Care of the Difficult Patient

Manos, Peter; Braun, Joan

doi:10.4324/9780203004364

Cited by 7 publications

(9 citation statements)

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“…The ‘success’ of their therapeutic endeavours and patients’ approbation (Lotzkar & Bottorff 2001) arguably enhance nurses’ satisfaction and self‐worth (Healy & McKay 2000): a pronounced mutuality of caring (Benner & Wrubel 1989). However, drug users may be non‐compliant, aggressive, indulge in illegal behaviour and self‐discharge (McCreaddie & Davison 2002, Manos & Braun 2006, Mehta & Langford 2006). They are likely to be readmitted for similar problems and are unlikely to offer praise and gratuities.…”

Section: Resultsmentioning

confidence: 99%

Routines and rituals: a grounded theory of the pain management of drug users in acute care settings

McCreaddie

Lyons

Watt

et al. 2010

Journal of Clinical Nursing

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Section: Resultsmentioning

confidence: 99%

Routines and rituals: a grounded theory of the pain management of drug users in acute care settings

McCreaddie

Lyons

Watt

et al. 2010

Journal of Clinical Nursing

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“…Drug users are considered ‘difficult’ patients per se (McCreaddie & Davison 2002, Manos & Braun 2006,) and nurses in acute care settings are known to enact prognostic pessimism (Howard & Chung 2000) towards this group. Conversely, Heather and Kay – a general nurse and a midwife – operate within a harm reduction philosophy and setting: a social justice perspective that seeks to minimise risk (Denning et al 2004).…”

Section: Findings and Discussionmentioning

confidence: 99%

Harsh humour: a therapeutic discourse

McCreaddie

2010

Health &Amp; Social Care in the Community

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Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)-patient interactions and CNS pre- and postinteraction audio diaries provided the baseline data corpus. Follow-up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non-laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90-minute follow-up interview and 10 hours of field note observations. The negative case - a CNS working with female drug users' sexual and reproductive health needs - contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient personal was evident in the baseline data corpus but the negative case worked with 'bad' patients. Accordingly, a specific type of humour - harsh humour - was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients - disenfranchised or otherwise - in healthcare interactions.

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“…“Difficult patients” are usually assigned key characteristics, including being emotionally unstable, highly anxious, depressed, hostile, overtly dependent or independent, aggressive, unappreciative, non‐conforming, and manipulative (Russell et al. , 2003; Manos & Braun, 2006):…”

Section: Findings and Discussionmentioning

confidence: 99%

Improving mental health care for older people within a general hospital in the UK

Harrison

Brandling

2009

Nursing & Health Sciences

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This article describes a participatory action research study aimed at improving the care of older people with mental health needs who are cared for in an older people's unit of a general hospital in the UK. A multicollaborative and interpretivist action research approach was adopted, whereby the researchers, managers, clinical staff, patients, and carers came together to identify the problems and their potential solutions. Focus groups, interviews, and observations of care were used to collect the data and to inform the action and development cycles and a grounded theory approach was used to analyze these data and to develop theoretical descriptions regarding the dynamics that occur within this setting. Four overarching themes were identified as contributing to the theoretical understanding of this type of care: cultural knowledge, contextual reality, giving care, and coping with "the problem". Understanding the theoretical elements is of importance in assisting nurses, and others, to consider care that is person-centred.

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Care of the Difficult Patient

Cited by 7 publications

References 0 publications

Routines and rituals: a grounded theory of the pain management of drug users in acute care settings

Routines and rituals: a grounded theory of the pain management of drug users in acute care settings

Harsh humour: a therapeutic discourse

Improving mental health care for older people within a general hospital in the UK

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