The Difficult Inpatient: Identification and Response by Staff

Abstract

This paper discusses the findings of a pilot study of the phenomenology of the “difficult” psychiatric inpatient. Twenty-five nurses and 12 psychiatric residents were asked to identify and describe the behaviours or characteristics of patients they found difficult. In addition, subjects were asked to describe behaviours and feelings they experienced when treating or caring for a specific difficult patient. Content analysis revealed similar diagnostic categories of patients identified as difficult. While feelings of incompetence and lack of control were aroused in both nurses and residents their expression and identified origins pointed to some interesting differences. Nurses’ responses were more personalized and affect-laden. Residents tended to blame the system and remain more objective.