People that
are usually very calm may reach their limit when illness impedes on their
health, mobility and independence. Fear
and pain can increase stress, anxiety, and frustration; the result can be a
very angry person, very upset at whoever is near them, including you as their
nurse. Don't take the anger from the
patient personally; they may be angry at the world in that given moment. The goal is to defuse the situation before the
patient gets angry.
Look for the signs
There are
signs that can indicate a patient's emotional state is deteriorating. Look for
changes in body language, including a tightened jaw, tense posture, clenched
fists, fidgeting, and any other significant change from earlier behavior. A
talkative person, for example, may suddenly become quiet. Observe the patient for additional signs that
his temper is rising. Is his voice raised? Is he demanding excessive attention?
If you detect
any of these warning signs, you'll need to act fast to help the patient vent
his feelings in a productive manner. Start by spending extra time with the
patient. Although you might be tempted to spend less time with him, doing so
only increases your risk of liability. Ignoring his complaints or, say, rushing
him may prove detrimental to his care. And if something goes wrong,
dissatisfied patients are more likely to sue.
If, for instance, you work in a healthcare facility, take time to ensure
that he is thoroughly familiar with his plan of care and the rationale behind
it. Review the care he's received so far, the progress he's made, and how long
his recovery should take.
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Show empathy
Some patients
won't be soothed by your extra attention and may become belligerent, demanding
to know such things as, "Why can't you start my therapy now?"
"Why isn't my treatment working?" or "Why aren't my medications
ready yet?" Your calm approach in answering such obviously loaded
questions can prevent anger from turning into a behavioral crisis.
Rather than
becoming defensive, you'd be wise to respond calmly to the patient and treat
him with respect. If a patient is
uncooperative, try to identify the underlying reason. A patient who balks, for
example, when a PT suggests replacing one exercise for low back pain with
another may actually be anxious about an upcoming procedure or the results of
tests. After you hear him out, reassure him that you take his concerns
seriously. Empathize with him, saying something like, "I understand how
upsetting this must be for you."
Be sure,
however, to calmly explain the consequences of his refusal. In this example,
the PT would need to elaborate on the reason for the new exercise and explain
that the patient's unwillingness to cooperate will delay his recovery. If, on the other hand, the problem is an
administrative one--such as having to wait too long to see a healthcare
provider--speak to the appropriate person about scheduling a time that's less
likely to involve a wait.
Keep Calm, Don't Lose your Temper
If a patient
is angry enough to verbally abuse you, remain calm and professional. Keep some
distance between you and the patient and do not respond until the verbal barrage
is over. When it is, speak softly and call the patient by name. For instance,
an EMT confronted by a patient screaming that he doesn't want to be touched
should listen quietly until the patient is done. He can then try to soothe the
patient, saying something like, "I know you're scared, Mr. Smith, but I
just want to take your blood pressure and make sure you're okay." That
approach may calm the patient enough to allow for a more thorough examination.
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Trying to
justify the situation or defend your actions will only make things worse. Use
active listening instead: Paraphrase back to the patient what he's already told
you, while at the same time identifying the real feelings behind the
words--fear or helplessness, for instance. Keep your statements short and
simple. Continue to treat the person with respect and show accepting body
language by letting your arms hang loosely at your sides rather than standing
with your hands on your hips or with your arms crossed. If the patient "blows up," he has
lost control and is so irrational he will no longer hear what you say. As in
dealing with a child's temper tantrum, your reaction may determine exactly how
long the fireworks last.
When the
person has quieted down, acknowledge his feelings, matching your words to his
level of anger. Express regret about the situation, and let the person know you
understand. Try to find some point of agreement, perhaps acknowledging that his
complaint is a valid one. Keep your cool
and don't be manipulated by the patient's anger. Never get angry yourself or
try to set limits by saying, "Calm down" or "Stop yelling."
As the fireworks explode, maintain eye contact with the patient and just
listen. Try to understand the event that triggered the angry outburst. Ask for the patient's solution to the
problem. Use phrases like, "Can you tell me what you need?" or
"Do you have some suggestions on ways to solve this problem?" End the
conversation by trying to reach an acceptable arrangement. Offer options by
saying, "Here's how we could handle this."
If the patient
threatens you physically or you fear for your safety, don't hesitate to contact
security or the police. For more immediate assistance, consider establishing a
code phrase that indicates when a staffer needs help. Regardless of the extent of the patient's
anger, documenting complaints--as well as attempts to resolve them and the results
of each intervention--can ward off frivolous claims or help in your defense if
a lawsuit proceeds to trial. If applicable to your line of work, note
administrative complaints in an incident report. Document clinical complaints
in the patient's chart. Dealing with
difficult patients will always be a challenge. But your finesse in defusing and
managing anger will keep the focus on getting the patient healthy and protect
you from unwarranted legal action.
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