Nursing Diagnosis – Implementation

Implementation

  • Milieu therapy
    • Appropriate for individuals with antisocial personality disorder who respond more adaptively to support and feedback from peers where feedback from peers is more effective than in one-to-one interaction with a therapist.
    • Appropriate for patients 
      • With self-destructive behaviors
      • Who require a structured environment
    • Focuses on
      • Realistic expectations
      • Process of decision making
      • Process of interactional behaviors in the here-and-now
  • Therapeutic communication strategies
    • Manipulative behavior
      • Maintain honest, respectful, and non-retaliatory stance
      • Avoid labeling the patient as manipulative
      • Encourage putting feelings into words
      • Monitor your own reactions and avoid becoming defensive
      • Discuss neutral and less emotionally charged topics
    • Dependent behaviors
      • Convey a sense of optimism about the patient’s abilities
      • Use a patient non-aggressive tone
      • Discourage negative remarks about self that lessen confidence
      • Avoid making decisions for clients
    • Angry behaviors
      • Firmly and calmly instruct the patient to stop the angry behavior
      • Avoid touching the patient
      • Maintain a calm respectful demeanor
      • Do not react angrily or defensively
      • Avoid ultimatums
      • Avoid arguments
  • Promotion of healthy interactions
    • Manipulative behavior
      • Set clear, realistic expectations
      • Determine the goal behind the manipulation
      • Give positive reinforcement
      • Avoid collusion with “splitting” behaviors
      • Use supervision and consultation with other staff
      • Review patient’s behavior with interdisciplinary staff to promote consistency
    • Dependent behavior
      • Strongly encourage self-care
      • Promote participation in activities that encourage accomplishment
      • Role model taking responsibility for decisions and actions
      • Give positive feedback
      • Point out behaviors that are undermining the patient’s care
    • Angry behaviors
      • Identify triggers to angry remarks and behaviors
      • Role model appropriate behavior
      • Set limits on excessive complaining or degrading remarks
      • Use written contract to reinforce appropriate behaviors
      • Problem solve alternative ways to manage anger
  • Patient and family education
    • Describe characteristics and consequences of maladaptive behavior
    • Describe behaviors characteristic of interpersonal anxiety and relate anxiety to maladaptive behaviors
    • Explain, demonstrate, and role play stress-reduction techniques
    • Identify adaptive responses to anxiety producing situations
  • Strategies for preventing or reducing violence to self or others
    • Address verbal and physical threats of harm
    • Provide a time and space for the patient to collect himself/herself and think about the behavior before discussing it
    • Set limits on dangerous and/or unacceptable behaviors
    • Point out behaviors that are undermining the patient’s care
  • Psychopharmacology
  • Psychotherapy