MH115 PDF - Nursing Care Plans for Personality Disorders

11/27/23, 3:34 AM Realizeit for Student Table 18.2 summarizes the symptoms of and nursing interventions for personality disorders. TABLE 18.2 Summary of Symptoms and Nursing Interventions for Personality Disorders and Behaviors Personality Disorder Paranoid Schizoid Schizotypal Antisocial Bo...

11/27/23, 3:34 AM Realizeit for Student Table 18.2 summarizes the symptoms of and nursing interventions for personality disorders. TABLE 18.2 Summary of Symptoms and Nursing Interventions for Personality Disorders and Behaviors Personality Disorder Paranoid Schizoid Schizotypal Antisocial Borderline Symptoms/Characteristics Nursing Interventions Mistrust and suspicions of others; guarded, restricted Serious, straightforward approach; teach client to validate affect ideas before taking action; involve client in treatment planning Detached from social relationships; restricted affect; Improve client’s functioning in the community; assist client in involved with things more than people finding case manager Acute discomfort in relationships; cognitive or Develop self-care skills; improve community functioning; perceptual distortions; eccentric behavior social skills training Disregard for rights of others, rules, and laws Unstable relationships, self-image, and affect; impulsivity; self-mutilation Histrionic Excessive emotionality and attention seeking Narcissistic Grandiose; lack of empathy; need for admiration Avoidant Dependent Limit setting; confrontation; teach client to solve problems effectively and manage emotions of anger or frustration Promote safety; help client to cope and control emotions; cognitive restructuring techniques; structure time; teach social skills Teach social skills; provide factual feedback about behavior Matter-of-fact approach; gain cooperation with needed treatment; teach client any needed self-care skills Social inhibitions; feelings of inadequacy; Support and reassurance; cognitive restructuring techniques; hypersensitive to negative evaluation promote self-esteem Submissive and clinging behavior; excessive need to be taken care of Obsessive– Preoccupation with orderliness, perfectionism, and compulsive control Foster client’s self-reliance and autonomy; teach problemsolving and decision-making skills; cognitive restructuring techniques Encourage negotiation with others; assist client in making timely decisions and complete work; cognitive restructuring techniques Nursing Care Plan: Antisocial Personality Disorder Nursing Diagnosis Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources Assessment Data Low frustration tolerance Impulsive behavior Inability to delay gratification Poor judgment Conflict with authority Difficulty following rules and obeying laws Lack of feelings of remorse Socially unacceptable behavior https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 1/10 11/27/23, 3:34 AM Realizeit for Student y p Dishonesty Ineffective interpersonal relationships Manipulative behavior Failure to learn or change behavior based on past experience or punishment Failure to accept or handle responsibility Expected Outcomes Immediate The client will: Refrain from harming self or others throughout hospitalization. Identify behaviors leading to hospitalization within 24 to 48 hours. Function within the limits of the therapeutic milieu; for example, follow no-smoking rules, participate in group activities within 2 to 3 days. Stabilization The client will: Demonstrate nondestructive ways to deal with stress and frustration. Identify ways to meet own needs that do not infringe on the rights of others. Community The client will: Achieve or maintain satisfactory work performance. Meet own needs without exploiting or infringing on the rights of others. Implementation Nursing Interventions Encourage the client to identify the actions that precipitated hospitalization (e.g., debts, marital problems, law violation). Give positive feedback for honesty. The client may try to avoid responsibility by acting as though he or she is “sick” or helpless. Identify unacceptable behaviors, either general (stealing others’ possessions) or specific (embarrassing another by telling lewd jokes). Develop specific consequences for unacceptable behaviors (e.g., the client may not watch television). Rationale These clients frequently deny responsibility for the consequences of their own actions. Honest identification of the consequences of the client’s behavior is necessary for future behavior change. You must supply clear, concrete limits when the client is unable or unwilling to do so. Unpleasant consequences may help decrease or eliminate unacceptable behaviors. The consequences must be related to something the client enjoys, to be effective. Avoid any discussion about why requirements exist. State The client may attempt to bend the rules “just this once” with numerous the requirement in a matter-of-fact manner. Avoid arguing excuses and justifications. Your refusal to be manipulated or charmed will with the client. help decrease manipulative behavior. Inform the client of unacceptable behaviors and the resulting consequences before they occur. The client must be aware of expectations and consequences. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 2/10 11/27/23, 3:34 AM Realizeit for Student The client may attempt to gain favor with individual staff Communicate and document in the client’s care plan all behaviors and consequences in specific terms.* members or play one staff member against another (“Last night, the nurse told me I could do that”). If all team members follow the written plan, the client will not be able to manipulate changes. Avoid discussing another staff member’s actions or statements unless The client may try to manipulate staff members or focus the other staff member is present. attention on others to decrease attention to him or herself. Be consistent and firm with the care plan. Do not make independent changes in rules or consequences. Any change should be made by the Consistency is essential. If the client can find just one person staff as a group and conveyed to all staff members working with this to make independent changes, any plan will become client. (You may designate a primary staff person to be responsible for ineffective. minor decisions and refer all questions to this person.)* Avoid trying to coax or convince the client to do the “right thing.” The client must decide to accept responsibility for his or her behavior and its consequences. Consequences are most effective when they closely follow the When the client exceeds a limit, provide consequences immediately after the behavior in a matter-of-fact manner. unacceptable behavior. Do not react to the client in an angry or punitive manner. If you show anger toward the client, he or she may take advantage of it. It is better to get out of the situation if possible and let someone else handle it. Point out the client’s responsibility for his or her behavior in a nonjudgmental manner. The client needs to learn the connection between behavior and the consequences, but blame and judgment are not appropriate. Immediate positive feedback will help increase acceptable Provide immediate positive feedback or reward for acceptable behavior. behavior. The client must receive attention for positive behaviors, not just unacceptable ones. Gradually, require longer periods of acceptable behavior and greater rewards, and inform the client of changes as decisions are made. For example, at first the client must demonstrate acceptable behavior for 2 hours to earn 1 hour of television time. Gradually, the client could progress to 5 days of acceptable behavior and earn a 2-day weekend This gradual progression will help develop the client’s ability to delay gratification. This is necessary if the client is to function effectively in society. pass. Encourage the client to identify sources of frustration, how he or she This may facilitate the client’s ability to accept responsibility dealt with it previously, and any unpleasant consequences that resulted. for his or her own behavior. Explore alternative, socially, and legally acceptable methods of dealing The client has the opportunity to learn to make alternative with identified frustrations. choices. Help the client try alternatives as situations arise. Give positive The client can role-play alternatives in a nonthreatening feedback when the client uses alternatives successfully. environment. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 3/10 11/27/23, 3:34 AM Realizeit for Student Discuss job seeking, work attendance, court appearances, and so forth when working with the client in anticipation of discharge.* Dealing with consequences and working are responsible behaviors. The client may have had little or no successful experience in these areas and may benefit from assistance. *Collaborative interventions. Adapted from Schultz, J. M., & Videbeck, S. L. (2013). Lippincott’s manual of psychiatric care plans (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Nursing Care Plan: Borderline Personality Disorder Nursing Diagnosis Risk for Self-Mutilation: Behaviors that indicate potential for deliberate physical damage to self that is not intended to be fatal Risk Factors Impulsive displays of temper Inability to express feelings verbally Physically self-damaging acts Attention-seeking behavior Ineffective coping skills Expected Outcomes Immediate The client will: Be safe and free from injury throughout hospitalization. Refrain from harming others or destroying property throughout hospitalization. Respond to external limits within 24 to 48 hours. Participate in treatment plan; for example, talk with staff or participate in group activities for at least 30 minutes twice a day within 24 to 48 hours. Stabilization The client will: Eliminate acting-out behaviors (temper tantrums, self-harm, suicidal threats). Develop a schedule or daily routine that includes socialization and daily responsibilities. Community The client will: Independently control urges for self-harming behavior. Demonstrate alternative ways of expressing feelings, such as contact with a therapist or significant other. Implementation Nursing Interventions* In your initial assessment, find out if he or she has any history of suicidal behavior or present suicidal ideation or plans. Rationale The client’s physical safety is a priority. Although absence of a suicidal history does not preclude risk, presence of a suicidal history increases risk. The client with a history of self-harm can also be at risk for suicide. Do not underestimate the suicidal risk for the client by only focusing on self-harm behaviors. Place the client in a room near the nursing station or where the client can be observed easily, rather than a room near an exit or The client is easier to observe and has less chance to leave the area undetected. stairwell, and so forth. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 4/10 11/27/23, 3:34 AM Assess the client for the presence of self-harm urges and history of scratching, cutting, or burning behaviors. Closely supervise the client’s use of sharp or other potentially dangerous objects. Realizeit for Student The client has a pattern of injurious behavior and is likely to engage in similar selfharm behaviors when stressed. The client may use these items for self-destructive acts. Be consistent with the client. Set and maintain limits regarding behavior, responsibilities, rules, Consistent limit setting is essential to decrease negative behaviors. and so forth. Withdraw your attention as much as possible if the client acts out (if the client’s safety is not at Withdrawing your attention will tend to decrease acting-out behaviors. risk). Encourage the client to identify feelings that are related to self- The client may be unaware of feelings or experiences that trigger mutilating or self-destructive behaviors. Encourage the client to self-destructive behavior and needs to develop more effective skills express these feelings directly. to avoid self-destructive behavior in the future. When talking with the client, focus on self-responsibility and active approaches that the client can take. Avoid reinforcing the client’s passivity, feelings of hopelessness, and so forth. Help the client identify strengths and successful coping behaviors that he or she has used in the past. It may help to have the client make a written list. Encourage the client to try to use these coping behaviors in present and future situations. If the client is blaming others for his or her problems, it is unlikely that the client will accept responsibility for making changes. The client’s self-perception may be one of hopelessness or helplessness. The client needs your assistance to recognize strengths. Teach the client additional positive coping strategies and stress The client may have limited or no knowledge of stress management management skills, such as increasing physical exercise, techniques or may not have used positive techniques in the past. If expressing feelings verbally or in a journal, or meditation the client tries to build skills in the treatment setting, he or she can techniques. Encourage the client to practice these skills while in experience success and receive positive feedback for his or her the hospital. efforts. *Collaborative interventions. Adapted from Schultz, J. M., & Videbeck, S. L. (2013). Lippincott’s manual of psychiatric care plans (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Paranoid Personality Disorder Nursing Interventions Forming an effective working relationship with paranoid or suspicious clients is difficult. The nurse must remember that these clients take everything seriously and are particularly sensitive to the reactions and motivations of others. Therefore, the nurse must approach these clients in a formal, businesslike manner and refrain from social chit-chat or jokes. Being on time, keeping commitments, and being especially straightforward are essential to the success of the nurse–client relationship. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 5/10 11/27/23, 3:34 AM Realizeit for Student Because these clients need to feel in control, it is important to involve them in formulating their care plan. The nurse asks what the client would like to accomplish in concrete terms, such as minimizing problems at work or getting along with others. Clients are more likely to engage in the therapeutic process if they believe they have something to gain. One of the most effective interventions is helping clients validate ideas before taking action; however, this requires the ability to trust and listen to one person. The rationale for this intervention is that clients can avoid problems if they can refrain from taking action until they have validated their ideas with another person. This helps prevent clients from acting on paranoid ideas or beliefs. It also assists them to starting to base decisions and actions on reality, rather than distorted ideas or perceptions. Schizoid Personality Disorder Nursing Interventions Nursing interventions focus on improved functioning in the community. If a client needs housing or a change in living circumstances, the nurse can make referrals to social services or appropriate local agencies for assistance. The nurse can help agency personnel find suitable housing that accommodates the client’s desire and need for solitude. For example, the client with a schizoid personality disorder would function best in a board and care facility, which provides meals and laundry service but requires little social interaction. Facilities designed to promote socialization through group activities would be less desirable. If the client has an identified family member as his or her primary relationship, the nurse must ascertain whether that person can continue in that role. If the person cannot, the client may need to establish at least a working relationship with a case manager in the community. The case manager can then help the client obtain services and health care, manage finances, and so on. The client has a greater chance of success if he or she can relate his or her needs to one person (as opposed to neglecting important areas of daily life). Schizotypal Personality Disorder Nursing Interventions The focus of nursing care for clients with schizotypal personality disorder is development of self-care and social skills and improved functioning in the community. The nurse encourages clients to establish a daily routine for hygiene and grooming. Such a routine is important because it does not depend on the client to decide when hygiene and grooming tasks are necessary. It is useful for clients to have an appearance that is not bizarre or disheveled because stares or comments from others can increase discomfort. Because these clients are uncomfortable around others and this is not likely to change, the nurse must help them function in the community with minimal discomfort. It may help to ask clients to prepare a list of people in the community with whom they must have contact, such as a landlord, store clerk, or pharmacist. The nurse can then role-play interactions that clients would have with each of these people; this allows clients to practice making clear and logical requests to obtain services or to conduct personal business. Because face-to-face contact is more uncomfortable, clients may be able to make written requests or to use the telephone for business. Social skills training may help clients talk clearly with others and to reduce bizarre conversations. It helps to identify one person with whom clients can discuss unusual or bizarre beliefs, such as a social worker or a family member. Given an acceptable outlet for these topics, clients may be able to refrain from these conversations with people who might react negatively. Antisocial Personality Disorder Data Analysis People with antisocial personality disorder generally do not seek treatment voluntarily unless they perceive some personal gain from doing so. For example, a client may choose a treatment setting as an alternative to jail or to gain sympathy from an employer; they may cite stress as a reason for absenteeism or poor performance. Inpatient treatment settings are not necessarily effective for these clients and may, in fact, bring out their worst qualities. Nursing diagnoses commonly used when working with these clients include the following: Ineffective coping Ineffective role performance Risk for other-directed violence Intervention Forming a Therapeutic Relationship and Promoting Responsible Behavior The nurse must provide structure in the therapeutic relationship, identify acceptable and expected behaviors, and be consistent in those expectations. He or she must minimize attempts by these clients to manipulate and control the relationship. Limit setting is an effective technique that involves three steps: 1. Stating the behavioral limit (describing the unacceptable behavior) https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 6/10 11/27/23, 3:34 AM Realizeit for Student 2. Identifying the consequences if the limit is exceeded 3. Identifying the expected or desired behavior Consistent limit setting in a matter-of-fact nonjudgmental manner is crucial to success. For example, a client may approach the nurse flirtatiously and attempt to gain personal information. The nurse would use limit setting by saying, “It is not acceptable for you to ask personal questions. If you continue, I will terminate our interaction. We need to use this time to work on solving your job-related problems.” The nurse should not become angry or respond to the client harshly or punitively. Confrontation is another technique designed to manage manipulative or deceptive behavior. The nurse points out a client’s problematic behavior while remaining neutral and matter-of-fact; he or she avoids accusing the client. The nurse can also use confrontation to keep clients focused on the topic and in the present. The nurse can focus on the behavior itself rather than on attempts by clients to justify it. 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 confronted with problems. The nurse can teach problem-solving skills and help clients practice them. Problem-solving skills include identifying the problem, exploring alternative solutions and related consequences, 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 is not running, so he or she stops 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 discuss the various options and choose one so that he or she can go back to work. Managing emotions, especially anger and frustration, 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 assists clients in anticipating stressful situations and to learn ways to avoid negative future consequences. Taking a time-out or leaving the area and going to a neutral place to regain internal control is often a helpful strategy. Time-outs help clients to avoid impulsive reactions and angry outbursts in emotionally charged situations, regain control of emotions, and engage in constructive problem-solving. NURSING INTERVENTIONS For Antisocial Personality Disorder Promoting responsible behavior Limit setting State the limit. Identify the consequences of exceeding the limit. Identify the expected or acceptable behavior. Consistent adherence to rules and treatment plan Confrontation Point out the problem behavior. Keep the client focused on him or herself. Help clients solve problems and control emotions. Effective problem-solving skills Decreased impulsivity Expressing negative emotions such as anger or frustration Taking a time-out from stressful situations Enhancing role performance Identifying barriers to role fulfillment Decreasing or eliminating use of drugs and alcohol CLIENT AND FAMILY EDUCATION For Antisocial Personality Disorder https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 7/10 11/27/23, 3:34 AM Realizeit for Student Avoiding use of alcohol and other drugs Appropriate social skills Effective problem-solving skills Managing emotions such as anger and frustration Taking a time-out to avoid stressful situations Borderline Personality Disorder Data Analysis Nursing diagnoses for clients with BPD may include the following: Risk for suicide Risk for self-mutilation Risk for other-directed violence Ineffective coping Social isolation Interventions Clients with BPD are often involved in long-term psychotherapy to address issues of family dysfunction and abuse. The nurse is most likely to have contact with these clients during crises when they are exhibiting self-harm behaviors or transient psychotic symptoms. Brief hospitalizations are often used to manage these difficulties and to stabilize the client’s condition. Promoting Clients’ Safety Clients’ physical safety is always a priority. The nurse must always seriously consider suicidal ideation with the presence of a plan, access to means for enacting the plan, and self-harm behaviors and institute appropriate interventions. Clients often experience chronic suicidality or ongoing intermittent ideas of suicide over months or years. The challenge for the nurse, in concert with clients, is to determine when suicidal ideas are likely to be translated into action. Clients may enact self-harm urges by cutting, burning, or punching themselves, which sometimes causes permanent physical damage. Self-injury can occur when a client is enraged or experiencing dissociative episodes or psychotic symptoms, or it may occur for no readily apparent reason. Helping clients avoid self-injury can be difficult when antecedent conditions vary greatly. Sometimes, clients may discuss self-harm urges with the nurse if they feel comfortable doing so. The nurse must remain nonjudgmental when discussing this topic. It has been common practice in many settings to encourage clients to enter into a no-self-harm contract, in which the client promises not to engage in self-harm and to report to the nurse when he or she is losing control. The no-self-harm contract is not a promise to the nurse but the client’s promise to him or herself to be safe. Although not legally binding, such a contract is thought to be beneficial to the client’s treatment by promoting self-responsibility and encouraging dialogue between client and nurse. However, there is no evidence to support the effectiveness of these contracts, and in fact, some believe they may give staff a false sense of security. When clients are relatively calm and thinking clearly, it is helpful for the nurse to explore selfharm behavior. The nurse avoids sensational aspects of the injury; the focus is on identifying mood and affect, level of agitation and distress, and circumstances surrounding the incident. In this way, clients can begin to identify trigger situations, moods, or emotions that precede self-harm and to use more effective coping skills to deal with the trigger issues. If clients do injure themselves, the nurse assesses the injury and need for treatment in a calm, matter-of-fact manner. Lecturing or chastising clients is punitive and has no positive effect on self-harm behaviors. Deflecting attention from the actual physical act is usually desirable. Promoting the Therapeutic Relationship Regardless of the clinical setting, the nurse must provide structure and limit setting in the therapeutic relationship. In a clinical setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse’s immediate attention. In the hospital setting, the nurse would plan to spend a specific amount of time with the client working on issues or coping strategies rather than giving the client exclusive access when he or she has had an outburst. Limit setting and confrontation techniques, described earlier, are also helpful. NURSING INTERVENTIONS https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 8/10 11/27/23, 3:34 AM Realizeit for Student For BPD Promoting client’s safety No-self-harm contract Safe expression of feelings and emotions Helping client to cope and control emotions Identifying feelings Journal entries Moderating emotional responses Decreasing impulsivity Delaying gratification Cognitive restructuring techniques Thought stopping Decatastrophizing Structuring time Teaching social skills Teaching effective communication skills Entering therapeutic relationship Limit setting Confrontation CLIENT AND FAMILY EDUCATION For BPD Teaching social skills Maintaining personal boundaries Realistic expectations of relationships Teaching time structuring Making a written schedule of activities Making a list of solitary activities to combat boredom Teaching self-management through cognitive restructuring Decatastrophizing situation Thought stopping Positive self-talk Using assertiveness techniques, such as “I” statements Using distraction, such as walking or listening to music Histrionic Personality Disorder Nursing Interventions The nurse gives clients feedback about their social interactions with others, including manner of dress and nonverbal behavior. Feedback should focus on appropriate alternatives, not merely criticism. For example, the nurse might say, “When you embrace and kiss other people on first meeting them, they may interpret your behavior in a sexual manner. It would be more acceptable to stand at least 2 ft away from them and to shake hands.” It may also help to discuss social situations to explore clients’ perceptions of others’ reactions and behavior. Teaching social skills and roleplaying those skills in a safe, nonthreatening environment can help clients gain confidence in their ability to interact socially. The nurse must be specific in describing and modeling social skills, including establishing eye contact, engaging in active listening, and respecting personal space. It also helps to outline topics of discussion appropriate for casual acquaintances, closer friends or family, and the nurse only. Clients may be quite sensitive to discussing self-esteem and may respond with exaggerated emotions. It is important to explore personal strengths and assets and to give specific feedback about positive characteristics. Encouraging clients to use assertive communication, such as “I” statements, may promote self-esteem and help them get their needs met more appropriately. The nurse must convey genuine confidence in the client’s abilities. Narcissistic Personality Disorder Nursing Interventions Clients with narcissistic personality disorder can present one of the greatest challenges to the nurse. The nurse must use self-awareness skills to avoid the anger and frustration that these clients’ behavior and attitude can engender. Clients may be rude and arrogant, unwilling to wait, and harsh and critical of the nurse. The nurse must not internalize such criticism or take it personally. The goal is to gain the cooperation of these clients with other treatment as indicated. The nurse teaches about comorbid medical or psychiatric conditions, medication regimen, and any needed self-care skills in a matter-of-fact manner. He or she sets limits on rude or verbally abusive behavior and explains his or her expectations of the client. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 9/10 11/27/23, 3:34 AM Realizeit for Student Avoidant Personality Disorder Nursing Interventions These clients require much support and reassurance from the nurse. In the nonthreatening context of the relationship, the nurse can help them explore positive self-aspects, positive responses from others, and possible reasons for self-criticism. Helping clients practice selfaffirmations and positive self-talk may be useful in promoting self-esteem. Other cognitive restructuring techniques such as reframing and decatastrophizing (described previously) can enhance self-worth. The nurse can teach social skills and help clients practice them in the safety of the nurse–client relationship. Although these clients have many social fears, those are often counterbalanced by their desire for meaningful social contact and relationships. The nurse must be careful and patient with clients and not expect them to implement social skills too rapidly. Dependent Personality Disorder Nursing Interventions The nurse must help clients express feelings of grief and loss over the end of a relationship while fostering autonomy and self-reliance. Helping clients identify their strengths and needs is more helpful than encouraging the overwhelming belief that “I can’t do anything alone!” Cognitive restructuring techniques such as reframing and decatastrophizing may be beneficial. Clients may need assistance in daily functioning if they have little or no past success in this area. Included are such things as planning menus, doing the weekly shopping, budgeting money, balancing a checkbook, and paying bills. Careful assessment to determine areas of need is essential. Depending on the client’s abilities and limitations, referral to agencies for services or assistance may be indicated. The nurse may also need to teach problem-solving and decision-making and help clients apply them to daily life. He or she must refrain from giving advice about problems or making decisions for clients, even though clients may ask the nurse to do so. The nurse can help the client explore problems, serve as a sounding board for discussion of alternatives, and provide support and positive feedback for the client’s efforts in these areas. Obsessive-Compulsive Personality Disorder Nursing Interventions Nurses may be able to help clients view decision-making and completion of projects from a different perspective. Rather than striving for the goal of perfection, clients can set a goal of completing the project or making the decision by a specified deadline. Helping clients accept or tolerate less-than-perfect work or decisions made on time may alleviate some difficulties at work or home. Clients may benefit from cognitive restructuring techniques. The nurse can ask, “What is the worst that could happen?” or “How might your boss (or your wife) see this situation?” These questions may challenge some rigid and inflexible thinking. Encouraging clients to take risks, such as letting someone else plan a family activity, may improve relationships. Practicing negotiation with family or friends may also help clients relinquish some of their need for control. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhy… 10/10