How to Establish Trust and De-Escalate Stressful Situations
More often than not, any patient receiving medical care probably isn’t having one of their best days. People dealing with health issues are often scared, stressed, in pain—or all of the above. And while many patients will show gratitude and do their best to make healthcare providers’ jobs easier, nurses are also bound to encounter difficult patients from time to time.
When patients take out their frustrations on a nearby nurse, it can be tough not to take it personally. However, learning how to deal with difficult patients is one of the most important skills any nurse can develop. Staying calm, positive, and professional can de-escalate many situations and lead to better outcomes for your difficult patients—and the rest of the people under your care.
Let’s explore some strategies nurses can use for handling difficult patients, with examples of how to put them into practice.
1. Active Listening
Patients want to feel heard, and like their healthcare team is taking their concerns and symptoms seriously. Nurses who practice active listening demonstrate to their patients that they truly care about helping them get better. They can also gather important information from patients that determines next steps in treatment, testing, or hospitalization.
Active listening is about truly understanding the speaker and their perspective. Maintaining eye contact, using warm body language, asking follow-up questions, and paraphrasing the patient’s concerns after they’re done speaking are all useful active listening techniques.
2. Empathy Building
Empathy building is closely related to active listening, because it validates the patient’s experience and the difficulties they’re going through. Patients want to be seen as individuals, not just room numbers, and an empathetic nurse can ease anxieties and make patients more willing to follow instructions. Acknowledging a patient’s pain, fears, or concerns goes a long way toward building rapport with their healthcare team.
While showing empathy for patients is essential, it’s also important for nurses to establish boundaries to prevent emotional overload and ensure objective decision-making. Great nurses make their patients feel understood and cared for while maintaining the necessary professional distance to avoid burnout or ethical gray areas.
3. Establishing Trust
Trust between patients and their nurses is an important part of providing effective treatment. Patients who trust their healthcare providers are generally more willing to share information about their symptoms, condition, and medical history, which enables providers to make better-informed care decisions. Patients who trust their healthcare providers may also be more receptive to treatment, and more likely to follow ongoing treatment instructions upon release from the hospital or clinic.
Nurses can establish trust with their patients through open and honest communication, treating patients with dignity during their most vulnerable moments, and by consistently providing empathetic care without judgment or bias. Patient-centered care shows each individual you value their needs, which can help difficult patients understand you’re there to help them get better.
4. Effective Communication
When a patient is in discomfort and seeking care, not fully understanding what’s happening with their body can be unsettling—as can confusing instructions or invasive treatments. Clear communication helps patients understand what to expect, and empowers them to be proactive participants in their healthcare rather than just along for an unpleasant ride.
Because healthcare professionals undergo so much specialized training, it’s easy for nurses and physicians to forget how foreign medical language can sound to the average patient. Taking the time to clearly explain procedures, treatments, and options in terms anyone can understand helps minimize the anxiety patients experience in a clinical environment.
5. De-Escalation Techniques
Some patients will inevitably become agitated despite significant efforts to put them at ease and make them comfortable receiving care. Throughout their careers, nurses must be able to de-escalate tense situations with difficult patients who may be angry or confrontational.
People often see someone else’s body language and hear their tone of voice more than they understand the actual words being spoken—especially when they’re in a wound-up, emotional state. A calm, confident posture with open palms makes your nonverbal communication seem more welcoming and less threatening. Avoid crossed arms, sarcastic responses, or getting defensive—even if somebody questions your expertise or authority.
Redirect challenging questions or comments back to the patient’s symptoms and concerns, and try to focus on understanding what’s happening behind the emotions they’re experiencing. Laying out potential options and giving patients a choice of how they’d like to proceed can also make them feel more in control of their situation, and help them stay focused on solutions.
6. Team Collaboration
Modern healthcare teams are often made up of a panel of multidisciplinary experts, and collaboration between these professionals is key to providing great care—even to difficult or uncooperative patients. If a patient has a history of particular behaviors or symptoms, for example, those factors may inform certain care decisions or precautions taken by nurses or other providers.
Successful multidisciplinary healthcare is dependent on great communication between healthcare professionals. Close collaboration ensures everyone on the care team has a full understanding of the patient’s history, condition, and risk factors, and helps build trust with patients as they observe the team of experts working hard on their behalf.
7. Boundary Setting
While it’s important for nurses to show empathy to their patients and relate to their discomfort, fears, or other emotions, nurses must maintain a certain professional distance to ensure objectivity during clinical decision-making. Getting too close with your patients can cloud your judgment and cause potential ethical concerns.
At the same time, it’s essential for nurses dealing with difficult patients to set clear boundaries on any behaviors that are unacceptable. Nurses must remain calm and professional in challenging situations, but that doesn’t mean they have to put up with verbal abuse or threats to their physical safety.
8. Cultural Competence
Cultural competence is about providing better-quality care through respect for an individual’s background and beliefs. Nurses who understand their patients’ communication style, gestures, and cultural values can more effectively deliver patient-centered care that addresses each individual’s unique needs.
Besides learning about different cultures and the health disparities they experience, cultural competence also encourages providers to examine their own biases and how they react to people whose values or cultural identity are different from their own. By developing an awareness of their own biases and internal belief systems, nurses can learn how to interact with patients of all backgrounds respectfully and effectively.
9. Patient Education
In many cases, difficult patients are reacting to feeling out of the loop or a lack of control over their own health. When nurses can effectively educate patients and their families about their circumstances and their options, it helps establish realistic expectations and avoid misunderstandings. Patients who thoroughly understand their follow-up instructions are also less likely to experience complications or require readmission.
While educating patients and their families, nurses should try to keep instructions as simple and concise as possible. Ensure any printed materials are provided in a patient’s native language, and ask the patient to explain back any follow-up steps to ensure they understand what’s expected of them. Use layperson-friendly language, and explain the reasoning behind any important instructions or things to watch out for.
10. Self-Care for Nurses
It’s normal to feel frustration when a patient undermines your efforts to help them get better. Allow yourself to experience the emotion in the moment, and remember that how you deal with a difficult patient can determine whether a situation escalates or resolves quickly.
Nursing can be an emotionally exhausting job, and compassion fatigue is a real phenomenon among many healthcare providers. Taking a short break for a few deep breaths is always a good strategy when dealing with a challenging patient, as is talking with a trusted colleague or mental health professional to process your emotions. Learning to separate your sense of duty at work from your personal life is key to avoiding burnout and maintaining your own well-being over the long term.
11. Patient Advocacy
One of the best ways to calm down a difficult patient is to demonstrate you’ve got their best interest in mind. Nurses who advocate for their patients build trust by taking a whole-person approach to their needs both inside and outside the clinic.
Patient advocacy can take many forms—like protecting a patient’s right to privacy and autonomy, preserving their dignity, or minimizing their discomfort. Beyond the clinic, nurses advocate for their patients by connecting them with health, social, or financial resources. Patient advocacy could also be double-checking a medication dosage, or respectfully communicating with your colleagues on behalf of a patient’s comfort or safety.
12. Collaborative Goal Setting
When patients are dealing with health challenges, setting achievable goals is important for motivating them to participate in their own care. Agreeing on short- and long-term health-related goals builds rapport between patients and providers, and encourages the patient to reflect on what they hope to accomplish through their treatment plan and follow-up care.
Patient goals could include things like getting their vital signs within a normal range before they’re discharged, reducing their pain to a more manageable level, or simply standing up from their bed a few times a day. Focus on one or two measurable goals at a time, and be sure to acknowledge your patients’ successes along the way.
13. Time Management
Nurses almost always care for multiple patients at a time, and dealing with a difficult patient can take up valuable time you need to accomplish other tasks. While it’s important for nurses to spend quality time with each person, they must also be able to take control of an interaction when dealing with patients who are particularly chatty or looking for lots of reassurance.
Prioritizing tasks, taking notes, and creating ever-evolving to-do lists help nurses stay organized and manage their time, even when they’re faced with potential distractions. Try to batch tasks for each patient together to minimize the amount of time you spend running back and forth between rooms. And during slower periods, catch up on lower-priority tasks like restocking supplies so you’ve got everything you need close at hand during the next rush.
14. Recognizing Signs of Distress
Whether it’s a patient’s clinical condition or their emotional state, learning to recognize the early signs of distress allows nurses to take action before a situation escalates. Changes in vital signs like blood pressure, heart rate, or respiratory rate may indicate a patient’s health is deteriorating. On the other hand, tense body language, clenched fists, or fidgeting may indicate a patient is in pain or emotional distress.
Proactively addressing issues (and anticipating potential future problems) can prevent minor incidents from becoming more serious concerns. Through a combination of learning and experience, nurses develop an instinct that tells them when something isn’t quite right with a patient. Listening to those internal alarm bells and following up with the appropriate precautions has enabled countless nurses to take life-saving action on behalf of their patients.
15. Seeking Supervision and Support
Nursing attracts givers who want to “save the world”—it’s a big part of why many people get into the field. However, it’s important to remember that healthcare is a team effort, and you don’t have to do everything on your own. While problem-solving and de-escalation skills are essential for a successful nursing career, it’s OK to ask for backup when you’re dealing with a particularly difficult patient.
Don’t hesitate to ask for advice or support from your colleagues or supervisor—they may be able to offer insight into a particular patient’s behavior, or share stories of how they’ve handled similar situations in the past. Regular team debriefings are also useful in processing the emotions of challenging patients or stressful situations that arise during your shift.
Of course, you should always reach out to your supervisor or on-site security team if a patient is excessively abusive or you worry they may become violent. Remember you owe it to the rest of your patients to maintain a safe, orderly care environment, and you’re always justified in taking action if anyone is threatening to jeopardize that.
Your Journey into Nursing Starts Here
While any nurse is all but certain to encounter patients that test their patience, the above strategies will help you navigate those tough interactions. Remember that learning to deal with difficult patients is an ongoing process that continues throughout your career. Fortunately, great patient-centered care prevents many situations from escalating in the first place, thanks to its focus on understanding each patient’s needs and concerns, and delivering care that aligns with their values, beliefs, and goals.
If you’re considering a career as a registered nurse, it’s important to choose an educational program that prepares you for all aspects of the field, including how to handle difficult patients. In addition to our experienced instructors, the Bachelor of Science in Nursing program at Brookline College uses immersive simulation tools to prepare you for all types of patient interactions. By the time you graduate, you’ll be confident in your ability to respond to challenges and take control of tense situations.