9th Meeting - Handling Patient With Difficulties - Mod

9TH
MEETING
Handling Patients with difficulties/Dealing with
Difficult Patients
DA 3: Students are able to comprehend the theory and
techniques and apply them in practices.
MC 3: Students are able to perform the topic.
THE BACKGROUND
A nurse spends their whole working lives dealing with people; sick
people, their families, other nurses or doctors, medical staff, and many
others. However, the dynamics of their human interactions with
patients and their families is anything but normal; people seek out a
medical care usually when they feel abnormal or when they are hurt
and vulnerable. Add to this emotional stress, time pressures, lack of
information, lack of options, financial concerns, and family pressures,
to name a few, and the interactions become quite complex when the
patients come from other countries / international patients.
A nurse must face both the burdens and the difficulties in different
languages and cultures.
It therefore stands to reason that nurses should be both good
communicators and good at human relationships in order to have
a successful career.
Nevertheless, not every nurse -patient interaction goes smoothly
for reasons, on both sides, that are only now being investigated. The
focus of this lesson is on the difficulties nurses have in dealing with
patients who they classify as “difficult to deal with” especially
When they are foreigners / international patients.
THE “DIFFICULT” PATIENT
The nurse-patient relationship ideally has a common goal, to get

the patient better as soon as possible. Nevertheless, it is a common
reality for nurses to have to deal with difficult patients on an almost
daily basis throughout their working lives. So what is it that makes
someone who is unwell and seeking a nurse’s attention a “difficult”
patient? Recognizing what makes some patients “difficult” and
responding therapeutically are key elements in dealing with such
challenging patients.
Difficult patients definitely stand out. They can be aggressive,
angry, demanding, manipulative, noncompliant, rude, self-destructive,
and even threatening. What such patients have in common is their
demand for excessive amounts of the nurse’s time and attention. Nurses
frequently find themselves frustrated and exhausted after
interactions with such patients and may sense that the patients
themselves may harbour similar bad or hurt feelings.
TYPES OF DIFFICULT PATIENTS
Some of the most common types of difficult patient can be categorized
as the following:
a. The Angry patient has a short fuse and is ready to lash out at
anyone who doesn’t tell them what they want to hear.
b. The Anxious patient lets their worries get the better of them and
they are often not attentive to what the doctor is trying to tell them.
c. The Dramatic or Manipulative patient seeks attention and their
own way rather than listening to what the doctor has to say.
d. The Orderly and Controlled patient presents a cool front and
demands strict adherence to procedures that may not be necessary.
e. The Rambling or Talkative patient will dominate the consultation
with long stories and pointless details.
f. The Silent or Reticent patient is often unresponsive to the doctor’s
questioning and may well be purposefully holding back important
information out of fear or being thought foolish.
g. The Superior patient believes they know better than the doctor and
may insult and try to belittle younger doctors.
h. The Vague patient does not provide accurate information the doctor
needs for the diagnosis.
HOW TO DEAL WITH THOSE DIFFICULT PATIENTS
1. Remember what position the patient is in.

He’s sick. He’s uncomfortable. He’s frustrated. He’s frightened. He
may feel that he isn’t getting enough attention from caregivers or
that people aren’t listening to his concerns. It’s not his choice to be
a patient. It is our choice to be a nurse.
2. Don’t just hear what the patient says, listen to him.
Let him know that you are listening by maintaining eye contact. It’s
been said that approximately 80% of our communication is
nonverbal.
Don’t stand with arms crossed, don’t look at your watch as if you have
someplace else more important to be, etc. Also, watch for the
patient’s nonverbal cues.
Note: If the difficulties are the words in their language they talk to.
Simplified by paraphrasing, speaking more slowly, and requiring
for a repetition.
3. Be nice. Be caring. Keep your promises.
Remember that our role as nurses is not only to provide safe care, but
also to provide information, support, and reassurance to our patients.
We made a commitment to do these things when we chose nursing.
4. Adequately document any relevant events.
If an adverse event occurs, document it in the appropriate part of
the patient record or on an incident report per facility policy. In the
event of litigation involving the patient, good objective
documentation can increase the chances of a positive outcome for
the nurse.
5. Pay attention if a patient threatens to sue you, the facility, the

physician, etc.
While in many cases these are only threats, you never know for
certain.
Inform your nursing supervisor and risk manager that the patient has
made this statement, so that steps can be taken to resolve any issues
that the patient may have, thereby potentially avoiding litigation. If a
patient tells you that they have previously sued a healthcare provider,
pay even closer attention.
Seek the assistance of your supervisor.

This is important if you are caring for a patient who makes you feel
uncomfortable, either physically or emotionally. There are times when
a change in patient assignment is a reasonable step to take.
THE “REAL” DIFFICULT
A. TO COMMUNICATE
B. TO BE CARED
A. DIFFICULT TO COMMUNICATE
1. Language barrier (different languages)

2. Angry
3. Anxious
4. Dramatic/Manipulative
5. Orderly and Controlled
6. Rambling/Talkative
7. Silent
8. Superior
9. Vague
B. DIFFICULT TO BE CARED
1. Reject the treatments

2. Reject certain Medications
3. Picky for certain cares
THE ASSIGNMENTS
Make 3 different dialogues between A nurse
and A patient / patient’s family member with
different background:
1 communication problem
2 medical cares / Settings
NOTES
FILE FORMATS:
•Folder :
9th Meeting_KP.001_I Putu Darsa
djokodwipurnomo.official@gmail.com
REFERENCES
• Everyday English for International Nurses, Joy Parkinson & Chris
Booker, Churchill Livingstone 2004.
• Fundamental Nursing Skills, Penelope Ann Hilton, Whurr Publisher,
London 2005
• Fundamentals of Nursing: Standards & Practice, Second Edition,
Sue C. DeLaune & Patricia K. Ladner, Delmar, a division of
Thomson Learning, Inc. 2002
• Proffesional English In Use Medicine, Cambridge University Press
by Eric H Glendinning& Ron Howard
• Medical English For Nurses, Anglo-European College Of
Chiropractic

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9TH

The nurse-patient relationship ideally has a common goal, to get

1. Remember what position the patient is in.

5. Pay attention if a patient threatens to sue you, the facility, the

Seek the assistance of your supervisor.

1. Language barrier (different languages)

1. Reject the treatments

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