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.
Keywords: Watson; altruism; bearing witness; coping; difficult-patient.