Communicating assertively and responsibly with unpopular clients

Chapter 27


Communicating assertively and responsibly with unpopular clients






Who are the unpopular clients?


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:



Now, compare your answers with those of your colleagues in your class. Where do your views overlap? In what ways do your preferences and nonpreferences for clients differ? What do your collective opinions suggest to you about the client–nurse relationship?


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.”



Characteristics of unpopular clients and their effects on nurses


Researchers (Kus, 1990; Lorber, 1975; Stockwell, 1972) report that unpopular clients have the following characteristics:



• They grumble or complain.


• 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).



Nurses’ reactions to unpopular clients


In reacting to unpopular clients, nurses feel:



Nurses act by:



• 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)


• Scolding and reprimanding


• Administering tranquilizers and sedatives to control clients’ behavior


• Recommending transfer and discharge


• Requesting psychiatric consultation to manage unruly behavior


• Extending minimally adequate care


• Withdrawing from peers


• Becoming critical of the profession or the institution


• Withholding pain medication


• Ignoring clients’ call lights or bells


• Being cool, detached, and insensitive


• Feeling guilty


This evidence suggests that nurses and other health professionals have definite ideas of what is acceptable client behavior and what is not. Look at the list you prepared earlier of client characteristics you dislike. How does it compare with the findings from the literature?


In contrast to unpopular clients, popular clients were found to have the following characteristics (Lorber, 1975; Stockwell, 1972):



Nurses demonstrate the following reactions to popular clients:



Look again at your list of appealing client characteristics and compare your reactions to these findings from the literature.


We would all agree that each of our clients deserves to receive courteous care regardless of cultural background, length of illness, personality, and type of illness (including the extent of complications). Is it not surprising to discover that despite the emphasis on compassion in our nursing education, we are unable to consistently extend respectful nursing care to all our clients? It is not humanly possible to like all our clients.


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).


To ignore or convey dislike to our clients is in direct contrast to the policy of nurturing a therapeutic helping relationship with them. When we show our dislike to clients, they feel unsupported. The message we convey is that they are unimportant and that we do not care about them or their problems. By extending our compassion, administering effective nursing interventions, and minimizing evidence of our dislike, we can be influential in eliminating some of the client behaviors we find problematic.


Oct 26, 2016 | Posted by in NURSING | Comments Off on Communicating assertively and responsibly with unpopular clients

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