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Tips on Defusing Situations with Difficult Patients

We have all come across difficult patients at some point in our nursing career. They complain, criticise, shout, swear and may even try to lash out at us. Dealing with difficult patients is unfortunately part and parcel of our working life in the NHS. However, knowing how to deal with these patients can make a huge difference as well as ensure a safer and less stressful environment for staff. While an abusive patient’s actions are not in any way condoned it is important to know what to do and how to handle them should a situation arise.

It is often impossible for us to predict which patients will become difficult, abusive or indeed violent, but depending on the situation and the environment, we may be able to prevent patients from becoming agitated.

An example of a situation where patients are likely to get annoyed is in an Outpatients Clinic setting. If you can imagine the clinic is running about 45 minutes late and the waiting room is full to capacity. Patient X has arrived 10 minutes before his appointment time. When it gets to an hour after his appointment time he approaches the receptionist’s desk and starts to verbally abuse her regarding the state of the NHS. He also demands that he be seen immediately as his money has run out on his car parking ticket and he refuses to pay for another. As he is so angry this situation could flare up as more patients could potentially join in and their anger could escalate to aggression and even perhaps violence.

Could this situation have been predicted and avoided? The answer is YES.

How could this situation have been avoided? When patient X booked into the clinic he should have been informed that the clinic was running late and that he could rebook the appointment if he wished or wait to be seen. There should have been regular announcements made by staff to update all patients in the waiting room and there should also have been visual information on notice boards.

Many patients are afraid of hospitals and they fear the worst for their appointments. This frustration added to the fact that there is a delay meaning that they have to spend longer in an environment that they dread is enough to send them over the edge. Is their behaviour right? The answer is NO. There are many situations where patients and their relatives can become aggressive, but learning how to prevent them and how to handle them is the key.

Many patients also feel let down by their failing bodies, their illness, being hospitalised or being placed in a nursing home. We need to understand why they are behaving like this and we should try to put ourselves into their shoes and try to see their perspective.

This can help staff to gain a better understanding of what it is like to be a patient as so many have never experienced this. It is also important to note that trauma patients arrive into hospitals in situations that they did not expect and are often the ones that will need the most attention and reassurance. Also, we need to look at patients suffering with dementia and other mental health illnesses. Is it their fault that they lash out?

Once we understand what makes some patients so difficult, it can be easier to deal with. There are so many scenarios when patients become difficult but I think the main thing is to observe them.

You can pick on so much by their tone of voice, what they say and their body language. Sometimes we are too busy rushing around to notice that patients are in need of assistance or that they are getting angrier by the minute.

Reassurance is important. If the patient can see that they are being listened to and taken seriously then they will behave in the appropriate manner. The same goes for relatives. Bedside manner is extremely important here.

If all this fails and a patient becomes aggressive, you need to call security as soon as possible as well as getting colleagues to help you. In severe cases you will have to phone the police but do not worry about having to do this. The NHS operates a zero tolerance level to staff abuse and in cases that warrant it, the patients are often barred from the hospital.

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