Personality and Mood Disorders Q 22
A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate?
A. “I believe we need to sit down and talk about this.”
B. “Don’t you know better than to try to bend the rules?”
C. “What you’re asking me to do is unacceptable.”
D. “Why don’t you bring this request to the community meeting?”
Correct Answer: C. “What you’re asking me to do is unacceptable.”
These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client’s nor the nurse’s boundaries are violated.
Option A: By sitting down to talk about the request, the nurse is telling the client there’s room for negotiating when there is none. Be aware of flattery as an attempt to feed into your needs to feel special. Giving into the client’s thinking that you are “the best” or “the only one” can pit you against other staff and undermine the client’s need for limits.
Option B: Regardless of the clinical setting, the nurse must provide structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse’s immediate attention.
Option D: Be clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move on. Institutional policies provide structure and safety.