- 156 pages
- English
- ePUB (mobile friendly)
- Available on iOS & Android
About This Book
Developed collaboratively by a doctor and nurse team, this is the first text to deal specifically with nursing difficult patients. Whether patient problems stem from mental distress and ill health, historic substance abuse, demanding family members or abusive behaviour, difficult patients place extra demands on nurses both professionally and personally. Caring for difficult patients requires both technical and interpersonal skills along with an ability to exercise power and set limits.
This text presents invaluable practical recommendations and advice, well founded in experience and supported by relevant literature, for nurses coping with challenging, real world situations. Including learning points, further reading, case studies and dialogue examples to highlight good (and bad) practice, the book covers pertinent issues such as psychiatric diagnoses, setting limits and establishing authority, death and dying, stress and work. It is ideal for pre- and post-registration nurses, providing concrete direction on the management of difficult patients.
Frequently asked questions
Information
Chapter 1
Mental status assessment
Pam Green, R.N., works on an oncology unit, having graduated from nursing school a year and a half ago. Her new patient, Mr. Allen Johnson, a high school English teacher who worked until a week prior to admission, has just been admitted for chemotherapy of his newly diagnosed, inoperable pancreatic cancer. He is terse, formal, and remote. His wife provides Pam with most of the intake history.The next day he has not gotten up to eat breakfast. Pam enters the room.āGood morning, Mr. Johnson.āInitially lying on his left side facing the door, he turns away from her and pulls the covers over his head.āMr. Johnson, may I help you with something?āāNo, Iām fine.āāYou didnāt eat any breakfast.āāIām fine.āāIād just like to get your blood pressure and temperature.āEarlier he had refused to let the nursing assistant get his vital signs. Now, reluctantly, he allows it.āTry to have some breakfast, Mr. Johnson.āSadly recalling the association between pancreatic cancer and depression, she leaves the room, intending to return shortly.Later, the blanket removed from his head, Mr. Johnson is picking at the sheets and grimacing.āMr. Johnson, whatās wrong?āāDonāt give me that innocent bullshit. You know whatās wrong, alright.āāAre you in pain?āāDonāt come near me, do you understand?āBecause she doesnāt know whatās going on, Pam is unsure what to do next, but she heeds the fear she feels and does not approach any closer.āIām going to get some morphine. Iāll be right back.āAt the narcotics cart, she sees her respected colleague, Susan Eiman, R.N., and explains her consternation.āI donāt know how much morphine to give. He had a lot last night but I think he wants more.āāDid you examine him?ā asks Susan.āHe wonāt let me.āāWhat does he tell you?āāNot much.āOn Susanās recommendation, they look at the night shift nursing notes. Mr. Johnson was quiet most of the night but heās also described as āforgetfulā. He had a low-grade fever. Together they return to his room. Just inside the doorway, Susan stops.āMr. Johnson, my name is Susan. Iām a nurse here at City Hospital. Iām coming in for a minute to talk.āShe then slowly walks around the bed to face the patient, pulls up a chair four feet away from him, and sits down. The sheets and blankets are twisted and in disarray. There is a urine stain on the sheet. She says nothing for a whole minute, which feels like ten minutes to Pam. Finally Susan speaks.āWhatās on your mind, Mr. Johnson?āāLeave me alone.āāYouāre in the hospital and weāre your nurses here. We want to help you. Please tell us whatās bothering you.āNo response.āMr. Johnson, please tell us whatās bothering you.āNo response.āDid anything unusual or frightening happen last night?āāJust the wedding. How can you so-called nurses have a wedding when there are people dying in here?āAfter they leave the room, Susan explains that Mr. Johnson is delirious and gets an order for some IV haloperidol. She withholds the opioids that might have been contributing to the delirium, and calls the intern to express concern that the patientās fever might be due to pneumonia or a urinary tract infection and which also might be contributing to the delirium.
Parts of a mental status examination
Appearance
Behavior
Emotion ā mood and affect
A depressed elderly man with a history of alcoholism was hospitalized for the treatment of lung cancer. Throughout his hospitalization, he asked for help for pain and insomnia. One morning he was found in bed, the plastic garbage can liner over his head. He had taken his accumulated stash of opioids and sleeping pills and committed suicide. No one, including his family, had understood the depth of his anguish. Probably no one had asked.
A stoic 60-year-old man with multiple myeloma, and multiple spinal compression fractures appears depressed. His nurse asks him about suicidal thoughts. He admits that when heās in a lot of pain, he wants to die, but that when the pain is controlled, he wants to live. He says heād never commit suicide. He has no history of depression and no family history. His nurse arranges for better pain control. He does not need suicidal precautions.
- āDo you ever feel so bad that life doesnāt seem worth living?ā
- āHave you considered taking your own life?ā
- āHave you thought about how you might do this?ā
- āDo you have the means to do this?ā
- āHave you thought about where you might do this?ā
- āHave you thought about when you might do this?ā
Table of contents
- Cover Page
- Title Page
- Copyright Page
- List of tables and figure
- Acknowledgments
- Introduction
- Chapter 1: Mental status assessment
- Chapter 2: Substance abuse
- Chapter 3: Delirium
- Chapter 4: Psychiatric diagnoses
- Chapter 5: Setting limits
- Chapter 6: The nurseās authority
- Chapter 7: Manipulation, clinging, sexual provocation, anger, and violence ā the feelings they evoke and the interventions they may require
- Chapter 8: The ethics of limit setting
- Chapter 9: Families
- Chapter 10: Communicating with doctors ā the difficult and the easy
- Chapter 11: The nurse and the dying patient
- Chapter 12: Nurses and stress
- Chapter 13: Getting psychiatric consultation
- Notes