How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
How do you handle cares for patients that are known troublemakers? I have bumped into this recently. Add in the mix any sort of known behavioral problem and it seems 10x worse. Management knows that these people are quick to write up nurses over ridiculous things, but yet they don't seem to step in to politely reorient the patient to reality.
So, the question is, how do you deal with patients like this without compromising your license each day? Part of me wants to say to management "you deal with them then", but of course that would not go over nor ever happen.
Thoughts?
When I have a pt like that (and I have several) I take a nurse aide or another nurse into the room with me and then document thoroughly
Specializes in Med-Surg, Geriatric, Behavioral Health.
You bring up a good point. Had a situation recently. Family member (son), very litigious, in fact, was pretty much pouncing on one of my female colleagues about everything under the sun regarding his mom (patient). Risk management has been involved from day one. Made supervisor aware. Pulled son aside, out of concern for my colleague, and let him vent about an hour. His story took me from the beginning of Creation to the trials he had in an accident as a child, his father's death from diabetes complications, and now his mother. Pretty much just stood there and listened. I offered no advice other than agreeing with him that his mother's course of care needs to be discussed between him and her doctor. Did a lot of head nodding in relation to the trials of his life. Currently, mom had a crani and many health concerns which debilitated her...now, she is requiring rehab. However, son has some very unrealistic expectations. Mom is in her 70's...he has the snapshot of her in his mind before her health debilitated and pretty much expects "the exact" same picture of health afterward. Son having difficulty accepting mom's major setback...and doesn't see age as having any factor, nor what she has had to overcome. But, letting him vent deescalated him. But the message was clear...he was afraid. Before venting, it didn't bother him the least to interrupt, follow behind, and hound my colleague to no end. After venting, he was calm, agreeable, stated that he acknowledges that the nurses need to care for many other patients other than mom too, and left the floor shortly. His concerns, several valid, were communicated up the chain. The next day, he gave consent to a procedure which yesterday he was violently opposed to out of fear, was appropriate with staff when he visited, and had a much briefer visit. So, to make a long story short, sometimes venting in a safe manner can be very helpful.
As an idealistic first year nursing student, I did see an elderly patient vocalizing her angry feelings of inadequate care and threatening legal actions. She was being very distruptive on our floor that day. This was a very well run floor and there were no credible reasons for her anger (in my humble opinion). The nurses were very professional with her. I was not assigned to this patient, but in some way I wish I had been. From a distance I could see how frightened she was. I could be wrong, and very, very naive - but I felt a heavy dose of handholding was in order or at least an understanding ear. Would it be appropriate to sit by the bedside of this patient and let her vent her concerns? Often I feel that ranting and raving is the only way some people know how to communciate their concerns. Laying in a hospital bed, helpless and powerless can bring out less-than-stellar behavior in some people. Maybe she had experienced a medical mishap in the past and this was her way to try to protect herself. I felt her behavior was masking something else she was unable to communicate and I wish I had the opportunity to help her discover this.
I realize on a busy shift this kind of one-on-one time is probably not possible and psychotherapy is outside the scope of nursing practice. Would it be appropriate to get some kind of counseling for a patient in dire straights from a behavioral specialist, if one is available? Do hospitals have policies for dealing with these situations?
I have often thought about what I would have done if I had been the nurse assigned to the angry patient. As a nursing student I would like to devise a course of action for dealing with patients like this in the future. I would really appreciate hearing more feedback from seasoned nurses who have been successful in these situations. How did you get through to your patients?
hipab4hands post made me think - being mindful of HIPPA, are there other ways of responding to inaccurate accusations of neglect by summarizing (verbally) what has been documented for the frequency and type of care given to the patient and shared with the inquiring/accusing family member - or does this, in itself, violate HIPPA?
Of course, there are many people out there who want to support themselves by suing for anything they can. Many of the other posts suggesting extensive documentation and professional behavior at all times seem like the best way to deal with this.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Last thing to point out:
People, usually, do not get angry for no reason. Fear is often the kissing cousin of an angry or rageful person. Address the fear, the anger usually subsides. Venting allows this to happen.
We recently had 2 episodes of these types of patients......management did NOTHING to help the nurses/staff with these people........I know the old addage...."the customer is alwasy right"...but where do we get a break??
Patient #1: Didn't want to come to our facility but other one was full. Came in with attitude and stated that she only wanted 'white' nurses/techs. This is a problem since most of our staff are 'of color' (black and asian). Well, sadly on the part of a good tech, she responded back to this lady with the same 'attitude' and was fired.
Patient #2: They too, didn't want to come there but did at the request of the surgeon. The patient and dtrs (from 'you-know-where) wrote everything down......EVERYTHING!!!! Time when they pushed the call light, time when you answered it, time pain meds requested, time they were given.........I just did my job and treated them no better then I did any of the other patients. We even had a code on the floor and during this code, the tech came to tell me that this patient wanted her pain meds. I told the tech to tell one of the other nurses. She didn't but told the patient I was 'too busy' to get her pain meds. Well, after 45 min I was able to get back to my patients. This family tried to chew me up and spit me out...I quickly explained why I didn't respond and that the tech was instructed to tell another nurse. The tech was wrote up and put on probation.
Just stay professional, sweet and do your job......good luck!!
I appreciated reading everyone's views on this. As you may have guessed, I worked with a pain in the butt pt lately, and after one day of dealing with this them, I asked to be given a reprieve on day 2.
However...:chuckle :chuckle :chuckle ....as it turns out, I got the pt again, go figure. It was actually a good day, as I spent a little more time than I generally would have with the pt, listened to the litany of complaints etc, then asked (nicely) point blank how they intended to cope with x, y, z? After about 15 seconds of stunned silence, they admitted they didn't know and admitted that they were scared about various things ( Wolfie btw!) so we had a discussion about that. Now, I don't think for a moment that everything is magically solved, but I was able to have a positive professional working relationship the remainder of the day, and when the pt started in with complaints/suspect behaviors, I was able to point it out and we had a chat about how to channel that behavior in a positive way.
I hope the unit continues to be pleasant this weekend! Thanks again everyone for the feedback.
Specializes in Med-Surg, Geriatric, Behavioral Health.
, listened to the litany of complaints etc, then asked (nicely) point blank how they intended to cope with x, y, z? After about 15 seconds of stunned silence, they admitted they didn't know and admitted that they were scared
Excellent....you threw the ball in their court where it needed to go and addressed the REAL concern...which had nothing to do with your care. Sometimes, we only need to "open the door" to make it happen. Your approach was beautiful. Good work!
People, usually, do not get angry for no reason. Fear is often the kissing cousin of an angry or rageful person. Address the fear, the anger usually subsides. Venting allows this to happen.
Excellent point. It is often times very true. I think most often when we are dealing with angry/difficult people they are reacting out of fear. We need to bear in mind that rarely is it about us, the nurse when they are acting this way.
Listening is a skill. It can be a very useful skill as you pointed out Wolfy.
Excellent point. It is often times very true. I think most often when we are dealing with angry/difficult people they are reacting out of fear. We need to bear in mind that rarely is it about us, the nurse when they are acting this way.
Listening is a skill. It can be a very useful skill as you pointed out Wolfy.
Wolfie, In my opinion,You have done the most important tool in nursing which is listening and observing.Most of the time this patients are asking for help may it be verbal or expressing it in a manner they think we can easily understand.not knowing that they have become a pain for us nurses.and that patient is labelled "litigious patient". I have encountered a patient years ago. I was the 11-7 shift head Nurse and it was my first day of work after a requested days off,upon entering the unit i can hear a loud scream saying "aw,aw,aw" very loud. non stop.it is this patient whom the nurse said had a sudden change in behavior and now has a behavior problem,she said the patient was sexually preoccupied(SOP).Because his always in a wheelchair chassing nurses in the hallway showing off his "thing" on top of it his been cursing really bad saying all kinds of dirty words.to the point of pulling my fellow nurses skirt.He has been referred to a social worker and for psych evaluation.they also gave the patient medication to calm down.This behavior lasted for a week but prior to that this patient is SWEET AND VERY COOPERATIVE.What i did after the nurse gave me the report. I went to check the patient,i checked every gadget that was connected to the patients body.With my surprise, The urethral Catheter was not properly placed and the balloon was inflated at the wrong area,Just imagine the pain that this patient had to go thru. and that explains why the patient had a violent behavioral outburst."following nurses persistently for help."Most of the time i have encountered patients with emotional set back "problems with the Family " and trying to cope up with change in body image.Identity crisis, etc... etc...these patients are often hard to manage. Hope to hear from you again ...nice exchange of thoughts...
Gerinurse05
6 Posts
When I have a pt like that (and I have several) I take a nurse aide or another nurse into the room with me and then document thoroughly