Published Mar 3, 2004
I'm new to nursing and would like some tips. How do experienced nurses handle and/or recognize manipulative clients...example...I had a patient during my last semester of nursing school who saw me coming a mile away. She was 'so weak' she couldn't even move herself in the bed. I went all out for her (she was my only patient at the time). I later caught her easily, moving about her room rummaging thru her purse for something. When our eyes met, she new she was busted. I felt like such a dufus. Actually, I really don't know who was more embarrassed...her for tricking me or me for being tricked. Anyway, I'd like some tips on how to pick up on this quickly. I could have requested a sicker patient who really could have benefited from a one-on-one.
purplemania, BSN, RN
you were obviously nice to her and gave her the attention she craved. Sorry to say this, but you will not have time to do this eventually. If you suspect duplicity, get someone else (CNA, Orderly, another Nurse) to go into the room a time or two to get their impression. Think of it this way: if she was in pain and you gave her a pill and it worked you would be proud. She may be in emotional pain and her "pill" is attention. If you can give it, do so, and don't feel tricked, because you are being kind.
This is why we give report nurse to nurse, to share info about the client's capabilities, signs, symptoms, tx, etc. On the flip side, some clients don't know their limits and think they can get up alone and will fall, taking you down with them if nurses haven't asessed this and shared the information.
Some new nurses tend to overdo for their patients until they realize its not helpful to anybody, most of all the patient. Learning to be kindly yet firm is part of the art of nursing. You'll get there. Best wishes.
Think of it this way: if she was in pain and you gave her a pill and it worked you would be proud. She may be in emotional pain and her "pill" is attention. If you can give it, do so, and don't feel tricked, because you are being kind.
Wow...your post really made me think. I have never imagined attention being like a pill for emotional pain. Very interesting point :)
To answer the OPs question...You will only learn to recognize these types of patients through experience. It took me a while and I watch, with pain, new nurses be run ragged by a patient I know is manipulative. I usually will clue the nurse in, but sometimes they don't listen.
I always get sucked in, usually I get it after about 6 hours of non-stop running. Manipulative patients are so hard to care for and should be rotated in the shift assignments. I never thought of attention being like a pill for these patients I usually try not to feed into their behavior. Unfortunately there are too many patients to give one all the attention they need.
don't feel tricked, because you are being kind
This is the ultimate conundrum: we have to risk being made fools, in order to take the chance to help someone who needs us.
Don't worry about whether you guess right or not about whether a patient needs as much attention as it seems. Remember that business about "first do no harm." If you guessed wrong, and didn't give her the attention she needed, you would be doing her harm. Always err on the side of the conservative: if one choice may benefit and won't harm, and the other may harm, take the first choice.
In this case, yeah, maybe she saw you a mile away, but did you do her any harm? Naw--she's been doing that for a while, and she's gonna keep doing it. Nobody, not even a therapist, is going to make a difference in that behavior--so why should you worry about changing it or not? If you wanted to talk to her about it, when you "busted" her would have been a good time. You can even do it in a friendly manner--this is more for yourself than for her.
I think ya done good. Keep it up.
Hellllllo Nurse, BSN, RN
I don't agree that being manipulated by a pt to do her bidding does no harm.
For some of these pts, it's akin to giving liquor to an alcoholic. It does do them harm, in that they are rewarded for using ineffective coping mechanisms.
Plus, when you have more pts to care for, manipulative pts indirectly harm other pts by taking your time and attention away from them. Also, what about your back? Nurses have been injured by pts who are faking weakness and papalysis. If you get hurt, you won't be able to help anyone.
I don't agree that being manipulated by a pt to do her bidding does no harm.For some of these pts, it's akin to giving liquor to an alcoholic. It does do them harm, in that they are rewarded for using ineffective coping mechanisms.Plus, when you have more pts to care for, manipulative pts indirectly harm other pts by taking your time and attention away from them. Also, what about your back? Nurses have been injured by pts who are faking weakness and papalysis. If you get hurt, you won't be able to help anyone.
Great points - there's definitely a fine line between being compassionate and being manipulated by patients. I had a very manipulative patient a few weeks ago who called me into the room 3-4 times an hour on a night shift to 'adjust her fan, dim the lights, pull the curtain 2 inches to the left/right,' etc. Finally I told her about another patient in the next room who was a brand new quadriplegic, on an insulin drip with Q1 hour blood sugars and needing a lot of emotional support. It worked! From then on she only rang for legitimate reasons.
Certainly any position can be carried to an extreme and be made to look like something other than it is. I feel you have taken my legitimate points and done this, which is your prerogative, I suppose.
There are some good points to your argument. I believe I pointed out that this is not a black and white issue, that it is better to err on the side of the conservative, and that the OP ought not to be beating herself up for having been kind, a reflection of another member who beat me to the punch, as it were.
In the last post, isn't telling one patient about another's condition a violation of the second's privacy? And the HIPPA guidelines? Just asking for clarification.... Could always make something up, I suppose.... Good idea though, and it worked.
for the most part, i believe that manipulative patients require pleasant but firm limit-setting. true manipulators know the art of playing the staff; quite frequently even split the staff and will go to great lengths to get what they want. again, i am saying for the most part. a manipulative patient, by definition, is a personality disorder and interventions need to address the potential damage they are so adeptly capable of. and it's an acquired art to learn how to effectively deal with this special population.
Ok, here is my two cents on this.....
I recently had one of these pts. (The pt. wasn't really ICU, but Neurology just loves the care their pt's get in the ICU so much, they hate to move them when it's time......but that's another posting! LOL)
Now, if a person is needy because they are truly sick and scared, or if they just flat out don't know what they're doing, then I'll do as much as I can and it doesn't bother me a bit.
However, in this particular case, the person (also an RN) was being particularly demanding, and when she did have demands, she wanted you there "right now". But when they are needy and manipulative like this person was, I DO NOT put up with it. I kindly, yet firmly, let her know that this behavior was unacceptable and we weren't going to put up with it. Well, she finally chilled out after that and as of the next day, hadn't give either of the nurses after me any problems! (She requested to not have me back.....thank goodness)
I also agree that feeding these behaviors does the patient no good at all! The way I look at it is this....I'm a nurse, not your waitress, personal assistant, slave, etc. and I refuse to be treated like a 2nd class citizen by these people. So, if you do put up with it, then shame on you!
It's amazing how patient's often suddenly have the power to reach for their sweets and chocolate, but suddenly loose this power if they see you. I had a patient yesterday who suddenly couldn't wipe his own bottom. I left him for a moment and he suddenly acquired the power.
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