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9 Types of Manipulative Patients

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J.Adderton has 27 years experience as a BSN, MSN .

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Are Manipulative Patients Weighing You Down?

Does a patient’s manipulative behavior easily turn your good day to bad?  Read on to learn how you can be better prepared when you become the target of a patient’s relentless demands. You are reading page 2 of 9 Types of Manipulative Patients. If you want to start from the beginning Go to First Page.

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All of this is less common and less problematic overall when the nurse's personal self esteem and nurse-identity don't hinge upon constant reassurance and/or being approved and adored by anyone/everyone. Instead, let kindness, professional prudence and fairness/neutrality be the things that reinforce one's self-esteem. Encountering these situations in patient care should not bring on a personal existential or self-esteem crisis.

If you know that you are acting with competence and genuine kindness then you will not feel validated (manipulated) by things like fawning, and will not be intimidated (manipulated) by belittling, splitting, filibustering and the like.

Threats of complaints are easily handled: Immediately refer the complaint or threat to a member of administration. Get a witness with some authority.

Threats of physical contact or violence of any kind are also to be dealt with immediately by security and admin.

Basically the nurse's job is simply to practice in a competent/prudent, and kind manner. It is possible to build a decent and genuine professional rapport with difficult people--but all of it begins with understanding oneself. Avoid what I call emotional flailing, which leads to grasping around for acceptance and reassurance from any source as if these are some sort of effective lifeline--which they are not; they are flimsy and not anchored to anything. Another useful picture is that of the tumbleweed being blown this way or that by the direction and force of the wind. Don't be that. Instead, do what is kind and right and when difficulty arises handle it as kindly, neutrally and efficiently as possible.

-My unsolicited $.02 which I think is useful for many areas of life, not just nursing.

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FolksBtrippin is a BSN, RN and specializes in Psychiatry, Pediatrics, Public Health.

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21 hours ago, CommunityRNBSN said:

I agree with the above— humans are manipulative!  Including me when I am at my worst, including you when circumstances turn you that way. I try not to lose my compassion for people.
 

That being said: flirtation makes me uncomfortable and I hate when a patient uses it to “manipulate”. (I sometimes find that people who are physically attractive are in the habit of being constantly flirtatious, so they aren’t consciously manipulating; it’s just how they get their needs met.). I had a young male patient today flirting, and I felt like I was walking a tightrope to convey that I am friendly and kind, but I am NOT flirting back or being impressed by that behavior. 

This is tough for me too. Culturally, women are often held responsible for a man's attraction to them, so when a patient flirts with me I instantly feel shame.

A male psychiatrist once told me a story about a patient who invited him to partake in a threesome with her and her boyfriend. He says "Of course I declined. But that was a good day..." I was taken aback by his irreverence. He went on to explain that our patients can feel a kind of love for us that is sometimes expressed romantically or sexually, and that it doesn't really matter as long as we don't respond similarly. 

I'm not sure I see it exactly the way that psychiatrist does. But his attitude helped me feel better about the patient who asked me to make out with him twice in one visit, once after being told not to do that.

 

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mmc51264 has 8 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

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there are some that are legitimately manipulative. I do not usually play into people trying some behaviors. 

When I was a new nurse, I had a pt that accused me of not giving her narcotic pain medication. I scanned her and the medication but she had her brother in the room and he stated that he never saw me actually give the medication. 

I was so upset, it was the first time I had encountered someone being like that to me. I documented it, wrote a safety report, notified my charge nurse and the physician. I take issues about narcotics very seriously. From then on, I brought another nurse in with me to witness medication administration. 

It was scary. I don't get "got" very much anymore, but it is hard when they try.

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perc71 has 14 years experience as a BSN, MSN, APRN, NP.

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You summed up an informative post (OP), thank you. Patent's with Borderline PD are good in splitting and gaslighting. Identifying patients with manipulative tendencies is great but try not to loose your objectivity to the patent's problem to be able to be an effective nurse. It is a delicate balance indeed.

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I disagree with exaggeration. It could be the worst pain they’ve ever felt. How do we know? I suffer from anxiety and, after caring for my mom in my home who has Alzheimer’s, started having panic attacks. It was, and is, the worst anxiety I have felt. Should a doctor refuse to help me because he/she thinks I’m exaggerating? I think that’s an irresponsible conclusion to come to with a patient. 

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LibraNurse27 has 5 years experience as a BSN, RN and specializes in Community Health, Med/Surg, ICU Stepdown.

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I used to get stressed out by some of these behaviors, especially sick patients refusing care. I have learned that I cannot force someone to care about their health and I cannot care about them more than they care about themself. I provide them with compassion, educate them on all treatments ordered and offer the meds, blood draw, etc once or twice, then respect their right to refuse, let them know I will notify the MD, not in retaliation but just so they know what’s going on.
 

I don’t neglect patients, I still check on them. But if a patient is verbally or physically aggressive I refuse to return to their room, argue with them or try to convince them to receive care. I call management and security. I will not get injured trying to force people to do things they don’t want to do. Often the patients want to get a reaction from you and see you upset that they are refusing. If you don’t buy into it sometimes they later want the care and it is a win for both of you 😊As someone with a severe mental health issue I give people the benefit of the doubt for behaviors but I do not tolerate abuse.

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mja79 has 16 years experience as a APRN and specializes in Advanced Practice Critical Care and Family Nursing.

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Great post! Good psych nursing 101 here.

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5 Posts; 1,219 Profile Views

Big problem, great discussion!

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