Nurse holding up hand to say stop

In a sense, nursing is a form of customer-oriented service. The industry involves interacting with patients from all walks of life and delivering high-quality service and satisfaction to each of them.

Even before engaging with a health professional, anyone seeking service will have expectations at a satisfactory level. The challenge for healthcare providers is that some of those expectations are simply impossible to meet. Although most patients will be cooperative and understanding, you can expect to encounter dissatisfied and irate patients from time to time. While we can all agree that we cannot please everyone, this doesn't mean that dealing with a difficult patient has to create a negative experience for both parties.

Why Do Patients Become Difficult to Handle?

More often than not, resistance is a reactive stance to stimuli. Understanding the reasoning for a patient's behavior is the first step toward handling the patient and de-escalating the situation.

Research shows that patients recognize poor communication and environmental conditions as a cause of resistive behavior. The following conditions can also be a result of several common scenarios in patient-provider interactions:

  • Anxiety and distress
  • Being in pain or unwell in general
  • Dissatisfaction from the previous hospital experience
  • Unrealistic expectations
  • Blame toward themselves or the healthcare provider

Typical behavior of difficult patients may include one or more of the following:

  • Being overly controlling and demanding
  • Refusal to listen and cooperate
  • Verbal abuse or threats toward themselves and others
  • Using physical violence on objects or people

Frequently, resistance will come from the patient's family members as well. Remember that this behavior is a product of coping and should not be taken personally.

RELATED: How Nurses Can Avoid the Most Common Ethics Violations

Dealing With Resistant Patients

Despite the presence of hostility and violence, patients must not be denied the necessary treatment - especially if the patient is experiencing a life-threatening condition.

It's common for resistant patients to make demands and even propose how they should be treated. As a health provider, it is your responsibility to perform treatments based on their clinical needs and not on their demands. Upon facing rejection or discomfort, an irate person's behavior may escalate toward an aggressive or passive-aggressive stance.

Dealing With Passive-Aggressive Patients

Passive-aggressive behavior is when a person indirectly expresses negative feelings, rather than openly displaying them. Passive-aggressive people can also display one or more of these red flags:

  • Opposition to other people's instructions.
  • Deliberately delaying or failing a task
  • Frequently voicing dissatisfaction and mistrust
  • A cynical or hostile attitude

Dealing with a passive-aggressive patient can be challenging. However, health providers should avoid becoming discouraged and continue to perform interventions by implementing one or more of the following strategies:

  • Help the patient recognize the negative consequences and take responsibility for their behavior
  • Review the patient's medical record for a previous or existing psychiatric diagnosis related to the behavior
  • Involve the patient in formulating a care plan
  • Avoid debating with the patient to discourage manipulative behavior
  • Encourage the patient to express themselves more openly
  • Promote healthy coping methods
  • Refrain from apologizing for doing your job properly
  • Set a patient's expectation on limits and consistently enforce them

RELATED: The Importance of the Nurse-Patient Relationship for Patient Care

Be Prepared to Deal With Difficult Patients

These types of difficult interactions are inevitable in the healthcare industry. If you haven't already done so, individuals at all experience levels can benefit from taking conflict resolution courses. This reduces the chance of a difficult patient catching you off-guard and preventing you from delivering quality healthcare.

Karen Cas-Alinas
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