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Home Health Aide On The Go In Service Lessons Vol 12 Issue 6 Cultural Diversity
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Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 6: Cultural Diversity by : Cheryl McDaniel
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 6: Cultural Diversity written by Cheryl McDaniel and published by Beacon Health, a Division of Blr. This book was released on 2013-02-26 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Every patient will be different. Every patient has a different background or culture and will live their life in their home in a different way. As an HHA, it is important to respect how each patient wishes to live their life. Cultural awareness is, and has always been, a key component in responding to and communicating with all different types of people. It is of utmost importance for HHAs to recognize and understand the diversity of cultural forces that surround them. In order to perform their roles effectively, they must be aware of some common cultural differences and develop a respect for those differences. HHAs must also understand how to communicate with and observe patients so that you have a better understand of their culture and background. Home is the primary place in which the patient and family live by their own cultural standards, so respect for those standards is even more important in homecare than in other areas of healthcare. LESSON OBJECTIVES After completion of this program, the home health aide will be able to: Identify different types of culture Explain why it is important to respect patients' cultures within their homes Explain why observing a patient might give you clues to their cultural beliefs and practices Understand why it is important to treat every patient as a unique person and not stereotype Contents of this lesson: A clearly written fact sheet A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 1, Issue 11: Cultural Diversity by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 1, Issue 11: Cultural Diversity written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Cultural Diversity includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: * Define what culture means * Name three different cultural groups * List three examples of how cultural beliefs of a patient might affect the role of the home health aide. OVERVIEW There is much discussion about cultural diversity in homecare. The extent of the discussion has mistakenly led to the idea that cultural diversity is a "politically correct" mixture of gender and race. Neither race nor gender represents a true culture. Cultural awareness is, and has always been, a key component in responding to and communicating with all different types of people. Nowhere is this more important that in health care. It is of utmost importance for home health aides to understand and recognize the diversity of cultural forces that surround them. In order to perform their roles effectively, they must be aware of some common cultural differences and develop a respect for those differences. Home is the primary place in which the patient and family live by their own cultural standards, so respect for those standards is even more important in homecare than in other areas of health care.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 12: Personal Wellness by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 12: Personal Wellness written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Personal Wellness includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Identify three signs of stress Define burnout, and Explain two ways to deal with stress. OVERVIEW Since the home health aide's job is to care for others, most of your day is spent directly caring for another person. In addition to that, you have your own professional and personal obligations. It is common for all people, and especially for caregivers, to experience some stress and even "burnout" due to the pressures and responsibilities of caregiving. This in-service reviews the importance of caring for yourself first. It outlines how to do that by recognizing and dealing with stress. In addition, the in-service explains burnout and suggests ways to manage it effectively.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 1, Issue 6: Observing, Recording, and Reporting by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 1, Issue 6: Observing, Recording, and Reporting written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Observing, Recording, and Reporting includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: * List three methods of observing patients * Identify the differences between objective and subjective reporting * List four patient observations which must be recorded and reported, and * Recognize the importance of knowing what to report. LESSON OVERVIEW One of the Conditions of Participation (COP), §484.36, addresses home health aide services. A frequently cited deficiency is in the Standard: Assignment and duties of the home health aide, §484.36(c). The State Operations Manual indicates that surveyors should always make at least one home visit to observe a home health aide providing direct service. In addition, the surveyor may question the aide informally and will certainly review records of patients receiving home health aide services. The Standard: Coordination of patient services is another problematic area frequently cited during surveys. The standard in §484.14(g) mandates that all personnel providing services maintain liaison to ensure coordination of care and that the clinical record establishes that effective interchange and reporting of patient care does occur. A lack of documentation by home health aides frequently contributes to deficiency in this standard. The Interpretive Guidelines gives specific guidance to surveyors to look for documentation by home health aides in the clinical record describing significant information or changes in the patients' conditions and to whom these changes were reported. As agencies struggle to provide the highest quality, most cost-effective care for patients in the Prospective Payment System (PPS), the importance of observation and reporting by home health aides has taken on even greater importance. Patient problems need to be identified and acted upon as quickly as possible. It is likely that the home health aide spends more time with the patient than any other discipline and thus is more likely to note changes in the patient sooner. The subject of observing, recording, and reporting should be addressed frequently with them.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 1: Professionalism by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 1: Professionalism written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Home Health Aide Professionalism includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Describe two examples of professional workplace behavior Identify three characteristics of acting professionally Explain two ways to treat patients professionally OVERVIEW Professional behavior in the workplace can be difficult to define. Professionalism means different things to different people and can vary from agency to agency. It is something that isn't formally taught and is often left up to the home health aide to figure out. Further, behavior that some patients may find perfectly acceptable may offend others. It is therefore important that home health aides know what actions make up professional behavior and put those into practice. Home health aides must be aware of the agency's standards and there must be proof that aides follow them. The agency's reputation, and the health and safety of patients, depend on this knowledge and practice. This aide in-service outlines professional behavior and will serve as a guideline to training the home health aide on professionalism.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 10: Teamwork by : Cheryl McDaniel
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 10: Teamwork written by Cheryl McDaniel and published by Beacon Health, a Division of Blr. This book was released on 2013-02-26 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Teamwork is one of the most essential qualities for the success of any healthcare system. It has been seen that in the absence of teamwork, teams fail to perform to the best of their abilities. Home health is not about the care one individual clinician provides; it is the patient who the team exists for, and it is quality patient care that is the end result. A healthcare team that practices patient-centered care understands and believes that thinking, planning, decisions, and actions are better when done together to achieve the common goal of quality patient care. The belief that "none of us is as good as all of us" is recognized in a great team approach. We exist to serve the patient. Teamwork exists in its finest when it is recognized that each individual brings to the healthcare experience their unique beliefs, their unique values, their unique experiences, as well as their unique strengths. For a brief moment in time, the team will touch and make a difference not only in the patient's life but also in the life of each member of the team. Every member contributes and is a valuable part of the team. LESSON OBJECTIVES After completion of this program, the home health aide will be able to: Define the attributes of a team Understand the responsibilities of being a good team member Assess your team and what you can do to make it more successful Understand the contributions and responsibilities of a team member Understand the different stages of forming a team Contents of this lesson: A clearly written fact sheet A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 2: Observing and Reporting by : Laura More
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 2: Observing and Reporting written by Laura More and published by Beacon Health, a Division of Blr. This book was released on 2013-02-26 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Observing and reporting are vital to the health and safety of the patient in home health care. Because the patient is at home, the HHA may be the first person to notice the signs of a serious health problem. Careful observation and prompt reporting are an important part of the HHA's responsibilities. LESSON OBJECTIVES After completion of this program, the home health aide will be able to: Describe the difference between a sign and a symptom List three signs that require an immediate report to the nurse Describe observations needed for one body system, such as circulatory List nonverbal signs of pain Contents of this lesson: A clearly written fact sheet A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 3: Role of the Social Worker by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 3: Role of the Social Worker written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Role of the Social Worker includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Describe two signs of elder abuse Identify three types of services a social worker may provide to a patient Describe two situations to report that may indicate a need for social services OVERVIEW Knowing when to seek the services of a social worker can be an important aspect in a patient's recovery. Oftentimes it is a home health aide who first sees a situation where a social worker might be needed. Therefore, it is important that home health aides understand the many situations in which social workers can help, and when to report the signs and symptoms indicating a patient may need a social worker's support. This in-service reviews the role of a social worker in home health. It also offers examples of when social workers could be called upon. Finally, it reviews the home health aide's role as being instrumental in making sure social services are appropriately and fully used. In the best circumstances, social workers help patients and caregivers by supporting care.
Book Synopsis Home Health Aide On-The-Go In-Service Series, Volume XII Set by : Beacon Health
Download or read book Home Health Aide On-The-Go In-Service Series, Volume XII Set written by Beacon Health and published by . This book was released on with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Every year, home health aides must satisfy 12 hours of in-service training. With today's irregular, part-time schedules, making sure they complete their required in-services can be a never-ending chore. Now you can satisfy Medicare's annual 12-hour aide in- service requirement without bringing your staff into the office for training. Home Health Aide On-the-Go In-service provides authoritative, comprehensive, yet easy-to-understand training for self-study or the classroom. As aides need training, simply copy the pages from each lesson as needed. The training is flexible, so aides can learn at their own pace at a time that is convenient for them. Even if they miss your regular in-services they can still get the training they need. Each lesson provides one hour of study on a homecare-specific topic. This 12-lesson volume fulfills one year of Medicare's annual requirement of 12 in-service hours. Each lesson includes: A clearly written fact sheet about a timely, homecare-specific topic A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion A convenient storage binder is included with your purchase. Volume 12 Topics: Congestive Heart Failure Observing and Reporting Incontinence Flu Season Patients with Sensory Impairments Cultural Diversity Seasonal Safety ROM and Contracture Prevention Swallowing Disorders Working as a Team Sleep Disorders Osteoporosis
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 6: Medicare and Home Health by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 6: Medicare and Home Health written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Medicare and Home Health includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Identify two qualifying factors for homecare Explain the history of homecare, and List the traits/roles of a home health aide. OVERVIEW Home health care is a service that provides skilled nursing care and other health-related treatments to patients in the comfort of their homes. Patients with Medicare insurance may be eligible to receive home health care if they meet certain requirements. Since the federal government provides Medicare, these requirements are established through the Centers for Medicare and Medicaid Services (CMS). Home health aide services are part of the Medicare home health benefit. This in-service reviews the history of homecare, basic Medicare qualifying services, and how home health aides provide patient care in the home. We'll also reveal some interesting homecare facts and statistics.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 9: Effective Documentation by : HCPro
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 9: Effective Documentation written by HCPro and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Effective Documentation includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Understand the importance of accurately documenting patient care Describe his or her role in the documentation process Explain the relationship between documentation and the plan of care, and Document patient care clearly and according to regulations. OVERVIEW The patient's clinical record is the primary source of information regarding a patient's care. Caregivers and agencies use it as a record of the care the health care team provides. It is not only a home health aide's source of instruction, but it is also an aide's tool for documenting care provided. As such, it is important that aides know what documentation is required and the best way to describe that information. This in-service discusses the aide's role and documentation reasons, tips, and examples, and includes a short grammar review.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 5: The Home Environment by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 5: The Home Environment written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on The Home Environment includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Describe three methods for improving safety in the kitchen Explain three ways to make a home safe for patients, and State three things that attract burglars. OVERVIEW Home health aides care for patients with many different diseases and needs. However, one thing applies to all patients: the need for a safe and effective home environment that allows for proper recovery. While the nurse or physical therapist may conduct a home safety assessment for patients, it is often the home health aide who must observe and report changes in the environment that could affect patient safety. In addition, aides are often responsible for preparing meals for patients. Given that many home fires start in the kitchen while cooking, it is important that aides know the basics of fire prevention. This in-service reviews the home environment and ways to keep it safe for patients. It specifically outlines ways to prevent fires, falls, carbon monoxide poisoning, and burglaries. Finally, this in-service covers methods to improve home safety for visually impaired patients.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 11, Issue 6: Rights of the Homecare Patient by : Paula Long
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 11, Issue 6: Rights of the Homecare Patient written by Paula Long and published by Beacon Health, a Division of Blr. This book was released on 2012-01-09 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Every year, home health aides must satisfy 12 hours of in-service training. With today's irregular, part-time schedules, making sure they complete their required in-services can be a never-ending chore. Now you can satisfy Medicare's annual 12-hour aide in-service requirement without bringing your staff into the office for training. Home Health Aide On-the-Go In-service provides authoritative, comprehensive, yet easy-to-understand training for self-study or the classroom. As aides need training, simply copy the pages from each lesson as needed. The training is flexible, so aides can learn at their own pace at a time that is convenient for them. Even if they miss your regular in-services they can still get the training they need. Each lesson provides one hour of study on a homecare-specific topic. This 12-lesson volume fulfills one year of Medicare's annual requirement of 12 in-service hours. Each lesson includes: A clearly written fact sheet about a timely, homecare-specific topic A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion A convenient storage binder is included with your purchase Volume 11 topics*: Communication Strategies Difficult Patients Diet and Nutrition Medication Management Arthritis Patient Rights MRSA Strokes and Seizures Bariatric Patients Vital Signs and Documentation Amputee Care Ventilator Care
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 7: Seasonal Safety by : Cheryl McDaniel
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 12, Issue 7: Seasonal Safety written by Cheryl McDaniel and published by Beacon Health, a Division of Blr. This book was released on 2013-02-26 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each change of season presents unique care challenges for HHAs. For example, the winter may bring cold-weather concerns such as proper heating and hypothermia, and summer poses increased risk for heat exhaustion and dehydration. While winter and summer may create some obvious safety concerns, recognizing the seasonal safety risks for patients throughout the year is key for HHAs when providing quality care. The elderly and the ill often have slower metabolisms, weakened muscles and coordination, and compromised immune systems, setting them at high risk for complications when exposed to extreme weather or seasonal illnesses, such as the flu. HHAs should recognize the signs symptoms of common seasonal concerns and promptly address these issues at the first sign. LESSON OBJECTIVES After completion of this program, the home health aide will be able to: Recognize common seasonal safety concerns Identify the signs and symptoms of specific seasonal safety concerns Promote positive safety habits for aides and patients Contents of this lesson: A clearly written fact sheet A 10-question post-test to measure understanding of the subject matter An answer sheet with a place for the instructor's comments and signature An illustrative, homecare-specific case study Suggested supplemental learning activities An attendance log and certificate of completion
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 8, Issue 11: The Homecare Team by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 8, Issue 11: The Homecare Team written by and published by Beacon Health, a Division of Blr. This book was released on 2009-04-14 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on The Homecare Team includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 4: Therapy Patients by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 6, Issue 4: Therapy Patients written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Therapy Patients includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Discuss the different types of therapy home health patients may receive Explain three ways to support a therapy plan of care, and State three reasons a patient might receive therapy services OVERVIEW A rehabilitation program in the home may require the skills of physical therapists, occupational therapists, and speech-language pathologists. However, a patient's care doesn't stop with the therapists. Home health aides are dedicated to supporting a program's daily requirements. They offer encouragement that can be a determining factor in the patient's recovery. Observing, documenting, and reporting even the slightest change in a patient's health can have a significant impact on a patient's therapy plan. This in-service focuses on the role of the home health aide when working with therapy patients. It looks at the different therapies prescribed for patients suffering from common diseases and injuries. It also offers examples of how home health aides carry out portions of the therapy program as directed by the therapists. Finally, it emphasizes the home health aide's role as being instrumental in helping a therapy patient reach his or her full potential and recovery.
Book Synopsis Home Health Aide On-The-Go In-Service Lessons: Vol. 5, Issue 6: Aide/Patient Conflicts by :
Download or read book Home Health Aide On-The-Go In-Service Lessons: Vol. 5, Issue 6: Aide/Patient Conflicts written by and published by Beacon Health, a Division of Blr. This book was released on 2007-12-31 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This lesson on Aide/Patient Conflicts includes a complete training packet. Each in-service packet takes approximately one hour to complete and fully meets the Medicare in-service training requirements. As aides need training, you can make as many copies as you want - there's no restriction when used with aides assigned from your office location. Remember that Home Health Aides must have 12 hours of in-service training every year. LESSON OBJECTIVES Upon completion of this program, the home health aide will be able to: Better understand why patients may exhibit difficult behavior List techniques to handle difficult patients, and Explain the importance of reporting and documenting events regarding difficult patients. OVERVIEW For the most part, home health patients are pleasant and welcoming to the presence of home health aides, and are eager to do what it takes to get better. Occasionally, however, the home health aide will experience a conflict due to behavioral issues with the patient. A patient may be having a hard time learning to live with a disease or adjusting to the lifestyle changes an injury or disease requires. The patient may take out these frustrations on the caregiver. The patient may be resistant or bitter and even, at times, aggressive. The patient may also have mental status changes directly related to disease or to aging. Instead of reacting negatively and making the situation worse, a home health aide can use techniques to build a more solid, trusting relationship with the patient. Understanding the potential causes of the behavior helps aides know how to respond effectively. This inservice looks at some of the possible reasons a patient may be difficult and offers tips on dealing with such patients.