Altruism and the Difficult Patient

Abstract

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.

Altruism in nursing from 2012 to 2022: A scoping review

“…Details of the study characteristics are provided in Table 1. The 13 studies came from 12 different countries: Saudi Arabia (n = 1) (17), India (n = 2) (2, 13), Australia (n = 1) (4), Turkey (n = 1) (19), Mauritius (n = 1) (21), USA (n = 1) (22), Poland (n = 1) (23), Iran (n = 1) (24), Sweden (n = 1) (14), Kenya (n = 1), South Africa (n = 1), Thailand (n = 1) (25) and China (n = 2) (26,27). The year of publication ranged from 2012-2021.…”

“…It was the core of the nursing profession or the basis for choosing nursing as a profession. More than half of the studies identified altruism as a personal or work value (4,14,17,21,22,25,26). Three studies perceived it as the professional equivalent to professional skills and as a reflection and representation of the level of expertise (13,19,27).…”

“…(2) honors own and others' gifts and talents; (3) recognizes vulnerabilities in self and others; (4) treats self and others with loving kindness; (5) listens respectively with genuine concern to others; (6) accepts self and others as they are; (7) demonstrates respect for self and others; (8) listens to others; (9) treats others with kindness; (10) pays attention to others; (11) respects others; (12) honors human dignity of self and others; (13) practices equanimity with patients; ( 14) is open to connectedness with self, others, environment, and the universe; (15) models selfcare and caring for others; and ( 16) validates the uniqueness of self and others (22,29). Organ donation was mentioned in three studies, including living donation and post-mortem donation; living donation mainly refers to donating organs to a relative/stranger with kidney failure (17).…”

“…Kubsch proposed two improvements: (1) developing Psychological Hardiness to remain resilient by employing several complementary therapies, such as deep breathing, walking, and yoga; (2) bearing witness to understand the needs and stories behind the patients when facing difficult patients. The difficult patient may be a survivor of mental or physical trauma, sexual abuse, homelessness, abandonment, and so on (22). Sanjai proposed five improvements: (1) a curriculum for medical professionalism (i.e., a medical professionalism curriculum should emphasize skills such as communication, empathy, emotional intelligence, and professional values in addition to preparing students for a lifelong self-directed career and the pursuit of professional excellence); (2) the influence of parents, peers and role models; (3) volunteering; (4) participation in medical camps; and (5) humanitarian activities.…”

Power Dynamics within Icelandic Nursing: Walking the Fine Line

“…Nursing has indeed long been linked to the meaning of vocation and altruism, where the need to help and care for others is considered one of the most salient attributes of the professions' identity (Carter 2014;Kenny 2010). Altruism is then associated with a genuine desire to alleviate another's suffering (Eley et al 2010), and to put the needs of others before one's own (Kubsch et al 2021). The concepts of vocation and altruism are still contrasted to professionalism and paid employment today (Slettmyr et al 2017).…”