How do you deal with an angry/anxious patient?

venz · Apr 18, 2005

I just want to say hello to everybody.

Nurse Ratched, RN · Apr 18, 2005

It's good that you're trying to be introspective and wonder if there is anything you can change to have angry pt's interact with you. Certainly we can do very little to change how others act - only how we react to it. Some people are just angry and you didn't do anything to invite it. A *lot* of people don't tolerate being ill very well, and you didn't do anything to invite it. Since it's harder for those of us who don't know you personally to judge your interactions with pts, is there anyone you trust at your workplace to give you some thoughts?

Personally, while I'm not necessarily a confrontational person, I do believe backing down from a bullying person just encourages them to continue with inappropriate behavior. I generally walk in room, introduce self, and if known angry pt starts in with some insulting comment because 'all you idiots do' (whatever thing.) Smile sweetly, ask pt if you personally have done anything to offend them in the three seconds you've been in the room? If no, ask for the latitude to at least be allowed to make your own mistakes and be credited for them. I like humor. Doesn't work with everyone and you have to be careful in how you use it. I've had a certain degree of success with referring to an obviously ridiculously irritable pt as "Mr. Crankypants." Pt starts blasting you the second you walk in the door for your initial look at him, "Whoa there a second Mr. Crankypants, you've clearly mistaken me for someone who has actually had time to annoy you. Since we just met three seconds ago....." Either it defuses them or not, but they're probably no more angry than when they started . Keep smiling. It's nearly impossible for someone to keep up an argument with another person if the other person refuses to play along.

I've also been known to be a little intentionally childish - if someone is being deliberately insulting with no grounds for it, I've stuck my tongue out at them. It shows them that that's the only way I can argue with them on their level. It rarely fails to stop the person or even make them smile. Works particularly well with older people in my experience.

Sometimes you just have to have a 'come to Jesus meeting' with someone - x behavior is unacceptable, I realize you're ill but that doesn't give you the right to be mean, and how are we going to learn to get along? Sometimes just being very direct brings out the real issues someone is dealing with.

KatieBell · Apr 18, 2005

Well, it may be simple, but I have had definite success, with a very direct approach. I work in the ER so I often have very upset and angry patients. I usually say, "Wow, you are really upset, what's going on?" and then I just listen, I try ot sit down, because they say that if you sit, people think you actually spend more time than you did...

Then I say, OK, I understand and here is what I can do to help you. #1 I am going ot X,then Y then Z.

Asking What can I do for you works, but it is more risky, as there are a lot of things we can not do as nurses...much better to listen and let the person blow off steam and then summarize any non ridiculous complaints and try to do something about it.

for example: Mr Jones complains he is hungry, needs a urinal emptied, and has had pain for 6 hours and "no one is doing anything about it, and no one cares about me, you are all stupid, and can't do anything right."

I say, "Wow, you have had a really bad day. Here's what I'm going to do. I'm going to empty your urinal right now, then I am going to see what I can do about your pain, and also check on a snack. We have juice and pudding and cheese sandwiches, what would you like?" Now Mr. Jones has to refocus on what food he wants rather than irritating you.

Sometimes I do use humor, saying, well, we have juice and milk, but no dancing girls... but again, this only goes if you have a good feeling about the person.

The other thing I do which is annoying to me is that I make sure that person always has a call bell and that whenever possible I answer it immediately. Most angry people are scared and may feel a bit abandoned. I find once I answer the bell a few times promptly (when possible!!!!! some days you know!), they stop calling so much. The other option is to force yourself to actually step into the room uncalled and ask if there is anything you can do for Mr. Jones at that time. It is a huge surprise for them, and generally gets them when they are not already riled up....

But these patients are not really that much fun no matter what, they require a lot of patience...

Sooo, good luck!

z's playa · Apr 18, 2005

I just want to say hello to everybody.

Hello...welcome to allnurses. :balloons:

Maybe one of our moderators can re post this in the INTRO section so this person can get their proper greeting?

Z

sorry...back to the topic.....

tiroka03, LPN · Apr 19, 2005

Thanks for your helpful answers. This particular situation was hard because I am orientating a new place. I didn't want to be to direct on my first day there. I wish now I had been.

Even if it hadn't worked, I would have felt better about it. I am not naturally a really direct person, I would run from conflict if I have half a chance. I really appreciated your answers and hints. I will try them from now on, of course knowing each situation is unique.

PicklesRN, RN · Apr 19, 2005

...But no matter how I try, it seems these angry people that a personal interst in harrassing me, or singling me out. As far as I know, I am not doing anything to antagonise these people more. ...

I really do relate to what you say, I've been there. While it was happening I honestly, sincerely, truthfully had no idea what the problem was but I knew it had to be me because these same people didn't seem to have a problem with anyone else.

I think you have to learn to read people. Over time I have really worked on that skill to a large degree and it has paid off. In the beginning people were complaining about me, today they think I am the greatest thing since sliced bread. It is all because I learned to read people and I can walk in the room and 99.9% of the time I know how far I can push. I know who I can kid around with and I know who I have to be extra ultra professional with. The way I start off when I have someone who is nasty, pissy, and angry is I imagine myself in their bed dealing with their medical issues. Then I try to consider how I would feel and what little tiny things would make me feel better. One 50'ish person was a retired doc and dying of CA. It was the kind of hit and run CA, by the time it was dx'ed it had run it's course and even if found early it wouldn't have helped anyway. The guy was going to die.

In *his* case he needed to be angry and tell someone. His family was begging for miracles, nobody knew what to say so everyone avoided the obvious. This man would die, period. And it would happen soon. He was angry, not at me but at the fact that nobody would talk to him about it. When I asked him how he was he snapped, "Dying!" Instead of talking about the weather and other silly stuff I sat on the end of the bed and said, "I know, and I am so very sorry." Turns out all this guy needed was acknowledgement, that's all! His family wouldn't discuss it, nobody would talk to the man about dying. The man couldn't even reposition his own legs because he was simply weak. I put myself in his position and realized I would want my legs moved because after time it is just darned uncomfortable.

While he realized I didn't have the time to go in there and move his legs for him q 15 minutes I made it a point that each time I passed his room I'd scrunch up his legs. It literally took 30 seconds longer to walk down that hallway. He's a doc, he knows how little time nurses have and that one little thing I did made him fall in love with me. I heard him and I sincerely tried to do little things to make him feel better. He went from a ranting and raving madman to calling his buddy the CEO of the hospital down to tell him in person how much I tried to make things better for him and how good I was to him. He went from 6' 8" 300lbs of angry to an absolute sweetheart to care for.

Another person is nasty and obnoxious and when he started in on me I let him finish and then I started laughing while I had my hand on his arm. While making sure he knew via body language and tone of voice I just said, "Feel better now?" That would not work on most people but you have to read people and see what works for them.

People in the hospital are asked to undress, they are asked to do things that hurt, they are asked to let us hurt them, they don't like the sounds, the smells, the routines, they like nothing about being where they are. To top it off, they don't likely feel well. Put yourself in each individual patient's place and see what you think. It isn't nice but sometimes it can be a real eye opener. If you go out of your way to do some little thing for them, sneak them a bowl of ice cream and make it a secret between the two of you, anything that makes them feel special and unique and it makes a big difference. Make them feel special, like you enjoy taking care of them for some small reason and they will melt in your hands. If you made a bunch of cookies for your coworkers, make a little issue of sneaking one into your nasty patient.

If you think it is okay to do, come clean with your patient. Tell them you must be doing something wrong but you don't know what it is. Be sincere, ask the one who doesn't want you caring for them just what the problem is. People will usually calm down and tell you. Perhaps it is you, so let them tell you, listen carefully, weigh out what they say to what happened and if they might be right, tell them so. I think most people can handle anything as long as you come clean with them and let them know you sincerely want to do better. If you make a mistake, admit it. Then apologize for it. If you forgot their pain pill.. don't make excuses, tell them you messed up and you are so very sorry and you won't do it again. People can handle honesty.

But #1 is learn to read your patients.

tiredfeetED · Apr 19, 2005

I had a patient yesterday in the ED who was very upset because he had waited 30 min in the lobby for visit. Were a 18 Bed ED with 5 fast track, 6 ICU holds at the time. I was told this guy wanted to talk to the supervisors, I put it off and got him placed in a chair in fast track...He was still upset that a kid went staight in before him. So I came out from my 10min lunch forthe day and spoke to this man. I explained that I knew he was in pain from a broken finger dx last week. He wanted his RX for vicodin refilled. I told him that the child that went in front of him was currently being intubated because his airway was almost closed from recent surgery. "But my finger hurts and i have go to a funeral 5 hrs away ". He just got a 5pk of vicodin and was pissed with no refills..I dont think Ive been so pissed at a pt before for there lack of consideration! what i wanted to tell him and almost did was get the hell out of my ER!

erroridiot · Apr 19, 2005

The first thing I do with this type of patient is make an excuse to leave the room.....such as "I have to go right now, it's an emergency!"

I make haste to the nursing station where I write a care plan for "disturbed energy field", place it in the patient's chart and immediately go home sick with something like food poisoning, see my physician, get an excuse slip for three or four days - maybe for a week, and then go back to work and act like nothing happened.

PicklesRN, RN · Apr 19, 2005

The first thing I do with this type of patient is make an excuse to leave the room.....such as "I have to go right now, it's an emergency!"
I make haste to the nursing station where I write a care plan for "disturbed energy field", place it in the patient's chart and immediately go home sick with something like food poisoning, see my physician, get an excuse slip for three or four days - maybe for a week, and then go back to work and act like nothing happened.

Disturbed energy field? Food poisoning? Huh??

snowfreeze, BSN, RN · Apr 19, 2005

Lots of input on how to deal with cranky patients. Just be yourself, dont let em mess with you. Walk out of the room if you have to. Remember you are the boss here as far as them getting well, but they have to decide they want to get well first. They can go home dead if that is what they want...'And last...Remember that you cannot fix years of what they were in 2 days or less. This is not the fast recovery drive through.

SarasotaRN2b · Apr 19, 2005

Katiebell and PicklesRN, thank you very much for your thoughtful responses. It gives us nursing students and nursing-to-be students ideas of how we can best help our patients when it is time.

Walkmygardenpath, I know that it is frustrating...but remember it is not always about you per say. It could be that they want to stay angry and maybe they see that with you, they might not be able too and in a sense losing whatever control in their situation that they can. I think the advice above was quite valuable and the next time you are faced with this, maybe it will go differently. Like KatieBell and PicklesRN state...put yourself in their place.

Kris