Given our ANA Nurses' Code of Ethics and our role as the Patient's Advocate, I think more is expected of us as nurses than to label patients who behave in ways we consider unreasonable.
When we label people as a) or b) we objectify them and erroneously think that we are perceiving the whole situation when in actuality we are only seeing a tiny snapshot of their lives during the time we are caring for them. It becomes very difficult to relate to people as individuals once we have conveniently categorized them, and real listening on our part stops.
Labelling patients/family members is ultimately unproductive and can actually be harmful for the patient and their family member.
Treating a patient (or their family member) as a type a) manipulative problem or a type b) manipulative problem may assuage our ego but the result is that it is actually impossible for the patient or their family member to communicate in a real way with the nurse once this happens. I'll give an example: My family member was admitted to hospital and hadn't eaten since early morning of the prior day. I happen to know that my family member becomes hypoglycemic - this is on their chart - and I could see that they were showing symptoms of low blood sugar, so I went to look for their nurse to ask them if my family member could have something to eat now as they hadn't eaten since yesterday and to let them know that I was concerned that my family member was showing symptoms of hypoglycemia. As I was making my request to the nearest staff member I could find (my family member's nurse was no-where to be seen) and was about to express my concern for my family member, another nurse informed me that a meal had been ordered and that we had to wait. So, case in point, the nurse who told us we had to wait failed to listen to me and had already decided what the situation was as soon as they heard me begin to speak - a demanding, unreasonable family member - and was treating us as though their perception was true when it wasn't. Some family members, being on the receiving end, would have escalated the situation in order to be heard and to try to advocate for the patient's needs, and this would have been due to the nurse's snap judgement and failure to listen and learn what the situation required.
While nurses need to be able to set boundaries with patients who are truly unreasonable, it is important to remember that patients who are hospitalized are usually very sick, sometimes lack a good support system, and are often unable to articulate their needs or concerns in the most polite manner even if they would like to.
Also, a number of medical problems are known to result in an altered mental status. It is also important to consider the stress of hospitalization, the stress of a patient's particular illness and it's affect on the other medical problems the patient has, and the effects of medications on patients.
Labelling patients and their family members negates relationships when in order for a patient and their family member to trust the nurses who provide their care it is important to build relationships with them. Being on the patient/family member end of a nurse who shows no compassion or kindness in dealing with the patient and their family member, who is unwilling to listen to them, and who treats the patient and their family member as a problem, is a truly horrible experience in my experience for the patient and their family member and is one where I will talk to administration and/or request medical records.
