Limitsetting: dealing with difficult patients

"Limitsetting" is an overall term for interventions that decrease problematic behavior. Orthopaedic units seem to have more than their share of patients with problematic behavior. Reasons for this include the pain, immobility, and body image changes as well as the fact that preinjury personality factors may include impulsive and angry dynamics. The limits set must match the behavior manifested. Dangerous behavior, the highest priority, demands an immediate, decisive strategy. Direct statements should be concrete and specific with positive, absolute directives of what must be done. Two case studies are included.