Chapter 27 1. Describe characteristics of unpopular clients 2. Identify possible reactions of nurses to unpopular clients 3. Identify strategies to deal with negative attitudes and prevent antagonistic behavior toward unpopular clients 4. Participate in selected exercises to build skills of caring communication with unpopular clients When we recognize we all have weaknesses, it’s easier to find a way to respect others. Patterson and colleagues (2002) Consider the distinction between the definition of disease, an interruption or disorder of part of the body, from illness, the state or time of being ill. We must understand disease to treat clients. We must understand the experience of illness to care for them (Cross et al, 2010). Before reading what the literature documents as the most popular and unpopular clients, take a moment to discover and examine your own attitudes toward your clients. Answer the following questions as specifically as possible: • What are the characteristics of those clients with whom you enjoy working? • What are the features of clients whom you find unpleasant? You might be surprised to learn that all clients are not viewed or treated similarly. All nurses at some time have clients they do not like (Kus, 1990). Although nothing intrinsic makes certain clients likable or not likable, nurses do evaluate some clients as popular and other clients as unpopular. The behavior, appearance, or social status of some clients has an associated stigma. Stigma means both a “societal and self-perception of shame or a flaw” that is seen as irreconcilable and is internalized by the person (Halter, 2002). This chapter helps you become more aware of how your prejudices about clients’ behaviors and personalities affect how you relate to them. You become more aware of client characteristics that trigger you to withdraw your caring. This knowledge alerts you to your negative tendencies and reminds you to treat all your clients fairly, safely, and in a way that respects their dignity. Noncaring behaviors may lead to “missed diagnoses and interventions, social isolation, and minimal or negative contact with the nurse” (Maupin, 1995). In a classic study, Stockwell (1972) set out to determine whether the nursing team enjoyed caring for some clients more than others, and whether there was any measurable difference in the nursing care afforded to the most and least popular clients. Her findings—startling at the time—still have potential impact for nurses. Stockwell reports that foreign clients, those hospitalized longer than 3 months, those with some type of physical defect, and those with a psychiatric diagnosis appear significantly in the unpopular group. Personality factors of clients also play an important part (sometimes the only one) in accounting for whether they are considered unpopular by the nursing team. Stockwell’s research findings reveal that unpopular clients do not generally receive individual holistic care and that nurses withdraw their caring interpersonal communication from these clients. When clients do not fit into our molds, we become annoyed with ourselves and respond to our anger by displacing it onto our clients as dislike. Clients who are estranged from mainstream society may face a wall of fear separating them and the community. The mentally ill have difficulty with clear communication because their perception of reality is impaired. They become alienated in the community and in a healthcare setting because their behavior interferes with treatment. Part of the stigma of mental illness is the misperception that all mentally ill people are violent (Arnold and Hallinan, 2000). Another example of estranged clients is the homeless, who may be referred to as disenfranchised or marginalized and “are defined by their own fear and by the avoidance of others because [other people] are afraid of their behavior or afraid of encountering their intense level of hardship and suffering” (Zerwekh, 2000). Does this also sound like someone with terminal illness? One woman in an “I Can Cope” cancer class said it seemed to her that when she walked down the street in her small town, people acted as if what she had was “catchin’.” In an investigation of the reactions of doctors and nurses to the attitudes and behaviors of surgical clients, Lorber (1975) found that medical staff label clients who interrupt well-established routines and make extra work for them as “problem” clients. Those who minimize the trouble they cause staff by being cooperative are considered “good.” Researchers (Kus, 1990; Lorber, 1975; Stockwell, 1972) report that unpopular clients have the following characteristics: • They indicate their lack of enjoyment at being in the hospital. • They imply that they are suffering more than nurses believe. • They have conditions nurses feel could be better cared for in other units or in specialized hospitals. • They require more time and attention than are deemed warranted. • They are complaining, uncooperative, or argumentative. • They have severe complications, poor prognoses, or difficult diagnoses. • They require extensive explanations, reassurance, or encouragement. • They are of low social value. • They are of low moral worth. • They have unchosen stigmata (such as sexual orientation, gender, race, or ethnicity). • They have illnesses considered to be their “own fault” (such as alcoholism or lung cancer from heavy smoking). • They have fear-causing conditions (such as highly contagious or incurable diseases or violent tendencies). • They engender feelings of incompetence in nurses (they have conditions about which nurses know little). In reacting to unpopular clients, nurses feel: • Frustrated and impatient with “grumblers and moaners” • Afraid of being trapped by complainers • Irritated that unpopular clients waste their time • Incompetent to provide the necessary care for complicated cases and psychiatric clients • Relief when “unmanageable” clients are transferred • Dissatisfaction with their jobs • Ignoring or avoiding demanding clients • Indicating to demanding clients that others need their attention more • Labeling demanding clients as nuisances or hypochondriacs • Showing a reluctance to provide necessary care if clients are thought to act inappropriately (e.g., repeated lewd behavior or aggressive language) • Administering tranquilizers and sedatives to control clients’ behavior • Recommending transfer and discharge • Requesting psychiatric consultation to manage unruly behavior • Extending minimally adequate care • Becoming critical of the profession or the institution • Ignoring clients’ call lights or bells • Being cool, detached, and insensitive In contrast to unpopular clients, popular clients were found to have the following characteristics (Lorber, 1975; Stockwell, 1972): • They are able to converse readily with nurses. • They know the nurses’ names. • They are able to joke and laugh with the nurses. • They are determined to get well again. • They are cooperative and compliant with the therapeutic regimen. • They can be managed by routine methods. • They rarely complain of pain or discomfort. • They minimize the trouble they cause staff by being cooperative. Nurses demonstrate the following reactions to popular clients: • Enjoy interacting with clients who are “fun,” have a good sense of humor, are easy to get along with, and are friendly • Give superior care and do more for popular clients in the long run • Give them special favors and readily fill ordinary requests It is, however, a professional expectation and responsibility that we treat all clients with courtesy and provide care that meets standards for nursing practice, regardless of whether we like our clients. Consider one nurse’s admonition to consider yourself lucky if the patient does complain because this might give clues to unidentified problems and ways to improve the quality of care. For example, a client afraid of soiling himself may express his fear as rage at the nurse who is delayed in answering the call light (Goldman, 1995).
Communicating assertively and responsibly with unpopular clients
Who are the unpopular clients?
Characteristics of unpopular clients and their effects on nurses
Nurses’ reactions to unpopular clients
Communicating assertively and responsibly with unpopular clients
