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HCPro

When your patients are seeing red


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Tips for dealing with anger at your facility

Editor's note: The following is adapted from HCPro's new book Stressed Out About Difficult Patients, by Joan Monchak Lorenz, MSN, APRN, BC. To purchase this book or any other from our library, visit www.hcmarketplace.com.

Everyone encounters angry people. And everyone gets angry from time to time; patients get angry; nurses get angry; everyone "loses his or her cool."

It may be uncomfortable to handle anger, but it is a necessary task. And dealing with anger or other emotions can often strengthen and enrich a relationship.

What makes our patients angry?

Patients often get angry when they:

Become frustrated, don't know what to expect, or experience a culture shock in the healthcare arena

Are afraid of the diagnosis, treatments needed, and/or outcomes of care

Don't get their way or feel like they've lost control

Feel overlooked, such as when they are not included in their care-planning discussions

Are discouraged with themselves when they don't understand something, think they could have done something better, and/or are not getting better as fast as they had hoped

Don't let an angry patient control you. Don't let an angry situation control you. Take charge of the situation. Otherwise, you'll be like a tightly wound top that spins out of control rather than a graceful dancer releasing your energy in a more controlled way.

Use active listening

Active listening is paying attention to what the other person doesn't say, as well as what he or she is saying; it is a way of listening without getting tangled up in your own emotions.

Learning the "whys" through active listening doesn't mean you have to ask "why" questions; this often makes matters worse. Avoid questions such as "Why did you do that?" and "Why didn't you talk to me about this before?" Asking a question beginning with the word "why" can make people defensive.

Instead, ask the person to tell you in detail "what" happened to cause him or her to be angry. Then repeat what you think you heard. In this way, you will show interest and will start to get to the real problem. Ask the patient if you got it right. Doing this helps you build a connection with that patient, shows him or her that you were listening, and helps you determine the feeling behind the anger.

Empathy goes a long way

An integral part of handling a patient's anger is letting the person know you understand the story, letting him or her know that you get it, or showing the person that you empathize with him or her.

Recall that empathy means you recognize, perceive, and directly connect with the emotion of another. It is different from sympathy, which means you feel bad because of another person's situation. Empathy is patient-centered; sympathy is you-centered. Make sure your responses take the patient into consideration. Keep your tone even.

In addition to those empathy dos, make sure you avoid these empathy don'ts:

Don't be condescending

Don't pretend to understand something that doesn't make sense to you

Don't give unsolicited advice

Don't respond with a cliché that dismisses how the person feels

Don't jump to conclusions

How to handle difficult situations

Don't waste a lot of time, emotion, and energy trying to solve a problem that's not solvable. If a problem is not solvable, admit it. Say something like "This situation is out of our control. What we can control is . . . " Then offer something that you can do to help the situation, even if only indirectly.

Do not allow yourself to get into a heated battle with the patient. There are many tricks to this. One way is to speak softly and slowly. Some nurses just mouth words so that nothing can be heard. Patients often quiet down because they want to hear how you might be able to help them.

Avoid saying things like "calm down" and refrain from touching the person. Even though you mean to soothe the situation by doing these things, it often inflames it.

Avoid escalating the situation by going one down, not one up. Going one up means that you try to outmaneuver the patient. Then the patient tries to one-up you, and the situation just escalates higher and higher. To stop the conflict from escalating, go one down, or make a conciliatory remark. You can say something like "You are right. It is extremely noisy in here. No wonder you can't rest." Or "Gee, I am late [even if you are only one minute later than the patient expected you]. But I am here now." A bit of levity, but not flippancy, and being patient-focused might turn things around quickly.

Avoid excuses or explanations, such as "Everyone is so busy," "We don't have enough staff members," or "There are sicker patients than you." No one really wants to hear that. They just want to know when their needs are going to be addressed.

Call for help if a situation seems unmanageable. Sometimes people are beyond frustration and are upset, angry, or furious. Always call for help and institute your facility's safety plan if you suspect a patient will become violent.

The following are some additional hints for handling a patient who seems frustrated, angry, and on the way to becoming violent:

Avoid threatening behaviors; this may increase fear or prompt assault.

Avoid shouting. If the person is not listening to you, raising your voice may not help. A person with schizophrenia may be preoccupied with inner voices (auditory hallucinations).

Avoid criticizing; this might escalate the situation.

Avoid eye contact or touching; this might be perceived as threatening.

Don't back yourself or the patient into a corner.

Give the patient some sense of control combined with a sense of safety. Often, the presence of others is reassuring.