386 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
continued from page 385You must supply limits when the client is unable
or unwilling to do so. Limits must be clear, con-
crete, and not open to misinterpretation.Unpleasant consequences may help decrease or
eliminate unacceptable behaviors.Your refusal to be manipulated or charmed will
help to decrease manipulative behavior.The client must be aware of expectations and con-
sequences.If all team members follow only the written plan,
the client will not be able to manipulate changes
in the plan.The client will attempt to focus attention on others
to decrease attention to himself or herself or may
attempt to manipulate staff members.Consistency is essential. If the client can find just
one person to make independent changes, any
plan will become ineffective.The client must decide to begin accepting per-
sonal responsibility for his or her own behavior
and the consequences resulting from poor choices.Identify behaviors that are unacceptable. These
may be general (stealing others’ possessions) or
specific (embarrassing Ms. X by using profane
language or telling lewd jokes).Develop specific consequences for the identified
unacceptable behaviors (the client may not go to
the gym that day, watching television is prohib-
ited, and so forth). To be effective the consequence
must involve something the client enjoys.Avoid any discussion or debate about why the
rules or requirements exist. State the requirement
or rule in a matter-of-fact manner. The client may
attempt to get special concessions or bend the rules
“just this once” with numerous reasons, excuses,
and justifications. Avoid arguing with the client.Inform the client of unacceptable behaviors and
the resulting consequences in advance of their
occurrence.*Communicate and document in the client’s care
plan all behaviors and consequences in specific
terms for all staff members. The client may
attempt to gain favor with individual staff mem-
bers or play one staff member against another.
(“Last night the nurse told me I could do that.”)Avoid discussing another staff member’s actions
or statements with the client until the other staff
member is present.*Be consistent and firm with the care plan. Do
not make independent changes in rules or conse-
quences. Any change should be made by the staff
as a group, and the new information should be
conveyed to all staff members working with this
client including professionals in other disciplines.
(Also you may designate a primary staff person to
be responsible for minor decisions and refer all
questions to this person.)Avoid trying to coax or convince the client to do
the “right thing.”continued on page 387