Thursday, August 2, 2012

The Self Compass Helps Nurses Cope with Troublesome Patients

I've trained many therapists in Compass Therapy who naively assumed that people come to counseling to hear advice, and show appreciation when receiving it.

Therapy clients sometimes don't like hearing the truth about their part in the problems they are experiencing. They can quickly become defensive, irritable, and critical of the therapist who has much to teach them, if only they will listen.

Nursing is much the same, in that most nurses enter the profession because they care about helping people. And it is very shocking to meet the first few patients who are defensive about receiving nursing care, who are rude and incessantly demanding, and who act as though they know better than the nurse about how to get well. You try to give them their medication and they argue with you. Or you try to draw blood and they snap at you. Or they expect you to drop everything you're doing and focus exclusively on their needs at the moment, and get mad if you don't.

Have you encountered these personality patterns in your nursing career? If so, I want to help you preserve your self-esteem and longevity in nursing through the power of the Self Compass.

In brief, there are four universal compass points in every human personality, and patients are no exception. Love and Assertion form one pair of compass points, while Weakness and Strength form the other.

When people have developed personality health, they integrate Love and Assertion. They show their caring openly, and when needed, assert themselves with diplomacy. They also integrate Strength with Weakness by showing a degree of confidence balanced by a degree of humility. When you nurse patients like this, you know why you chose this profession. Their politeness, appreciation, and willingness to comply with your guidance is gratifying.

However, trouble comes for nurses when patients are stuck on the Strength or Assertion compass points.

Strength-stuck controllers lack Love and Weakness compass points, so they are neither warm nor teachable. Instead, they are full of demands of what you should or shouldn't be doing. From their view, they are right, you are wrong, and that's that! So what do you do with a compulsively controlling patient who keeps making demands on your time and energy, and finding fault no matter what you do?

  • Recognize that perfectionist/judgmental patients get worse when you kowtow to them and need their approval. 
  • Show them from the start that you know your job by calmly performing it. 
  • Listen to their complaints without raising your anxiety level. 
  • Refuse to be rushed by their impatience. 
  • Relax and breathe when you're around them. 
  • Step back and objectively see the pattern in action. This will help you deal with the pattern without feeling frantic or picked apart. 
  • Be in charge of your own self-esteem.
  • When you walk out of their room, relax your shoulders and find something pleasant to focus on.

Oddly, it is your calm and professional demeanor that often quietens a patient like this. They sense that their criticisms don't ruffle you and their infantile demandingness doesn't distract you. Once they have sensed these firm boundaries within the nursing care, they feel emotionally secure and surrender to their temporary discomfort of having someone else in charge of their lives.

Now for aggressive patients, who are chronically stuck on the Assertion compass point.

Your secret here is to predict the arguments they will start, the rude comments they will make, the mean glare they're going to give you. This is the power of the Self Compass, that it gives you X-ray vision into a patient's motivation, and keeps you in charge of your reaction to them.

The hostile, antisocial, or verbally aggressive patient is used to getting their way through blaming and attacking others. But you are not in nursing to take a verbal beating from an obnoxious patient. They are quite unnerved if you don't fear them and do everything to appease them.

  • Again, don't be pushed into reaction behavior, where they pull your strings by escalating their aggression. 
  • Keep the rule of engagement simple. 
  • Keep your focus on what you are doing to provide competent treatment. 
  • When they show anger in their voice and eyes, make full eye contact that shows you have no fear. 
  • If they call you a name, take it in stride. 
  • If they make threatening physical gestures, call for assistance.
  • Keep providing your high standard of care, but take an attitude of nonchalance toward their antics. 
Strangely, aggressive patients will intuitively know that you are one of the few people they can't intimidate. And they will behave better once they respect you.

The key to dealing with both controlling and aggressive patients is to quickly recognize their rigid personalities, so you can disengage your emotions and deal with them firmly without feeling wounded. Keep a storehouse of the faces of positive patients and gratifying moments in nursing care. Keep your own Self Compass in good balance. And when you run across one of these troublesome types, handle it competently and let off steam in the break room!

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