9 Tips for CNA’s Dealing with Difficult Patients

Melissa Mills
August 10, 2022
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Angry outbursts from patients or residents can make loving your job challenging some days. It can leave you feeling unsafe and worried about getting hurt at work. These behaviors might be an extension of an already grumpy or stubborn personality, or they can mean something else. Older adults might display anger when living with pain or emotional health issues. It can also happen due to dementia, a stroke, communication difficulties, or other health conditions.

No matter the reason for the combative behaviors, they can be challenging to deal with as a CNA. You’ll spend a lot of time with the people you care for and must be near them, which might also be within striking distance. So, how do you manage this difficult situation? 

We’ve gathered the best strategies for dealing with difficult and combative patients. 

Tip 1: Be Aware

If you know a resident is commonly angry and displays physical aggression, keep this in mind whenever you provide care. Approach them slowly, maintain eye contact, and keep the tone of your voice light and friendly. Using this strategy will help minimize the risk of your presence becoming another trigger on bad days. 

Tip 2: Be Honest, Without Excuses

Some residents can be naturally grumpy. Feeling that you aren’t telling them the truth can put them in a bad mood and ruin your shift. Tell them about any changes in their routine or care as soon as possible. Don’t make excuses, but rather be honest and direct. For example, if you’re running late getting them to bed, don’t tell them it’s because of short staffing or an urgent matter with another resident. Instead, apologize for the inconvenience and then tell them when they can expect you to be ready to help them. 

Tip 3: Check Your Body Language

Our bodies can speak volumes about how we feel. For example, how we stand and our facial expressions can convey frustration, irritation, and annoyance. Yet, you might not even realize you’re displaying these emotions. So, how do you control your body language? 

Here are three quick tips to use when you’re feeling angry:

  • Look up - Have you ever noticed that you naturally look down when in a bad mood? You interrupt these negative emotions by looking up and triggering your body to release happy hormones.
  • Breath Deeply - Taking a few deep breaths can do wonders for our mood. Breathe in slowly to a count of five, then count to 10 as you exhale. Do this a few times to feel calm.
  • Be aware - Take a minute to check your body language the next time you feel angry. Pay attention to your posture, facial expressions, and how you breathe when frustrated. 

Tip 4: Be Kind

This tip sounds easy, but let’s be honest - you aren’t going to love every person you care for, and that’s okay. Remember that you don’t have to be the patient’s friend, but you must be professional, kind, and compassionate. Choose your words carefully when working with a combative resident.

Tip 5: Put Yourself in Their Shoes

Have you ever been in pain? Or, maybe you live with a chronic condition that causes you not to feel your best every day. If so, consider how you feel when dealing with your health problems. For example, you might be a bit irritable on bad days and snap at your friends or loved ones. It’s not that you mean to, but pain, exhaustion, and generally feeling unwell can make us grumpy. 

When noticing a resident who appears to be having a bad day, talk to them. Show compassion and empathy by letting them know you have bad days too. Then, work with them on a plan that works for both of you. You might find that connecting with them personally reduces their frustration with you and others. 

Tip 6: Report Changes or Escalations

It’s never okay to take unnecessary risks when giving care. If you begin providing care and the resident hits, curses, or engages in physical contact with you or a coworker, stop care immediately. Ensure they are safe, their privacy is protected, and leave the room. Report the incident to the nurse and ask if there is anything they can do to make care safer for you and your coworkers.

Facilities must handle these situations gently. Sometimes care facilities determine they can’t meet the needs of some residents who display these types of behaviors. However, it’s essential to know that they must try many care strategies first. So, if you find yourself in a situation like this, be patient with the care team, management, the resident, and yourself. 

Tip 7: Redirect the Behavior

If you’re caring for someone with a history of aggressive or combative behaviors, try offering distractions. This strategy might work well for residents living with traumatic brain injury, dementia, or other cognitive conditions. For example, you can try having them tell you a story, sing, count, or spell when they show signs of agitation or aggression. Another good strategy is to take them for a walk or a ride in a wheelchair outside to remove them from whatever is causing them to feel agitated. 

Tip 8: Separate the Behaviors from the Person

People living with cognitive disabilities might not fully understand how their behaviors affect you and your coworkers. So, if you start feeling annoyed or frustrated, you must think about healthy ways to separate the behavior from the individual. For example, instead of saying that a patient is combative, try saying that they show signs of combativeness. This simple change in our language can go a long way when trying to separate the two.  

Tip 9: Don’t Take it Personally

It’s easy to take someone yelling at or hitting you personally. However, nine times out of 10, they aren’t angry with you but with their situation. They might feel a lack of control over their circumstances, be confused, or just not understand what’s happening in general. No matter what’s happening with them, their behaviors are probably not really about you, and it’s critical to remember that.

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