Unwillingly or not, we bring our personalities into our duties. We often provide care in a manner in accordance to who we are and what we believe.
We learn in nursing school to objectively provide quality care and document accordingly, no matter what are our own personal beliefs or feelings toward the patient or their situation. However, we all possess our own personalities and subjective belief systems and separation from these traits is not always easy.
If a patient is treatment compliant and shows appreciation for services rendered, then our duties can be performed relatively easily and can be the icing on the cake of our paychecks.
However, if a patient, as many are, treatment noncompliant, demanding, and responds negatively in other ways in our attempts to provide quality care, then our duties are quite the chore to perform.
Our personalities and belief systems can be an adjunct or hinderance in performing our duties in difficult situations. If we become, like the difficult patient, forward and demanding, chances areall will not bode well. All patients are victims and we can easily be interpreted by them as being the perpetrator.
We are all actors in this thing we call life. Every patient playing the victim needs a perpetrator, because it always makes us feel better if we have someone to blame for our poor station or lot in life. With some patients, and a lot of people in general, we are always going to be battling or hitting a brick wall, no matter in which manner we play the part.
What is the rationale for this aberrant behavior and how is it best approached?
Well, I've got my ideas, and wish not to give a dissertation but begin a discussion.
Do you have any ideas for the rationale for which difficult patients act?
Have you used your personality and/or belief system to therapeutically achieve a desired goal of quality care?
Specializes in Psych (25 years), Medical (15 years).
Please pardon my density this morning, Hannahbanna.
2 hours ago, Hannahbanana said:
I am concerned with how nursing and medicine persist in using the word “compliance,” as if the patients are at the bottom of some chain of command and must comply with orders.
Words matter. They can change perceptions. Think on that.
To argue your premise of using the word compliance: Adherence to a prescribed medical regimen is either black or white or varying shades of gray. Adherence to a prescribed medical treatment mode is either to which adhered, or not, or followed in partiality.
The word compliance can be used objectively, and using it objectively is not condemning or demeaning- it is a factual state; a point of reference.
With a point of reference, we can be be open to plan a possibly more organically suitable route to which the patient may be more open to accept and follow.
The patient always has the right to refuse any option given to them, barring cases of moral, ethical, or legal issues.
Words do matter in the way in which they are used. The manner in which those words are expressed matter equally.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
My personality? After 24 years of this, it's simple. I am a crusty old bat. I don't take crap from coworkers, managers or patients. But I am careful in my words so I am clear and able to communicate in a way that they will listen. I have boundaries, well-established.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
On 3/12/2021 at 9:21 AM, Davey Do said:
This line caused me to recall a situation when I was a patient back in '76, mmc.
I was a 19 year old involved in an MVA, suffering from multiple fractures, internal injuries, assorted other injuries, including a closed head injury. I regained consciousness after three weeks, got my trach out and was transferred from ICU to ortho.
Soon after, early one morning, this pretty little nurse came beebooping into my room, and as if speaking to a child, asked....
I find this approach even more galling. I always say, “I don’t know how you are today, but I wouldn’t be here if I were better.” Grumble, grumble, COB.
Specializes in Psych (25 years), Medical (15 years).
7 minutes ago, SmilingBluEyes said:
My personality? After 24 years of this, it's simple. I am a crusty old bat. I don't take crap from coworkers, managers or patients. But I am careful in my words so I am clear and able to communicate in a way that they will listen. I have boundaries, well-established.
I can (or could) identify, SBE.
I was, as you probably are, SBE, not always liked, but demanded, and got, respect.
Everybody needs boundaries, with some stretching to the horizon, while others need to have their feet nailed to the floor. And their mouths duct-taped.
I once made mention of my hard-nosed method of dealing with patients to Rooty Payne, psych tech. Rooty responded, "Yeah, Dave, the patients don't always like what you have to say, but they know that you care".
Specializes in Psych (25 years), Medical (15 years).
16 minutes ago, Hannahbanana said:
I hear you, my dear DaveyDo, but in this case I think the long historical association of “compliance” with “orders” is too much to ignore. YMMV.
My mileage does vary, and I had to look that one up!
In essence I agree with you, HB with a case in point going back to the setting of my previous cartoon:
I had not had a BM while unconscious for three weeks. I was given an enama with good results, because the stool hit the bedpan with a sound that was described at the time as Big Ben chiming the one o' clock hour.
The next morning a nurse brought in another enama and I told her that I had had one the day before and had a good BM. The nurse replied, "But the doctor ordered it!"
At that time, in my mind, it was as if God had decreed the enema be administered, so I relinquished. After sitting on the bedpan for quite a while, it was taken away with no results.
Sometime later, I felt as though Mt. Vesuvius was going to erupt, so I called the nurse for a bedpan. Well, time passed, and Mt. Vesuvius erupted and lava flowed all over me and the bed with no bedpan.
It was a humiliating experience, but one from which I gained a perspective which I used my entire nursing career.
So, yeah, HB, we need to be reminded of where the buck, or order, stops.
Do you have any ideas for the rationale for which difficult patients act?
Have you used your personality and/or belief system to therapeutically achieve a desired goal of quality care?
What has worked, and if you dare, what has not?
It has been my experience that most difficult patients act that way for a number of reasons. They are scared, they are total control freaks (even before becoming sick), they are a total orifice (even before becoming sick) etc. The key is to attempt to find out the reason/s they are behaving badly. So, as you say, you need to read the room and go from there. Are they scared, having pain N/V etc or just a PITA for no (obvious reason). Even with the same pt they may have a day to day change which requires an adjustment in how the nurse will interact. I have always tried to assess where a pt is coming from today and then try to meld my "personality" with their's as much as possible. I have always been on the quiet side but I don't think it really matters as far as the melding goes because we all have different personalities that would have to go one way or the other. I think if we just remain professional that also helps with some pts, esp the ones that think they are getting substandard care. My "belief system" at work was always to be professional and do the best I could with what I had to work with. But, as always there will be pts that just cant be reached, or don't want to be, and over the years those that had no intention/interest in hearing/wanting care, well I gave them exactly what they wanted, after trying at least once. I have never been the type to take crap from people but did adjust that a little for nursing but after so many years that eventually flew right out the window and I had zero to none patience for people who are just plain ole orifices.
was a humiliating experience, but one from which I gained a perspective which I used my entire nursing career.
So, yeah, HB, we need to be reminded of where the buck, or order, stops
Sounds horrible, if I had been your nurse I definitely would have listened to you. I learned early on that people/patients know their own bodies better then we do (in most cases). And also to question MD orders!
Specializes in Psych (25 years), Medical (15 years).
13 minutes ago, Daisy4RN said:
I have always tried to assess where a pt is coming from today and then try to meld my "personality" with theirs as much as possible.
Your post is status quo as always with wisdom and insight, Daisy. I chose this particular line because I had a revelation very early in my career, as a student LPN in fact, after treating a difficult, complaining patient as he treated me.
In a sense, I imitated the patient complaining, and got a laugh out of him. "Ah ha!" I thought, "This patient wants to be treated as he treats others!"
I learned that this patient had been a Drill Sergeant in the Army, lived alone, and was an independent, outdoorsy type. He also resided in a rural area near where I had spent the Winter of '81, in a cabin.
Our common ground was found. He continued to complain about this or that here and there, but before his hospital discharge, he sincerely thanked me for helping him during his hospital stay.
Many opportunities, as this treating badly recourse, presented themselves in my career that allowed a connection and led to a therapeutical end.
Specializes in Psych (25 years), Medical (15 years).
45 minutes ago, Daisy4RN said:
Sounds horrible, if I had been your nurse I definitely would have listened to you. I learned early on that people/patients know their own bodies better then we do (in most cases). And also to question MD orders!
At the time laying in my own feces and having others clean me up was probably one of the most degrading things that had ever happened to me in my young life. But I never forgot it when providing hygienic measures to an incontinent and I'm sure that my empathy for the situation allowed both nurse and patient to feel more comfort.
Of course, my knowledge and perspective were so different 45 years ago as a patient, and then later nearly 40 years ago as a nurse.
Things have changed so much since then- some for the better, some not.
In a sense, I imitated the patient complaining, and got a laugh out of him. "Ah ha!" I thought, "This patientwants to be treated as he treats others!"
Reminds me of a time I did this also. I was walking down the hall, my patient (a well known PITA) saw me and started yelling..."nurse, nurse" (which just drove me crazy), so I went in and said to him .."yes patient, is there something you need". He looked at my kinda embarrassed and said..."oh is that disrespectful", I said yes and he apologized. Never had another problem with him (which also kinda surprised me at the time).
Davey Do
10,666 Posts
Please pardon my density this morning, Hannahbanna.
To argue your premise of using the word compliance: Adherence to a prescribed medical regimen is either black or white or varying shades of gray. Adherence to a prescribed medical treatment mode is either to which adhered, or not, or followed in partiality.
The word compliance can be used objectively, and using it objectively is not condemning or demeaning- it is a factual state; a point of reference.
With a point of reference, we can be be open to plan a possibly more organically suitable route to which the patient may be more open to accept and follow.
The patient always has the right to refuse any option given to them, barring cases of moral, ethical, or legal issues.
Words do matter in the way in which they are used. The manner in which those words are expressed matter equally.