When the Conflict Is with a Patient
Sydney Johannson, a 67-year-old man, was admitted to the medical/surgical unit 3 days ago for unresolved nausea, vomiting, and jaundice. A tumor was discovered in his bile duct, and he is scheduled for surgery tomorrow. His probable diagnosis is cancer.
You have been the primary RN caregiver for Mr. Johannson the past 3 days. He is short tempered and verbally abusive to you. He barks orders at you, ridicules almost everything you say, and is never satisfied with the care you give him. You realize that he is sick and frightened, but his behavior is frustrating and obnoxious. You find yourself avoiding going into his room just to avoid his verbal backlash. Today, when you enter his room to adjust his IV and give him his routinely scheduled medications, he makes several derogatory comments about your ethnicity and taunts you about looking like “an overstuffed pillow” and moving “slower than a snail.”
Instructions:
Read the Scenario above, and then answer the questions below:
What is the source of this conflict?
Answer the following questions concerning the scenario: Decide how you will respond. Is conflict avoidance justified since the patient is sick? Are other conflict resolution strategies more appropriate? Is bullying by a patient any more acceptable than bullying by coworkers? Role play with your peers how you might respond to this patient and what if any limits, you might set in terms of his behavior. How much control do you have over the patient’s behavior?
What is your bottom line in terms of behavior you will accept from this patient?
Write in APA format, include references
Patient Factors (Underlying Source): Mr. Johannson is facing a life-threatening, probable cancer diagnosis and impending surgery. This is generating intense fear, anxiety, and a feeling of loss of control. His verbal abuse is a manifestation of displaced aggression, where he is projecting his distress and anger about his illness onto the most immediate and accessible target: the nurse. His physical symptoms (nausea, vomiting, jaundice) also contribute to discomfort and irritability, further lowering his tolerance for interaction.
Interactional Factors (Proximal Source): The nurse's avoidance behavior is a natural response to the abuse but inadvertently contributes to the conflict by increasing the patient's feeling of unmet need or lack of control, potentially fueling further demanding behavior.
How will you respond?
My response must prioritize safety, professionalism, and boundary setting while maintaining the duty to provide essential care.
1. Immediate Response to Abuse
Upon the patient making derogatory comments about my ethnicity and physical appearance, I would pause and use a clear, professional, non-emotional statement to set a boundary.
Response: "Mr. Johannson, I understand you are feeling very sick and scared about your surgery tomorrow. However, your comments about my ethnicity and appearance are derogatory and unacceptable. My focus is on providing you with the best possible care, and I will continue to do so, but I require you to treat me with professional respect. If you have concerns about your care, please state them clearly."
2. Conflict Avoidance and Alternative Strategies
Is conflict avoidance justified since the patient is sick? No, conflict avoidance is not justified. While understandable from a psychological self-preservation perspective, avoidance in this clinical context is unethical and unsafe because:
It is a form of abandonment or neglect, as it delays necessary care (e.g., adjusting the IV, administering routine medications).
It reinforces the patient's abusive behavior by allowing him to control the caregiver relationship through intimidation.
It compromises the nurse's professional integrity and contributes to burnout.
Are other conflict resolution strategies more appropriate? Yes. The most appropriate strategy is Confrontation-Boundary Setting combined with Empathy and De-escalation.
Empathy: Acknowledge the feeling ("I know you are scared"), but do not validate the behavior (abuse).
Boundary Setting: Define clear limits regarding the language and tone accepted.
Collaboration: Shift the focus back to the medical goal. Involve the charge nurse, social worker, or medical team to address the underlying psychological crisis (fear of cancer).
Is bullying by a patient any more acceptable than bullying by coworkers?
No, bullying by a patient is not more acceptable than bullying by coworkers.
The source and context differ: Coworker bullying is often about power dynamics, competition, or horizontal violence, while patient bullying is frequently rooted in illness anxiety and emotional distress.