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Caring for a Difficult Patient

Lilia Murashov
Western Washington University


Sometimes it is challenging to care for a patient without an internal struggle. I have a

difficult time caring for a client, who is lying to the medical personnel in order to get a disability,
and for the drug addicted person, who is using medical treatments and surgeries as a way of
helping with their addiction.
A few months ago I had a patient in his forties, who came in to have a stress test on a
treadmill. This man was limping on his way from the waiting room to the exam room, and I
asked if he can walk on the treadmill. He answered angry that he does not know why his
cardiologist ordered this test. Instead of Bruce protocol, first stage is 1.7 miles per hour with
10% incline, I decided to use Manual, and adjust the speed as needed. After one minute of
walking 0.8 m/h with no incline, this client asked me to stop the belt. He was complaining of
back pain and feeling dizzy. His ECG and vital signs were normal, and I let him go home. My
initial response was empathy for this young man, but when I looked through the window and saw
him walking to his car fast, almost running, I was shocked. Why was he lying to me and faking
that he is sick? When I checked his chart, I found an answer: this client is applying for a
disability (SSI). It is hard not to judge a client, who challenges your own ethical balance.
Once in a while we encounter clients with IV drug abuse (IVDA) history, who have a
central intravenous access for their treatment. However, they take advantage of it for other
recreational drug use such as injecting illegal chemicals. They take advantage of technology to
assist with their addiction. I recognize that addiction is a disease, but it is difficult to not lose
compassion when I hear how they are trying to manipulate nurses in order to achieve their goals.
Another patient persisted in getting a prescription for a pain killer before a stress test. When we
told him that cardiologists do not prescribe opioids for the purpose of this test, he began to
become very aggressive and left the office.


There are unconscious biases in providing medical care for these types of patients.
According to the American Nurses Association [ANA] (2010), all humans that are treated by
nurses have rights and it is up to the individual nurse to uphold those rights in every setting. This
sounds logical, but it can be difficult when I, as a nurse, am needed to care for someone who
challenges my own ethical standards. We, as nurses, need to try to set aside our misconceptions
about a certain population and provide equal care to all patients despite their history and actions.
The ANA (2010) states that there is an ethical obligation in nursing to provide fair and
equal treatment to all patients in the Code of Ethics. The individual needs to be treated with
respect despite whatever health issues the person may have. It has to be done to the best of a
nurses ability without any judgmental approach. Health care needs to be given equally to all,
without any personal or social discrimination by the health care provider.
A very good example about treating patients equally despite their past was described in
the article Convicted in the American Journal of Nursing. Sometimes it is impossible to change
your feelings about the person but you still have to provide the best care possible as a nurse. Lisa
Cook states she did provide care for a pedophile as well as she could, Because Im the one who
made the decision to become a nurse, and I dont get to choose those placed in my care. It does
not matter who is under my care, I will do my best to provide medical help for all of my patients.

American Nurses Association, Center for Ethics and Human Rights Advisory Board. (2010). The
nurses role in ethics and human rights: Protecting and promoting individual worth,
dignity, and human rights in practice setting. Retrieved from

Cook, L.M. (2010). Convicted. American Journal of Nursing, 110(3), 72,
doi: 10.1097/01.NAJ.0000368961.56871.54. Retrieved from: