Search
Advice » In the Workplace» Workplace Issues » Difficult Patients
Difficult Patients

Difficult Patients

Why They're That Way and How to Handle Them

They complain, criticize, shout, swear and may even try to hit you. Difficult patients are an unfortunate fact of life in healthcare. But knowing how to identify, understand and respond to them can make your work life safer and less stressful.

Identify Difficult Patients

It's sometimes possible to predict which patients will likely become difficult, abusive or violent. Alzheimer's patients, for example, tend to be moody, irrational and easily agitated. Those with cancer, end-stage renal disease (ESRD), a history of violent behavior or some psychiatric disorders are also prone to disruptive or violent behavior.

Watch for certain emotions, advises Christine Simms, RN, MSN, a psychotherapist in private practice. Isolation and fear can lead to anger, which can escalate into violence.

"Look for isolated patients who are cut off from their families and communities," says Simms, a clinical specialist in adult and family mental health nursing. She has taught hospital employees and individuals how to spot potential trouble as well as how to manage conflicts if they happen.

Many patients also feel let down by their failing bodies, their illness or by being hospitalized, institutionalized or placed in a nursing home. Some experience spiritual betrayal, asking why God let this happen to them. "Cancer patients often feel betrayed, particularly if they are also feeling isolated and stressed by switching from competent caregiver to losing control over their life, spouse and children when illness strikes," Simms says.

Understand Why They're Difficult

For patients with dementia, mental confusion is at the root of many problem behaviors. "Because people with dementia misperceive their environment and the intentions of their caregiver, they often react in negative ways," says Dan Kuhn, MSW, director of education for Mather LifeWays Institute on Aging. The more cognitively impaired people become, the less able they are to express or defend themselves.

Many ESRD patients are testy, often for good reason. "They are sick and may be depressed because of their illness," says Dr. Godfrey C. Burns, nephrology section chief at Saint Vincent Catholic Medical Centers. "Many are frightened, have poor coping skills and have a personality that is hard to get along with." ESRD patients also aren't often prepared to go from a normal life to an indefinite regimen of thrice-weekly, four-hour-long dialysis treatments. As chairman of the End Stage Renal Disease Network of New York's grievance committee, Burns helped reduce the number of complaints about disruptive patients over the last 10 years by instituting a formal approach to treatment and educating staff.

Response Strategies

Once you understand what makes some patients so difficult, it can be easier to follow the experts' suggested dos and don'ts.

Make sure you:

  • Observe: Notice a patient's words, voice or attitude to pick up on rising anger levels. Overly compliant behavior is also a warning sign that a patient has lost his identity and sense of competence, which can lead to vulnerability, fear, anger and violence. "Worries and loss of control often are triggers of aggression," says Simms, who urges nurses to trigger a sense of capability in patients, not one of vulnerability.
  • Connect: Uncover and directly address a patient's underlying feelings with comments such as, "You sound worried. What can we do to help?" Establishing a personal connection can go a long way toward gaining cooperation, Kuhn says.
  • Show Respect: Make eye contact, and try to approach patients at eye level. Always address patients as Mr. or Mrs., and speak in a friendly manner.
  • Slow Down: Rushing can be counterproductive, especially when caring for those with dementia.
  • Recruit Help: Enlist relatives to help break the isolation, create solutions and provide support.
  • Be Informed: Know your employer's patient bill of rights, as well as its policies and procedures for dealing with difficult patients.

Avoid:

  • Bullying: Don't use your caregiver status to threaten patients.
  • Making Assumptions: Most patients are not intentionally abusive or disruptive. They often are responding to an irritation, vulnerability, cognitive impairment, inability to express themselves or loss of identity.
  • Putting Up Walls: Distance just fuels patients' anger.
  • Tolerating Disruptive Behavior: Clearly explain what is unacceptable to avoid problems later.
  • Taking It Personally: "You can't expect that everyone at work will act pleasantly," Godfrey says. "Interpersonal mishaps or confrontations are guaranteed when you work with the public."   

Latest Jobs

Posted: 11/29/2014
Seacrest, 32413
MILDRED MITCHELL BATEMAN HOSPITAL
Posted: 11/29/2014
Huntington, 25701
MILDRED MITCHELL BATEMAN HOSPITAL
Posted: 11/29/2014
Huntington, 25701
MILDRED MITCHELL BATEMAN HOSPITAL
Posted: 11/29/2014
Huntington, 25701
MILDRED MITCHELL BATEMAN HOSPITAL
Posted: 11/29/2014
Huntington, 25701

Want more personalized results?  Update Your Profile

 
 
 

Monster Communities

Teaching Community
Where teachers meet and learn.
ArtBistro
Create and connect.
Excelle
Networking for the career-minded woman.
Nursing Link
Where nurses call the shots.
More Monster Communities

Monster Partners

Scholarships
Scholarships, financial aid and more ways to pay for school.
Education.org
Find top campus and online degree programs.
Military.com
Military portal for the US Army, Navy, Air Force, Marine Corps and Coast Guard.
Financial Aid
Scholarships & financial aid.
Staffing for Government Jobs
Staffing and hiring solutions for federal government agency jobs.
More Monster Partners

Job Hunt Strategy

Six Ways to Make a Recruiter Hate You
If you want to blow your chances with recruiters -- and, by extension, with the companies they work for -- here are six perfect ways to do so.

Resumes & Cover Letters

Rev Up Your Resume to Relocate
Hoping to relocate? Get the ball rolling on landing the right job in the right location with these expert resume and cover letter tips.

Interviewing

100 Potential Interview Questions
Interview questions can run the gamut. You probably won't face all 100 of these, but you should still be prepared to answer at least some of them.

Salary & Benefits

10 Questions to Ask When Negotiating Salary
Most of us aren't natural negotiators, but asking these 10 questions during salary negotiations can help you get everything you deserve.

Employee Sourcing

Alt text
November Monster Employment Index Grows 13% Year-Over-Year, Tenth Consecutive Month of Positive Annual Growth.

For Seekers

Campus and Online Degrees
Advance your career and earn more with an online degree.
Free Salary Wizard
What are you worth? Find out and negotiate a better salary.
Research Careers
Get information on jobs and career paths to help guide your choices
Questions & Answers
Find answers to all your career related questions -- powered by Yahoo! Answers
Resume Distribution Service
Our distribution service puts your resume right in the hands of recruiters.
Resume Writing Services
Our experts will craft a keyword-rich resume that stands out in the crowd.
More Career Resources

For Employers

Career Ad Network
Target your job posting to more candidates on thousands of websites.
Hire Right Background Checks
Explore our background check packages to improve the quality of your hires.
Hiring Home Page
Find the best candidates for your business with Monster hiring solutions.
Job Postings
Find the right solution for your hiring needs. Starting at $99.
Power Resume Search
Monster's new search technology precisely matches people with your jobs.
Resource Center
Find staffing insights, labor trends, HR best practices and more.
Target Post
Connect with skilled, hourly and administrative candidates for only $99.

Social Media

Jobs on Twitter
Find jobs in your area and industry.
Monster Careers
Tune into our career advice and discussions tackling a wide range of topics and industries.
Monster Corporate & PR
Stay up-to-date on the latest news. Get the 'Who', 'What', 'When', and 'Why' on all things Monster related.
Monster Customer Service
Got a Monster question? We've got the answer. Whether you're a job seeker or employer, we can help you find the answers you need.
Monster for Employers
Find advice on hiring.
Follow Us
Check out our many pages and stay connected with the latest industry news, events, career advice and job openings.

Other Links

Monster Company Profiles
Explore companies and get information to guide your career decisions.
Compare Salaries
See how your pay stacks up to others in your field.
iPhone Application
Download the Monster app for iPhone and iPod touch.
Monster Job Seeker Blog
Monster Job Seeker Blog.
Monster Thinking Blog
Monster's Recruitment Trends Blog.
Jobs & Career Resources
Search Jobs:
For Employers: Post Jobs | Search Resumes | Advertise
About Monster | Work for Monster | Advertise with Us | AdChoices | Partner with Us | Investor Relations | Social Media
Terms of Use | Privacy Center | Accessibility Center | Help | Security | Contact Us | Sitemap | Mobile
©2014 Monster - All Rights Reserved U.S. Patents No. 5,832,497; 7,599,930 B1; 7,827,125 and 7,836,060 MWW - Looking for Monster Cable? - V: 2014.11.0.15-319
eTrustLogo