4 Step Action Plan: How to Deal with Difficult Patients & Families

When you entered nursing school you were probably warned that you’d have a few difficult patients. Maybe you even went as far as to mentally prepare yourself for the day you’d save someone’s life and they’d scream and yell at you for something trivial. However, there is something that’s equally – if not more so – challenging than a difficult or disruptive patient.

Their family members.

Difficult patients are a guarantee in nursing. After all, think about when you’re sick with a cold or the flu. How pleasant are you? I’ve always said that working with the public can be difficult, but imagine working with the sick public! The same thing happens to their families too. Even though you’re caring for their loved one to the best of your ability while doing everything in your power to keep them comfortable, families can behave just as badly as patients!

Why?

It’s been my experience that patients and their family members come to us possessing something that drives them to behave differently than they normally would; FEAR. If a family member is yelling at you about their loved one’s medication it’s easy to just write them off as one of those rude people no one likes to deal with, but the more likely truth is they’re probably a good person but they’re just too scared to express themselves properly. Fear is one of our most powerful emotions and it can drive us to say and do some crazy things!

Now don’t get me wrong, bad behavior by patients and their families shouldn’t be tolerated, but if we can understand where they’re coming from we can be better equipped to handle it. Do you remember a time when you were afraid? I mean truly afraid. If you can think back to that time I’m sure there are several things you wish you would have done differently, including how you treated those around you. Our patients and their families are no different!

Both of my daughters had significant ear issues when they were little (actually, they still do as adults!). We spent many hours/days in the ENT office, outpatient surgery departments, and at times, on the inpatient side of a children’s hospital. Let me tell you, although I’m a rationale human being and consider myself kind, caring, and compassionate, there were a few occasions when I felt like my head was going to pop off and I wasn’t exactly nice. Like a mother bear who thinks her cubs are being threatened, EVERY human being has the potential of being difficult when their loved ones are sick.

This is why I’d like to give you 3 steps to take when dealing with these scared and seemingly difficult individuals, but first, let’s define disruptive behavior.

WHAT CONSTITUTES DISRUPTIVE BEHAVIOR?

Disruptive behavior includes anything that gets in the way of you providing safe and effective care to your patient. This could be interfering with the physician’s treatment plan, yelling, kicking, using profanity, excessive questioning, or threatening statements. Basically, if it’s making you uncomfortable or interfering with patient care it’s disruptive.

Now that we know exactly what it is, let’s look at how to take control of it!

1. LISTEN

When someone is concerned or upset the best thing you can do is to listen to them. Don’t just listen to respond, but ACTIVELY listen to their concerns and frustrations.

Active listening is essential to our job as nurses, but it’s easy to forget how important listening is when we’re upset, overwhelmed, or just don’t understand why families are making a fuss. However, it’s important that we harness the power of listening because more often than not, it will ease and even help diffuse a difficult situation.

Here’s a tip: Try to sit down with the person; face to face, lean in towards them and look them in the eye. This conveys interest on your part and may take the person off of the defense just a bit.

2. ASK QUESTIONS

Once you’ve listened to what they have to say, go a step further and ask questions. Sometimes, patients and families will become upset over everything, when in reality only one thing is bothering them. If you can figure out what that one thing is, you can work on fixing the problem together.

Here are a few general questions that can help diffuse a patient or family member’s anger:

• “Help me to understand what is upsetting you.”
• “I want to make sure I understand your concerns, can we talk about them?”
• “What do you need right now?”

3. SET BOUNDARIES

We know that illness has a way of bringing out the worst in people, so we should be proactive and set boundaries before it’s actually necessary to do so. Take the time to decide what you’re willing to tolerate in difficult patient/family situations and what you absolutely will NOT put up with. Doing so will enable you to take action at the first sign of a problem instead of waiting for said problem to escalate beyond your control.

I realize it’s not always that simple, so use my good friend scripting! Doing so will establish why their behavior isn’t acceptable, as well as the consequences that will follow. For example:

• “I feel threatened by ____(described action). I am asking you to stop that behavior because it is not appropriate.”
• “The comment (swearing, use of profanity) you made was inappropriate. I am asking you to discontinue making comments like that or you will need to wait by security.”
• “I am WILLING to listen to your concerns and answer your questions as long as you are WILLING to be respectful.”

Setting boundaries not only establishes what you will and won’t tolerate, but also establishes a baseline of acceptable behavior going forward. Remember, most patients and their families are misbehaving because of the situation they are in and not because of anything you’ve done.

4. KNOW YOUR LIMITS

Know what you will tolerate and what you won’t ahead of time so that you’re prepared for how you will respond when someone crosses the line. For example, I can personally tolerate someone being angry and overtly questioning me like a drill sergeant, but if someone curses at me or calls me a name, they’ve crossed the line! It’s important for YOU to know what your limits are so that you can plan how you will respond ahead of time. For example, as soon as someone starts cursing, I’ll say, “I will answer your questions and do everything in my power to make sure you get what you need but I will not tolerate profanity.”

The bottom line is this – it’s easy to judge a patient or family member when they “act a fool” but remember, everyone has a story and handles illness differently. And although we need to always represent ourselves as professionals and do our part to extend compassion to our patients and their families, it’s important to set boundaries and establish expectations for how we intend to be treated.

Tell me about a time you had a disruptive patient or family member in the comments below. How did you handle it?

Take care. Be kind. Stay connected.