Patient handling
Mohinder Singh

Naresh, 40, a sales-tax inspector, was admitted in the emergency ward of a hospital after he swallowed sleeping pills in a suicide bid. After emergency measures such as stomach pumping, he was treated for liver damage.

In the beginning, Naresh lay passive, refusing food. And needed much coaxing for medicines. When the life-threatening phase was over, he started complaining about lack of hospital facilities and nursing attention. He kept on calling nurses for little things: tidying up his bed, getting him water or sending a message. He was particularly nasty to one night nurse who did not instantly give him the urine bottle.Naresh began to feel that the nursing staff had purposely started avoiding him.

Is Naresh a difficult patient — the way he had been dubbed by the nursing staff?

The term "difficult patient" is not new to nursing. Difficult patients are the ones who make nurses feel frustrated, uncomfortable or ineffective. By and large, nurses like to be liked and like to feel useful; in nursing, job satisfaction is important.

A difficult patient is described as one who is demanding, uncooperative, unappreciative, and generally unlikeable. This includes patients who grumble, complain, or are over-dependent. And then there are others who either withdraw (refuse to interact), or become aggressive.

Difficult patients are actually difficult people. So dealing with difficult people means dealing with difficult behaviour. They could adopt attention-seeking techniques like feigning discomfort, making unsubstantiated complaints, or seeking constant attention.

Nurses tend to avoid patients who, they think, make excessive demands; they are afraid that when they encounter the patient again, a new or additional demand will be made. And this view may be passed on from one nurse to another during handovers or at team meetings. As a result there is often an increase in "detachment" or gradual withdrawal. This, in turn, makes the patient more needy and more demanding. A vicious circle thus emerges.

Admittedly nurses have a hard task, especially when dealing with what they perceive as "difficult patients". Here are some ways that can help them cope better with such patients.

• The ward environment is filled with alien sights, smells, which generally generate feelings of fear, anxiety and uncertainty in patients. Nurses have a duty, therefore, to make the first move in alleviating a patient’s misgivings.
  
  

• It is increasingly recognised in health care work that compliance and cooperation is best achieved by involving patients in their care and adopting regimens to suit their individual needs and lifestyle as opposed to forcing patients to suit hospital-based routines.
  
  

• Guidance and advice is commonly required but the nurses must try not to coerce, force or insist.
  
  

• In patient-nurse relationship, little things count. For the patient, who may be vulnerable or afraid, minor worries and irritations can become major anxieties. The well-liked nurses not only possess a sunny disposition, but they also take care of "little things": give a cheerful smile, place a hand on the shoulder at the right moment, change the water of his flower pot, and so on. These little things can have a lasting impact on patients, and give amazing satisfaction to the nurse, too.
  
  

• It’s important to keep your commitments. Nurses are commonly heard saying, "I’ll just be back in a minute". And this one minute generally turns into hours and even longer. Breaking of a commitment can be very destructive for the patient-nurse relationship. The golden rule: aim to make promises, formal or informal, that can be kept amidst your busy schedule.
  
  

• There are many situations in nursing when an apology coupled with an adequate explanation could avoid escalation of patient anxiety, dissatisfaction and the resulting anger. There are undoubtedly numerous situations that are out of the immediate control of nurses: busy routines, cancelled appointments, difficulties contacting doctors, increasing paperwork, unrealistic patients; the list is endless. Yet what is controllable is the nurse’s ability to communicate with the patient, to offer acceptable explanations.

Some patients will always be easier to handle than others. But this does not mean that the difficult ones should be avoided and their genuine needs not met. Patients, too, must recognise and take some responsibility for their actions.

Are you a loser?
Mary Boote

DOES it seem that you just can’t get anything right? Do you feel that whatever you try your hand at, happens to go wrong? Answer these questions to find out why do you feel so.

a. yes, I win things all the time

b. no, I have given up trying

c. once I won a raffle prize

a. no, I would lose

b. occasionally I have a go

c. yes, and I have won a lot of money

3. Have you ever had a car accident?

a. yes, I have had lots

b. no, I keep out of trouble

c. just one small incident

4. Do you lose things?

a. yes, I am constantly losing keys, bags, umbrellas, gloves

b. no, I am very careful

c. just the odd thing

a. no, nothing has ever happened to me

b. no, I take care of myself

c. yes, I am always going to the hospital

6. Are you unlucky in love?

a. yes, I can never keep anyone

b. yes, I have been divorced three times

c. no, I am happily married

a. yes, they are always falling over or having accidents

b. no, things always seem to work out for them

c. no, they are just average

a. yes, I am always dropping cups and glasses

b. yes, I have broken my leg twice

c. no, I am careful not to

a. no, I don’t believe in such things

b. yes, it can’t always be my fault

c. sometimes it feels like that

a. because they think ahead

b. because they don’t take unnecessary risks

c. because Lady Luck smiles on them

66-100: If there is such a thing as Lady Luck then she definitely seems to favour you — or perhaps you are just careful to make sure things don’t go wrong.

35-65: Like most people, you have the odd stroke of bad luck, but on the whole things work out well for you most of the time.

0-34: You sound like a one-person disaster area. Perhaps you should try thinking ahead a little more, or maybe try cutting down on the risks you take. — AF