Background For some nurses, providing altruistic care to difficult patients is a challenge, leading to the use of negative coping strategies such as anger or avoidance, leaving the nurse frustrated and patients feeling rejected. Yet other nurses can deal positively with difficult patients. Purpose To study how the stress of caring for difficult patients affects the level of altruism and use of negative coping strategies in their care and to find out what positive coping strategies and interventions could be used. Design/Method A mixed-methods design was used. A survey tested the level of altruism, the use of negative coping strategies, and several demographics. Thematic analysis examined narratives generated by participants to three questions regarding how to provide altruistic care to difficult patients. Findings A purposive sample of 67 registered nurses (RNs) participated. The average level of altruism used by RNs with difficult patients was 99.7/120 points. An inverse relationship was found between the level of altruism and use of negative coping strategies ( r = −0.577, p < .001). Qualitative analysis of narratives identified three themes—Developing Psychological Hardiness, Bearing Witness, and Fending for Oneself. Conclusions This study provides insight into the experiences of RNs caring for difficult patients and how to ensure altruistic caring.

CPD reflective questions z z Think about how you could increase hope among care residents. z z How could aspects of the Eden philosophy be implemented in care homes, such as helping residents achieve meaningful goals, feel secure, have a sense of belonging and feel valued? z z How can nurses minimise the three plagues of helplessness, boredom and loneliness among care home residents? Key points z Nursing home residents display hopelessness, which is a strong predictor of adverse health outcomes z In addition to reducing helplessness, loneliness and boredom, the Eden Alternative promotes hope among people living in nursing homes z Additional rigorous clinical research on the effect of the Eden Alternative on hope is necessary There were no significant differences for the other eight hope indicators. Perhaps this is because, while the EA addresses ways to combat the three plagues, it does not specifically address these characteristics of hopelessness (Herdman and Kimitsuru, 2014).