De-escalating Anger in Patients with Cancer

TON - December 2020, Vol 13, No 6

Anger is a basic human emotion and a natural response to stress. Healthcare professionals should anticipate that patients with cancer may feel and express anger and be prepared to deal with these scenarios.

“Pain, injustice, fear, and frustration—emotions frequently occurring in people with cancer—can trigger anger. A diagnosis of cancer is an emotional crisis,” explained Virtud Oloan, PhD, PMHN-RN-BC, Advanced Practice Nurse, Behavioral Health, Scripps Mercy Hospital, San Diego, CA, who spoke during the virtual Scripps MD Anderson Cancer Center’s 2020 Cancer Care Symposium.

A cancer diagnosis is associated with loss—loss of body parts, loss of normal day-to-day functioning, and loss of control over one’s body. These factors can trigger anger in patients, as can obstacles they encounter within the medical system, such as being kept waiting for appointments or difficult interactions with healthcare professionals.

“Thus, the anger may be displaced, comprehensible, but not necessarily justified or fully justified,” Dr Oloan said.

Therapeutic communication is a basic component of the nurse−patient relationship, she pointed out, adding that this communication may be verbal or nonverbal.

“It is impossible not to communicate with patients. Verbal communication accounts for only about 35% of interpatient communication, while nonverbal communication accounts for about 65% of communication. Nonverbal communication is conveyed by facial expression, tone of voice, movement, appearance, eye contact, gestures, and postures,” she explained.

Dealing with Angry Patients

Fortunately, there are several strategies that healthcare professionals can use to deal with angry patients. These include self-management, not being the “hammer,” having empathy, and positive framing of statements.

Self-management involves learning to manage one’s affect and responses by remaining calm and maintaining a pleasant tone of voice. Nurses should monitor discussions and refrain from arguing with patients. They should be mindful of their facial expressions, and make a conscious effort to not freeze, overreact, or respond inappropriately.

Nurses need to tell themselves that it is not about them when patients are expressing anger. They should also try to ignore benign behaviors (ie, behaviors that are not harmful).

“You are the most important tool. Your actions, behaviors, and words should communicate, ‘I am calm, in control, safe, appropriate, and respectful.’ Modulate your voice. If the patient raises his/her voice, make your voice quieter,” Dr Oloan said.

“Patients in crisis are sensitive to voice, tone, and energy levels. Do not get into a power struggle with a patient; rather, manage, minimize, and stabilize the situation,” she added.

“Avoid the TACOS,” she continued. “Never Threaten, Argue, Challenge, Order or command, or Shame and disrespect the patient.”

Nurses should project empathy by asking and listening. They should not try to fix the problem, but rather acknowledge the patient’s experience with statements such as, “I can see that this is hard for you.” This type of communication decreases resistance and reduces problematic behaviors.

Positive framing should tap into the needs and emotions of patients and reduce the “us versus them” mentality.

“In cases of interactions with patients characterized by escalating anger, make sure to protect your personal safety. If it becomes obvious that your interventions are not working, stop and back off, calling for assistance,” Dr Oloan advised.

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