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'What can we do about 'difficult' patients?'

It’s no secret that some patients can be incredibly challenging to look after, but what exactly constitutes a difficult patient?

Is it non-compliance? Aggression? Someone who is more than a little enthusiastic with their call bell?

Nursing is hard work at the best of times let alone caring for patients who can be confused, demanding or even abusive. While nurses are remarkably resilient at coping with whatever is thrown at them (and sometimes this literally means objects that are thrown at them) it can be difficult to know exactly how to deal with ‘difficult’ patients.

Personally I dislike it when patients are labelled as ‘difficult’ when they are handed over. It implies that they are purposely trying to make things harder for the nurse when the truth is they are probably just anxious, scared, confused or unsure.

The vast majority of patients would not choose to be in hospital or dependent on others for care but they do not have a choice. Remember how lucky you are to be able to leave at the end of your shift and go home because some patients will never get that opportunity again.

I have found that taking time to listen to and acknowledge patients who have ‘caused trouble’ is often all that is needed to put them at ease and make them more co-operative; a luxury afforded to me by supernumerary student status; however there will always be times when nurses may come close to losing their patience with patients because we are after all, only human (though you could easily see why others may assume we are actually angels).

Everyone has their own strategies for coping with difficult patients but let me share mine with you; though I suspect you may already be familiar with it. Imagine you are at work and for whatever reason you are starting to feel frustrated and short tempered with a patient.

As clichéd as it may be take a deep breath, count to ten and take a step back.

Now take a look at that patient again. Are they young, old, male, female? It is irrelevant. That patient is someone’s family. They are someone’s mother, father, grandparent, child, husband or wife. How would you feel if they were your grandparent? Would you not want them to be treated with kindness and compassion?

There is no excuse for abusive or violent behaviour and these should be reported and handled appropriately; but for me the solution is simple. Treat your patients as you would wish your relatives and yourself to be treated – with the love and respect they deserve (even if they are being a pain in the gluteus maximus).

Laura Carter is a third year student nurse at the University of Kingston.

Readers' comments (3)

  • This article is so right and "difficult" is an unsafe term to use as it could encompass the situation when a nurse doesn't get on c. a pt while all the other nurses do.

    What's the alternative term: "challenging"? I don't really think that's any better.

    Maybe the phrase "requires extra input"? Don't know.

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  • Excellent article. Labelling patients as "dlifficult" at handover can influence attitudes and behaviour of staff towards the patient whom they may not have known before the shift and bias the therapeutic relationship which may in turn then negatively influence the behaviour of the patient towards the nurse (self fulfilling prophecy). It is of course helpful, and for safety reasons, better to inform colleagues but it would be more useful to cite an example of the type of behaviour the patient exhibits and whether it is diagnotically related such as a history of personality disorder and whether the patient is undergoing any type of therapy for this.

    We once had a patient with BPD on my acute medical ward with a medical condition and the information I was given at handover was that he had Borderline personality disorder which none of us really knew anything about, that he could be very difficult, sometimes aggressive, was under the care of a psychiatrist who visited the ward occasionally, and as he was independent should be avoided and not engaged in conversation in order to avoid conflict except to deliver care!

    Now, many years later with experience in PDs, I agree that patients with such disorders or any other problem which is making them 'difficult' for whatever reason such as those cited in the article, need to be approached, we need to seek dialogue with them and listen to them and their concerns which we must do what we can to address and, what should go without saying, treat them with the same respect we would any other and in the same way we wish to be treated.

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  • This is an excellent article. I completely agree with your statements about taking a step back and then looking again at the patient and treating patients the way you would want your family members to be treated. In the years prior to my going into nursing training I worked as a home carer and some days could be very challenging but I always treat every service user the way I would want my relatives to be treated

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