"First, I try not to make assumptions or judgments about the situation. I check myself and my emotions and keep my eye on the resolution and patient safety. I have already established a protocol to report essential information so that it is in place when my team member reports the need for help - the situation's basic who, what, where, how, and why. My first task when entering a crisis is to assess the need for stabilization and develop a plan. If it's emergent, I activate the emergency system. If a patient's behavior is challenging, I implement the nursing process quickly in my head and look at the subjective and objective information first and assess what needs to be done. I strive to be a calm and soothing presence. I ask information-seeking and not challenging questions, and always function as a team for the best outcome and include the patient or family member when possible."

"There are many reasons a patient can be challenging, and I would adjust how I handle the situation based on the underlying reason the patient is being difficult. If the patient has a brain injury, dementia, or another medical condition, I will ensure they are properly medicated and cannot harm themselves. If the patient is being cranky, I would explain that my staff and I are trying to help them and we do not like being harassed. I would calmly ask them how we can help and provide them with what they need."

As a nurse manager I was usually the one that staff nurses asked to handle difficult patients. I always try to lead by example, so I would begin by asking the patient what their concern was or why they were refusing care/ medication/ etc. I have found that a lot of the time a patient just wants to be listened too. Once they tell me what the concern is, I validate it and try to educate the patient on what is most important in their care. There is a feeling of loss of control when a patient is hospitalized and giving back some of that control often helps. It's important for staff to know not to argue with patients to not escalate the situation. I always remain calm with the patient. I also will demonstrate to staff to keep themselves safe. If there is a fear of the patient being hostile or violent, they want to keep themselves near the door and not be trapped in the room. They may also need to take other staff or security with them to help diffuse the situation.