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Journal of Nursing

A Difficult Patient

Catherine Stevens [email protected]


A Difficult Patient
By Catherine Stevens RN, BSN, CEN
In my nursing career, there are many different types of
challenges. Job challenges, schedule challenges and patient related
challenges. No matter what type of nursing I have encountered there are
always difficult patients that test my nursing skills. Whether the
demands are related to technical skill, assessment or cultural
understanding, I enjoy that critical thinking that is required to rise to the
occasion. As a seasoned nurse I feel that technical challenges have
become easier to handle, while the social or cultural challenges have my
increased interest. I continue to obtain as much education as I can to
assist my nursing challenges.

One particular patient I encountered in the main post anesthesia
care unit provided a challenge to the entire unit. While he was
recovering from simple incision drainage as the evening hours
approached. With a history of Parkinson’s timing medication
administration was a must. I walked by his bed as he spit one of his
pills at the nurse. The charge nurse came over and tried to explain to the
patient the importance of taking his medication. His “sundowners”
symptoms were increasing by the hour. Just as the charge nurse put the
pill down and began to walk away, defeated, I began to think. I had just
finished giving a presentation on giving culture sensitive care. Although
his culture was no barrier to his care, his attitude was. As I thought of
the new strategies I had learned I wondered if they would work in this
situation. Entering into a conversation that is non-medical related prior
to discussing pain or difficult medical situation was said to improve
assessment and communication. I stood next to his bed and asked him
his name. Then asked simple questions such as; where he lived, and
with whom lived with him, if he had any grandchildren and a
conversation began. He then told me he did not trust bald men. His
previous nurse was a bald male. As I was establishing trust I brought up
the subject of the pill. I educated him as why he needed the pill, and
asked if he would agree to take the pill. I offered him a drink of his
choice. He then took the pill with no complaint. That pill exchange
bought me a new assignment as his nurse for the remainder of the night.
Eight pills later followed that initial medication administration. He took
those pills also with no issues. Our conversations continued. At one
point he just looked at me and said “I like what you are doing.” I was
pleased that I was able to offer him comfort and security. It took a little
bit of a tender approach that I only learned through continuing
education.

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