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Nursing the sick and the well does not exempt us from encountering various personalities. Part of our distinctive profession is to deal with difficult clients. These clients could be manipulative, demanding, suspicious, irate, or uncooperative clients.
Unfortunately, some clients may show violent behaviours to which extent that assistance from our fellow health team members is usually needed.

difficult patient

Have you ever encountered one? What was the first thing you did to resume a therapeutic environment? What did you feel about it?

Back when we are student nurses, we had difficulties in making interactions with our clients. The awkwardness and the scripted details that we usually practice could provide passing rates from our clinical instructors but it was only for grade’s sake, right? It was difficult. And it is commonly accompanied with shaky knees and hoarse voice; but, how about with demanding or uncooperative clients? The dilemma starts when clients do not participate with their treatment modalities. Sometimes they would shout at you or worse if they would leave threats at your desk. It is somehow overwhelming and it drags your whole body up to the end of your shift. It never felt comfortable at all.

As a nurse, you really have to delve things out before reacting to such challenging scenarios. Some of these clients are depressed or hopeless of their disease conditions and they would obviously demand for quality care and attention from us. It is rationalized well, if that is. Part of their coping mechanism is to project their health issues and demand for superior management. Manipulative clients, on the other hand, are clingy and would subject you to giving what he believes is correct, which could be out of your own jurisdiction already. That is why, during college years we were taught to provide contract and limit setting with our clients or in other words, establishing a therapeutic nurse – patient relationship. A “nurse- patient relationship” promotes clients knowledge of how you are dealing with him. It is different from having social or friendly interaction; it is a professional contract between you and your client. It is as if you are telling him that, “I am your nurse and you are my client.”

Though we have to be as compassionate as ever our business is still to provide professional care to them.  The way we talk and project nonverbal cues can sometimes be misunderstood by clients. So, according to McCabe- Maucher (2005), we have to utilize therapeutic communication when interacting to difficult clients.  Maintaining a safe distance and speaking in a soft low voice are two of the essential tools. Plus we have to be confident and firm in order to resume the control of the situation.

Sometimes there are clients who are talking foul at us. It is emotionally distressing but we should not be carried with our emotions. Instead, breathe in deep, and exhale the negative vibes. Whoa! Disregard your own feelings for the mean time and instead maintain your own professional pace of duty. We should not be troubled with their personal views or critics. On the contrary, we should put theirs for consideration. It is not as if, “Clients are always right…” but we have to provide the best possible nursing interventions without them telling us that we had done less as expected or we are having negligence in our part.

According to F.D. Burgess (2007), the best that we can do is to document everything that we did to our clients. We have to take note everything and we should do our duty without disregarding these clients just because they are being labelled as difficult clients. Indeed, despite being demanding or uncooperative, these clients have their health concerns that a nurse should make it up to. It is our sole responsibility to consider too, their feelings but not to the extent that we become manipulated by them.

Knowing what is right and good for our clients and practicing the best nursing care that we can do are the things we should put in mind. These difficult clients behave the way they do because they feel that they do not receive the nursing care they expected to have. Sometimes, they are just as sensitive as ever that they have emotional outbursts to us. However, nurses are human beings, too and we are not perfect. We have our own personal problems which we just conceal before going to work. It is rightfully challenging to develop a skill in dealing difficult clients. That is why; we should first leave our own fears, worries, and concerns behind before stepping in. It is hard to work with baggage of problems and sometimes this predisposes us to behave in an unprofessional way.

praying nurse

Praying before and after the duty shift could be helpful, as the nurse’s prayer would say, “ …Though thou hidest Thyself behind the unattractive disguise of the irritable, the exacting and unreasonable, may I still recognize Thee and say, Jesus, my patient, how sweet it is to serve thee…”. Let us just remember that we have chosen nursing as our profession and to spice it up, we need to deal with demanding, irate, violent or manipulative clients. Let us view things positively, because sometimes empathy is only what they needed.

Photo credits and References:
http://talktowarren.wordpress.com/2010/06/21/difficult-job-dealing-with-difficult-patients/
http://nursetalksite.com/wp-content/uploads/2011/09/praying-patient.jpg
Burgess, F. (2007). Nursing Care of Difficult Patients. Retrieved Last May 17, 2012 from http://voices.yahoo.com/nursing-care-difficult-patients-686055.html .
McCabe- Maucher, A. (2005). Managing angry patients. ADVANCE Online Editions for Nurses.
Shives, L. R. (2008). Basic Concepts of Psychiatric- Mental Health Nursing 7th Edition. Lippincott Williams & Wilkins.

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A dedicated registered nurse who loves to view life as a revolving conundrum with spectacles of light and an aspiring writer who wants to share her expertise and experience in the nursing profession. She had pursued continuing education specializing in Psychiatric Nursing but had her practice on MNCHN.