A patient with antisocial personality disorder tells Nurse A,"You're a much better nurse than Nurse B said you were." The patient tells Nurse B,"Nurse A's upset with you for some reason." To Nurse C the patient states,"You'd like to think you're perfect,but I've seen three of your mistakes this morning." Which nursing intervention would be most helpful for addressing this behavior?

Question

Quizplus · Accepted Answer

Staff splitting is occurring here,wherein the patient is setting up conflict among the staff to manipulate them into focusing on each other,thus taking the focus off the patient.It is important that staff help each other recognize this dynamic and develop a plan of response that all will use consistently.A weekly meeting to discuss the behavior is beneficial.Threatening the patient with loss of privileges implies that staff will punish or reject her if she is "bad," setting up a scenario perhaps similar to others wherein relationships have been conditional;this would increase abandonment fears and increase acting out behavior.Similarly,ignoring the patient each time her behavior is inappropriate is an excessive response that will heighten abandonment issues.Instead,staff should aim for a happy medium,wherein inappropriate behavior is labeled as such and addressed but not in a punitive or other manner that inadvertently reinforces it (e.g. ,negative attention can also be reinforcing).A medication increase or transfer would not help the patient behave more adaptively or appropriately.Staff supporting such measures are often experiencing countertransference and acting out their own negative feelings about the patient.

A Patient with Antisocial Personality Disorder Tells Nurse A,"You're a Much