Do Difficult Patients get bad care

 

We do not always like the patients to whom we administer care.  It sounds harsh, but let’s be honest, we do not have to like them. We do however, have to provide the best possible patient care that we can while maintaining an appropriate level of professionalism and compassion.

If you are a nurse who is shaking her head that you love all your patients, this is my diagnoses: you either just got out of school or you do not have a pulse. People in general are hard to take care of. Adding sick people who are frightened makes it even more of a challenge.

Some of our patients are just demanding and never seem to be satisfied with anything that we do for them. The few times I have been in the hospital I have not been a very good patient, since I am used to being the nurse. I have been blessed to have not been very sick, or as frightened as some of the patients for whom I administer care.

When some of our patients are brought into the hospital, they have been brought in by the police, and are shackled and cuffed. This would be scary enough to begin with, and adding delusions and voices to their sickness only makes their situations worse. I cannot imagine the fear that these patients have.

As a nurse, even though we may not like the patients that step in front of us to be cared for, we have to look at them from the professional side of caring. This can be extremely challenging when someone is standing in front of you cursing you, calling you every name in the book, except your own name.

Remember in which position the patients remain.  They are sick. They are uncomfortable. They are frustrated. They are frightened. They may feel that they are not getting enough attention from caregivers or that people are not listening to their concerns. It is not their choice to be a patient; it is our choice to be a nurse.

Do not just hear what a patient is saying, but instead really listen. Let them know you are listening by maintaining eye contact. Do not just shake your head as you are thinking about other things you may need to be doing. Listen; you could hear something no one else has heard about this person and be able to help them at a different level of nursing.

I have been asked many times why I sit and listen to someone speak in grand delusional statements. It is because in those many statements, a true statement appears. Once I hear that little bit of information I can then ask questions that will redirect the conversation and really learn about the person I am listening to.

One patient I enjoy listening to talks almost nonstop some days. He is highly intelligent and has not one Masters Degree, but two. Because I have always listened to him, he shares stories of his life no one else has heard. Not all the stories are good, and I will ask, "Why did you do that?" and he will tell me his version of the story.

 

Be nice. Be caring. Keep your promises. Remember that our roles as nurses are not only to provide safe care, but also to provide information, support, and reassurance to our patients.

Trust me when I say there are patients that make me roll my eyes, blow my breath, huff and puff, and grumble just to hear them ask for something. It takes a lot of self control some days to just hand that person a cup of juice because of the nasty comments that are going to come right behind the gesture. I provide the care they need, and I do not offer more than I have to. Some people are so foul that it is best to stay clear of them, than to subject yourself to more of their behavior.

Nurses, I cannot stress enough the importance of adequately documenting any relevant events. If an adverse event occurs document it in the appropriate part of the patient record, or on an incident report per facility policy. In the event of litigation involving the patient, good objective documentation can increase the chances of a positive outcome for the nurse. Nurses, the best source of passing information and events is in the patients’ charts.

In mental health, patients threaten the nurses daily with being sued or fired. Most of them are just angry threats and they will come and apologize later. However, even though they may have apologized, it might not be the complete end. They are sick, but the facility still listens to each threat and investigates them as if they are completely true. This leaves the nurse hanging on the ledge, so to speak, to take care of the person, document the threat, and remain professional without adding fuel to the fire that has already sparked.

As nurses, we have our tender spots and we have our days that we are really tired. When someone attacks you verbally it becomes really hard to hold your tongue and not say the things that come to mind. I could not tell you how many times while working in a male patient unit over the years that I have been called a "bitch.” To which I have learned to reply, “Mrs. Bitch to you.” It will either cause them to apologize, stop and stare, or like in most cases walk away mumbling. That is not being mean to the patient; it is redirecting them. Those same patients have also become the ones who I am able to gain the most rapport with while they are in the hospital.

    Seek the assistance of your supervisor or other appropriate persons if you are caring for a patient who makes you feel uncomfortable, either physically or emotionally. There are times when a change in patient assignment is a reasonable step to take.

Have you had a difficult patient?

    

Angela Brooks has worked in a state-funded psychiatric hospital in Kentucky for 21 years as a nurse, assisting sometimes-dangerous patients who come in shackled and cuffed. At AngelaBrook.com, she offers stories of life on the inside of a psychiatric ward, and the site, as well as her company, offers support for nurses in the mental health field and helps them bring passion into their role at work.

On her BlogTalkRadio show, Mental Happiness with Angela Brooks, she shares some of her experiences “learning to love those others have forsaken” and gives tips on how to bring peace to your own life.

* Please note: I am not here to CURE, DIAGNOSE, Treat or suggest replacements for what a doctor prescribes – I am sharing my nursing adventures with you.

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