From staff nurse to nurse consultant: Survival Guide part 10: Surviving ‘difficult’ patients

One of the first nursing research studies I read was Felicity Stockwell's The Unpopular Patient (Stockwell, 1972), part of the early groundbreaking nursing research that began the shift towards evidence-based nursing. Stockwell's findings showed that nurses did identify some patients as ‘unpopular’ and challenged the readers to examine their interactions with patients and consider the reasons for such feelings. One particularly interesting finding was that unpopular patients were not avoided by the nursing staff, who often spent more time with them at the expense of the ‘uncomplaining’ patients who received less attention. In the 50 years since the work was carried out relatively little empirical research has gone on into the cause, management and effects on staff of those often referred to as ‘difficult patients’.

Although I'm aware of the danger of labelling some patients as ‘difficult’—and that most people can be difficult given certain stressors and frustrations—nearly all clinical staff that I talk to have found some of their patients difficult in terms of their medical, social or mental health needs, and many have experienced verbal and at times physical abuse from patients. All too often the nurse accepts these difficulties and abuse and just carries on with their work. Verbal and physical abuse is most common in emergency departments and acute mental health settings, often fuelled by alcohol, frustration and fear, but is not uncommon in all other areas of nursing practice. It is triggered by many factors: pain, confusion, anxiety, frustration, fear, mental health problems and a variety of communication difficulties. It is important not to label patients, relatives and staff as ‘difficult’, but it is important to recognise and acknowledge that not all nurse–patient interactions are wonderful and life enhancing.