Communicating with difficult patients : nurses' perceptions

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Strevy, Sonia R.
Ryan, Marilyn E.
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Thesis (M.S.)
School of Nursing
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Communicating With Difficult Patients: Nurses' Perceptions Effective communication is paramount in any nurse-patient relationship. Nurses must develop good interpersonal skills with which to evaluate patient needs, provide therapeutic interaction and obtain mutual goals. The purpose of this study was to describe the variables present in nurses self reported communication with difficult patients.Imogene King provides the theoretical framework for this study using the concept of goal attainment as the basis. The Difficult Patient Assessment Tool (Podrasky & Sexton, 1988) was used to measure communication with difficult patients, along with the addition of an open-ended question. A convenience sample of 25 (40%) R.N.'s and L.P.N.'s from a community hospital in the Midwest was used. The procedures for the protection of human subjects were followed. Descriptive statistics were used to analyze the data.Findings of the study included that nurses perceive difficult patients as demanding, never satisfied, confused, frustrating, female, noncompliant, manipulative and uncooperative. Nurses reacted to the communication that takes place with the difficult patient, with feelings of frustration, incompetence, anger, disgust, anxiety, and at times, "O.K.". Nurses most frequently interact with difficult patients in informative, pragmatic, supportive, prescriptive and catalytic manners. The resulting transaction between the nurse and the difficult patient included feelings of frustration, fright, confusion and hurt.Conclusions were that difficult patients are perceived as making unrealistic demands on the nurses' time, and impair nursing interactions. Nurses' transactions resulted in both positive and negative reactions, depending on the situation, and the reactive patterns of the nurse. Nurses tend to take a more authoritative, rather than a facilitative role in interactions with difficult patients.Implications include the need for learned communication patterns which may or may not be effective in dealing with difficult patients. Effective communication skills involve not only acquired knowledge, but also knowledge of self and one's perceptions and values. Self knowledge of communication patterns, and how to improve on those patterns, might be helpful.