Strategies for Diffusing Difficult Patient Situations

Healthcare Training Resource
June 14, 2013 — 2,782 views  
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This article addresses the ways in which nursing staff can develop effective strategies for dealing with difficult patients. Patients can be “difficult” for a variety of reasons including disease, medications or temperament. The ability to discern the reasons behind the behavior and developing strategies to diffuse situations before they escalate is fundamental.

When a patient is displaying difficult behaviors, it is helpful to remember that patients are generally scared, sick and frustrated. They may not be receiving enough information regarding their treatment or feel their needs are not being met. They have, in general, not chosen to be a patient. The staff has, however, chosen to work in healthcare. Given the hands on nature of the job, nurses often bear the brunt of the patient’s behavior (Anderson, 2012).

Strategies to diffuse an episode with a difficult patient lie in two main areas: behavior toward the patient, and changes in the healthcare setting. A patient usually exhibits signs of escalating behavior or makes statements indicating that they are becoming difficult. According to, nurses should use these strategies to create an environment conducive to a positive nurse/patient experience (Schubert, 2007).

Nonverbal Tactics

Respecting a patient’s personal space reduces patient anxiety. Research shows that as personal space decreases, anxiety increases (Schubert, 2007). Nurses need to keep an arm’s length between themselves and their patient. When procedures need to be done, explanation should be given prior to decreasing this distance.

Nurses must be aware of their own body position as well. Avoiding eye-to-eye contact is crucial as this is seen as a challenging stance. Standing off to the side at an angle from the patient is the least confrontational position. Other nonverbal cues, such as tone of voice and facial expressions, should be self-monitored to further decrease anxiety.

Verbal Tactics

Empathy for the patient and their situation reduces tension quickly. Using words and actions that acknowledge the patient’s feelings diffuses their negative behavior. Remaining composed during the episode by choosing non-threatening words and restating their concerns deescalates such events.

Patients may ask questions challenging the nurse’s authority when they make a request in order to feel they have some power in the situation (Schubert, 2007). Nurses must ignore the challenge and calmly repeat their request. Establishing limits in a clear and concise manner and providing clear choices provide patients with proper expectations of their care, further reducing the chances of difficult behavior.

It is useful to allow patients to vent their feelings. Patients often reveal the reason for their behavior during such events allowing nurses to identify the reason for the behavior. Nurses must listen for the “feelings behind the facts” (Schubert, 2007).

Healthcare Setting

Many difficult encounters occur due to inadequate time for nurse/patient interaction (MacDonald, 2007). While nurses often cite inadequate staffing as the major reason for the failure to develop relationships with their patients, it is often lack of supplies and equipment failures that prevent successful interactions. 

Nursing staff that works as a team is essential to successful patient care. A staff that works well creates a harmonious environment on the floor which is essential to positive patient behaviors. Nurses experiencing high job satisfaction will have better patient relationships (MacDonald, 2007).

Nursing staff are on the front lines of patient care. Empathizing with a patient’s fears, providing clear instructions and expectations, positive nonverbal communication provides the basis for a successful nurse/patient relationship. A harmonious work environment benefits both nurses and patients by providing a backdrop for successful relationships.

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