Navigating Challenging Patient Behaviors: Strategies for Nurses

Working in healthcare, especially in units catering to patients with complex conditions, can be incredibly rewarding. However, it is also fraught with challenges. One of the most difficult aspects for nurses is dealing with challenging patient behaviors. This article explores common behaviors that can make a nurse's job particularly challenging and offers strategies to manage and improve patient care.

Understanding and Addressing Difficult Patient Behaviors

Patients often exhibit behaviors that can be shocking, distressing, or even dangerous. Such behaviors can range from mild to severe and can be triggered by various factors including physical pain, mental distress, confusion, or the occurrence of sundowning episodes (a subset of behaviors that arise as the day turns to night). Here are some common behaviors that nurses might encounter:

Spitting, hitting, pinching, and punching. Forcibly bending fingers and grabbing hold of clothing. Verbal abuse and swearing. Smearing feces over themselves and the environment.

These behaviors can make a nurse's job extremely challenging, often requiring extra patience, care, and resourcefulness. Additionally, it is crucial for nurses to understand the underlying causes of these behaviors to address them effectively.

The Problem of Sundowning

One particularly difficult aspect of caregiving is the phenomenon of sundowning. Sundowning refers to the worsening of symptoms in patients with dementia during the late afternoon and early evening. During these times, patients with dementia may show an escalation in aggressive behaviors, agitation, and confusion.

My Caribbean co-workers would often say, “The Devil got into her,” which was a shorthand for these changes in behavior. Typically, these patients were once amenable and pleasant but would suddenly become banshees, hopping out of bed, throwing things, and tying themselves to the call button. By dinner time, the situation would often normalize. This cyclical pattern can be highly unsettling and demanding for both nurses and patients.

Strategies for Managing Challenging Behaviors

While it can be difficult to manage these challenging behaviors, there are several strategies that can help:

1. Communication and Empathy

Build a relationship of trust and understanding with your patients. Communication is key. Even if a patient is unresponsive or uncommunicative, being respectful and kind can make a significant difference. Take the time to understand what might be triggering their behavior. Offering a quiet, calm environment can also be very helpful.

2. Safety Measures

Ensure that the patient is safe at all times. Preventative measures such as secure door locks or safety belts can be considered, especially for patients who are prone to wandering or aggressive behaviors.

3. Distractions and Activities

Engage the patient in activities that they enjoy. Providing distractions can divert their attention from the source of distress. Music, art, and gentle conversation are often effective.

4. Medication and Professional Support

Consult with the medical team to explore appropriate medical interventions. Sometimes, medications are necessary to manage severe behaviors. Additionally, support from mental health professionals can provide additional strategies and resources for managing difficult behaviors.

5. Support Systems

Lastly, remember to take care of yourself. Working with patients who exhibit challenging behaviors can be emotionally draining. Make sure you have support systems in place, whether that be colleagues, family, or counseling services.

Conclusion

Dealing with challenging patient behaviors is a significant aspect of nursing. By understanding the root causes and employing effective strategies, nurses can better manage these behaviors and provide compassionate, quality care. The challenges are real, but with the right approach, these situations can be navigated more effectively.