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7 Types of Challenging Patients and How to Interview Them

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By Iris Dawn Tabangcora, RN

Working as a nurse comes with a daily subscription of patient encounters. Most of the shift revolve around coordinating aspects of care between patients and other members of the health care team. Of course, there is that classic moment of meeting the whole family of the patient, each of them with a set of prepared questions for the nurse to answer. The profession’s proximity with interaction makes everyone with the license to care flexible and well-adjusted to different kinds of people.

The concept of patient interviews is a complex process that requires the nurse to be fully equipped with knowledge and skills necessary to obtain valid and accurate assessment data. For example, the nurse should practice the habit of active listening and clarification of patients’ agenda. The interview process is necessary because the gathered data will be used to formulate the mutually-agreed plan of care ready for implementation and this will set the patient’s journey towards recovery.

“patient interviews…requires the nurse to be fully equipped with knowledge and skills necessary to obtain valid and accurate assessment data.”

However, patient interviews become more challenging when patients fail to show full participation with the nurse during the process. Truly, not all interview experiences are smooth and accurate because the nurse doesn’t get to demand patients’ willingness and interest while working with them. Nevertheless, nurses continue to strive to meet goals and even go beyond what is expected of them.

Here are the seven types of challenging patients and how to interview them:

1. Silent Patients


Interviewing patients who are silent is probably one of the most difficult tasks of the nurse because silence does not give anything concrete away as a clue for the nurse to pick up. However, silence should not always be taken as a negative response towards interview skills.

Silence has many meanings and purposes. Basically, silence in patients communicates three things: 1) defensiveness; 2) a challenge for the nurse to seek patient out, and 3) hostility or resistance. Patients who use defensive silence are under the impression that they will not be hurt when they will not express their thoughts and feelings. Silence is also used to provoke and test the nurse, which is a manipulative behavior and may lead to patient withdrawing them away when this is not fulfilled. In addition to this, silence may also be a response on how the nurse asks questions (e.g. very direct questions). It may also be a response when the patient has difficulty verbalizing emotions.

What to do: It is important for nurses to accept patients’ silence by listening beyond what is unsaid and reflecting on it. Approach topics with respect, particularly those in which patients go silent as a response and be aware of your tone of speaking. Silence should be addressed but not directly (e.g., “Why are you silent?”). Nurses may suggest that silence means something is bothering patients, and if they try to talk about it, they may be able to cope effectively.

2. Confusing Patients


Some patients may baffle nurses by stating they have multiple symptoms. It is important for the nurse to focus on the context of each symptom and from there, decide if a psychosocial assessment is imperative. There are times patients’ histories are vague, and patients’ description of symptoms are profoundly unique to them. In acutely ill and intoxicated patients, assess the presence of delirium. On the other hand, elderlies may suffer from dementia. When nurses suspect a neurologic problem, a shift of focus to the level of consciousness, orientation, and memory should be done.

Additional tip: Don’t get confused by mixing up the details of your interview. Write them down and run through them again when you’ve decided to conduct another assessment.

3. Patients with Altered Capacity


Patients with delirium and dementia cannot provide a clear history of their manifestations. As early as this, nurses should determine if patients are capable of making sound decisions regarding their health. Consent should be taken if the patient is proved able for decision-making capacity.

For those who can’t: A surrogate informant or a decision maker should be present. Before commencing a plan of care, it is important to determine whether patients can understand health-related information and make informed medical choices.

Next page: The Talkative Patient and More… »

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.

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