In an earlier post entitled Nursing the Angry and Demanding Patient we examined issues surrounding difficult patients and what measures nurses can take to help deal with them.
We continue down the difficult patient route here to have a look at another patient behavior that can cause huge problems for the nursing staff. Manipulative behavior is such a tricky one to deal with and there are so many different aspects to it that I have dedicated a whole post to it.
The Manipulative Patient
What exactly do we mean by manipulative? Well these patients again, are often overly demanding and prone to angry outbursts too, but often the behaviour is much more covert.
Once again, I will take a trip down memory lane. Mrs Pink arrives on our medical ward for investigations and treatment of her diabetes, which has been uncontrolled at home. She has an extensive medical history and is a veteran of the hospital.
On arrival, Mrs Pink immediately begins to explain the exemplary treatment that she has received in other hospitals and wards, pointing out how amazing the nurses were and naming a couple for good measure. I’m already starting to feel a little guilty and somewhat lacking ~ Yes, nurses are human too!
After a few days, the complaints begin. The first problem is a male member of staff that she has taken a dislike too. She subtly suggests inappropriate behavior towards herself and other patients. She doesn’t want me to report or address the issue with the male staff nurse because she is sure that, ‘he didn’t mean it!’
Mrs Pink then proceeds to tell me that a respected senior nursing colleague of mine, ‘doesn’t think much of my work.’ But, ‘don’t say anything because I don’t like to tittle-tattle.‘ I am mortified now and the rest of my shift is spent in abject misery.
As Mrs Pink’s hospital stay continues into weeks the staff are at loggerheads and Mrs. Pink has chosen a few ‘favourites’ who she insists on working with her when they are on duty. This resulted in a division of the team and left the rejected nurses feeling inadequate.
The constant unreasonable demands and insinuations continue and finally, Mrs. Smith beginning to ask questions such as,
“What are the official procedures for making a formal complaint in this hospital?”
Panic sets in and all the staff are now uneasy, disturbed and walking on egg shells. In real life on the wards, when a patient threatens an official complaint they often end up receiving preferential treatment because the reality of an investigation for most medical staff is a stressful nightmare, whether the complaints are founded or not.
Here are some of the traits of manipulative behaviour. Most of us may display some of these tendencies at one time or another and patients may use some, or even all of them to achieve their goals.
- Passive Aggressive Behavior: This behavior usually stems from a person feeling angry or resentful. Instead of addressing and communicating the real causes of the negative feelings the passive aggressive will often appear friendly and kind whilst embarking in very destructive behaviours.
- Divide and Conquer: Manipulative patients split the staff and engage in game playing and rumor spreading. Favoring some nurses and rejecting others and insinuating unprofessional behaviour, whilst all the time appearing innocent.
- Verbally or Physically aggressive: Usually the real anger will surface if the manipulative patient is ‘found out’ in a lie or challenged on their bad behaviour.
- Complain a lot: These patients can be very demanding. Nothing is really quite good enough and obviously, other wards and staff have done the job much better. Again, the complaining is often ‘covert’ that is, not direct.
- Promote special relationships with Staff: Again, this crosses over into the divide and conquer category and leaves some staff with their egos stroked and some with their egos bruised.
- Threats: At some point, the manipulative patient may make a formal (ungrounded) complaint against one, or a number of staff. This is the ultimate act of passive aggression.
Nurse Megan’s 5 Top Tips for dealing with Manipulative Patients
1) Share Information: Communication is key when dealing with any of the manipulative behaviors outlined above. If the situation is becoming serious call a staff meeting. Share everything that the patient has said regarding accusations against other staff members or complaints about quality of care. Remember the key goal is to divide and conquer so unite and defend. Make sure that all staff are aware of the situation including doctors and administrators.
2) Document, Document, Document: Make sure that comments and complaints are well documented over the whole of the patient’s stay. Be as objective as possible simply quoting the exact words that were said. Do not add value judgements or personal opinions. Also document what course of action that you took, such as ‘reported allegations to Nurse White.’
3) Adopt Appropriate Strategies: Once all staff members are aware of the issue then plans can be laid down for damage limitation. If the manipulative patient is playing staff off against each other then enter the room in pairs. Do not allow the patient to choose who is going to nurse them. Simply state that you are all professionals and it is up to the ward manager to allocate staff to patients. Diffuse any gossiping about other staff members by refusing to get drawn in.
4) Remain Calm and professional: If the patient has upset or unsettled you try not to let it show. Create an atmosphere of calm, methodical nursing. Likewise if you are being unduly praised, be aware that you may be having your ego stroked but this could be another set up. Remain as objective as possible and try not to respond to any value judgements ~ negative or positive.
5) Involve the Experts: If the manipulative behavior is linked to addictions such as drugs or alcohol, involve the specialist in the patient’s care. Likewise if the patient is extremely manipulative a referral to a hospital psychologist may not be such a bad idea. (Be Aware: Informing a specialist will not go down too well!)