We’ve all been challenged by difficult patients and family members. Whether unofficially labeled as “frequent flyers,” “malingerers,” “drug seekers,” “noncompliant,” or otherwise difficult, some individuals can try nerves and push emotional buttons of even the most composed and experienced nurses. "Difficult patients" may be a fact of life for our profession. Once I realized I couldn’t change underlying behavioral problems, I began to develop strategies to try to constructively deal with disruptive and demanding behavior. Here are a few ideas:

First, even when pressed for time, I try to actively listen and recognize specific concerns of disgruntled patients or family members. Most often they just want to be heard. So while I may not share their perspective nor condone their approach, I try to acknowledge their concern, which can lead to building their trust.  Other clients just need clarification of their condition or treatment options. When possible, I try to share brief bits of relevant information. Although handing over a thick packet of information during their discharge seems easier, providing ongoing education and reinforcement throughout a patient’s hospital stay is more effective. It also helps to supplement ongoing education with approved written material which the patient can refer to during their stay.

Next, remaining objective, consciously avoiding assumptions and stereotypes can make a big difference. Obviously, not all chronic pain complaints are somatic, and frequently distressed patients are not necessarily anxious or drug seeking. In nursing school we learned that pain is what the patient states that it is, period. If prescribed therapy and nursing interventions are not working, we need to work with patient, family and provider to address the problem. Empathy and compassion are key.

Third, I try to establish clear boundaries and set appropriate limits. That’s not always easy, as many of us see ourselves as nurturers and may consequently yield to unreasonable demands. I try to avoid power struggles by setting clear expectations early on and maintaining my professionalism throughout the patient’s stay. Some patients feel overwhelmed or powerless as a result of their condition or hospitalization. By upholding professional boundaries, we provide reassuring structure and comforting expertise.

Patient charts and hand-off reports provide insight into possible causes and effective management of difficult behavior.  Why reinvent the wheel? I quickly review the difficult patient’s medical history for such clues as underlying physiological and psych issues, current medications, and ongoing substance abuse. Care notes often reveal patterns of behavior and previous interventions. Specific behavioral concerns should be objectively documented and passed along in report.

Finally, document all interventions, such as the use of restraints, according to facility policy. You may think that you will never forget details about a difficult patient. But, chances are that months or years from now, you will not recall every detail. As we so often hear in health care, “If it isn’t documented, it didn’t happen.”

How do you deal with difficult patients or family members? What pushes your buttons?