Psychiatric Mental Health Nursing by Videbeck

16 PERSONALITYDISORDERS 387

continued from page 386

A consequence must closely follow the unaccept-

able behavior to be most effective. If you are

angry, the client may take advantage of it. It is

better to get out of the situation if possible and let

someone else handle it. Do not react to the client

in an angry or punitive manner.

The client needs to learn the connection between

his or her behavior and the consequences of that

behavior, but blame and judgment are not

appropriate.

Immediate positive feedback will help to increase

the frequency of the acceptable behavior. The

client must receive attention for positive

behaviors, not just unacceptable ones.

This gradual progression will help to develop

the client’s ability to delay gratification. This is

necessary if the client is to function effectively in

society.

This activity should facilitate the client’s ability to

accept responsibility for his or her own behavior.

The client has the opportunity to learn to make

alternative choices.

The client can role-play alternatives in a non-

threatening environment.

The client may have had little or no successful

experience in these areas. Dealing with conse-

quences and working are responsible behaviors.

The client can benefit from assistance in these

areas.

When the client exceeds a limit, provide conse-

quences immediately after the behavior in a

matter-of-fact manner.

Point out the client’s responsibility for his or her

behavior in a nonjudgmental manner.

Provide immediate positive feedback or reward

for acceptable behavior.

Require gradually longer periods of acceptable

behavior to obtain a reward. Inform the client of

changes in requirements and rewards as these

decisions are made. For example, at first the client

must demonstrate acceptable behavior for 2 hours

to earn 1 hour of television time. Gradually, both

the requirement and the reward are increased.

The client could progress to 5 days of acceptable

behavior and earn a 2-day weekend pass.

Encourage the client to identify sources of frus-

tration, how he or she dealt with it previously,

and any unpleasant consequences that resulted.

Explore alternative, socially and legally acceptable

methods of dealing with identified frustrations.

Help the client to try alternatives as situations

arise. Give positive feedback when the client uses

alternatives successfully.

*Include exploration and information on job seek-

ing, work attendance, debt paying, court appear-

ances, and so forth when working with the client

in anticipation of discharge.

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.