7 Types of Challenging Patients: How Nurses Can Interview Them

A good patient interview gives you the valid, accurate assessment data you build a care plan on. It takes active listening and clarifying the patient's agenda, because the data you gather sets the direction of their recovery. The hard part is that you cannot demand a patient's cooperation, and not every interview goes smoothly. Here is how to work with the patients who make it difficult.

1. Silent patients

Silence is one of the toughest interviews because it gives you nothing concrete to work with. Do not read it as a verdict on your skills. Silence usually communicates one of three things: defensiveness, a challenge for you to draw the patient out, or hostility and resistance. A defensively silent patient believes that staying quiet keeps them from getting hurt. Silence can also be a test of you, a manipulation that the patient may abandon once it stops working. It can be a reaction to how you ask questions, especially very direct ones, or a sign the patient struggles to put emotions into words.

What to do: Accept the silence and listen past it. Approach sensitive topics with respect and watch your tone. Address the silence indirectly rather than asking "Why are you silent?" You might suggest that something seems to be bothering them, and that talking it through could help them cope.

2. Confusing patients

Some patients report multiple symptoms at once and leave you unsure where to start. Focus on the context of each symptom and decide whether a psychosocial assessment is warranted. Histories are sometimes vague, and patients describe symptoms in ways unique to them. In acutely ill or intoxicated patients, assess for delirium. In older patients, consider dementia. When you suspect a neurologic problem, shift focus to level of consciousness, orientation, and memory.

Tip: Don't let the details blur together. Write them down and run through them again before your next assessment.

3. Patients with altered capacity

Patients with delirium and dementia cannot give a clear history of their symptoms. Determine early whether the patient can make sound decisions about their own health, and obtain consent only if they have decision-making capacity. For those who cannot, you need a surrogate informant or decision maker present. Before starting a care plan, confirm whether the patient can understand health information and make informed medical choices.