The difficult patient.... or not so difficult

Hi everyone,

We have all had that admission…. The one where the patient basically comes screaming into the ward, they don’t want to be here, they want a single room, the nurses don’t look after them, the hospital is crap…. You know the patient I mean.

So how do we deal with these patients?  Everyone has their different techniques, sometimes they work and sometimes they don’t, and sometimes you have to try something totally different.  Often the technique you use depends totally on the patient and their reactions and may result in you trying something else because whatever you are doing is failing miserably. 

I’m going to tell you guys a little story now about how I handled a difficult patient on their admission to the ward (I’ve changed the story around and changed names etc. to protect patient privacy and confidentiality) and I would love to know your thoughts.

So on this day I happened to have a first year nursing student working with me who, as it generally happens on placement, was pretty anxious and nervous.  Our new admission arrived into her shared room on a wheelchair.  There was no hello, it was straight away ‘this isn’t right, I need a private room, I was promised a private room, I’m not sharing’.  As you can imagine, my heart sank.  I introduced myself and my student Mary and calmly told her we had no single rooms available at the moment.  She seemed to accept this and in my head I though ‘crisis averted’.

But then the next crisis happened.  ‘I can’t get out of the wheelchair, I need a frame, I can’t walk, I had a fall yesterday because the nurse wouldn’t walk with me….’ And it went on.  So we management to get her organized and managed to get her comfortable on the bed.  And then the real fun began.

Everything I said, she wasn’t happy with.  I said they physiotherapist would be coming to see her soon, she wasn’t happy with that because she had seen physio’s before and they made her worse and were the reason she needed the surgery she had in the first place.  I said we would look at how she was managing with showering and give her aids to help her, she said no, that she needed a nurse and not aids.  And it went on and on.  Mary, my poor nursing student was getting more anxious by the minute and I think she was starting to reconsider her career in nursing and my patience was running thin.

I then thought, ‘well, nothing that I’m doing at the moment is working, what else can I try?' 

So I pulled up a chair beside her bad, patted her arm and said ‘its been pretty full on for you hasn’t it, tell me what’s been happening since your surgery and what brought you into hospital’.  At this, she began talking and I began to understand her a bit better.  I didn’t offer much input into the conversation, I just listened and emphasized. 

It turned out she was pretty anxious about her recovery, she was experiencing new pain different to any previous pain she had experienced prior to the surgery, and that she had had multiple surgeries before with some not so great outcomes.  There were other things besides this that she told me and it ended up being a very personal conversation. 

I probably spent 15-20mins just listening to her, and I think this amount of time would have been doubled if I had continued on my previous way of explaining things to her and would have resulted in a totally different outcome. 

The outcome here was that she calmed down.  She became a different patient to the one that had come into the room full of demands and dislikes.  I took the time out to listen to her and focus all my attention on her and I think that’s what she needed, she just needed to know that someone was listening to her and taking her thoughts into consideration.

Everyone’s different, so it’s good to have some different techniques up our sleevse when we come across a difficult patient or situation.  And back to my student Mary, I think it’s so important that we should students how to deal with these situations, because you just can’t get it from a textbook. 

Does anyone have any situations that they've had to diffuse quickly and efficiently?