Challenging Patient Encounters for a Psychiatric Nurse Practitioner?
As a psychiatric nurse practitioner, I am likely to have challenging encounters with difficult patients. “Difficult patient” encounters are a common phenomenon in the mental health care nursing practice. The phrase highlights the difficulties encountered by practitioners during their interaction with patients; it underscores the lack of cooperation between the practitioner and the patient (Lemmergaard & Muhr, 2009). Although the patient presents to the clinic to seek care and help, he typically does not accept the interventions offered willingly or readily. Difficult behaviors can be categorized into four primary dimensions. These dimensions include dangerous and aggressive, manipulating and attention-seeking, claiming and demanding, hard to reach, and withdrawn (Fischer et al., 2019). The aspects mentioned above are standard among patients diagnosed with psychotic disorders and those with personality disorders.
Concerns about the Encounter
The encounters with these patients are usually frustrating due to the elusiveness of satisfying the interactions between patients and practitioners. Difficult patient encounters trigger various physical complaints from both the practitioner and the patient (Sandikci et al., 2017). These patients also present with distinct behaviors, for instance, psychiatric symptoms such as depression and anxiety, frequent or regular requests for unrealistic interventions and tests, and dissatisfaction with the delivery of care. The provision of care to difficult patients can be time-consuming and frustrating, and it significantly contributes to the psychiatric nurse practitioners’ burnout and exhaustion; this, in turn, impedes care quality, and it triggers unnecessary expenses incurred by the health care system. One out of six patients who present to the mental health clinic daily is a difficult patient. On the contrary, health care practitioners may lack adequate training on how to manage and engage these patients; this may, in turn, impact the nurse practitioner's capacity to deliver quality care to the patient (Sandikci et al., 2017).
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How to Manage this type of Encounter
To effectively manage this particular encounter, I will employ the following strategies. First, I will apply effective communication techniques while handling these patients. Some of the aspects I will incorporate during my conversation with the patient include depicting an understanding and caring attitude, careful listening techniques, being nonjudgmental, validating the patient’s ideas and feelings during care delivery. I will create a holding environment or surrounding in which the client may feel safe and secure to experiment with various behaviors and experience different feelings. I will set limits for the patients in the holding environment; this is an effective strategy to promote the safety of this particular environment. I will also elicit a conversation with the patient regarding personal issues, for instance, emotions, both directly and indirectly. Once the client shares his feelings, I will show empathy and support; this is a strategy aimed at building an alliance between the practitioner and the patient. Communication techniques may also assume a non-verbal approach, for instance, timely therapeutic silence and thoughtful nodding (Fischer et al., 2019). Employing these techniques as part of the broad patient-centered curriculum during consultations and the provision of interventions plays a critical role in promoting a nurse practitioner’s capacity to handle these patients (Fischer et al., 2019).
Secondly, I will initiate the necessary changes in the patient’s therapeutic structure in line with the patient’s needs to manage further the behaviors of difficult patients (behaviors considered to be bothersome). For instance, I might implement significant changes in the way in which I organize patient visits. I will organize brief but regular appointments for these patients and share the plan with the patient; this will provide the patient with evidence of support and a concrete timeline. I will also avoid scheduling these clients for the last timeslot. Whenever patients suffer from unexplained symptoms, I will initiate effective interventions that seek to manage the condition. For instance, I will conduct frequent diagnostic tests to determine the patient's specific ailment, introduce the necessary prescriptions, and conduct regular physical exams. Moreover, I will assign the patient the accountability or responsibility for her or his safety, develop a clear treatment contract and structure, and maintain one professional nurse as a case manager for the patient. Other specific therapy techniques I may employ include modifying the patient's dialectical behavioral therapy, utilizing paradoxical and strategic interventions, and developing specialized aftercare programs in patients perceived to be difficult. I will further organize the individual supervision of patients and interdisciplinary consultation among other health care practitioners (Lemmergaard & Muhr, 2009).
Pros and Cons for Managing a Challenging Encounter in the way Proposed
Effective communication techniques play a critical role in care delivery in the mental health department. First, it encourages a nurse practitioner’s capacity to understand the condition and needs of a patient. Secondly, it fosters a practitioner’s ability to comprehend his or her patients’ emotional states. Thirdly, it enhances the care practitioner’s ability to identify the specialized needs of patients. Fourthly, it allows the practitioner to comprehend the concerns and needs of a patient which, in turn, enables nurses to target their clinical and communication strategies towards patient-specific preferences (Fischer et al., 2019). One primary con associated with this approach is the fact that it increases the vulnerability of a patient. Secondly, this approach is impacted by language-related limitations, for example, language barriers, and this may, in turn, cause poor communication between the practitioner and patient (Sandikci et al., 2017).
Modifying a patient’s therapeutic structure to meet the patient’s needs has significant impacts on both the practitioner and the patient. First, it increases the levels of satisfaction experienced by both patients, particularly during care delivery. Secondly, it causes significant increases in the morale and productivity of health care providers and the ancillary staff. Thirdly, this approach plays a critical role in reducing health care expenses and increasing financial margins all through the health care continuum (Sandikci et al., 2017). Some of the cons associated with this approach are that it is time-demanding; it takes time for a practitioner to establish an effective relationship with the patient to enhance this particular health care approach. Secondly, a practitioner may experience significant levels of difficulties in his attempt to gather information from the patient. A patient is likely to hold back important information that may be critical in care provision (Sandikci et al., 2017).
References
Fischer, C., Cottin, M., Behn, A., Errázuriz, P., & Díaz, R. (2019). What makes a difficult patient so difficult? Examining the therapist’s experience beyond patient characteristics. Journal of Clinical Psychology , 75(5), 898–911.
Lemmergaard, J., & Muhr, S. (2009). Treating threats: the ethical dilemmas of treating threatening patients. Service Industries Journal , 29(1), 35–45.
Sandikci, K. B., Üstü, Y., Sandikci, M. M., Kayhan Tetik, B., Işik, D., & Uğurlu, M. (2017). Attitudes and behaviors of physicians in dealing with difficult patients and relatives: a cross-sectional study in two training and research hospitals. Turkish Journal of Medical Sciences , 47(1), 222–233.
