Please help-how can I deal with difficult patients?

[Nurse Beth, MSN]

Dealing with difficult patients can be challenging but also rewarding. Nurses  become better people when we choose to learn important people skills such as communication and service recovery.

Here are some strategies to help manage these situations effectively:

Communication

• Active listening. Show empathy by listening to the patient's concerns without interrupting. Acknowledge their feelings and let them know they are being heard. 
• Acknowledging is not agreeing. "I wouldn't want anyonelse to have that same experience" shows empathy without agreeing. "I understand how this is upsetting."
• Apologize sincerely. Apologizing is not agreeing. "I'm really sorry for what you're going through." Research shows that people who have suffered a wrong want to be overcompensated. 
• Think about times when you had poor customer service and how it made you feel.
• Now think of a time when you had excellent customer service. what made it excellent? Patients who perceive that their complaint was well handled (service recovery) are more loyal than patients who never had a complaint.
• Repeat what the patient told you. "It sounds like your breakfast menu was not what you ordered two days in a row. Did I get that right?"
• Search for the feeling behind the words. "That sounds very frustrating."

Tip: Avoid using the word "policy". It angers people who feel they have been wronged to be lectured about the policy. Find a different way to give the message.

After listening, a good question to have in your toolbox is, "What can I do for you now?" This re-focuses the patient and provides for the beginning of the end of the encounter

Clear and simple language: Avoid medical jargon and ensure your explanations are easy to understand. This can help reduce misunderstandings and frustration.

Empathy and Compassion

• Show empathy. Put yourself in the patient's shoes. Understand their fears, pain, and frustrations. Patients are not at their best. They are sick, and we are not.
• Stay calm and patient. You're a professional! Keep your composure, even if the patient is angry or upset. Your calm demeanor can help de-escalate the situation.

Setting Boundaries

• Set clear boundaries. Establish what behavior is acceptable and what is not. Be firm but respectful in maintaining these boundaries. 
• Consistent approach. Ensure that all staff members are consistent in handling difficult patients, so patients know what to expect. Some patients try to divide staff by complaining about other staff/shifts, and try to manipulate with flattery.

Problem-Solving

Identify the root cause. Try to understand the underlying issue causing the patient's behavior. Addressing their primary concerns can often alleviate their difficult behavior. Fear is usually behind anger.

• Offer solutions.  Provide options and involve the patient in their care decisions. "Do you want me to change your dressing now or after lunch?" This can help them feel more in control and less frustrated.

Support and Resources

Seek support. Don't hesitate to ask for help from colleagues, supervisors, or patient advocates. Working as a team can provide better outcomes. The charge nurse should be able to step in to help talk with the patient and family so you can attend to your other duties.

Utilize resources. Use available resources such as counseling services, patient education materials, or mediation services to assist with the situation.

Pick a person on your unit who has the skills you want to develop, and watch how they communicate and act.

Self-Care

Take care of yourself. Managing difficult patients can be stressful. Ensure you take breaks, seek support, and practice self-care to maintain your well-being. Strive to understand your triggers. 

Documentation

Document. Keep detailed records of all interactions with difficult patients. This documentation can be crucial if there are any disputes or if additional intervention is needed. If a case goes to court, it is a long time (months or years) before you would be called to give a deposition. Any notes you keep will help to jog your memory.

Report difficult situations to your charge or nurse manager so they are not blindsided by patient complaints. Also, some patient complaints require a response within a couple of days, so you should loop in your supervisor.

Training and Development

Continuous learning. Participate in training sessions on conflict resolution, communication skills, and stress management to improve your ability to handle difficult patients.

By applying these strategies, you can manage difficult patient interactions more effectively, improving outcomes for you and your patients.

Best wishes,

Nurse Beth