Psychiatric Assessment and Fundamentals Q 9
Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following interventions would be most appropriate?
A. Allowing a snack to be kept in his room.
B. Reprimanding the client.
C. Ignoring the client's behavior.
D. Setting limits on the behavior.
Correct Answer: D. Setting limits on the behavior
The nurse needs to set limits on the client’s manipulative behavior to help the client control dysfunctional behavior. A consistent approach by the staff is necessary to decrease manipulation. Interventions such as employing limit-setting techniques help reduce stress and hostility for both patients and staff. To successfully limit problem behavior, limits must be consistent and reinforced by everyone, including the family and all health care personnel. Staff working with manipulative patients are best prepared when they establish firm rules that are rigidly interpreted and consistently enforced among all members of the health care team. Frequent discussions regarding the patient’s progress can help reduce staff frustration and isolation and minimize the patient’s attempts at staff splitting.
Option A: State limits and the behavior you expect from the patient in a matter-of-fact, non-threatening tone. State the consequences if behaviors are not forthcoming. Written limits and consequences can be useful (one copy for the patient and one for the staff). Be direct and assertive, if necessary, in a neutral, factual manner, not in anger.
Option B: Anger is a natural response to being manipulated. Deal with your own feelings of anger toward the patient. Peer supervision can be useful. Assess your feelings toward patients who use manipulation, and work on being assertive in stating limits. Workshops in assertiveness can be very helpful for nurses.
Option C: Confronting unacceptable, inappropriate, or harmful behavior needs to be done immediately, and setting limits on patient behaviors is the pivotal intervention when working with manipulative patients. Clear, enforceable consequences of continuing unacceptable behaviors need to be spelled out and consistently and matter-of-factly enforced by all staff involved in the patient’s care. The most effective approach with the patient is to maintain a professional therapeutic relationship with clear boundaries. A professional relationship is based on the patient’s therapeutic needs, not on being liked or the nurse’s personal feelings. People who manipulate others need clear and firm boundaries with clear and firm consequences identified for overstepping those boundaries.