A client diagnosed with borderline personality disorder frequently interrupts unit meetings, monopolizes conversations, and attempts to engage other clients in arguments regarding facility rules. The registered nurse is developing a plan of care to maintain a safe and therapeutic milieu. Which interventions should the nurse include in the plan of care? Select all that apply.
- Establish a behavioral contract outlining specific expectations for unit meeting participation.Answer
- Redirect the client to a designated quiet area when disruptive behaviors escalate.Answer
- Schedule regular, brief one-on-one interactions with the client outside of meeting times.Answer
- DRestrict the client from attending all group activities for 48 hours following an argumentative outburst.
- EInstruct the unlicensed assistive personnel (UAP) to evaluate and correct the client's behavior during sessions.
- FAsk the client why they continuously feel the need to argue with peers about the facility rules.
Answer
The nurse should establish a behavioral contract, redirect the client to a quiet area during escalation, and schedule regular one-on-one interactions.
Maintaining a therapeutic environment when a client is highly disruptive requires a multifaceted approach. Establishing a behavioral contract provides clear, objective boundaries. Redirecting an escalating client is a safe, immediate, and least-restrictive way to protect the milieu. Scheduling brief, regular interactions provides the client with positive attention, reducing their need to act out to gain the nurse's focus.
Step-by-Step Solution
Key Concept
Management of disruptive behavior in a therapeutic milieu requires clear boundary setting, consistent consequences using the least restrictive measures, and proactive fulfillment of the client's underlying needs without reinforcing negative actions.