Care of the Difficult Patient: A Nurse's Guide was written primarily for the nurses caring for hospital patients, but it has much to offer nurses performing outpatient procedures. Almost every chapter, from "Mental Status Assessment" to "Nurses and Stress," has concrete descriptions and strategies applicable to daily routines in the ambulatory setting.

I read this book because its authors are colleagues of mine, in a midsized tertiary care community hospital. Peter J. Manos is a consultation-liaison psychiatrist, and I have found his evaluations helpful in dealing with hospital patients during our short interactions for gastrointestinal (GI) procedures. Joan Braun is a medical/surgical nurse and nurse educator who cares for many of the GI inpatients of the hospital and has spoken at our regional GI conference.

The book jacket commentary states,

This is the first text to deal specifically with nursing difficult patients. Whether problems stem from mental distress and ill health, historic substance abuse, demanding family members or abusive behavior, difficult patients place extra demands on nurses [horizontal ellipsis] and require technical and interpersonal skills.

As I read this, I realized that many of the types of patients described were familiar to me. They had come to our endoscopy department for emergency GI bleeding or endoscopic retrograde cholangiopancreatography, or were "frequent fliers" with chronic GI diseases requiring many follow-up procedures.

Some patients I remembered fondly, such as the gentleman who spent a year in our hospital. I did not recognize him walking upright in the halls because I had only seen him horizontal on gurneys. Others were memorable for the amount of medication required to sedate them, as they were on chronic pain medications. I felt the authors' suggestions of using routine, scheduled narcotics for these patients particularly useful.

The book frequently acknowledges that nurses are in the front line of patient care, especially in dealing with difficult patients. Physicians spend less time with the patients, but must be informed and involved. The authors stress the importance of a united plan for care. The term "difficult" encompasses patients with dementia, substance abuse, psychiatric disorders, terminal illness, and many other factors that affect patient response and care.

One chapter is devoted to communication between a nurse and a physician, and gives specific scenarios and scripts to improve this collaborative process in challenging situations. Another section offers an insight into "difficult" families, with vignettes describing limit setting and effective/ineffective responses to family demands.

Many chapters include charts and mnemonics to summarize and simplify the material covered, making it easy to refer back quickly when the need arises. I think this is especially beneficial, along with the specific words or scripts, to help the nurse deal with an uncomfortable situation.

I feel this book will be an important addition to the library of any gastroenterology procedural area. It acknowledges the stress all healthcare workers live with, while giving concrete suggestions for dealing with difficult people, from professional colleagues to hospital or ambulatory patients. It reinforces the GI nurse's ability to sensitively care for a variety of patients, using humor and experience effectively.