Hostile and demanding patients. How do you handle them?

[Virgo_RN]

My recent experience with a hostile and demanding patient got me thinking of ways I can improve the way I handle these patients in the future.

This patient was a homeless man with a history of chronic pain, uncontrolled diabetes, COPD, and MRSA, currently being worked up due to his presentation in the emergency room with complaints of dyspnea and abdominal pain. The man is getting every diagnostic under the sun, and is on scheduled and PRN pain medications.

He is rude and demanding. Constantly on his call light and will come seek out his nurse to demand pain meds. Accuses staff of lying to him and withholding his pain meds. Doesn't even know what medications he is on for other conditions, but thinks he knows what time he gets pain meds. When he thinks nobody's looking, the man has a RR of 8, but as soon as he knows someone is looking, of course it's 16. So, we try to explain to him that the PRN medication is not *scheduled* for every two hours, but that two hours is the minimum amount of time we have to wait between doses, and that if he is too sedated, we cannot give him more. He insists that he is supposed to get the pain med every two hours. In the meantime, he is nodding off in bed.

How do you reason with someone like this?

[maelstrom143]

Yes; I once had to take the mars to the pt to show them the veracity of my claims...lol. I thought she was the cutest little old lady, though, so I just had to laugh. I also make sure I let them know that prn is meant for their safety as too much of a good thing is not always good and let them know how important it is to get them back to feeling good again. They (so far) have appeared to appreciate our staff's care of their safety in that regard.

[Virgo_RN, BSN, RN]

Just an update. I had the patient today, and he was much more cooperative and almost pleasant! I killed him with kindness and let him know the specific times I would be back to do what. I even caught him watching one of the hospital videos about diabetes management!

[UM Review RN, ASN, RN]

NancyNurse08 said:

Just an update. I had the patient today, and he was much more cooperative and almost pleasant! I killed him with kindness and let him know the specific times I would be back to do what. I even caught him watching one of the hospital videos about diabetes management!

Cool beans!! That's what I call real nursing! It really is an art to quickly develop a trusting relationship with a patient that will help the patient cooperate with his treatments and motivate him to get better.

[Sabby_NC]

NancyNurse08 said:

Just an update. I had the patient today, and he was much more cooperative and almost pleasant! I killed him with kindness and let him know the specific times I would be back to do what. I even caught him watching one of the hospital videos about diabetes management!

Awesome to read this and thanks for the update.

[maelstrom143]

NancyNurse08 said:

Just an update. [...]

Outstanding. I am so happy for you. Thanks for the update.

[EmmaG, RN]

NancyNurse08 said:

Just an update. I had the patient today, and he was much more cooperative and almost pleasant! I killed him with kindness and let him know the specific times I would be back to do what. I even caught him watching one of the hospital videos about diabetes management!

Cool.

But doesn't it kinda makes you want to say "Who are you and what did you do with ___ ?"

[jlcole45]

Angie O said:

Cool beans!! That's what I call real nursing! It really is an art to quickly develop a trusting relationship with a patient that will help the patient cooperate with his treatments and motivate him to get better.

I totally agree! Sometimes these patients just need to feel like they are being treated like a person! Once the gossip mill starts about a difficult patient and/or family, it's hard to get past it, regardless if its true or not. Perhaps I'm more tolerant then other folks, but over the years I have often found other's assessments often do not to match mine once I have the patient.

I get report and the nurse says "this family, or this patient is driving me crazy, blah blah ..." I go in, I act like my usual self I.e., kill'm with kindness, explaining what I am doing, answering their questions, smiling (it's amazing how much a simple smile and kind word can make or break their day), setting limits if necessary but always asking before I leave the room "is there anything else I can do for you?" etc... and I find that 9.9/10 times they respond and I don't have near the problems that were reported to me.

I'm so glad you had a better shift with him and I am sure you made his day as well. Believe me patients can pick up if the nurses don't like taking care of them and of course this only feeds fire to the fuel of bad or attention seeking behavior.

[truern]

"Hostile and demanding patients. How do you handle them?"

With wrist restraints X 2 and 5 of Haldol...

Seriously, though...most times they're just scared and need some TLC...or what I call "Teresa Treatment".

[Katie82, RN]

When I worked as a case manager for Medicaid in Baltimore, I had many homeless patients, and you have just described most of them. His primary reason for being in the hospital is pain medication. The abdominal pain complaint might mean he's new at this, most present with complaint of chest pain because they are almost assured admission and pain meds.... Some of these folks are "cheekers", they will take the pill and put it in their mouth, then spit it out after you turn your back - pain pills bring a lot of money on the streets. You cannot reason with your patient, you can only firmly, but respectfully, say NO.......

[showbizrn]

Give him cool-headed, deadpan, textbook/facility rules/regs with repetition, repetition, repetition!

Sure he'll get nasty.

Sure he'll get frustrated and might hurl some florid profanities at you.

The trick to the nasty ones is to keep it professional!

Believe it or not, the patient "tires out after a while"---it's too much energy and after all, the patient is sick and you want to maintain your professionalism.

Never fight fire with fire!

Water works better!

[banditrn]

Sabby_NC said:

Hostile and demanding patients. How do you handle them?

With Care.

You never know which way they are going to go.

For some reason I like handling difficult patients. I like to get to the bottom of their behavior and actions.

I always will speak with the Doctor if their pain medication is not holding them for as long as it should. Sometimes we just need to add an adjuvant to the opioid to calm or settle the patient down.

Take care and continue giving them the care they all need and deserve without any prejudices getting in the way. Yes it is hard but we are better than that eh?

At the hospital, when I worked in ICU, that was considered my 'specialty' - difficult patients or families!! I used to get a little disgusted sometimes to know that I was probably going to be the one to get these types of people when they showed up, but I knew my nurse-manager depended on me to do the best I could.

I did consider it a challenge, tho, to be able to find the right way to deal with different personalities. Each person got a different treatment - with one I might joke around, with the next I might be all business. One person might be 'babied' a little, while with the next, I would insist that they try to do things for themselves. It's kind of hard to explain.

It all worked out tho, and I never got complaints, and frequently would get written notes thanking me for my care.

I considered education to be a big part of my job, and would try to do a little each time I was in a room.

[chadash]

TheCommuter said:

If I could get away with it without any consequences or disciplinary action from management, I'd tell all of my abusive and demanding patients that "You have other options and if you don't like our facility, you are free to pack up and go to another place. I'd really wish you'd seriously consider this option."

Ooops, do you mean I should not have said that?