Challenging Patients and Therapeutic Dialogue
One of the many challenges of patient care is caring for a difficult patient or family member. This includes caring for substance abusers, the mentally ill, non-compliant patients, confused patients, and patients with uncontrolled pain. It can even be more challenging caring for those who are socially, culturally, and philosophically different. While nursing these patients can alone become wearisome, don’t forget about the variety of family member and visitor personalities. How do you therapeutically handle the most challenging situations?
1. What complaints do you typically hear from patients?
2. How did you respond to a patient communicating their anger and mistrusts?
3. How do you ensure good pain control?
4. If a complaint is about uncontrolled pain, how do you respond?
5. What do you say if a patient communicates an issue regarding another department or another coworker?
6. Frustrations with patients is inevitable, how do you respond during these interactions?
7. How do you respond to patients and family members who continually verbalize their displeasure?
9. How do you manage non compliant patients?
10. What’s your advice to the new nurse concerning disruptive or abusive patient with inappropriate behavior?
11. How do you handle the disrespectful, socially inappropriate family member?
12. How do you protect yourself and ensure “safety” for all?
13. How do you therapeutically care for the difficult population such as alcohol abusers, prescription medications abusers, and patients who use illicit drugs?
14. It’s difficult to care for the mentally impaired or mentally ill patient. What is most challenging for you and how do you care therapeutically?
15. What special considerations do you follow when taking care of a patient who is suicidal?
16. Do you give into a patients disillusions or reorient the patient? Why?
17. How do you overcome the communication barriers for those patients with hearing impairment, speech impairment, language, cultural difference, or illiteracy?
18. Listening is the best medicine, but where do you draw the line?
19. Tell of a time when going above and beyond greatly benefited a patient/family situation.
20. What are things somethings you should never say to an already upset patient?
when families don't understand what is going on, do some educating
if you tell them you're going to be in there and turn the pt evey two hours, be there every two hours and followup on your promise
family members are intimidated and feel powerless by all the technology and equipment, They feel they can at least help by doing small things like feeding someone some ice. When the ice cup is emtpy and after several requests and a long wait, a small thing can become a big deal.
Beeping iv's bother families members because something is not working right. They know an alarm needs attention and when one comes, they feel "no one cares". You may be super busy but they don't know that.
Even though it may not be your iv alarm beeping, attempt to resolve the problem. and if it's a critical gtt, immediately notify the attending nurse.
Garbage is over flowing, linen is on the floor, water ptichers are emtpy, urinals are full, no one's been in to check the patient for a while, and the family is angry and complaining! Don't make excuses, no one wants those. And although some of those are not my primary concern, i will take the garbage out, pick up the linen, fill the water pitcher, empty the urine, and double my rounding patients checks. My job is to keep the patient and if possible, keep the family happy.
For a complaint, apologize sincerely, restate their concern, and attempt to resolve the complaint and notify the coordinator and doctor if appropriate. If you want more info on this, check to see if your hospital offers complaint resolution classes.
unreasonable expectations....know some people you just can't make happy, nothing you can do, and nothing you can say will work.
know when to relay the problem to your coordinator and manager.
if their complaint is about a previous associate/nurse, manage it up.
Never, never something derrogatory about another coworker or a doctor or associate in front of a patient and family members. Instead say something like "oh that surprises me about them..."
If someone else begins to talk down about another coworker in front of the patient or family members, politely ask them to step out of the room and try to resolve the issue, never in front of the family.
If someone is unruly understand you're seeing the patient/family at their absolute worst, don't take it personal.
Patient's issues can go much deeper when they over react on something.
Posted by: suzie and shannon | Dec 20, 2009 at 17:50
"my biggest pet peeve is murses whpo try to rehab patients off their pain medication, don't try to be a rehab nurse. So he's been taking pain medication for his back pain for the last 15yrs, it's not up to you to decide if he's getting too much, plus you'll have better shift if his pain is controlled." shannon
I do all I can to try to soothe the pain complaint and if it's not working,Sometimes you just gotta call the doctor. I always look to see what their pain medication hx is, its useful to let the doctor know so he doesn't order something that the doesn't work.
Ask the patient what they want first or what has worked for them, relay their preference to the MD.
know their allergies, and have the chart with you
Determine if pts complaints are triggered by anxiety or pain, post op patients can be restless after surgeries and may need something for their anxiety more than their pain.
I tell the doctor, "your patient... tell him what's the "pain story" and always rate the pain for him/her.
SBAR, always repeat back to him what you just wrote, they know it, so don't let them rush off the phone.
Work with the patient reasonable pain expectation level, & try to manage the pain around that level. I use the wong baker scale often.
Pain can potentiate anxiety.
Ask a patient to compare their pain to the worst pain they've ever had in their life.
I always tell them your body needs to focus on healing not on fighting the pain.
Sometimes its not reasonableto think you can take it all away, but you can atleast try, get to the tolerable level.
If you walk into a paitents room and they contintue to tell you your interventions are not working you need to be on the phone.
Recognize elderly people and some cultural groups don't like to ask for pain medication because they think they're going to get addicted to it.
Look for patients who won't tell you they're in pain but recognize and offer to treat it.
for your nonverbal or non english speaking patients, look for guarding and vital sign changes.
Posted by: suzie and shannon | Dec 20, 2009 at 17:01
understand surgical pain is real pain, as you mature you'll know when to be generous and when to take the minimalist approach
disgruntled family over
Ventilated patients having saliva hanging out of his mouth, even though i just suctioned them
doctors slip in an slip out and families are left uniformed, i ask ask the doctor if i can discuss results or treatment plan
with patients who you can't please, you have to be direct, "how do you want to be positioned" and then you need to cut them off
I had a trach patient continue to pull everything off and I told him, "you're not helping me take care of you"
Dementia patients,
find within your self extra patience for this population
I don't argue with the patient and their delusion, you'll never win.
Give them a wash cloth to fold, something to hold onto and try to figure out, it's better than picking at their IV site.
I am still unsure about whether or not to give into a patients delusions but the delusions might get worse.
Posted by: melissa | Dec 18, 2009 at 06:36