T.S. Eliot aptly described some people as not wishing to do harm, but causing harm nonetheless as they are so “absorbed in the endless struggle to think well of themselves.” Such a description could define those who are narcissistic. For them, life’s events are always centered on them; and all that occurs is “all about me.”

Narcissism: It’s all about me
Here are some ways to cope with narcissistic behavior in your patients:

• When explaining something, point out how it will benefit them.
• Recognize that their perception of you will be clouded by their self-centeredness.
• Be firm, but kind. Stay focused on their care, and do not stray into casual conversation.
• Listen quietly to what they have to say. There is no need to agree. Just listen.
• Take frequent breaks from them and ask others for help as needed.
• Don’t take their comments to heart.
• Recognize that their inflations of themselves are most likely a way to cover up their feelings of inadequacy.
• Be professional and straightforward.

Histrionics: Throwing a fit
A histrionic (or sometimes called hysterical) personality has a pattern of excessive emotionality and attention-seeking behavior.

Like Albert Goldman (played by Nathan Lane) in The Birdcage, a histrionic person can exhibit excessive behaviors. For example, Goldman bursts into tears, swishes his clothes as he moves, overdrinks, exaggerates, and walks with a very prominent flair.

Here are some hints on how to handle histrionic behavior in your patients:

• Don’t give them an audience, because they like to draw attention to themselves.
• Recognize that their affections are shallow and don’t take offense if they tell every nurse they are the best nurse on the unit.
• Remember that they may exaggerate their symptoms, and their reactions to medications and treatments. As a nurse, you need to do a thorough assessment and avoid discounting their concerns.
• Although they may be able to develop rapport easily, you might recognize that they may come across as fake or shallow. They may be unable to display a wide range of depth of emotion.
• Be supportive, but resist the urge to rescue them. This may occur as they may seek constant reassurance and express the need to be rescued from their day-to-day problems, which they might express in very dramatic terms.
• Set clear boundaries, especially with people of the opposite sex, as they may become sexually provocative.
• Set clear expectations of their behavior and the limits of your involvement with them.

Editor’s note: This excerpt is adapted from Stressed Out About Difficult Patients, the newest addition to the Stressed Out collection. It’s due out early next month. All this week, we’ll be presenting excerpts of the book so you can get a good look at our new title.