Psychiatric Mental Health Nursing by Videbeck

388 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

sent. The nurse can focus on the behavior itself rather
than on attempts by clients to justify it (Tredget,
2001). For example:
Nurse: “You’ve said you’re interested in learning
to manage angry outbursts, but you’ve missed the last
three group meetings.”
Client: “Well, I can tell no one in the group likes
me. Why should I bother?”
Nurse: “The group meetings are designed to help
you and the others, but you can’t work on issues if
you’re not there.”

HELPING CLIENTS SOLVE PROBLEMS AND

CONTROL EMOTIONS

Clients with antisocial personality disorder have an
established pattern of reacting impulsively when con-
fronted with problems. The nurse can teach problem-
solving skills and help clients to practice them.
Problem-solving skills include identifying the prob-
lem, exploring alternative solutions and related con-
sequences, choosing and implementing an alternative,
and evaluating the results. Although these clients
have the cognitive ability to solve problems, they need
to learn a step-by-step approach to deal with them.
For example, a client’s car isn’t running so he stopped
going to work. The problem is transportation to work;
alternative solutions might be taking the bus, asking
a coworker for a ride, and getting the car fixed. The
nurse can help the client to discuss the various op-

tions and choose one so that he can go back to work

(McMurran, Fyffe, McCarthy, Duggan & Lathem,

2001).

Managing emotions, especially anger and frus-

tration, can be a major problem. When clients are

calm and not upset, the nurse can encourage them to

identify sources of frustration, how they respond to

it, and the consequences. In this way, the nurse as-

sists clients to anticipate stressful situations and to

learn ways to avoid negative future consequences.

Taking a time-outor leaving the area and going to a

neutral place to regain internal control is often a

helpful strategy. Time-outs help clients to avoid im-

pulsive reactions and angry outbursts in emotionally

charged situations, regain control of emotions, and

engage in constructive problem-solving.

ENHANCING ROLE PERFORMANCE

The nurse helps clients to identify specific problems at

work or home that are barriers to success in fulfilling

roles. Assessing use of alcohol and other drugs is

essential when examining role performance, because

many clients use or abuse these substances. These

clients tend to blame others for their failures and dif-

ficulties, and the nurse must redirect them to examine

the source of their problems realistically. Referrals to

vocational or job programs may be indicated.

◗ NURSINGINTERVENTIONS FOR THECLIENT

WITHANTISOCIALPERSONALITYDISORDER

• Promoting responsible behavior
  Limit-setting
  State the limit.
  Identify consequences of exceeding the limit.
  Identify expected or acceptable behavior.
  Consistent adherence to rules and treatment plan
  Confrontation
  Point out problem behavior.
  Keep client focused on self.


• Helping clients solve problems and control
  emotions
  Effective problem-solving skills
  Decreased impulsivity
  Expressing negative emotions such as anger or
  frustration
  Taking time out from stressful situation


• Enhancing role performance
  Identifying barriers to role fulfillment
  Decreasing or eliminating use of drugs and
  alcohol.

Problem-solving skills