A Difficult Patient
Submitted by Catherine Stevens RN, BSN
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.