During a sick call visit for lower back pain, a patient begins shouting at the nurse that no one is helping him with his pain. “I need something stronger than these baby pills!”, he shouts as he stands up and puts his face in front of the nurse.
Dealing with angry patients is a challenge, especially when you have a patient population prone to anger management issues like many of our inmate patients. Successfully managing anger in others is mostly about your own response to the anger as Dr. Melissa Caldwell discusses in the Correctional Nursing Today Podcast “De-Escalating Critical Incidents”. A while back I wrote a post on dealing with inmate anger and recently came across some new research on response to anger that may help make your work life calmer. Neuroscience is providing some helpful direction for those of us confronted with angry patients. Much of the findings noted here come from the books Handbook of Emotional Regulation and Crisis Negotiations: Managing Critical Incidents and Hostage Situations in Law Enforcement and Corrections.
Dealing with a tense and angry patient can easily make you react in kind. It is natural to reflect a similar emotion yet if you stay calm the patient is less likely to escalate. This takes practice and self-awareness. Studies in neuroscience show that the answer is not to suppress your own anger, though. Suppressed emotions don’t help the situation and can actually continue to escalate the confrontation. Venting your angry response, of course, doesn’t help either. Distracting yourself from the emotion was actually found to be the most helpful method for staying calm. How would that work in a patient interaction like the case above?
It’s Not About You
Neuroscientists found that reappraising the situation was of the most benefit. Reappraisal is the consideration of alternative explanations of a situation. Reconsider the situation from the patient’s perspective: he is in pain; he is under a lot of stress. In other words, focus on the underlying cause of the anger.
Smart parents do this all the time with toddler temper tantrums. Rather than confronting the emotion, they ignore the tantrum and consider possible causes such as overstimulation. Sometimes a brief time-out is all a child needs to regain control. This concept can work for out-of-control adults, too.
Slow Things Down
Crisis negotiators advocate slowing down the conversation to help the angry person get control of their emotions and to show a desire to actively listen to them. Your response can be as simple as stating that you would like to help but need them to speak slowly so that you can understand. Slowing down the conversation helps the person gain control of their emotions while you get organized to respond effectively.
Crisis negotiators use active listening techniques to diffuse emotional situations. Active listening is established through body language and verbal response. Here are some verbal responses that show an angry patient that you are listening to them.
- Acknowledge: “It sounds like you are frustrated with your treatment.”
- Paraphrase: “The medications you are now taking are not helping your back pain.”
- Open-ended Questioning: “Let’s work on this. Tell me more about your back pain.”
The Texas Medical Association has a resource for handling patient confrontations with some verbal communication techniques that can help with an angry patient. Here are three techniques they recommend:
- Wish I Could: “I wish I could give you stronger pain medication, but we first need to establish the cause of your back pain.”
- Agree in Principle: “I agree that we need to get your back pain under control. Although I can’t give you other pain medication, here is what we can do.”
- Broken Record: If the patient continues to try to get their way, don’t come up with new reasons why you can’t do it. Instead, restate the same response with slight variation.
Oh, by the way, these techniques work well in all areas of practice and life. Try them when communicating with angry coworkers or family members, too!
Have you had success dealing with an angry inmate? Share your experience in the comments section of this post.
Photo Credit: @master1305