_________________________________________________________________ Managing Disruptive Patients
HEALTHCARE PROFESSIONAL INTERVENTIONS AND RATIONALE FOR MANAGING PATIENTS’ MANIPULATIVE BEHAVIORS (CONTINUED)
Independent Healthcare Professional Interventions Recognize and refuse to respond to manipulation.
Rationale
Refusing to support the manipulative behavior tells patients who are manipulative that you, the healthcare professional, cannot be used as an object. They will have to find another way to get the healthcare professional to meet their needs. Patients who manipulate are in desperate need of acceptance and positive regard. The healthcare professional should recognize the patient’s behavior as manipulative rather than label the patient as a “manipulator.” Do not assume that empathy comes naturally to patients who manipulate. Help them develop an awareness of their impact on others by being honest about how it feels to be manipulated. Although patients will most likely rail against limits, they will be enormously relieved by them. Limits will provide the external control patients need until they can develop internal control. The patient needs to recognize not only unacceptable behavior but also acceptable behavior. Reinforcement of positive behavior is likely to elicit more of the same.
Do not accept the behavior but accept the patient.
Help the patient to understand the impact of their behavior on others.
Set limits that are reasonable, clear, firm, and consistent.
Provide positive reinforcement every time the patient is able to: • Communicate needs directly, • Take responsibility for their own actions, or • Accept limits.
Source: [2; 33]
Table 5
Bonnie begins her assessment by asking David ordinary ques- tions such as his name, address, date of birth, and marital status. Each time he answers, David adds a short comment such as, “Yes, I already answered that one” or “Seems like you people could pass along information better; are you people all incompetent?”
UNFOLDING CASE STUDY: GENERAL SURGERY UNIT
David Andrews, a single, 32-year-old man, has been admitted to the general surgery unit for a hernia repair. His healthcare profes- sional, Bonnie Blake, introduces herself and welcomes him to the hospital. Bonnie is a recently divorced 28-year-old and has been a healthcare provider for about 6 months. She explains to David that she will need to ask a series of questions, some of which he may already have answered, but that she would like to hear his answers herself. David says he will be very happy to answer questions asked by such a cute healthcare provider. He tells Bonnie that he hopes she is his healthcare provider the whole time he is in the hospital and will meet his “every need, if you get what I mean!”
Self-Assessment Quiz Question 12
Which would be the best response for Bonnie to make to David’s comments? A) “I told you these questions may have already been asked.” B) “I agree that all this makes things very repetitious.” C) “I do understand your frustration, there aren’t too many more items.” D) “I really wish you’d stop interrupting, then we’d get done sooner.” The correct answer is C. Acknowledge that the process is cumbersome without taking sides or “scolding” the patient.
Self-Assessment Quiz Question 11
How should Bonnie interpret David’s last remark? A) David is probably very nervous about being admitted to the hospital. B) David is a big flirt. C) David is probably guilty of sexual harassment in his work situation. D) It is hard to be sure of how to interpret his remark at this point. The correct answer is D. Rationale : The other response may be true later. It is still to early to make a definitive judgement.
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