Dealing with Difficult Patients

The other night I had a particularly difficult patient. On top of being in acute alcohol withdrawal, this individual also had an extensive psychiatric history and history of previous substance abuse. This is a winning combination that leads to a busy night. First this patient had been getting better during the day, and for the beginning portion of my shift, this patient was fine. Then as the night progressed and my other patients drifted off to sleep, the patient began to escalate. Everyone that is a fall risk in the hospital has a bed alarm on so that we as nurses know that patient is getting out of bed and can run in there to prevent any harm or falls to the patient. This patient was setting off the bed alarm at an increasing rate. I was giving this patient Valium 10mg every hour as that was how his PRN (as needed) order was ordered. The patient was not responding to Valium, and I even tried giving a dose of Ativan, which had a temporary fix for about an hour before the patient was climbing out of bed again.

12 hours worth of this is enough to make anyone lose their mind, but as nurses we need to keep our cool and treat each patient with the respect and courtesy everyone deserves. There are a couple of ways that I have found that work for me when I do this.

  1. Remembering what the patient is here for and that patient safety comes first. I will be the first to admit after the 203 time the bed alarm rang I was tempted to just turn it off. But this of COURSE would be dangerous for the patient, and neglectful of me, so of course I did not do this, but just taking the extra moment either before running into the room to steady the patient, or after settling them back in to remind yourself that they don’t know any better and are there because they need your help is a good way to keep yourself sane.
  2. Speaking with your coworkers about it. Just allowing a little bit of your frustration to leak out and have someone who understands validate your frustration can help relieve some of it.
  3. Speaking up and knowing when to ask for help. We are nurses. We are strong. We are patient. We are also human and have our limits, so knowing when to ask for help is crucial. On my particular unit we all work as a team, so my fellow nurses would occasionally run in there as needed when I was running behind or with another patient. I of course reciprocate as needed when my patient load is not as crazy, and someone else has a difficult patient.
  4. After work activities. Make sure that your shift doesn’t totally get to you! I know this probably sounds ridiculous with the above story I just told, but have a glass of wine or cocktail with friends and just vent it out. Especially with some nursing buddies, they can relate and maybe even give you advice about how they deal with it. I included a picture enjoying some time out with friends. Or just do whatever you enjoy doing to blow off some steam.

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This is just one example of a difficult patient and they come in many different forms. What’s the most difficult patient you have ever had? Leave it in the comments

~Niki

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