The mental health nurse is planning care for a client newly admitted with dissociative identity disorder. Which interventions will the nurse include? Select all that apply.

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Dissociative identity disorder is a condition in which 2 or more identities alternately control the client's behavior. The alternate identities likely develop as a response to abuse or traumatic events and serve to protect the client from stressful memories. The client may not be aware of the alternate identities and may be confused by "lost time" and gaps in memory. Switching between identities occurs as a reaction to stress and individual triggers. The goal of treatment is to integrate the identities into one personality while maintaining safety. The client should journal about feelings and dissociation triggers and use a grounding technique (eg, deep breathing, rubbing a stone, counting coins) to counter dissociative episodes (Options B and E). Identities may be volatile and should be monitored for indications of harm to self or others (Option D). The nurse should attempt to form trusting, therapeutic relationships with each identity to explore feelings and facilitate identity integration (Option A). (Option C) Dissociation and memory gaps are protective mechanisms. Forcing the client to hear or attempt to recall memories may result in distress and regression. Allow clients to recall memories at their own pace. Educational objective: When caring for clients with dissociative identity disorder, the nurse should establish relationships with each identity, listen for expressions of self-harm, allow clients to recall memories at their own pace, encourage journaling about feelings and dissociation triggers, and teach grounding techniques to counter dissociative episodes.

The Mental Health Nurse Is Planning Care for a Client