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Zorluk: ZorBehavioral Interventions

A client with a history of borderline personality disorder is receiving care on an orthopedic unit following surgical repair of a fractured tibia. The client tells the evening nurse, 'You are the only person who actually cares about me; the day nurses are terrible and ignored my pain.' Later, the client begins shouting in the corridor because a requested snack was unavailable. Which behavioral interventions should the evening nurse implement? Select all that apply.

  1. Schedule regular, brief interactions with the client throughout the shift regardless of call light usage.Cevap
  2. Acknowledge the client's frustration while calmly restating the unit expectations for acceptable behavior.Cevap
  3. C
    Validate the client's negative comments about the day nurses to establish an immediate trusting rapport.
  4. Ensure all interdisciplinary team members provide uniform, consistent responses to the client's demands.Cevap
  5. E
    Warn the client that physical restraints will be applied if the disruptive shouting in the corridor continues.
  6. F
    Delegate the responsibility of enforcing behavioral limits to the unlicensed assistive personnel assigned to the client.

Cevap

The nurse should schedule regular interactions, acknowledge frustration while restating expectations, and ensure uniform responses from all staff.
Clients with borderline personality disorder frequently employ splitting as a defense mechanism and test boundaries when stressed. The most effective interventions involve establishing a highly structured environment. Scheduling regular check-ins prevents manipulative attention-seeking. Acknowledging feelings while firmly restating rules de-escalates the situation without validating the inappropriate action. Ensuring all staff provide uniform responses directly neutralizes attempts at splitting and maintains unit consistency.

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1
Identify the client's underlying psychological dynamic.
The client is demonstrating 'splitting' (idealizing one nurse while devaluing others) and escalating behavior (shouting in the corridor).
Recognizing borderline personality traits such as splitting and low frustration tolerance is required to select appropriate behavioral interventions.
2
Determine the priority behavioral goals for this client.
The goals are to maintain staff consistency, set clear and firm limits, and de-escalate the immediate disruptive behavior without being punitive.
A structured, predictable environment reduces anxiety and prevents the client from successfully manipulating staff boundaries.
3
Evaluate each intervention against therapeutic communication and safety standards.
Proactive scheduling, firm limit-setting, and team consistency are therapeutic. Validating splitting, threatening restraints, and improper delegation are contraindicated.
Interventions must adhere to the principles of least restrictive care, appropriate scope of practice, and therapeutic boundary maintenance.

Anahtar Kavram

Management of Borderline Personality Disorder and Splitting Behaviors
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Konular

Behavioral Interventions

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