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Improving the Nurse-Patient Relationship with Difficult Patients

Difficult Patientsby Sarah Stasik

The nurse patient relationship is a critical element of high-quality care that is also notoriously difficult to balance. 

As a nurse, you can't be the patient's friend and you can't always cheer for the solution or behavior they may want you to support. 

At the same time, when you can quickly develop a positive relationship with some level of trust, you have a chance at improving patient satisfaction and outcomes.

Dealing with Difficult Patients in Nursing Through Empathy

When you're dealing with difficult patients, building a relationship that supports success can be hard. 

All the same helpful nursing communication skills still apply, but you may have to be even more proactive about how you go about using them. 

For example, while empathy is an important trait for almost any nurse, you may have to lean on it a bit heavier when you're working on a nurse-patient relationship with an especially grumpy or even mean individual.

Dr. Wyatt Fisher, a Licensed Clinical Psychologist, says empathizing is the first step in dealing with difficult patients. 

"Most likely," says Dr. Fisher, "[that patient is] in high distress from their illness/injury and the impact it's causing in their life."

Taking time to listen to the patient — no matter how difficult they may be — and providing an immediate solution to at least one issue can make a big difference. 

Even solving a small issue, such as thirst or being too cold, can reduce patient anxiety and help them begin to see you as a trusted partner in their care.

Pamela Glenn, CNM, APRN and Walden University School of Nursing field education supervisor, clarifies that even further. 

"Be sure to fully listen without also thinking about what your response may be," she says, "It's so easy to assume you know where the conversation is going, only to listen and find out it goes a different direction."

Building Small Bonds Outside of the Medical Relationship

Building rapport with patients within the context of their medical treatment is critical, but sometimes you have to start with something even smaller.

"Is there a football game on the TV? Spend a few minutes asking them about their favorite team and how often they watch football," says Chirag Shah, MD. 

"See a personal item like a phone or a pair of shoes that you have some experience with? Ask them about it and why they like it and even consider sharing your own experiences. With a little practice, it becomes easy and you can almost always find something to bond over for a short time."

Shah says even the smallest bond outside of a medical context can transition into a more positive nurse patient relationship because it demonstrates that you care.

Difficulty isn't an Excuse to Avoid Honesty

Honesty, even in the face of difficult information, is critical to the nurse patient relationship. 

When trying to figure out how to deal with difficult patients in healthcare, there may be a temptation to leave out information or sugarcoat answers to reduce the chance of an unpleasant response.

But RNs must always be honest and forthright when providing patients with information and education. 

"Be honest about what can be done to resolve the situation and what cannot be done," says Glenn. She adds that nurses should explain why something can or can't be done.

After all, the information you provide patients may be one of the primary sources they draw from in making decisions about their own healthcare. 

Even when dealing with difficult patients, most nurses want individuals to have everything they need to make the best possible decision for themselves.

Encourage a Cooperative Approach for Better a Nurse Patient Relationship

Sometimes difficult patients and family members are acting out because they feel a loss of control in their current circumstances. 

Glenn advises nurses to avoid certain types of phrasing that can increase those feelings of being out of control.

"Don't 'should' on people," she says. "For example, don't focus on you should do this or you should do that."

She also reminds nurses that validation is important to patients. Instead of saying "I understand," say "It's understandable that you are feeling this way."

The way you speak to patients can also be important. "Tone of voice is everything," Glenn says. "Use a calm, gentle tone of voice to let them know you want to listen and work with them on a solution."

Heal Them with Kindness

Finally, if all else fails when dealing with difficult patients in nursing, be as kind as you can and hope for the best nurse patient relationship given the circumstances.

Dr. Fisher says anticipating patient needs and taking extra steps of thoughtfulness help create a more positive feeling toward you, and something as simple as greeting them with a warm smile each time you enter their room or approach them goes a long way toward creating a positive environment.

If you're ever in doubt as to how to deal with difficult patients in healthcare, the experts seem to agree on a tried-and-true tactic. 

First, listen. Then act out of kindness, professional concern and a desire to partner with your patient to support his or her improved health.

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