Patients aren’t the only ones who can be difficult and demanding; nurses often have to deal with challenges from the patient’s family members, as well. Their concern for a loved one can translate into behaviors that range from pestering and complaining to downright threatening.

In some cultures, large numbers of family members may come to visit a patient all at one time. In addition, many healthcare organizations have eased visiting hour restrictions and are allowing more people to be in the room at extended hours throughout the day. While a patient’s family should feel welcome, these increased numbers can raise the possibility of difficult interactions.

Family members may feel they need to “do something” for the patient. For example, many in the public are aware of the importance of, “bringing someone with you to the hospital to advocate for you.” Some may interpret advocacy as permission to aggressively protect the patient from staff.

What You Can Do

Here are several things that you can do to show professionalism and address a patient’s or family’s concerns ― all while squelching negative behaviors and defusing potentially volatile situations:

• Proactively and honestly tell patients and family what to expect. They may not realize that you or another member of the nursing staff routinely checks on the patient. Avoid false promises and statements such as, “I’ll be right back,” when you know that you will be delayed in returning.
• Access your organization’s policies and procedures concerning response to threatening or violent behavior before you need them. Be sure that you know your role in protecting yourself, managing the situation, getting help, and reporting any incident.
• Be alert for signs of agitation: Raised voice, rapid speech, pacing, withdrawal, balled fists, shaking, erratic and aggressive movements. When you observe these signs, tell the patient or family member what you observe and ask questions to determine what the problem really is and what might be done about it.
• Take a deep breath or two to prevent reacting in a way that might escalate the situation. Respond professionally by working with the patient and family to clarify the problem and possible solutions. Do not react with impatience or allow yourself to be intimidated. You have a professional role to play.
• Speak with a calm voice. Avoid indicating impatience or condescension. Convey that you are listening – give your full attention, nod your head, maintain eye contact, and repeat back what is said to you. Avoid medical jargon which can confuse or frustrate laypersons.
• Trust your instincts. If you anticipate a difficult situation, ask a colleague or the charge nurse to go with you to see the patient. If you believe there is a potential for violence, remove potential weapons. If you feel threatened, position yourself between the patient and the door to create an escape route, if needed.
• Threatening, violent, and rude behavior is not acceptable. Communicate this to the patient and family. State consequences and limits in simple, reasonable, and enforceable terms. For example, “I can see that you are upset. I cannot allow you to speak to me that way. When you’re ready to communicate more effectively, we can continue.” Be consistent in your unwillingness to accept bad behavior.

Remember, you are working in a professional capacity; if a patient becomes rude or threatening, do not take it personally. You are a professional: Stay in control of your own behavior.

The Difficult Patient Tool Kit Series: Part 1 focused on preventing difficult patient situations, part 2 explored ways to manage demanding patients and families, and part 3 will identify assertive actions and teamwork methodologies to resolve difficult situations. Part 3 of the series will appear in an upcoming issue of the RN.com Bulletin newsletter.

Biography:
Bette Case Di Leonardi has worked in nursing, education, and healthcare administration for more than 40 years and was among the first group of nurses certified in Nursing Professional Development. Today, Di Leonardi is an independent consultant who publishes and presents on a variety of professional and educational topics.