10 Tips for Dealing With Difficult Patients

Every occupation has its challenges, and nursing is no exception. One of the biggest recurring issues is dealing with difficult patients. What’s considered “difficult” exists on a spectrum: Issues can run from patients who are repeatedly admitted for a diagnosis rooted in lifestyle factors, to those in correctional facilities, or outright physically combative patients instigating violence against nurses.

If you are wondering how to handle difficult patients, this article is for you. We’ll share with you a 10-step guide and expert tips to navigate these stressful situations with confidence.

Dealing With Difficult Patients: Key Considerations

Patients often behave in a difficult way because they are stressed — being in a medical facility can be scary. And the degree of their difficulty will often, but not always, be directly proportional to how stressed they are. To understand how to handle difficult patients as a nurse, it’s important to understand the stages of crisis development:

• Stage 1: Minor anxiety, but the patient can still control their emotions and behavior.
• Stage 2: Rising anxiety with minor confusion and physical symptoms, such as a high-pitched voice, finger or foot tapping, and forgetfulness.
• Stage 3: Severe anxiety, accompanied by diminished reasoning, and disruptive behavior, such as shouting, swearing, pacing, and making threats.
• Stage 4: Full-blown crisis marked by overwhelming anxiety and loss of control, requiring immediate support.

As people move through these stages, their ability to think logically decreases. Stress negatively affects the prefrontal cortex, which handles decision-making and sound judgment. It also activates the amygdala, the body’s fight-or-flight center. Therefore, the higher the stress levels, the cloudier your patient’s thinking might be.

So first, determine which stage your patient is in. If they’re in stage 1, simply having a heart-to-heart conversation with them can help. However, as their anxiety level rises, their clear thinking diminishes, requiring you to take more decisive actions.

How to Handle Difficult Patients: 10 Steps

Whether you need strategies for dealing with difficult patients at work or gearing up for a nursing interview and need tips for answering the “Describe a difficult patient and how you handled it” question, we’ve got you covered. Here are 10 steps to help a patient going through crisis.

1. Respect Personal Space

Give your patient plenty of personal space. Maintain a comfortable distance that allows them to feel at ease, and avoid standing too close or making physical contact unless necessary.

2. Do Not Provoke

If you can identify the trigger that provoked your patient, remove it from the environment immediately. If there is no trigger, simply avoid behaviors or statements that could provoke your patient. Remain calm and composed, even if the patient becomes confrontational.

3. Establish Verbal Contact

Start talking to the patient calmly and respectfully. Use a friendly tone of voice and maintain non-threatening eye contact. Focus on conveying empathy, compassion, and respect.

4. Be Concise

Keep your communication clear, simple, and to the point. Remember: Stress affects one’s ability to think clearly. Skip the fancy medical terminology that may confuse the patient, and keep your language as direct as possible.

5. Identify Needs and Feelings

Patients might want different things, like someone to listen to them, medication, help with paperwork, or support dealing with family issues. It’s important to ask patients what they need, even if you can’t always give it to them. Saying something like, “I really want to understand how can I help you,” can help to de-escalate your patient quickly.

6. Listen Closely to What the Patient Is Saying

Pay close attention to the patient’s words, tone, and body language. Reflecting their statements back to them lets them know you’re really listening. Using phrases like, “Let me make sure I understand correctly…” can help calm down the patient as they feel respected and understood.

7. Agree or Agree to Disagree

Find common ground with the patient whenever possible. Acknowledge their viewpoints and validate their feelings, even if you do not fully agree with them.

8. Set Clear Limits

Reassure your patient that you want to help them regain control over their behavior. However, if the patient doesn’t cooperate, firmly but respectfully communicate the boundaries of acceptable behavior and the consequences for violating them to maintain a safe environment for both the patients and staff.

9. Offer Choices

Empower the patient by offering them choices whenever possible. For example, during a crisis, you might say to a patient, “Would you prefer to go for a short walk and talk it through, or shall I contact a doctor to see if we can administer medication to help you through this?”

10. Debrief the Patient

Once the situation is resolved, gather with the patient for a debrief. Try to help your patient identify triggers and learn new coping mechanisms to deal with challenges to avoid similar situations in the future.

Dealing with Difficult Patients: 5 Tips

1. Have Empathy

Let’s face it, people aren’t always intentionally nasty, but simply acting out because they’re feeling overwhelmed. When you approach your patients with a compassionate attitude, it becomes easier to avoid internalizing their behavior.

But how do you put empathy into action? One way to do it is by active listening. Try repeating the patients’ words back to them to demonstrate your understanding and show them they’re being heard. This simple practice shows patients that you’re invested in their opinions — and helps develop your emotional intelligence.

2. Don’t Take It Personally

Sometimes, despite all your efforts to learn about how to deal with difficult patients, you still won’t be able to help your patient calm down. Remember, it’s not about you; it’s about them. Although aggressive patient behavior is not excusable, some people don’t express negative emotions until they’re with someone they believe won’t make them face consequences for their behavior. Sadly, nurses are often left to take the brunt of that.

3. Be Mindful of Your Behavior

Do your best to maintain a respectful tone and non-threatening body language. At the very least, mindfulness of your non-verbal communication ensures you’re not communicating in a way that makes patients feel defensive, and at best you’re presenting yourself as someone they can finally relax around.

4. Take a Time-Out

If you know you’re about to enter a tense situation, take a moment to collect yourself before dealing with difficult patients and families. If you sense you’re nearing your limit during a tense conversation, stepping outside the door or out of the patient’s line of sight is an option so long as it’s safe.

Additionally, you can take a time-out by delegating the task. Don’t hesitate to ask your manager or security department to support you. The presence of an authority figure might quell certain people and could save you trouble when dealing with difficult patients.

5. Set Boundaries

Speak up for yourself by setting boundaries when dealing with demanding patients. For example, if a patient is using foul language, you can calmly tell them that if they don’t change their word choice, you’ll leave the room and return when they’re able to communicate respectfully. This ensures you’re not carrying resentment that could potentially bleed into the next interaction.

You must also uphold boundaries with yourself throughout the day to maintain emotional and physical well-being. Do you feel your blood sugar dropping? Grab a quick snack so you’re not “hangry” when speaking to a patient. Need to use the restroom? Don’t continuously put it off so that you’re rushing so much a patient feels dismissed. Take a moment to de-stress and relax so you don’t take out your feelings on someone in dire need of positivity.

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