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Managing difficult patients

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 5, 2004

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Q: A patient presents in the ED complaining of back pain. The patient has no obvious injury or broken bones that seem to support his or her vague complaints about pain. What signs and symptoms can you look for that may indicate this person has a substance abuse problem?

A: Observe the patient closely. In addition to physical signs-such as needle marks, erratic behavior, and evidence of tweaking-look for an increase or alteration of reported symptoms between triage and the physician's examination.  Another potential sign is the list of reported medication allergies.  Often, individuals seeking specific drugs will report allergies to all but the most potent narcotics.  This evidence may give you early warning that you are dealing with a volatile patient who may need additional resources and more complex case-management strategies.

Editor's note: The above case scenario is from the new online course "Nursing CE Series: Managing difficult patients - A guide for nurse managers." For more information on this and other Nursing courses go to www.hcprofessor.com and click on Nursing CE Series.

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