Main Content

11 tips for dealing with challenging patient behaviours

11 tips for dealing with challenging patient behaviours

Caitlin Chamberlain, a registered nurse at the Correctional Medicine Centre . Photograph by Chris Hopkins

From body language to beverages and breathing, a health service manager in the prison system gave nurses and midwives at the Australian Nurses and Midwives Conference tips in dealing with the challenging behaviours of patients and families.

Caitlin Chamberlain, a registered nurse at the Correctional Medical Centre, said nurses and midwives needed to be mindful when communicating with patients who were mentally ill, had delirium, acquired brain injuries, Alzheimers, intellectual disorders or were drug or alcohol-affected, that reality for these patients was not entirely within their control.

‘Their perception of a situation is completely different, so we need to be mindful when we’re trying to communicate with someone with a different reality,’ she said.

‘They can be very reactive and defensive because they’re not seeing what we’re seeing.’

Ms Chamberlain gave an overview of challenging behaviours exhibited by patients with personality disorders such as anti-social and borderline personality disorder.

People with anti-social personality disorders were highly motivated by power and control and were anti-authority, Ms Chamberlain said. Males with the disorder often hated women and were calculating in their actions.

People with borderline personality disorder – a more common disorder for emergency department patients – can experience extreme mood swings, explosive anger and poor impulse control. They are often trying to contain feelings of abandonment and may act out with self-harming or risky behaviour.

11 tips for dealing with challenging behaviours

  1. Know your patient’s history and whether they have a previous record of aggression or violence, or drug and alcohol use.
  2. Observe the patient’s body language and their demeanour with others before engaging with them. If they’re already agitated, don’t go in there without a game plan.
  3. Know your exit points and stay close to them.
  4. Know your triggers – and what you can and cannot handle. It’s OK to say no.
  5. Be aware of your body language. ‘Are you coming across hostile yourself because you feel defensive?’ Ms Chamberlain said if a patient is trying to intimidate her, she will either place herself at the same level as them or lower to give the person a greater sense of control.
  6. Be aware of your breathing. Taking deep breaths can calm your nerves, helping with clear perception and sound decision-making.
  7. Be mindful of your aims. What do you want out of the situation?
  8. Don’t take a person’s difficult behaviour personally. It’s not about you, or whether you’re a nice person.
  9. Be aware of what you can do to decrease stimulation and create a more soothing environment for someone who is agitated or psychotic. Can you turn the lighting down, take them to a quieter room or give them a beverage/blanket?
  10. Keep your boundaries but prepare for escalation when you refuse to give in to unreasonable demands. Tell them what your expectations are, what you’re going to agree on and what’s not OK.
  11. Debrief, practise self-care, and access your employee assistance program or Nurses and Midwives Health Program Victoria if you need further support or counselling.