Most nurses go into the job because they want to help people, but dealing with difficult patients can be hugely challenging, especially for those who are newly qualified. While every patient and situation is different, here are eight tried-and-tested techniques that can help.
1. Assess where the anger’s coming from
Nurses are only human and it can be easy to get caught up in the heat of the moment, but the ability to step back and assess the situation is an essential skill.
‘Often patients and their loved ones can express anger towards nurses, but it is likely that their outbursts are masking a whole host of emotions. They may be afraid or defensive, or just frustrated,’ says Nick Simpson, CEO of nursing agency MSI Group.
‘Patients and families can sometimes complain about lots of things when, in fact, there’s only one thing that’s worrying them. Ask questions and try to read between the lines. If a patient is expressing anger because they are frightened or unsure about their situation, offering them reassurance may help resolve the situation.
‘However, if a patient or relative is threatening or being physically aggressive, stay calm and call for a colleague’s assistance.’
2. Figure out what the person wants
Jonathan Beebee is a nurse consultant, behaviour analyst, and director of pbs4.org.uk, an organisation which supports people with learning disabilities using positive behaviour support.
Jonathan says: ‘All people will choose the behaviour they have learnt to be the easiest and most effective to get them what they want. It may be that aggression, throwing things or shouting, are the best behaviours they have to get their needs met.
‘Try and understand what they are after and give them an easier and quicker way to get what they want. This will make the challenging, aggressive behaviour redundant.’
3. Use positive language
How you respond to a difficult patient can make a huge difference to the outcome.
‘Often, patients can be firmly set on arguing their view point and may try to coerce nurses in to reciprocating their own verbally aggressive language,’ warns Nick.
‘Remain objective, use positive language, and speak in a calm tone. Deliberately not raising your voice to be heard can encourage others to lower their volume and stop shouting. The same is true of body language. For example, if someone is pacing the room, sitting down and asking them to sit down with you can immediately lower levels of tension.’
4. Use active listening skills
Acknowledging the person’s viewpoint (whether you agree with it or not) is essential.
‘If the patient feels that you aren’t listening to their feelings you may find they become more obstreperous,’ warns Nick. ‘Instead of dismissing their opinion, ask them to explain their reasoning and in turn explain your own.’
Jonathan adds that’s it’s important to use active listening skills. ‘Show the person you hear them and that you can put yourself in their shoes. Saying things like “yeah, if that happened to me I’d be fuming too!” is much more effective than a corporate: “I hear your concerns”.’
5. Accept you can’t always control the outcome
Sometimes a person is so set on a destructive behaviour that your intervention won’t make a difference – and nurses shouldn’t feel bad about that.
‘Don’t try to stop a falling elephant, you will just get crushed,’ warns Jonathan. ‘Sometimes people are determined to do something and we can get caught in the trap of feeling we have to control them, stop them from harming themselves. Sometimes the elephant has to fall so you can pick it back up.’
6. Let them win – the customer is always right
One of the worst things you can do is get involved in a power battle. You might know what’s best for the patient, but trying to exert your will or win the argument can be counterproductive.
‘Avoid getting trapped in an “I must win” battle,’ warns Jonathan. ‘”The customer is always right” is a phrase we don’t use much in health and social care, but maybe we should. If people feel they have “won” they may be appeased and calm down.’
7. Give them plenty of time to cool off
You might feel ready to talk things over, but it’s important to give the person plenty of time to cool off.
Jonathan explains: ‘When people are upset their bodies are pumped full of adrenaline. It can take up to 90 minutes for this adrenaline to leave the body. Keep this in mind and avoid rehashing the situation or looking for an apology. Avoid anything that may re-fuel the adrenaline for at least 90 minutes.’
8. Ask for help from the team
Finally, don’t be afraid to ask for help.
‘If you find dealing with a patient particularly challenging do not hesitate to approach your colleagues for support or guidance. Every patient is different, and they may be able to offer you advice based on their own experiences,’ says Nick.