Excerpt

Preface

Professionalism and Caring

I believe that the Nursing profession is one of the most admired in America. We think of Nurses as being professional. That is, they have a knowledge base and skill set that is unique and valued and that the quality of their work is important to them. We also, very importantly, think of Nurses as people who care about their patients they are concerned with our well-being when we are under their care. These considerations are the focal point for our discussion on how to best deal with difficult patients.

This book will specifically consider the concerns that arise when Nurses encounter patients who are difficult. While we will very briefly consider other important relationships Nurses have in the work place their peers, Nursing Supervisors, and Physicians the emphasis here will be on the unique relationship that develops when a Nurse interacts with a client, a patient.

This is a key consideration. A patient, either directly or indirectly, is a customer. A Nurse is the service provider. As such, certain parameters are automatically set up that create general guidelines for action. The customer expects to be treated in a certain way; the Nurse is expected to provide a certain type of service. Boundaries, whether written or tacit, are drawn as a result. Both the Nurse and the patient are expected to interact appropriately and considerately within those parameters.

Patients/customers expect you, the Nurse, to be professional; and in a sense that is far more important than most other service professions, they expect you to care. The focus of this book is to demonstrate how you, the Nursing professional, can use these two key concepts professionalism and caring to your advantage and to the patients advantage in dealing with difficult concerns.

Yes, there will always be difficult people we have to deal with both professionally and non-professionally. While I am not a Nurse, I have written many books about Understanding and Working with Difficult People and in Difficult Situations. I do have an intimate knowledge of the Nursing profession from Nursing professionals, research, and study. Dr. Pam Koob, whose input has been invaluable to the writing of this book, is a consummate Nursing Professional with years of caring experience at all levels of Nursing and in many different hands-on experiential situations. Her work experience includes, but is not limited to: general care, Nurse Practitioner, ER, Hospital, University-level teaching, and Wound Care Nursing.

Part I

Introduction

The delivery of high quality care depends increasingly on processing skills (communication, empathy, willingness to listen, common goals, ability to find alternative ways of solving problems, etc.) in addition to medical/care competence.

(Skjorshammer, Scandinavian J Caring Sci, 1999)

Key Ideas

TLC

Authors Note: I truly believe that the phrase Tender Loving Care is how the patient, and this is a key point, sees the Nursing profession. However you, as a professional, consider or interpret this, it is important to always keep in mind what patients think and expect. Patients not only expect you to be a consummate professional, they expect you to care something that can be interpreted in a variety of ways:

To give them quality Nursing care

To care about how they feel, what they think, who they are

To care about making them better

To care that they are a fellow human being and you are intimately involved with their well-being for this moment in time

In some ways this is a heavy extra burden that is placed on your profession. How you approach this expectation, especially with difficult patients, can make all the difference in how that patient behaves, reacts, acts, and generally deals with you and others involved with his/her care.

How you as a professional handle this important preconception of patients is a major emphasis in this book (see Chapter 2 and Part II, Chapters 6-9).

Professionalism

Nursing is a service profession. Patients see you as a professional and they expect you to act in a professional and caring manner.

In a sense that is almost an oxymoron. How can you be expected to be completely professional, do an outstanding job, and yet balance on that delicate thread of propriety and come across as caring as well?

Is it possible for you to balance the two?

Yes, it is possible. AND it is essential if you wish to be acknowledged as the best in a quality profession, and if you expect to be able to handle those difficult cases.

Consider this: your professionalism, i.e. the high quality image you bring to your patients via your knowledge, skills, and Nursing care, sets the stage for their accepting you as a person as well, but it doesnt get you the whole way that takes caring.

Fear

Always and while this is an all-encompassing term it is still used here always a patient feels angst when in a medical care situation, i.e., hospital, Physicians office, treatment center, etc.

Be sure to keep this key idea in mind throughout this book and at any time when you are dealing directly with a concerning situation.

Fear lies at the root of all difficult behavior.

(Perkins; Koob)

Understanding Your Approach

How you act, react, and approach a patient often dictates how they will act with/toward you. Knowing Yourself is one of the primary tools we can bring to working through difficult people concerns.

The better you come to understand your affect on others and the better you begin to see how others affect you, the more control, Self-Control, you will have. This is especially important in working with difficult individuals.

Understand the Patient

First and foremost patients want you to understand how they feel.

They also want to be understood. They want you to listen to them, even if you have heard it a hundred times before, and they want to know that you have heard them. They expect you to respond in some way directly to their concerns, questions, ideas, etc.