What do you say when a patient family member is taking out their rage out on the world on to you?

[BeatsPerMinute, BSN, RN]

Started new job in outpatient IR. Many patients are sick, in pain, frustrated, and are with angry family members. I am trying to find the balance between keeping them happy and setting firm boundaries. I want to be kind, helpful, encouraging, professional while also protecting my own self. Manipulative and guilt tripping patient/ patient family members are difficult for me sometimes. 

What are some tips for this? What do you say when a patient and/or patient family member is being completely unreasonable? What do you say when a patient family member is taking out their rage out on the world on to you? 

I am asking for "go to" phrases that communicates empathy, understanding, and clearly states boundaries. 

[who_u_gonna_call]

Hi BPM, I'm personally trying to work on the same thing myself. A colleague pointed me to a specific Ted Talk by Helen Riess, "The power of empathy." While it's not specifically about our profession (she's a psychologist), there were quite a few good tips. Specifically, she had an acronym that I've been trying to stick in my brain:

• E for Eye contact

• M for Muscles of facial expression

• P for Posture

• A for Affect

• T for Tone of voice

• H for Hearing the whole person

• Y for Your response

I know it doesn't perfectly answer your question, but I feel it's been helpful to me and I thought it may be worth sharing.

[BeatsPerMinute, BSN, RN]

who_u_gonna_call said:

Hi BPM, I'm personally trying to work on the same thing myself. A colleague pointed me to a specific Ted Talk by Helen Riess, "The power of empathy." While it's not specifically about our profession (she's a psychologist), there were quite a few good tips. Specifically, she had an acronym that I've been trying to stick in my brain:

• E for Eye contact

• M for Muscles of facial expression

• P for Posture

• A for Affect

• T for Tone of voice

• H for Hearing the whole person

• Y for Your response

I know it doesn't perfectly answer your question, but I feel it's been helpful to me and I thought it may be worth sharing.

I appreciate this. Thank you. 

[who_u_gonna_call]

Glad to hear it, best of luck to you ?

[Been there,done that, ASN, RN]

Refer their concerns to the provider. If family is really out of control,  call security.

[NRSKarenRN, BSN, RN]

Active listening is important here.  When possible/safely, I sit at eye level, lean slightly forward with direct eye contact, tell myself to relax to minimize perception my posture is threatening or domineering.   Listen intently face to face and allow a vent. Nod to confirm you are hearing the person.

I lower my voice to slowly say:  "I'm sorry that you feel this way and that your expectations have not been met."    Often that takes with wind out of their sails.   "What I hear from you is.."  repeat back their major talking points.  Avoid using abbreviations or health care terms.

When appropriate/time permits:  "I'd like to discuss this further with you"  or "I need to gather more information.... let me contact X, Y, X  and I'll followup with you info I received."  " Let me call clarify info with Doctor"...

Totally irate, throwing things, back out of situation, call security, get colleague support/notify nursing supervisor.

Sometimes this works, other times security or management needs to deal with issue.

Use These De-Escalation Techniques To Help Keep Staff, Patients Safe

Quote

 

According to Carder, specific de-escalation strategies that nurses can practice are:

• Stay two arms' length away.
• Maintain a relaxed posture and look.
• Speak with a calm voice with visible hands.
• Acknowledge what the patient is saying.
• Do not threaten.
• Set boundaries.
• Do not use medical jargon.
• Be non-judgmental.
• Show empathy.
• Use this patient's name.
• Be OK with silence.
• Do not argue.
• Define consequences of behavior.
• Be respectful.
• Do not answer inappropriate questions.
• Treat with dignity.
• Use Trauma-Informed Care, and take the whole person into account: past experiences and current experiences.

 

Crisis Intervention and De-escalation Techniques

How can I de-escalate a situation when someone is angry or agitated?

JC:  De-escalation in health care

Looking forward to others advice.

[Nurse Beth, MSN]

Great advice. You can also add "What can I do for you now?"- after hearing their concerns- to refocus them.

 

[NRSKarenRN, BSN, RN]

Nurse Beth said:

Great advice. You can also add "What can I do for you now?"- after hearing their concerns- to refocus them.

 

Excellent point.

[Nurse Beth, MSN]

Usually behind the anger is fear.

[Wuzzie]

These situations seem to spiral out of control and everyone gets worked up so nothing is accomplished. When I find myself facing this I have not infrequently stopped the dialogue with something like this " we both are getting upset and I really do want to help you. I'm going to step out of the room for 15 minutes so we can both gather our thoughts and when I come back we can work together to fix this.” Then I set my phone alarm and go back in exactly 15 minutes. Often I use that 15 minutes to get hold of the patient rep or run the problem by my manager or peers. It doesn't always work but for the majority of the time it at least stops the screaming and personal insults. The key is to acknowledge that we both are not being our best in that moment. Don't put it all on them. Also when you do what you say you are going to do (come back in 15 minutes) it starts establishing trust. It may be just a little but it's a start. 

[TriciaJ, RN]

I would really avoid the use of the typical go-to lines.  "I'm sorry you feel that way" is one.  Also "We take your concerns seriously".  The problem is that they're overused and sound trite and insincere.

If the behaviour is really out of control, look the person in the eye and tell them specifically what to stop doing:  "I need you to stop screaming."  "First, you need to let go of my lapels."  If those things continue or if you're physically unsafe, then the next step is to call security.

If the person settles, then ask "Tell me what is not happening that is supposed to" or "What is going on right now that needs to be different?".

First, express empathy with whatever is being experienced.  "Yes, I know that you're in a lot of pain."  "I know that you're very concerned about this."  "I bet you're really starting to feel hungry".

Then tell them what you can do for them, or why you can't, what needs to happen and the timeline.

"The Dr. is supposed to come here next.  As soon as he gives the go-ahead, I'll get you food."  OR "I'm calling pharmacy right now and making sure your pain med gets here ASAP."  OR "I know you're having a really horrible time and I wish I could make it better.  Is there anything I can do right this minute that would make this suck a bit less?"

The key is genuine empathy.  Pretend you're in their shoes, hungry, painful, anxious and not feeling listened to.  What would someone need to say or do to make you believe they actually care about you?

Of course, some people just enjoy picking fights so don't beat yourself up if you don't make any headway with them.

[mdsRN2005, ASN, BSN, RN]

Nurse Beth said:

Usually behind the anger is fear.

Agree.  I helps me to remind myself they're not actually angry at me, but at the situation.  I calmly tell them that I will try to help them address the issue but I need them to stop yelling/cursing/etc first.  But I don't engage in an argument while they're doing that.  It's pointless because nothing I try to tell them or explain would get heard. I had a boss once who would just let them rant til they ran out of steam.  I don't always have his patience but it did work. Finally like others have said if you feel threatened remove yourself from the situation and call security.