one else would. Invariably, the behaviour showed up when the docs were not around. Now there is video monitoring equipment to document what goes on.
We had to institute a written contract for 'no weapons' because of ugly threatening remarks made by some clients. We had nurses who would refuse to work with some of these clients. And not all of the inappropriate behaviour was displayed by clients that had been incarcerated. It just seemed that way.
But remaining calm and neutral in tone goes a long way. And sometimes a little humor early in the relationship is helpful. I became 'friendly' with a somewhat scary individual who was a very snazzy dresser, and I always made it a habit to comment on his clothing. One day he came in with an ugly (in my mind) pair of boots, and I told him so. Everyone around got quiet. He looked at me for a moment and then burst out laughing. He said that no one except his mother ever told him that they didn't like something he wore. But I wasn't one of his posse, so it didn't matter to me. I was never afraid of him at all after that, and always offered to take care of him. He also had the highest serum K of any living person I ever knew!
Thanks for another good article.Aug 1, '12Hi - I'm a former dialysis nurse with 16 years experience. Worked in 2 large hospitals with units and worked for a number of years in freestanding clinics. In the hospital units - there was one unruly patient in one hospital and one in the other. In both cases, we ended up having a security officer sit with the patient during the entire treatment. The first one was dialyzed in a separate room. In the 2nd facility, we did not have an appropriate secondary room, so the security officer sat only a few few away during the treatment. On the 2nd one, he actually tried hit a nurse - but she happened to be a black belt in karate and kicked him. That took care of that problem - After that - we got security.Aug 1, '12You could not possibly pay me enough to work in dialysis. We had a full dialysis center in the hospital where I worked back in the late 1990s, so we cared for the patients on the floor before and after treatments. It was a miserable experience.....for them and for us both. I can't judge too harshly because I know they feel rotten pretty much all of the time; besides, that could be me in one of those chairs one day (HTN, diabetes---take your pick). Thank God for nurses who can handle this population---they need all the care and compassion they can get!Last edit by VivaLasViejas on Aug 1, '12 : Reason: typoAug 2, '12One mistake that I have seen many nurses make is giving unruly patients face time. Sometimes walking away is the best thing to do. If they continue to escalate, end the treatment and kick them out (using police if necessary). Some are just trying to get a rise out of you and by discussing or arguing about their behavior, you are giving them what they wanted....a scene. Believe me, they will respect you a lot more if you don't play the game.
I say this after 8 years of experience in an inner city clinic that has had to install cameras and a door that can only be opened by staff. We have also had our share of armed gaurds sitting at the door....fun times!!!
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