difficult patients

Posted
by dlrrn2010 dlrrn2010 (New) New

I'm a fairly new nurse who has encountered a difficult patient. She has a bipolar diagnosis but is in my facility for rehab. She is in pain from RA with contractures. She questions all actions of the nurses and stna's. I'm opening this up to get suggestions on how to deal with this type of patient!

merrick

merrick

Specializes in Psych Charge RN/ Med Surg/Float Nurse. 44 Posts

I work in psych so I deal with this type of patient a lot. Bear in mind that she has a mental illness as well as a painful debilitating physical one. That combination is not usually going to make for an easy, pleasant patient. My advice would be to not take anything personally and try not to engage in power struggles. Do what you can within your ability and that's all you can do. Try to remain calm and not feed into the negativity. Remain matter of fact and let her know what her choices are and that that is all you can do.

dlrrn2010

dlrrn2010

12 Posts

i let her know that if she wanted a different nurse that was her right...she questions my fingerstick method for accuchecks, my eyedrop method, etc....it's a control issue and i want to help her and let her be in control as much as possible but it's becoming rediculous..

Davey Do

Specializes in Psych (25 years), Medical (15 years). Has 43 years experience. 1 Article; 10,115 Posts

Good move, dlrrn. Gathering data is an important part of the problem-solving process.

She questions all actions of the nurses and stna's.

Often times, we have to check our own attitude when we experince certain emotions as a result of a patient's actions. For example, it's a Patient's Right, and in most cases responsibility, to question their treatment. Often times, we PERCIEVE their questioning as a type of challenge, and we react defensively, as if our actions are under critical scrutiny.

When we realize that we can never change someone else, yet can change our perception, we then understand that we do have some power and control over a situation: How we react to a stimulus. And how we react to that stimulus is up to us. Merely answering questions to the best of our ability is really all we need to do.

Okay, in reality, some Patients just get on our nerves. That's probably just a good time to act the part of a competent, empathetic Nurse. Just do your job and answer the questions in the most appropriate manner possible, sometimes while biting the bullet.

My :twocents:, thank you.

Dave

gettingbsn2msn

gettingbsn2msn, MSN, RN

Specializes in medical surgical. Has 5 years experience. 610 Posts

Just be kind to her. I know it is difficult but it will be easier for you just to smile. Maybe no one has been kind to her for a long time. Also give her choices and that will help with her control issues. For example, ask which finger she wants you to stick if you are checking BG. Ask which arm she wants her insulin shot in. Ask her what helps to reduce her RA pain. You get the picture. We get lots of these patients and kindness goes a long way.

mentalhealthRN

mentalhealthRN

433 Posts

He behavior does not come accross as having anything to do with her bipolar dx. Are you seeing signs of mania or of depression. Someone being "moody" is really not part of the dx. This behavior, to me, comes accross as more what we might see with an Axis II dx such as borderline personality disorder. However this could also just be her own personality. Being patient with her and explaining that she may do things differently and each nurse may do things a little bit differently but that you can assure her that she is being taken care of. Acknowledge how difficult it is to have others in control of her care when she is used to doing things for herself at home but that she can be assured that all of the staff is there to be sure she is well taken care of. It is not easy for some patients to feel a loss of control of their own health/care and they often times over compensate out of the anxiety this feeling creates for them. If there are things that maybe you could allow her to do herself this can help. Some units will allow a pt who is used to doing their own BG check to do it themself on the unit--yes with the nurse there supervising the entire process. Or even after drawing up the insulin letting the pt administer it to themself witht the nurse there and watching closely. I have worked in a couple of places where this was allowed. Think of times when a nurse may work with a patient newly dx with DM to assure that they are able to do the BG check and draw up and administer of the insulin as part of the pt teaching for d/c. We want them to be able to do this for themselves when they go home. So as long as the pt can do it safely with supervision what is the problem? Usually if you talk to the doc and the doc feels this is appropriate for the pt they will write this as an order for the nurse to monitor closely and the pt to test or give the insulin injection. This kind of thing can help a lot in giving a pt back some control of their care when they are really struggling and this is causing a problem. As long as you are professional and can deal with her in a kind and respectful way while letting her know that you need to do your job in a firm way it can be effective. Its all in how you package it. Being empathetic goes a long way.

MouseMichelle

MouseMichelle

Specializes in Home Health/Hospice. Has 16 years experience. 192 Posts

Go to your happy spot, and answer her questions, before you enter the room take a deep breath knowing you're going to get asked a bijillion questions and just bite the bullet.

that's how I deal with patients like that :)

Michelle

mama_d

mama_d, BSN, RN

Specializes in tele, oncology. Has 10 years experience. 1,187 Posts

I find that chanting "she has a mental illness, she can't help it" helps me sometimes. I'm sure my crying jags when I was in the throes of depression were no fun for my family to deal with, but I truly couldn't stop myself at that time...I figure it's gotta be the same with some of these folks. Even if they are able to recognize that their behavior is out of control, their psych diagnosis could easily be preventing them from being able to alter their behavior to a more acceptable level.

We also tag team when we start getting frustrated. Of course, we present it in a way so that the pt doesn't know that's what's going on..."Jane is tied up in another room right now, and I have time to help you to the bathrrom instead. Is that OK with you?"

Dalzac

Dalzac, LPN, LVN, RN

Specializes in CCU,ICU,ER retired. 697 Posts

The patient has already lost control of her body and having the pain as well can be very depressing. Maybe the way she acts is her only control of anything

dlrrn2010

dlrrn2010

12 Posts

thanks for all the info....I've tried most of your comments, even offered to let her do her own accucheck but she declined...My STNA and I tag teamed and she was a good distractor so I could administer all the meds..I think that's what we will keep on doing for right now. Glad to hear your comments and know I'm on the right track! Thanks:yeah::)

kids

1 Article; 2,334 Posts

i let her know that if she wanted a different nurse that was her right...she questions my fingerstick method for accuchecks, my eyedrop method, etc....it's a control issue and i want to help her and let her be in control as much as possible but it's becoming rediculous..

Get an order for her to self administer her eye drops and do her CBGs with nurse supervision. Give the lady back some control of her life. (I've always wondered why we don't allow patients to do what they can for themselves).

steelydanfan

steelydanfan

784 Posts

Give her choices as much as possible to take away the resistance.

If you tell her "We need to do your FSBG between 11-12:00, what time do you want it?, it saves her arguing about WHY it needs to be done at all. Distraction, just like you did with your STNA

Perfect choice of interventions, keep up the good work.