Simulating Difficult Nurse Patient Relationships: Meeting the Online Continuing Professional Development Needs of Clinical Nurses with Low Cost Multimedia E-Simulations

Simulating Difficult Nurse Patient Relationships: Meeting the Online Continuing Professional Development Needs of Clinical Nurses with Low Cost Multimedia E-Simulations

Peter Kandlbinder (University of Technology Sydney, Australia) and Scott Brunero (Prince of Wales Hospital, Australia)
DOI: 10.4018/978-1-61350-189-4.ch009
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Abstract

Difficult nurse-patient relationships are an area where general nurses can improve their knowledge, confidence and skill. This chapter describes a user-centred approach used to create a low-cost e-simulation of a commonly occurring case of manipulative patient behaviour. This e-simulation required nurses to focus on specific problems, gain understanding about the possible causes, and use empathetic understanding of what was needed to improve patient care. Specific examples from our experience of including nurses from the very beginning of the design process illustrate how everyday technology can provide an authentic experience of difficult nurse-patient behaviours to prepare general nursing staff who are facing a higher incidence of mental illness in patients that are now in the general hospital setting.
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Kate’S Story

Kate was a 33 year old single mother who had been admitted from the Emergency department with severe abdominal pain and nausea. According to staff, she was demanding (pressing the patient buzzer regularly), shouting, and crying during the shift. She verbally abused two staff members and threatened to walk out unless she received stronger pain relief and use of the telephone and a TV.

Nurses encounter patients like Kate each day in any large metropolitan hospital. Kate was not deliberately intending to create stress or more work in the nurses’ day. Yet a difficult nurse-patient relationship began to develop and consume more nurses’ time than the patient’s condition would originally have suggested. Nurse Unit Managers are well aware that managing difficult behaviours from patients is a common problem experienced by general nurses (Stein-Parbury, 2009). These difficult behaviours limit the nurse’s ability to carry out their normal nursing care, as more time is spent in dealing with patients’ demands and complaints.

As a result of an increased likelihood of confronting difficult behaviours, nurses need to have the self-confidence to be able to call upon appropriate strategies to pre-empt, de-escalate, and manage these behaviours in a way that ensures the safety of staff, patients, and visitors. Fortunately, managing difficult nurse-patient relationships is a skill that can be learnt and improved with practice. Aggression, complaints, or negativity from patients require nurses to be able to understand how they respond to these behaviours. The nurse needs the ability to evaluate each incident using empathetic questioning so that she can identify the best plan of nursing care to manage these difficult behaviours (Smith & Brunero, 2007).

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