Unreasonable female 30 something p'ts

loriangel14, RN · Dec 11, 2010

I had one of these and I think the issue was all of a sudden she had no control over her busy life. After a few days she got better. I tried to acknowledge her feelings and asked her to talk about her concerns and frustrations.

KaringOne · Dec 11, 2010

Try to remain calm. It is obvious that all their anger & frustration does not stem from you. They are being reminded that they really don't have complete control of the goings-on in their lives & may be a bit bothered by that. Just smile (or smile-grimace) & try to get them to voice their concerns,etc. But don't take it personal.

SCnurse2010 · Dec 11, 2010

I try to address any legitimate concerns to calm their anxiety. If it's an all out whinefest, I tend to ignore, just like with my kids. I maintain a normal tone and speak to the things that are relevant and let the whining go. I agree that it has a lot to do with a loss of control on their end.

Meriwhen, ASN, BSN, MSN, RN · Dec 11, 2010

I've had a spate of these lately.
Educated professional, articulate 30 something female p'ts who have been made comfortable ( pain/nausea relieved etc) ....behaving like morons just because they feel they can.
Becoming all over-wrought and throwing an absolute wobbly because they are annoyed at being in hospital ...annoyed because they can't go home yet ... because their husband has to go home / the dog is by himself / they are bored / dr is taking too long to discharge ...and so on.
I've had the most silly unreasonable behaviour lately. These people know they can get away with this ... as long as they are not verbally or physically abusive.
Anyone have any useful tactics for these ones???

I get these patients all the time in psych.

Validate their feelings (whether you agree, they have a right to be upset), address the concerns that you can (if they have pain, give them something), keep them posted on what's going on (since most anxiety is due to patients not knowing what's going on), explain hospital policy and procedures (and emphasize that you can't bend/break them on the patient's say-so)...and then set boundaries and stick to them. You need to do your job so don't let one patient throw you off.

If you feed into their hissy fit by bending the rules or showering them with excessive attention, they're going to throw more fits since they've gotten something out of the first one.

VICEDRN, BSN, RN · Dec 11, 2010

I get these patients all the time in psych.
If you feed into their hissy fit by bending the rules or showering them with excessive attention, they're going to throw more fits since they've gotten something out of the first one.

I agree with the last few lines here. Other than properly addressing their needs and listening to them, establish and maintain the proper boundaries.

I think we all get "runs" of particular types of patients. It always sickens me to see the type you describe since they sucker everyone around them in to their nonsense drama and there is almost nothing wrong with them.

PostOpPrincess, BSN, RN · Dec 11, 2010

Poor coping skills.

I had someone in recovery the other day crying because we wouldn't let her little baby stay at the bedside. She had major surgery and had a lot of pain and nausea. Although I can understand her need to see the baby, I also had to appeal to the mother side of her to remind her that HER need to see the baby would in effect scare the bajeebers out of the little toddler.

After that explanation, she realized that her baby was more important to her than her own needs AT THE MOMENT.

Eventually, she got relief and relaxed.

It was a harrowing, screaming, hissy fit for two hours.

But it was understandable...it's just one of those things that comes with the territory. Don't let it get to you.

pedicurn, LPN, RN · Dec 11, 2010

I agree with the last few lines here. Other than properly addressing their needs and listening to them, establish and maintain the proper boundaries.
I think we all get "runs" of particular types of patients. It always sickens me to see the type you describe since they sucker everyone around them in to their nonsense drama and there is almost nothing wrong with them.

Agree.

I always listen/encourage verbalisation.

However the last few times, I have had difficulty setting boundaries ....when I did, the hissy fit esculated. Added to that ...the last one threatened behaviour that could have compromised safety. Therefore I couldn't walk away at that point.

I felt she was quite manipulative as I felt she knew my license would be on the line if I did what she was sreaming for.

If it's not the license ...then it's some very mnor subjective complaint that they hnow they can write to the hospital and complain about.

Reflecting, I am totally over these p'ts and the acceptance of their 'loss of control' issues. Their pain/nausea has been relieved/hydrated/ given oral food and fluids if indicated PLUS they do not have serious illnesses.

Primarily I feel the issue is about a lack of responsibility, rather than 'loss of control' being the major focus IMHO

johwiklundRN · Dec 11, 2010

These people need empowerment.

Remind them that their health care experience is a result of choices they have made. Listen to the feeling the pt is expressing, what she may be experiencing that may precipitate those feelings, listen for needs that may not be met, and a possible request. then reciprocate, by by telling the patient your feelings needs and requests.

Nonviolent Communication - Wikipedia, the free encyclopedia -

if people are willing to be honest, this usually works...

however sometimes people just have a need to be an ass.

pedicurn, LPN, RN · Dec 11, 2010

These people need empowerment.
Remind them that their health care experience is a result of choices they have made. Listen to the feeling the pt is expressing, what she may be experiencing that may precipitate those feelings, listen for needs that may not be met, and a possible request. then reciprocate, by by telling the patient your feelings needs and requests.
Nonviolent Communication - Wikipedia, the free encyclopedia -
if people are willing to be honest, this usually works...
however sometimes people just have a need to be an ass.

Well ...yes...theoretically so.

However these p'ts don't like to be managed ...and if they pick this up they esculate....because it's the 'contol' issue LOL

They are intelligent and educated ...and a lot of the techniques we use on other p'ts don't work here because they understand what we are doing. We as nurses, often don't have enough authority to circumvent the process so we don't have the tools to deal with these ones - I find this frustrating. A docotr would simply walk in and refuse to take any nonsense and have them sign a AMA form

Because they understand our nurse processes ....they get worse because they feel patronised when we try and manage them

So I am pulling out my hair here ...

VICEDRN, BSN, RN · Dec 11, 2010

Agree.
I always listen/encourage verbalisation.
However the last few times, I have had difficulty setting boundaries ....when I did, the hissy fit esculated. Added to that ...the last one threatened behaviour that could have compromised safety. Therefore I couldn't walk away at that point.
I felt she was quite manipulative as I felt she knew my license would be on the line if I did what she was sreaming for.
If it's not the license ...then it's some very mnor subjective complaint that they hnow they can write to the hospital and complain about.
Reflecting, I am totally over these p'ts and the acceptance of their 'loss of control' issues. Their pain/nausea has been relieved/hydrated/ given oral food and fluids if indicated PLUS they do not have serious illnesses.
Primarily I feel the issue is about a lack of responsibility, rather than 'loss of control' being the major focus IMHO

Anytime you feel that the patient may be acting in a manner that is unsafe to herself or others, you should immediately ask her if this is the case and remind her that the "nursing process" requires you to seek a psych hold if she can not maintain her own safety.

As for the minor complaint, invite her to complain and let her know that you feel you can defend your care to a manager that will back you up. (Even if you are bluffing)

I once watched a nurse take a family member who was throwing a hissy fit to triage. Imagine her surprise when the nurse explain that if she couldn't stop "fallin out" then she clearly needed to be evaluated...

Maintain your own sanity at all costs.

pedicurn, LPN, RN · Dec 11, 2010

Anytime you feel that the patient may be acting in a manner that is unsafe to herself or others, you should immediately ask her if this is the case and remind her that the "nursing process" requires you to seek a psych hold if she can not maintain her own safety.
As for the minor complaint, invite her to complain and let her know that you feel you can defend your care to a manager that will back you up. (Even if you are bluffing)
I once watched a nurse take a family member who was throwing a hissy fit to triage. Imagine her surprise when the nurse explain that if she couldn't stop "fallin out" then she clearly needed to be evaluated...
Maintain your own sanity at all costs.

LOL ...

Would love to do that ...in fact was on the tip of my tongue :)

However in Australia we are not allowed to state they need a psych evaluation ... a doctor can though.

In retrospect, I am annoyed by these ones because the worst of them do in fact manage us ...rather than the other way round.

And that's a reflection of our relative lack of authority in the system