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?

[Bugaloo]

Oh my, this thread could go on forever. I had a hostile patient last night. She was not homeless, but she was 22 with some serious psych issues. I did my best to explain, teach, reason and attend to her concerns, but sometimes, you know that it is going in one ear and out the other.

She was argumentative, hostile, demanding, whiney and just plain dumb. I never lost my cool. I simply stated facts in a neutral tone of voice with a neutral facial expression. She finally had enough and signed out AMA.

She argued with me from time of admission to the time she left AMA (2 hrs and 10 min.) and then I spent 2 hours documenting her 2 hour admission. So meanwhile, I spent over 4 hours dealing with issues regarding her and her issues while my other patients got very little attention!!

Just another day in nursing paradise!

[Chaya, ASN, RN]

This may be totally out of the blue but in my experience , I've had several patients present like that when they came in. I've found if you take a smoker and hospitalize them, they will be generally "antsy" without a patch. Staff may not know they are nicotine deprived. The patient may not even know why he is so agitated, just that he can't sit still and there is almost nothing you can do or give that will keep him comfortable for more than a few minutes. Sometimes they will try to sneak out for a smoke, sneak it in the room, try to get staff to take them out to smoke. Or sometimes it just is overlooked. If no therapy seems to be working and this is a COPD pt living on the street he may well be in nicotine w/d. I've seen the nicotine patch work miracles in this population in 1-2 days.

Or yep, he could just be a miserable person, period. But now I try to assess if nicotine is a factor first.