How can nurses deal with difficult patient situations?

Nurses deal with difficult patient situations quite often. These situations may result from frustration, pain, stress, or even fear. What’s more, something considered a difficult situation for one nurse may not be considered difficult for another.

Nurses must be compassionate and work to maintain a positive, professional relationship with their patients.

But how can they achieve this when they have a patient they consider “difficult”?

Why would a patient be “difficult”?

For perspective, it’s important to consider why a patient may be difficult.

Common reasons behind difficult behaviors include the following:

Pain: Pain plays an important role in behavior. A patient who is in pain may be demanding or angry.
Anxiety: Anxiety can manifest as anger or defensiveness.
Stress: Whether for personal reasons or their health condition, stressed patients may react badly to different situations and people, even people who want to help them.
Fear: Fear can trigger anxiety, irritability, and diminished judgment.
Underlying health conditions: Underlying physical health or mental health conditions can affect behavior and thus create aggressive or combative responses.

Most people will agree that being a patient is uncomfortable. They often need to wait for long periods, endure different types of treatments, experience uncertainty regarding their health status, and more.

Difficult patient types

These feelings might trigger different behaviors, making the nurse's compassionate response even more critical for patients.

Some outcomes of what patients feel may be expressed in the following ways:

Non-compliant patients: Some patients may refuse to follow medical advice, take medications, or follow prescribed treatments.
Overly demanding patients: Overly demanding patients insist on special and immediate attention, asking for services beyond feasible.
Aggressive patients: Aggressive or combative patients display anger, physical aggression, and/or verbal aggression.
Withdrawn patients: Withdrawn patients do not communicate their needs effectively or simply remain silent. This can make it difficult for nursing professionals to assess and provide care.

With aggressive or violent patients, nurses should take precautions and preferably find a companion for these interactions.

What role does stress play in all this?

Sometimes, nurses consider a situation with a patient to be difficult, unrelated to the patient's actions. Nurses can negatively perceive their patients due to their own biases, stress, fatigue, or burnout.

Managing difficult situations can feel overwhelming. This can compromise nurse safety, patient safety, and quality of care.

Nurses can better respond to difficult situations when they have proper rest and nourishment and have a relatively balanced life. Therefore, it is important to:

Prioritize self-care: This may be different for every nurse but may include scheduling time off, enjoying a hobby, exercising, or even doing therapy.
Apply techniques for managing stress: Nursing professionals can apply all kinds of stress-managing techniques, like breathing exercises, mindfulness, and even humor, to help them cope.
Have a support system: Nurses need a support system to talk and vent about their problems. Support systems have proven useful for managing stress and fatigue.

So, how can nurses effectively deal with difficult patient situations?

How to successfully handle difficult situations

Although these situations are challenging, some tools can help nurses avoid issues or de-escalate difficult situations.

Communicate effectively with patients

Communication techniques can help nursing professionals prevent difficult situations from arising or escalating.

Effective Communication Techniques

Some communication techniques in nursing include the following:

Listening skills: From maintaining open body language to paraphrasing what the patient has said, active listening tools can help nurses improve confidence and improve care.
Empathy and validation: Empathizing with the patient's situation implies recognizing the patient's feelings. Nurses can validate those emotions—without excusing inappropriate behaviors—and ask open-ended questions to learn more about their patients.
Clarity and simplicity in explanations: Clear communication in a medical setting may involve simplifying the language. Nurses can avoid industry jargon and confirm that the patient understands before moving on.

All of these strategies can help reduce a patient’s anxiety by ensuring that patients feel listened to, respected, and supported.

De-escalation strategies

When emotions are running high, de-escalation strategies can help defuse the tension. Some tips that can help professionals include:

Respect personal space: Nurses should be aware of their own posture, positioning, and proximity to the patient. They should avoid entering the personal space of an agitated patient when possible.
Explain and give time: If they have to approach, they should explain what they are doing and why. By understanding the procedure, the patient may feel less intimidated. Respecting personal space might also include allowing time for patients to decide, especially when they feel agitated.
Identify how the patient feels: Patients might have a hard time understanding their own feelings. Validate their feelings with phrases such as “I know this is frustrating” or “That must be scary.”
Ignore challenging questions: Whenever patients make challenging comments or questions, nurses should ignore them and redirect the patient’s attention. Nurses should bring their focus back to finding a solution for the crisis.
Set limits: Nurses need to set and enforce boundaries and limits. This includes which rules are negotiable and which are not. They might also explain and remind the patient of the consequences of inappropriate actions and behavior.

Nurses should apply all of these tips with sincere empathy and avoid judgment. Throughout the process, nurses must remain calm, professional, and entirely rational without letting their emotions take over.

Documentation and reporting

Crisis situations with patients can quickly escalate and become violent. Thus, nurses need accurate and structured practices to prioritize patient safety and their own safety.

Importance of accurate documentation: Nurses need to stay objective. Document observable behaviors, responses, signs, and symptoms, leaving out all subjective judgments. For example: “patient became agitated during medication administration.”
Reporting procedures for incidents: First, nurses need to prioritize their safety in violent situations. Then, they need to document and report the incident as soon as possible while the details are still fresh. Nurses need to make an appropriate incident report with a description of the facts, the actions taken, and the follow-up.

Different facilities might have different protocols for submitting the reports. Nevertheless, the facility needs to investigate the incident and provide follow-up.

Legal and ethical considerations

Core responsibilities for nurses include giving the patient autonomy and informed consent.

Is it informed consent when the decision to refuse care is made out of anger, fear, or a heightened emotional response?

An emotional response doesn’t automatically mean the patient lacks the capacity to make an informed decision about their care—or a refusal of care.

Provided the patient has the capacity to decide and has been fully informed of the risks to their health and understands them, they have the right to refuse care.

The importance of continuing education for nurses

Continuing education courses and training programs can support nurses with theoretical and practical simulation training for skills specific to conflict resolution and empathy development. They may cover the following topics:

Patient autonomy
Resource allocation (situations when there are not enough resources for all patients)
Steps for reporting unethical behavior
When are restraints and seclusion necessary (or legal)
Negotiation and compromise
Legal considerations for nurses and patients

By taking different courses, nurses can continue their professional growth and thus better prepare for various roles and situations.

Find your support network

Whatever the situation, seek support. There are communities, including online communities, where other nurses like you can talk about their experiences. For example, there is the Nursa Community, where members can post their concerns and questions. There are also professional organizations that support nurses in every state.

Remember: You are not alone.

For more resources for nursing professionals spanning topics across careers, the nursing lifestyle, and per diem shift opportunities, check out the Nursa blog.

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