Dealing with negative patients is never easy. They can monopolize your time, make you angry, and frustrate everyone they come into contact with. What can you do?
According to a number of experts, quite a lot.
“I approach patient interactions using the nursing process of assessment, planning, intervention, and evaluation. These steps are taken with patience and understanding,” says Cynthia Rochon, MBA, BSN, RN, Director of Nursing, Behavioral Health Services, Largo Medical Center. “In order to assist with a problem, you first have to understand the root cause. Never make assumptions because that can lead to more negativity. After gaining a clear understanding of the problem or patient care need, you provide an explanation of how the nurse can assist to remedy the problem or facilitate access to the resource who can provide further assistance. The last step is evaluation—validate that the patient has a clear understanding of how to follow up on directions that have been provided. Patient education is an important component of nursing care. When communicating with empathy, the patient experience will usually change from a negative experience into a positive interaction.”
Oftentimes, patients become negative because they are scared, says Jodi De Luca, a licensed clinical psychologist working in the Emergency Department at Boulder Community Hospital in Colorado. “Firm empathy and compassion are an example of setting structure and limitations. Be kind, respectful, and validate the patient’s feelings, but remain professional and clarify unacceptable behavior and/or unrealistic patient expectations.”
“Although it’s true we deal with these patients in the same manner we would other patients, it does take a lot of listening on our end to determine where the negativity is coming from,” says Debra Moore, RN, Director of Nursing of the BrightStar Care Edmond/Oklahoma City as well as the Midwest Region Nurse of the Year for 2017. “They could feel mad because they’re sick, missing a spouse from a recent death, or they may have just heard some bad news or had a frustrating experience in some other area of their lives. After we determine the cause, we talk with the patients and reassure them that we are going to care for them as much as they will let us. These patients may also need a lot of education on their diagnosis and what we can do to help. While it may take time for them to trust us, they will see that we are there for them and that they still have free rein over their lives. We honor them. It will take them sitting back and observing exactly what great care we can provide them. This will, in turn, help them relax and trust us in the end.”
Kristin Baird, RN, BSN, MHA, president and CEO of the Baird Group, is a consultant who coaches and trains nurses and nurse leaders. She shares two of her training points:
1. Suspend judgement and assume a neutral position.
By doing this, you position yourself for great empathy. Empathy is portrayed more through non-verbal behaviors than verbal, but both matter. When a patient feels you are showing empathy, they will have greater trust.
2. Use empathy statements and body language that will diffuse anger.
Try sitting by the patient, touching his/her arm or hand, and saying something like, “You sound upset.” By validating them with your words and showing compassion with touch, you are demonstrating that you care.
If nothing else, becoming a patient in the health care system can be an unfamiliar and sometimes unsettling process. No matter how well you know the steps, trust the players, and value your experience, the unknown factors produce stress in the best of circumstances.
When Martina Raquel Gallagher, PhD, MSN, RN, assistant professor and director of Global Health Programs at the UTHealth School of Nursing, thought about how her nursing students could make the hospital and health care experience better for their patients, she came up with an unlikely method.
With teaching empathy foremost in her mind, Gallagher turned to an age-old partnership to develop those skills—the Argentine tango.
Such a novel approach not only worked, but Gallagher discovered it relieved stress in her nursing students as well. And learning compassion by experiencing different situations out of a student’s typical comfort zone builds a kindness and compassion into all interactions, she says.
“Using Argentine tango as a way of teaching empathy to students was a serendipitous result of a team building activity meant to provide students with a simulation of leading and following in a team,” says Gallagher. “The first time I delivered the activity and I did the debriefing on the experience of the followers, the students expressed the loss of control and anxiety in following with their eyes closed.”
Gallagher, who’s a qualitative researcher by training, says she noticed a pattern in what her students said and compared it to what patients go through in a hospital setting. In making a point about empathy, Gallagher taught her students that that very feeling of loss of control and unease is what they need to minimize for their patients. By understanding the patient’s feelings, the nursing students are more able to identify what their patients really need and not what they think their patients need.
“Understanding a patient’s experience allows a nurse to create interventions tailored to the emotional, mental, and spiritual needs of a patient,” says Gallagher.
“I see empathy as being aware of a person’s experiences by ‘walking in their shoes,’” says Gallagher. “This skill of awareness is something that occurs over time and as an individual matures emotionally. Delivering simulated learning activities where students can experience what patients undergo and feel can be used to help nursing students learn empathy.”
As Gallagher received positive feedback, her program has grown to not only be offered in her community clinical every semester, but also even as a short class to help students relax during a lunch break. They can laugh, dance, and bond—producing, as Gallagher says, levels of emotionally calming oxytocin.
“Students enjoy the activity because it brings a different way of learning,” says Gallagher. “They also enjoy the laughter they share as they are learning.”
New research suggests that reading fine novels heightens social sensitivity – the capacity to understand the beliefs and desires of other people, and how they differ from your own, that’s the bedrock of nursing.
A paper titled “Reading Literary Fiction Improves Theory of Mind,” and published in the journal Science, seems to prove what English teachers have been claiming for ages: Literature makes us more human and humane.
In a series of five short experiments, volunteers who read literary works for a few minutes were able to understand others’ mental states better than readers of nonfiction, popular fiction, or nothing at all.
What qualifies as literary fiction?: A work that requires deep thinking and imagination from the reader; complicated characters and a view into their inner life; stylistic devices versus less emphasis on plot or the conventions of genre (romance, mystery, etc.).
In this study, researchers looked to National Book Award finalists or winners of the 2012 PEN/O. Henry Prize for short fiction for examples of literary fiction. They tapped Amazon best-sellers for popular fiction.
One of the most exciting aspects of recent honorees is the racial and cultural diversity of authors tapped. For example: Junot Díaz was a National Book Award Finalist in 2012 for This Is How You Lose Her and Jesmyn Ward was a National Book Award Winner in 2011 for Salvage the Bones.
Oprah Winfrey has run a book club on and off for years now and many of her picks qualify as literary fiction. Check out Oprah’s Book Club for a complete list of her selections. It’s fun to read books as part of a group, but if you don’t have one nearby, virtual book groups — like Oprah’s — are a good option.
There may be other ways for you to get involved with books and book lovers. For instance, in my neck of the woods — Portland, Oregon — bibliophiles set up little community lending libraries in boxes on posts. The photo above is of the mini-library on my block. Neighbors drop off and pick up classics, literary novels, popular fiction, and anything else that strikes their fancy. It’s a way to chat with folks and get a glimps into their lives and interests.
Are you a bookworm? Do you believe that great novels help make you a great nurse? Let us know!
Jebra Turner is a health and business writer in Portland, Oregon. You can visit her online at www.jebra.com.
