Deal with Angry Patient
Before we can deal with an angry patient, we must understand the deeper meaning behind anger. Anger is the irrational attempt to manipulate a situation. The question of how to deal with an angry patient actually becomes a question of whether or not we will allow ourselves or the safety of our patient to be manipulated.
Manipulation is often seen in a negative light; however, according to Webster, manipulation is really a form of management or control, albeit by dubious methods. Often anger is a last-ditch effort on the part of our patients to try and exert some sort of control over a situation.
Anger is an emotion that overwhelms all feelings of insecurity, pain or doubt. In many cases an event that may have normally irritated or caused concern will escalate into anger or rage, catching even the patient off-guard. Other times the anger comes from deep within the subconscious with the patient being completely unaware of why they are so angry.
Whatever the apparent cause of the anger, as a nurse, you must understand the psychological undercurrents and address these rather than just the symptom of anger. Otherwise, it would be like treating a patient with only morphine for appendicitis. The morphine will cure the pain but the underlying condition is still present and will need to be dealt with at some point.
The first step in addressing an angry patient is to try and build a rapport. The best way to do this is to try and isolate the patient from distractions. Turn off the television or ask the patient to move to an area of privacy. In some cases, the patient may be too upset to move. In that case, seek assistance from other staff members in moving those around the patient to a better location.
Remember to restrain your own emotions. It is natural for your anger to rise to that of the patient's since the patient's anger has taken away some of your control. Sometimes it is helpful to understand that the anger you are feeling is exactly how the patient is feeling. It even has the same root cause: loss of control.
Mild fear is another healthy biological reaction to anger in others. However, you should avoid showing your fear or apologizing in situations that do not warrant it, as this can actually increase the anger directed at you. Fear is one sign that the manipulation is working, which positively reinforces the angry behavior. Instead, listen to your fearful emotions, if the fear becomes very pronounced, excuse yourself from the situation and seek immediate assistance in dealing with the patient. Sometimes our subconscious can pick up on a threat of which we may otherwise have been unaware.
No matter what the situation, always treat the patient with respect. Keep your voice at a conversational tone whenever possible. Sometimes it may be necessary to adopt a louder or more authoritarian voice to keep the patient from thinking that you are being condescending or to divert the patient's attention to you if their anger is not focused. Try modulating your voice from sterner to softer tones as soon as practical. Also, maintain eye contact only if culturally appropriate. Remember, some cultures see eye contact as rude.
Never interrupt the patient and avoid acknowledging vulgarity or yelling. Instead, allow the patient to express their emotions and then draw attention to any area of the angry outburst that was given in a calmer tone. There are usually one or two items in any heated conversation that are, by necessity of breathing and thought collecting, stated at a lower level and in a softer manner. Focusing on these areas of the conversation will reinforce the calmer behavior.
As in the appendicitis mentioned above, sometimes the symptoms of anger must be handled before the root cause. If the patient is making complaints restate the complaints to the patient to make sure you understand them correctly. Then, write them down while sitting with the patient so they know you are taking their complaints seriously. Then reassure the patient that their complaints will be either dealt with immediately or referred to the proper people.
Once the symptom - the angry outburst - has abated, the root cause must be addressed. Attention is usually the best medicine for treating the frustrations and lack of control that most often cause anger. Offer the patient more choices, such as when they would like their bath or what they want for a snack. Discuss their medical condition and current treatments. Find out if they have any questions, concerns or fear. If so, make sure your patient is properly educated and that everyone in their medical team is aware of the patient's current emotional state. Finally, make sure any underlying pain is under control. Pain potentiates anger since the patient is unable to even control the most basic of life functions, that of personal comfort.
Finally, the best ways to handle angry patients are preparation and prevention. Monitor your patients for signs of frustration, fear, inadequate pain control, or feelings of helplessness. If you spot any of these, work to alleviate these conditions prior to an anger outburst. Discuss options with your supervisors and fellow staff members for how to handle angry patients and for when to seek security or police assistance. For further study, theHealth Care Providers Organizationand theHealth Sciences Center in Winnipeghave wonderfully insightful articles about dealing with angry patients.
