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Communication Skills for the Health Care Professional Concepts, Practice, and Evidence Gwen van Servellen CHAPTER 16 © 2009 Jones and Bartlett Publishers Chapter 16 Communicating Effectively with Patients Displaying Significant Negative or Resistive Coping Responses © 2009 Jones and Bartlett Publishers Objectives Multidimensional situations: patients, tasks, and care contexts Types of difficult patient behaviors and underlying communications Ways provider can monitor and apply specific guidelines Difficult patient encounters and corresponding therapeutic responses © 2009 Jones and Bartlett Publishers Difficult Patients, Tasks, and Care Contexts Difficult patients: behaviors evoke distress in the provider exceeding that expected or accepted Up to 15% of provider-patient encounters are “difficult†10%-20% of consultations are with patients of this type © 2009 Jones and Bartlett Publishers Difficult Patients, Tasks, and Care Contexts Continued Care contexts, e.g. dying patient, newly diagnosed terminally ill patient Care situations, e.g. poorly staffed, little patient continuity, lack of transfer of important medical data © 2009 Jones and Bartlett Publishers Difficult Behaviors Dependent or manipulative Aggressive Condescending Self-pitying Complaining Demanding © 2009 Jones and Bartlett Publishers Behaviors and Underlying Meanings The non-adherent patient Patient barriers Treatment and disease burden Patient-provider relationship and system barriers © 2009 Jones and Bartlett Publishers Manipulative-Dependent Found among all genders, ages, ethnicities, income classes Exaggerated expressions of powerlessness and hopelessness and may be fabricated Reinforces the authority-subordinate relationship between provider and patient © 2009 Jones and Bartlett Publishers Responses to Manipulative Dependent Patient Thorough assessment of behaviors Set limits on demands and requests, especially if fabricated Establish the goals of treatment and engage patient actively as a partner Avoid honoring special privileges or patient bargaining Avoid accepting flattery © 2009 Jones and Bartlett Publishers Aggressive Patient Expressed aggression toward provider is troublesome and can occur for many reasons Patient may or may not be aware of underlying hostility Assault is rare but can occur © 2009 Jones and Bartlett Publishers Responses to Aggression Fully assess the foundations for the aggression, including health status Lower the stimuli in the immediate environment Avoid direct contact if possible or approach with a colleague Evaluate for medication needs, e.g. pain medications and mild sedative © 2009 Jones and Bartlett Publishers Discuss Underlying Meanings and Therapeutic Responses Complaining and demanding patient Patient in denial of illness or prognosis Depressed or anxious patient © 2009 Jones and Bartlett Publishers Monitoring Own Reactions Become aware of your reactions and reflect Enhance awareness and observation skills Show patient respect Practice unconditional positive regard Show concern and interest Practice objectivity Conduct analyses with input from colleagues © 2009 Jones and Bartlett Publishers Summary Dealing with difficult patients, difficult tasks, and difficult care contexts is omnipresent in health care.

Providers’ abilities rely on awareness, observation, and well placed responses. © 2009 Jones and Bartlett Publishers Adapted Lesson Plan Worksheet Class Subject: Class Topic: Students’ ELP Level: Standard: Content Objective: Language Objective: Teaching Strategies Used in the Lesson Strategy One: Strategy Two: Strategy Three: © 2015. Grand Canyon University. All Rights Reserved. Communication Skills for the Health Care Professional Concepts, Practice, and Evidence Gwen van Servellen CHAPTER 15 © 2009 Jones and Bartlett Publishers Chapter 15 Communicating with Patients in Crisis © 2009 Jones and Bartlett Publishers Objectives Define crisis response Individuals and groups in crisis Dysfunctional communication in times of crisis Relevance of stress and adaptation in periods of crisis Adaptive and maladaptive coping responses © 2009 Jones and Bartlett Publishers Objectives Continued Stressors, coping resources, and stress resistance resources Differentiate between situational and developmental crisis Stages of crisis resolution Interventions to manage highly anxious patients Interventions to manage agitated and/or confused patients © 2009 Jones and Bartlett Publishers Definition of Crisis and Crisis Responses More change is required of an individual than capable to deal with at the time Assumptions Not all crises are incapacitating Persons experience crisis in isolation of others Persons can worsen each others responses through further excitation Crisis is not the same as the stressor itself © 2009 Jones and Bartlett Publishers Dysfunctional Aspects of Crisis Communication Difficulty in perceiving accurately Abilities of processing information may be impaired Ability to express ideas, thoughts, and emotions may be limited Perceived state of disorganization can increase these deficits © 2009 Jones and Bartlett Publishers Impact: Over Stimulation and Under Stimulation Over stimulation Rapid bombardment or excessive stimuli Not too much but stimuli are noxious Exceed tolerance level Inability to hear, speak, and if they do hear, unable to move © 2009 Jones and Bartlett Publishers Stress Theories and Understanding Crisis Levels of anxiety and effects on patients; mild to severe and panic Stress and adaptation Lazarus and Folkman (1984) coping always discussed when stress effects are analyzed Studies of stress of different kinds; and stress of the same kind across several groups of individuals © 2009 Jones and Bartlett Publishers Adaptive Coping Responses Seek information Seek comfort/support from friends or family Search for solutions to the problem(s) Self-talk that will help them feel better Seek professional counseling or advice © 2009 Jones and Bartlett Publishers Types of Crisis Developmental Crises: interruption or unsatisfactory passing from one psychosocial task and developmental phase that correspond also to physical developmental growth Situational: Crisis emanates from precipitating events that occur and are typically out of the person’s realm of expectancy. © 2009 Jones and Bartlett Publishers Caring for Patients in Crisis Do not re-victimize in the process of helping Establish an emotional or psychological connection with the patient and family Do not challenge the validity of the crisis situation or underestimate its effect Practice active listening skills, direct straightforward approach, become aware of personal responses and their impact © 2009 Jones and Bartlett Publishers Summary Crisis is unavoidable; many illness or injury events can be perceived as a crisis to the patient and family. More needs to be known about the unique expression of crisis across individuals and communities. © 2009 Jones and Bartlett Publishers

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Communication Skills for Health Care Professionals: Managing Difficult Patients and Crisis Situations
Introduction
Effective communication is crucial in health care settings, especially when dealing with difficult patients and crisis situations. Health care professionals often encounter patients exhibiting significant negative or resistive coping responses. According to Van Servellen (2009), roughly 15% of provider-patient encounters are classified as "difficult." This paper explores various types of difficult patient behaviors, the underlying communications that inform these behaviors, and strategies that providers can adopt to enhance patient-practitioner relationships and improve care outcomes.
Understanding Difficult Patients
Difficult patients present behaviors that provoke distress in health care providers. These behaviors can manifest in various forms such as dependency, aggression, complaining, or manipulative tendencies (Van Servellen, 2009). Underlying these behaviors are a host of factors including medical conditions, psychological distress, or situational stressors. For instance, patients who have recently been diagnosed with terminal illness may exhibit resistance due to anxiety and fear, impacting their communication with healthcare providers. Recognizing the multifactorial nature of difficult behaviors is essential in developing effective communication strategies tailored to individual patient needs.
The characteristics of difficult patients can often lead to challenges within specific care contexts, such as a poorly staffed facility, lack of continuity in care, or failure to share important medical information (Van Servellen, 2009). In recognizing these contexts, health care professionals can prepare themselves to address the nuances associated with each unique patient interaction.
Types of Difficult Patient Behaviors
1. Manipulative-Dependent Behaviors: These behaviors often stem from a patient's profound feelings of powerlessness and helplessness. Patients may exaggerate symptoms or fabricate circumstances to gain dominance in the health care relationship (Van Servellen, 2009). For example, patients may feel a sense of control by eliciting sympathy or special treatment from caregivers. Health care providers can manage these interactions through thorough assessment, establishing treatment goals collaboratively, and maintaining professional boundaries (Van Servellen, 2009).
2. Aggressive Behaviors: Aggression in patients can be unsettling for providers and could arise from unmet needs, frustration, or underlying psychological issues (Van Servellen, 2009). Patients may display aggression verbally, through body language, or even physically. It is vital for professionals to assess the foundations of the aggression by understanding the patient's health status and environmental stimuli. Providers should approach with caution, evaluate potential medication needs, and try to create a calmer surrounding.
3. Demanding and Complaining Patient: Patients may express dissatisfaction or make excessive demands as a way to cope with their situation (Van Servellen, 2009). Some patients may struggle with denial regarding their illness or prognosis and may act out through complaints. Engaging in empathetic listening and providing clear, straightforward information can help these patients feel heard and may ease some of their frustrations.
Therapeutic Responses to Difficult Patients
Effective management of difficult patients necessitates specific responses based on an understanding of the patient's underlying motivations and emotional states.
1. Assess and Monitor Responses: Health care professionals should maintain awareness of their emotional reactions when faced with difficult patient interactions. Self-reflection and awareness can enhance the practitioner's ability to respond therapeutically rather than react impulsively (Van Servellen, 2009; Lazarus & Folkman, 1984).
2. Engage Patients as Partners: Establishing therapeutic alliances with patients—framing them as collaborators rather than passive recipients of care—is essential. By setting clear treatment goals, professionals can empower patients to engage actively in their care journey. This approach will help to diminish feelings of helplessness (Van Servellen, 2009).
3. Avoid Judgment and Maintain Respect: Practicing unconditional positive regard and showing respect is critical in de-escalating difficult interactions. Health care professionals should refrain from making judgments, even when faced with challenging behaviors. Listening actively and expressing genuine interest can positively influence the patient-provider dynamic (Van Servellen, 2009).
Communicating with Patients in Crisis
Crisis situations further complicate interactions and challenge the communication abilities of both patients and providers. Stressors and acute emotional responses can impede a patient’s ability to process information, perceive accurately, and express thoughts (Van Servellen, 2009).
1. Establish Psychological Connection: In crisis situations, creating an emotional bond with patients is crucial. By expressing empathy and understanding, health care professionals can help patients feel validated and supported. Esteeming the authenticity of the crisis situation enables meaningful dialogue (Van Servellen, 2009).
2. Utilize Adaptive Coping Strategies: Providers can encourage patients to seek solutions to their problems, utilize support systems, or engage in self-soothing techniques (Van Servellen, 2009). Promoting coping strategies during crises not only empowers patients but also aids in promoting calm and effective communication.
3. Active Listening: Active listening skills are essential for navigating crisis communications effectively. By listening without interruption, paraphrasing key points, and summarizing the conversation, health care professionals demonstrate their commitment to understanding and addressing patient needs (Van Servellen, 2009).
Conclusion
The intricate combination of coping responses in patients, particularly within challenging contexts, calls for a nuanced understanding of communication strategies among health care professionals. Acknowledging difficult behaviors, employing therapeutic responses, and managing interactions during crises are pivotal components in delivering quality health care. The collaborative relationship between provider and patient can ultimately lead to improved health outcomes, satisfaction, and overall well-being.
References
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