A nurse is managing the care of a client on a physical rehabilitation unit who has a history of substance use disorder. Over the past two days, the client has exhibited manipulative behaviors, such as attempting to pit nursing staff against each other to obtain early doses of PRN analgesics and frequently arguing about unit visitation rules. The nurse is updating the client's care plan to address these behaviors. Which of the following behavioral interventions should the nurse include? Select all that apply.
- Establish and clearly communicate specific limits and consequences regarding the client's behavior.Answer
- Ensure all members of the healthcare team consistently adhere to the established behavioral plan.Answer
- Designate one primary nurse per shift to handle all of the client's medication and scheduling requests.Answer
- DDelegate the task of explaining and enforcing the unit visitation rules to the unlicensed assistive personnel (UAP).
- EApply bilateral soft wrist restraints if the client becomes verbally argumentative about the pain medication schedule.
- FAllow occasional exceptions to the visitation rules to foster a more therapeutic nurse-client relationship.
Answer
The correct interventions are to establish and communicate clear limits, ensure strict team adherence to the behavioral plan, and designate one primary nurse per shift to handle the client's requests.
Managing manipulative behavior and staff splitting requires a highly structured, unified approach. Establishing clear limits, ensuring all interdisciplinary team members adhere strictly to the same plan, and centralizing requests through one designated staff member per shift prevents the client from successfully playing staff against one another and promotes a secure, predictable therapeutic environment.
Step-by-Step Solution
Key Concept
Management of manipulative and splitting behaviors through consistent limit-setting and unified interdisciplinary team communication.