Purposes

“Difficult patients”, as labelled by staff members, have been studied for their peculiarities in primary care, family and internal medicine, physiotherapy, psychiatry, dermatology, and dentistry. However, no data has been documented on “difficult patients” in hospice care settings. The aim of the study was to address the following research questions: (a) When do nursing staff label a patient suffering from advanced cancer as “difficult” in a hospice care setting? (b) What are the problems that the nursing staff face in dealing with them, and (c) What are the specific strategies that nursing staff adopt in their daily practice to overcome issues and improve their relationship with “difficult patients”?

Methods

A qualitative descriptive study design was performed in 2018 and reported according to the COnsolidated criteria for REporting Qualitative research. Three focus groups were conducted in three hospice settings in Northern Italy by involving 10 nurses and six nurses’ aides. Three trained researchers performed interviews based on a set of open questions. Qualitative content analysis of the data collected was then performed by the same researchers.

Results

Participants were labelled “difficult patients” according to three main themes: (1) “Feeling rejected”; (2) “Feeling uncomfortable with the life story experienced by the patient” and (3) “Experiencing the limits of the profession”. Participants reported feeling “Frustrated”, “Exhausted”, “Powerless”, “Overwhelmed” or “Embarrassed” when dealing with “difficult patients”. Strategies to overcome these issues emerged.

Conclusions

As in other settings, hospice care nursing staff perceive some patients as “difficult”. However, differently from other contexts, “difficult patients” are perceived as such also due to their relatives, who are perceived, in some cases, as being even more “difficult” than the patients themselves. Nursing staff should be aware of their personal attitudes and emotions in caring for patients perceived as “difficult” in order to identify and timely apply strategies to overcome issues that may compromise the therapeutic relationship and quality of care.

中文翻译：

---

护理人员经历的癌症晚期“困难患者”：一项描述性定性研究。

 目的

工作人员对“困难患者”进行了研究，了解他们在初级保健、家庭和内科、物理治疗、精神病学、皮肤科和牙科方面的特殊性。然而，没有关于临终关怀机构中“困难患者”的数据记录。该研究的目的是解决以下研究问题：(a) 护理人员何时将临终关怀机构中患有晚期癌症的患者标记为“困难”患者？ (b) 护理人员在处理这些问题时面临哪些问题；以及 (c) 护理人员在日常工作中采取哪些具体策略来克服问题并改善与“难缠病人”的关系？

 方法

2018 年进行了定性描述性研究设计，并根据报告定性研究的 COnsolidated 标准进行报告。在意大利北部的三个临终关怀机构开展了三个焦点小组活动，涉及 10 名护士和 6 名护士助理。三名训练有素的研究人员根据一组开放性问题进行了采访。然后由相同的研究人员对收集的数据进行定性内容分析。

 结果

参与者根据三个主题被贴上“困难患者”的标签：（1）“感觉被拒绝”； (2)“对患者经历的生活故事感到不舒服”和(3)“体验职业的局限性”。参与者报告在与“难缠的病人”打交道时感到“沮丧”、“疲惫”、“无能为力”、“不知所措”或“尴尬”。克服这些问题的策略出现了。

 结论

与其他环境一样，临终关怀护理人员认为一些患者“很难相处”。然而，与其他情况不同的是，“困难患者”也被认为是由于他们的亲属，在某些情况下，他们被认为比患者本身更“困难”。护理人员应了解他们在照顾被视为“困难”的患者时的个人态度和情绪，以便识别并及时应用策略来克服可能损害治疗关系和护理质量的问题。