Nurses and those in the medical profession are often thought of as angels of mercy, always kind, always patient, and always without a rude bone in their bodies. Patients and families often come into clinics and hospitals in foul moods, altered states, upset and demanding, and countless other behaviors might be exhibited, and yet the dear and helpful staff are expected to paste a smile on their faces and simply "deal with it."

Truth be told, it's not always easy. Most nurses understand that there is usually a reason for these sometimes over-the-top behaviors, and are trained to manage unruly patients and detach themselves from taking things too personal. Still, there are those days when just one too many out of control patient can put any stoic nurse over the edge. These situations arise so often, there are even online courses on dealing with difficult patients that you can take to help arm yourself.

So with this in mind, let's look at the issue of unruly patients and families, and how we can cope with these situations.

Dr. Hollister King, a family physician-in-chief at Women's College Hospital in Toronto stated it perfectly – "Situations arise that make you wish you never got into medicine." Of course this isn't the usual case all the time, and Dr. Hollister believes that using communication skills can turn situations of conflict into more constructive and satisfying experiences for both staff and the patient.

There are special types difficult patients that are usually fairly obvious when they enter the hospital or clinic; drug abuses, alcoholics, patients with mental disorders. These patients need help, but for obvious reasons they may be in altered states that both test and challenge medical staff. The other type of difficult patient is the one who may be acting out and not helping the staff help them simply out of fear. An example may be the patient who seems overly cheerful, cracking jokes, and who has a certain air of not caring about what is wrong with them. When asked a straight question, they might answer with a joke or seem distracted. The motivation behind this patient may very well be fear. If they were to be honest with their feelings about their illness, they may be facing realizations they simply aren't ready to deal with. Losing your patience with this kind of patient is not only pointless, but it's unkind and unnecessary.

How to Handle High Needs Patients

Altered or Mentally Challenged Patients

When someone enters a hospital or clinic and is clearly not himself, the trick is to remain calm. According to the Wisconsin Medical Society, choosing your words properly is very important. For example, you do not want to use the words "crazy" or "loony". These may be trigger words that might set the patient off. It is also important to remember that not every patient who presents as demanding, unable to accept feedback or carry on a clear and calm discussion is suffering from psychiatric condition. In either case, should a patient appear to be truly troubled, calling for help from other staff and/or security may be necessary to protect yourself and the patient.

Take it Easy, Sir! We're Here to Help!

The aggressive and even hostile patient is certainly not unfamiliar to most nurses. Often the patient doesn't start off aggressive, but becomes aggressive because he or she has become impatient with their situation. They are giving control of their health to strangers, they don't feel well, they are afraid, and they want a resolution. One way to deal with these patients is to calmly try to understand what the patient is trying to achieve. Do they want to know when they can go home? Do they want to know what their test results are and why it is taking so long to get an answer from somebody…anybody? Communication often works wonders with these patients because the main thing they want is to be heard and taken seriously. Allow them to get their worries off their chest, don't criticize them for being honestly upset, and try to find some real answers for them. Peace of mind is often all they really want.

Other Tips to From the Trenches

Sometimes You Just Have to Walk Away

Seriously! If you have a patient that simply refuses your assistance, and who believes that for some reason you are the reason for their misery and the chemistry between the two of you is truly toxic, ask another nurse to take over the care of that particular patient.

Always Expect Respect

An elderly patient has decided that you young "whippersnappers" don't know what you're doing and in their day things were different! These comments can easily be pushed aside with a smile and don't have to interfere with your care of the patient. However, should a patient become insulting, racially inappropriate, or completely disrespectful, you should try to explain to the patient that there are some things that are simply not acceptable behavior and that they need to offer you some respect so that you can help them.

Diffuse the Demanding Patient

Some patients, while we are sorry they're not feeling well, do seem to think the world revolves around their care. In their minds not only are they the only patient in the hospital, but the nursing staff is their personal maid service. When demands become a little out of line, responding kindly may that you are doing the best you can to help them, that you will tend to their needs, but you also have other patients who do need your help as well. Of course sometimes you just have to end the day shaking your head with the treatment some people give their attending nurses. It happens!

Juggling the Demanding Family!

Family members can sometimes be worse than the patients themselves! They are concerned about their family members' care, afraid and worried about their conditions, and are also feeling completely out of control. Unfortunately, they will often turn to the nurse to be the savior of the day. "Did you change her sheets?" "Is he eating? What did he eat? How much? When did he eat? " It's natural to feel bombarded by these questions that come at you like a hail of bullets, but if you can remind yourself that much of this behavior from difficult families is all based on fear, it will help you manage your communications with them. These difficult family members are afraid they are going to lose the one they love, and really, you are a stranger taking care of their needs. These are situations where taking a little time to introduce yourself, reassure the family that their loved one is getting outstanding care, and inform them that you will let the doctor know that they are inquiring about the patient will do wonders! You're listening and you're there for them. Very often this kind of five minute discussion can work wonders to ease their minds.

Communication and Mutual Concern Save The Day

Difficult patients and difficult families, as we said earlier, do have one thing in common. They want to be heard and understood. There is a fear and you are a stranger whom they are trusting to help them get better. It really is that simple. If you can reach out to the difficult patient and the difficult family and help them understand that it is your goal to make them happy, comfortable, and help them get well, you will diffuse most conflicts before they even start.

It can be a taxing emotional experience to deal with a range of emotions day in and day out, but it's important to know that most of the concerns are not directed personally at you the nurse. Be encouraged that you're not alone in your struggles to deal with patients, and that you do not have to accept problems when they become abuse.

As one doctor so wisely put it in an article from Podiatry Today called "How to Manage Difficult Patients", "Accept the patient, not the behavior. Acceptance means acknowledging the patient as a person of worth."

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