How to deal with challenging behavior in healthcare settings

Your job as a healthcare professional requires you to work closely with many different people each day. Some of these people, including your patients, will display challenging behaviors. It’s essential that the healthcare workers develop strategies on how to deal with challenging behaviors in healthcare settings. One very effective way of learning strategies like these is to take an online course.

Healthcare workers sometimes have a great deal of conflict with a client or patient. This is one reason why a client may be classified as “difficult”. Conflict is a part of interpersonal relationships. Therefore, you can expect that there will be times of conflict with clients. Many reasons exist for this conflict. It can be caused by misunderstanding, poor communication, differences in values or goals, personality clashes, and stress. Conflict is more likely if you are caring for a client with difficult behaviors, such as dementia or Alzheimers disease.

Conflicts can be managed, however. You must remain calm. Try to put yourself in the other person’s position. Use assertive communication. Dealing with difficult client behaviors is hard because our own emotions get involved. It is hard to remain calm when we think we are being attacked.

Understand your own response to conflict

The first step to managing conflict is to identify your own response to conflict. How do you feel if someone criticizes you? What do you do? Do you want to blame someone else? Do you get angry or defensive?

Be wary of the effects of labeling clients

By now you may have realized that there really isn’t such a thing as a “difficult” or “challening” client. Instead, there are clients, people just like you and I, who, in difficult and stressful situations, may display difficult behaviors. Labelling these persons as difficult clients creates lots of problems. When clients have been labelled as “difficult”:

They receive less time and attention from healthcare workers;

Their care is rushed;

Their individual needs are not met;

They receive less support;

They are criticized and disapproved of by healthcare workers.

Clients are going to be labeled even though it causes problems. What can you do to avoid the problems with labeling clients? Strategies include:

Be aware of your beliefs and emotions.

Be aware of the comfort or roughness in your gestures, touch, and facial expressions.

Be aware of the space you keep between yourself and your clients.

Listen to your own words and your tone of voice – how will it be interpreted? Be open to how your words and actions impact your clients.

Be aware that the label may not be accurate. There could be many reasons underlying the client’s actions.

Strategies for dealing with the different types of “challenging” clients

Clients may be labeled as difficult when they are withdrawn, silent, uncooperative, angry, hostile, demanding, or complaining.

Angry, hostile clients

Healthcare workers are often easy targets for criticism and anger from clients. You are dealing with people when they are feeling stressed, frustrated, and vulnerable. The client may be just looking to vent at someone – anyone. The words can be a cover for how scared they really are. Feelings of frustration, threat (anticipation of harm), conflict, and anxiety are all natural parts of the stress response.

Aggressive behavior or anger may also be the result of feeling out of control and powerless. Of course, it could also be the person not respecting our right to courtesy and consideration!

The following techniques are useful when dealing with difficult client behaviors, especially when clients are angry or hostile. Remember that all clients have the right to confidentiality, even those who behave poorly. Even if you are upset and want to express your frustrations, you must still keep the client’s confidentiality.

Use assertive communication techniques.

Remain calm and in control. Do not allow yourself to get defensive.

Be as caring as possible.

Try to put yourself in the client’s position.

Allow the other person to express his/her feelings and fears.

Lower your voice. The other person has to calm down, or at least lower his/her voice just to hear you.

Do not take the person’s behavior personally.

If the place where the argument takes occurs is inappropriate, try to get the person to follow you to a quiet place. It may be more difficult to get the person to calm down if other people are present. However, if you are concerned that the person may become physically aggressive, try to have other people around.

Try to get the person to sit down. People are often more aggressive while standing.

Ask for more information. “What do you mean by…?” “Tell me more about…” This will indicate that you are really listening. (Make sure your tone is not accusing or defensive.)

Stick to the facts and the situation, not emotions or personalities.

Stay with the person. Do not reject him/her.

Provide necessary information. Be prepared to repeat the information. People who are very upset often will not hear what you are saying.

Paraphrase (say in your own words) what the other person has been saying. This shows that you have been listening.

Be specific about what behavior (yelling, swearing, etc.) is causing the problem.

Let the person know why the behavior is a problem and the consequences of the behavior (I can’t understand what you are saying, I’m uncomfortable, I find it difficult to spend time with you, etc.).

Request a change in behavior.

State the benefits of the change in behavior or the negative effects associated with not changing.

Sometimes, allowing clients some control over routines, such as when to bathe will reduce their stress level. Decreasing the level of stress may reduce difficult behaviors.

Uncooperative clients

Healthcare workers may label a client as difficult when the client refuses to cooperate with the treatment plan. The following suggestions can help:

Tell the client the reasons for the planned care. Repeat the information whenever necessary.

Provide education about what you are doing.

Allow the client to be as involved in his/her care as possible.

Offer choices. “Would you prefer your bath this morning or just before you go to bed?” “Would you prefer tomato soup or vegetable soup for lunch?” Although it may not always be possible to give the client a choice, look for ways to involve the client in making decisions about care.

The client has autonomy. This means that the client has the right: a) to make decisions about his/her care; b) to receive any information needed to make the decisions; and c) to refuse any and all treatments. You may not agree with the decisions that the client makes. You may not always believe that they are in the client’s best interests. You must, however, respect the client’s wishes.

Dependent, demanding clients

Some clients are clingy, dependent, and demanding. They may fear being left alone. They usually have constant demands for the healthcare worker. Use these strategies to deal effectively with dependent and demanding clients.

Be as caring as possible.

Set realistic limits on requests (especially if you are working in a busy agency where you are also caring for other clients).

When you leave the client’s room, tell the client when you will be returning. Make sure the time before your return is not very long.

Be sure to keep your promise. If you say you will be back in 30 minutes, make sure you are.

Take some time to sit with the client and talk. This shows the client that he/she has your undivided attention.

Allow clients to express their feelings and fears.

Suspicious, complaining clients

Suspicious and complaining clients often ask many questions. They have many complaints about the care that they are receiving. This is usually a sign of anxiety. The healthcare worker may feel that nothing will satisfy the client. It usually does not help to try to reassure the person that everything is all right. Instead, use the following strategies:

Do not agree with the complaints, as in, “Yes, the care on the night shift is lacking.” This statement does not help the client.

Listen to the client and acknowledge the feelings being expressed. For example, “I understand that you are very upset by the food.”

Allow the client to make decisions about routines. This may increase the sense of control and decrease anxiety.

Always explain what you are about to do.

Try to understand that the client may be stressed or scared.

Do not avoid the client.

As a healthcare worker, you will sometimes be working with clients who display difficult behaviors. Rather than label them as “difficult clients”, consider why they are acting the way they do. Use the strategies outlined in this module to communicate with these clients and develop good relationships with them.

Dealing with challenging behaviours from clients or patients can be a trying experience. But the feeling of seeing your client find peace or comfort even if temporarily can be very rewarding. The fact that you’ve read this far signals that you are looking for solutions. We can help with that. Right now we are offering 20% off our Career Advancement course set from Mediscript Academy with the coupon code of CAREER20. Take advantage by clicking this link.

Think of an interaction with an angry client. Which of these techniques did you use? Which one would you use next time?