An important part of any nurse’s job involves getting patients to follow doctors’ orders for treatment. In nursing school, you are taught that whether it’s taking all medications as prescribed, attending rehabilitation, avoiding food and drink before tests that require fasting, or following recommendations regarding diet and exercise, many patients try nurses’ patience with their resistance, dishonesty, and other behaviors that may stymie efforts to diagnose or treat an illness.
Nurses’ lives are already busy and the work is already challenging, and that’s before a single issue of patient noncompliance has reared its ugly head. Given the numerous demands on your time and patience as a nurse, it’s understandable if you feel tempted to lose your composure when confronted with these instances of self-imposed counter-productive behaviors.
So how do you keep your cool and avoid escalating the interaction into a worse situation? Here are a few pointers that may help the next time a patient becomes belligerent, uncooperative, or downright combative:
Often, a patient is appearing before you at a low point in his or her life. They may be angry at a diagnosis, frightened for the same reason, confused by too much complex information delivered too rapidly, or simply worn down by pain. Physiological factors such as low blood sugar, dehydration, drug interactions, side effects, toxins, and other conditions may all play a role in influencing their behavior and cognition.
Accordingly, it would be a mistake to take unseemly behavior personally. If a patient treats you with less than the respect you deserve, be willing to cut him or her some slack. We’ve all been sick at one point or another in our lives. Try to remember what that felt like and allow that empathy to guide your response.
In many instances, patients are simply frightened. Terrified, even. Fear has an unpleasant habit of finding outward expression as raw anger. Again, you can’t take these expressions personally but you can try to understand them. In many cases, a patient may feel no one is listening to her concerns. Give her that attentive ear, and things may well improve.
It’s okay to be firm with an uncooperative patient, but it’s never okay to react with violence or abuse. The latter reactions would be serious offenses that could rightly jeopardize your career. Take a deep breath (the practice of yoga shows us that this can prompt a physiologically calming effect), let it out slowly, and leave the scene if necessary. Return when you have regained control over your own emotions.
Be Attentive to Nonverbal Cues
Listening to a patient’s words is an important skill, but an experienced nurse also knows that sometimes the most powerful messages remain unspoken. What is the patient not saying? Conversely, what is your own non-verbal “body language” telling the patient? Are you growing impatient? Angry? Dismissive? All of these states of mind tend to register through body language more than you might imagine. Crossing the arms, for instance, is universally read as an indication that someone is feeling defensive or dismissive. Try to keep your thoughts, and non-verbal cues open and attentive, or at least neutral.
Try EmpathyGetting a handle on difficult patients and wrestling with problems of non-compliance is time-consuming and stressful, to be sure. Your time is often limited, your workload high, and you know that patient compliance is not about control, but about maximizing the patient’s own health outcomes. So your frustration when faced with a difficult patient is understandable.
Again, it often helps to put yourself in the patient’s situation. What would you be thinking if the roles were reversed? How would you act? How would you feel? This simple mental exercise may give you the perspective you need to handle a difficult situation—and patient—with grace and calm. They may even thank you for your serenity later.