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?
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.
I think that God leads us/lets us experience situations so that we will have that empathy and will be better equipped to assist others in their difficulties. I know I have been able to assist in certain situations with sincere empathy that I would not have had if I had not experienced that same difficulty firsthand. I find it an honor!
Specializes in Psych (25 years), Medical (15 years).
2 minutes ago, Daisy4RN said:
I know I have been able to assist in certain situations with sincere empathy that I would not have had if I had not experienced that same difficulty firsthand. I find it an honor!
As Joseph Campbell said, "The consciousness is changed through trials and tribulations which can result in an illuminating revelation".
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
8 hours ago, SmilingBluEyes said:
I care less about being liked and more about being respected.
100% this. I remember when I was supervising in the LTC facility and I was not always liked by everyone because I would call them out on things like inappropriate phone usage, and maybe not doing their job, but everyone knew that I would be 100% fair and equitable with my criticism. Even the ones that didn't like me said they liked it when I was in charge because they all knew what to expect all the time. They also knew that no one was going to play games like "I don't want that assignment tonight" because I wasn't going to put up with it.
And in my job now I'm still there for the patients. If my coworker does something that is not in the best interest of the patient, I will call them on it. Again, while I have a couple coworkers I'm more friendly with, when I'm in charge that has no bearing on the work.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
On 3/11/2021 at 1:49 PM, Davey Do said:
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?
What has worked, and if you dare, what has not?
Great topic idea, and one I've given a lot of thought over the years, especially when someone asks if they should even be a nurse due to a particular personality trait or traits. In my case, had there been an allnurses way back when, would have been "introvert" and "tendency to freak out when overwhelmed".
Both of those things turned out to be manageable, if not always easy to manage. It turned out that I had a preconceived notion of what the perfect nurse personality was when I was a student. I thought the best nurses were perky extroverts. I suppose the lesson there is know yourself and work with what you've got. Not all patients are difficult in the same way, and some respond to different nurse personalities differently as well.
A couple of specific incidents I can recall, one was a time when an interaction threatened to go off the rails in spectacular fashion, which occured in an outpatient situation. where the majority are not acutely ill, and can walk, talk and yell at you just fine. The waiting room was packed, I was overwhelmed, and my tone indicated I'd forgotten all about the nurse to patient dynamic before the tall, loud man was even put in a room.
After he was seen, it was determined he needed the big shots of penicillin, and I was to give them. He pointed and said, "I don't want her to give me a shot.". Moment of clarity arrived from somewhere. He's the patient, and I'm the nurse. I stopped, looked him in the eye and said, "I'm so sorry, Sir." I took full responsibility for all of it, and honestly I should have. I felt terrible later on, but that incident has helped me put the brakes on my reflexive reactions ever since.
If you are an introvert, you know deep down you'Il never be perky. On the other hand, the perky people will never be you, and sometimes patients actually prefer what they perceive as calm and reassuring, as several difficult patients told me when I worked bedside nursing. I'm glad they did, because I learned my endeavor to keep my demeanor from reflecting whatever inner turmoil was going on inside turned out to be more than a coping mechanism, but an asset in the end.
I work in-patient mental health. For those of you familiar with Myers Briggs personality tools, I am an INFP, which stands for introvert, intuition, feeling, perceiver. We have several types of difficult patients. The first would be those who are transported to us from an emergency department or hospital on a mental health hold and they are mad. The second type would be clients with strong personality traits or personality disorders such as borderline, narcissistic, or histrionic. The third type would be people who are actively psychotic.
I think my personality lends it self to these situations because I am generally patient, calm, able to listen and to validate people. Like others in this thread, I believe that every patient gets to choose how they want to engage in treatment. For people who are actively psychotic, I do not push them to do anything that they don’t want to. One activity that I was hesitant to do as a new nurse, but now love for this patient population, is groups. I bring my Alexa and have very informal groups where people choose music to listen to while we do artwork or puzzles and talk about medications. I have found that the clients who crave attention love the groups because they get to speak up and usually have a great deal of empathy. And the people who are angry for being there get to vent to the entire group. I find that these groups do help the unit be more peaceful and the clients feel more comfortable. I think my INFP traits help me empathize.
Some of these difficult patients also have feelings of entitlement and expect us to fix every problem in their lives. Big sigh, I don’t know that I am very successful in helping these folks. One on one I feel my temper building at times, and sometimes I have to end a conversation. According to Myers-Briggs, the INFP will push back when their values are not respected. I definitely do this and I need to continue to work on it.
Specializes in Psych (25 years), Medical (15 years).
10 hours ago, nursel56 said:
I suppose the lesson there is know yourself and work with what you've got.
"With theses oxen we must plow."
10 hours ago, nursel56 said:
I stopped, looked him in the eye and said, "I'm so sorry, Sir." I took full responsibility for all of it, and honestly I should have. I felt terrible later on, but that incident has helped me put the brakes on my reflexive reactions ever since.
A humbling, consciousness raising experience.
10 hours ago, nursel56 said:
If you are an introvert, you know deep down you'll never be perky.
"You can play the game, you can act out the part, though you know
It wasn't written for you." -James Taylor
Thank you, nursel, for sharing such experience, wisdom, and insight.
I can act out the part of the extrovert, and found it helped me deal with the stress of the situation. I found that talking like a Pucker DJ- "Hello groovy guys and groovy gals we're going to listen to the boss sounds of the boss town that my boss told me to play, a golden platter that really matters straaaaaaaight from the grooveyard...."- got people's attention, was entertaining, and relieved my feeling of stress.
It's like you said, nursel, "work with what you've got".
Specializes in Psych (25 years), Medical (15 years).
12 hours ago, PsychNurse24 said:
I am generally patient, calm, able to listen and to validate people.
And isn't this the core of everything, PsychNurse24?
It's what we all want- just to be heard and validated.
Reading your post gave me a relaxing feeling. (Although I must admit, part of it could be the incense I'm burning in my art room.) I got a feeling of someone in control, who cares, has good insight, and enjoys their work.
Regarding your final statement...
12 hours ago, PsychNurse24 said:
I definitely do this and I need to continue to work on it.
...Kierkegaard said something along the lines of "the self is that which is in the process of becoming".
On 3/11/2021 at 7:18 PM, Davey Do said:As I was waiting for responses to this thread, I was thinking about methods to calm an irate patient. The hilarious scene from the movie Airplane! popped into my head, where the upset passenger is lucrudiously attempting to be calmed by the flight attendant, doctor, and others waiting in line.
Have you ever experienced such a situation?
I think it really depends on what has made the patient irate. In all honesty, I know there were situations in the ER that I did not handle well, said things I shouldn’t have said, or should have handled better simply from being exhausted, overwhelmed, burnt out, and due to circumstances that I truly couldn’t change (no rooms in the ER, busy with a high acuity patient, etc).
There are some patient issues I was able to smooth over....one time I know there was a patient and family that felt they weren’t being listened to (which was likely true in a busy ER) and I was able to take over the care of the patient as a charge nurse who didn’t have a patient assignment. There are patients that feel they are talked down to, or that a difficult piece of news was delivered inappropriately, etc.
I also think that healthcare is not what it used to be - there are unusual conditions or health issues that can only be discovered by specialists and sometimes I feel like patients are quickly ignored or dismissed when there are very real, organic medical conditions that are simply not discovered yet. Or healthcare providers try to insinuate that a condition is “all in their heads”. The research out there demonstrates that there are actually very very few cases of psychosomatic conditions. I think that would make anyone angry when they KNOW something is not right with their body.
However, I think there are issues that are very difficult to fix which make patients irate - ED boarding and overcrowding, understaffing, too many high acuity patients, etc. I think patient education can sometimes help with that and sometimes can’t. I unfortunately do think there is a very small portion of the population that really is narcissistic and can’t feel for others. The reason I say this is I will never forget an incident when there was a patient coding....long story.....
I do know that I have become much more empathetic since changing specialities because I CAN. I actually have the time to spend with my patients, talking to them, offering explanations, and listening. I have actually had very few patient issues since changing specialities.
Specializes in Psych (25 years), Medical (15 years).
11 minutes ago, speedynurse said:
I think it really depends on what has made the patient irate. In all honesty, I know there were situations in the ER that I did not handle well, said things I shouldn’t have said, or should have handled better simply from being exhausted, overwhelmed, burnt out, and due to circumstances that I truly couldn’t change...
There are situations where the vast majority of us "should have handled better" and I've been on both sides of the fence.
On different occasions, I had the other nurse "step aside" because it was obvious they were stressed out and not dealing well with the situation.
On the other hand, one time I had a 1:1 patient who was really getting on my nerves. He would loudly scream out for no apparent reason. I attempted various interventions to no avail.
I was relieved by a pulled medical CNA who worked magic with that patient. She gave him a bed bath and had him doing ROM exercises, following her instructions.
I mostly work Psych or Sub Abuse and I never listen to anything about a patient until I make my own assessment.
Above every thing else I approach patients assuming that it's not pleasant, even repeat customers, being there. I expect them to be anxious, angry, embarrassed and in pain from their illness or otherwise. I don't walk in their shoes and even the worst patients have a motive for their behaviors.
I always try to find out how I can make their immediate situation better. Don't want flack for this because I have found it works for me. Most of the patients are compromised by their situation and frequently by social status. This generally means that there's little manipulation going on and behaviors are more often instinctual. Motives are generally simple. So I address physical needs like food, hygiene, comfort etc for new admits. Seasoned occupiers just need perspectives changed if they are troubled.
My immediate priority is the patients safety. I honestly don't give a hoot about being liked or respected as long as the unit is quiet and no incident reports generated. Makes me objective. Nursing is a secondary aspect of my life and that really helps with not getting insulted or taking things personally. Work within the parameters of the care plan but safety first is my motto.
Specializes in Psych (25 years), Medical (15 years).
16 minutes ago, Curious1997 said:
I mostly work Psych or Sub Abuse and I never listen to anything about a patient until I make my own assessment....
...My immediate priority is the patients safety. I honestly don't give a hoot about being liked or respected as long as the unit is quiet and no incident reports generated. Makes me objective. Nursing is a secondary aspect of my life and that really helps with not getting insulted or taking things personally. Work within the parameters of the care plan but safety first is my motto.
Had I not had a vasectomy in 1986, before I got married the first time, I would have been proud to call you my son, Curious!
Daisy4RN
2,238 Posts
I think that God leads us/lets us experience situations so that we will have that empathy and will be better equipped to assist others in their difficulties. I know I have been able to assist in certain situations with sincere empathy that I would not have had if I had not experienced that same difficulty firsthand. I find it an honor!