Interventions used by staff nurses to manage "difficult" patients.

Interventions utilized by nurses to manage "difficult" patients and outcomes indicating successful interventions were investigated. Themes included getting the difficult patient label, difficult patient behaviors, reflecting on the label and passing it on, coping with a difficult patient, interventions that worked, and interventions that did not work. Clues indicating that patient behavior was changing were also identified.

"Being with" a patient who is dying.

Doubting her ability to assume the new manager's role in a specialty unit, the author reflects upon her first day of hospital orientation. The monotony of the day is interrupted by the admission of a patient with a traumatic burn injury. The new manager finds herself perplexed about what to do. Feeling at a loss and somewhat confused about her role as a nurse and manager, she delves into her soul and realizes that her place on the burn team has nothing to do with the type of emergency situation before her. Suddenly, she identifies that her feelings of fear and uncertainty are also experienced by people in their new role as patients. She recognizes that her place stems from the very essence of being a nurse. She wants to care. Basing her actions on her feelings, the nurse is able to comfort a man who is dying. She does not want him to feel lonely and afraid regardless of his imminent death. Clinically, she knows the team's life-saving efforts will be unsuccessful, yet her efforts in caring based on her lived experience of being the "newcomer" enable her to accept the challenge of meeting the needs of her patient and at the same time regain her confidence.