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Book Review
Care of the Difficult Patient: A Nurse's Guide
Peter J Manos and Joan Braun
ISBN: 978-0-415358-24-8 2005 152 pages Routledge, London
Anthony J O'Brien
Centre for Mental Health Research, Policy and Service Development, University of Auckland; Liaison Psychiatry, Auckland Healthcare Services Ltd, New Zealand
This book is for general nurses who encounter a range of patients who they describe as difficult. People whose behaviour is disorganized, confused, withdrawn or manipulative present challenges for nurses working in acute care hospitals, and raise numerous questions about how best to respond to them. The book is a collaborative venture by a consultation-liaison psychiatrist and a nurse educator, and claims to be the first text to deal specifically with difficult patients. If it is, then it is overdue.
In thirteen chapters, the authors discuss many of the commonly encountered mental health nursing problems of the general hospital. The book begins with chapters on mental status assessment, substance abuse, delirium, and psychiatric diagnosis, introducing a number of take home messages that are repeated throughout the book. To single one chapter out, the review of delirium is very clear and accessible. It provides an overview of causative factors as well as practical management advice covering communication skills and pharmacological management. Subsequent chapters cover topics such as setting limits, nurses' authority, manipulation and ethics, all of which contain useful discussion and management suggestions. The final chapters cover families, communication with medical practitioners, dying patients, stress, and psychiatric consultation.
The brief case studies and dialogue excerpts sprinkled throughout the book are pertinent and true-to-life and the authors avoid the temptation to adopt a prescriptive approach. The need to temper guidelines with clinical judgment is a theme throughout the book.
The book is rather short, and so there are some issues not covered. Depression is a surprising omission, and there is no specific chapter on behavioural emergencies. However, nurses working in general hospitals will find this book a useful reference in caring for difficult patients. While the audience is probably less experienced nurses, for those with years of experience the book is a useful summary of many of the issues they face on a daily basis in their clinical practice.
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