Personality is defined as the differences in the characteristic patterns of behaving, feeling and thinking of an individual.
A personality disorder is a type of mental illness in which a person’s personality traits have become rigid, inflexible, maladaptive and can hinder the person’s perception and association to situations and people. This can cause significant problems and restriction in the family, social activities, school, employment and other functional roles.
The nursing care plan varies according to the kind of personality disorder, its severity, and life situation. A collaborative intervention is needed to make sure all of the clients social, medical and psychiatric needs are met.
The goals of the nurse for clients with personality disorders focus on establishing trust, providing safety and comfort, teaching basic living skills and promoting a responsible behavior.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for personality disorders:
Impaired Social Interaction
- Impaired Social Interaction
May be related to
- Biochemical changes in the brain.
- Disruptive or abusive early family background.
- Genetic factors.
- Immature interests.
- Unacceptavle social behavior or values.
Possibly evidenced by
- Alienating others through angry, clinging, demeaning, and/or manipulative behavior or ridicule toward others.
- Destructive behavior toward self or others.
- Dysfunctional interaction with peers, family, and/or others.
- Observed use of unsuccessful social interaction behaviors.
- Patient will identify and express feelings as they occur with nurse.
- Patient will identify two personal behaviors that are responsible for relationship difficulties within two weeks.
- Patient will identify one specific area that requires change.
- Patient will verbalize decreased suspicions and increased security.
- Patient will begin to demonstrate an increase in nonviolent behaviors as evidenced by a reduction in reported outbursts.
- Patient will begin to demonstrate a reduction in manipulative behaviors as evidenced by nurse/staff.
- Patient will state that he or shes is willing to continue in follow up therapy.
- Patient will keep follow-up appointments.
- Patient will demonstrate, with the aid of the nurse/clinician, the ability to identify at least two unacceptable social behavior (manipulation, splitting, demeaning attitudes, angry acting out) that client is willing to change.
- Patient will work with the nurse/clinician on substituting positive behaviors for those unacceptable behaviors identified earlier on an ongoing basis.
|Set limits on any manipulative behaviors:
||From the beginning, limits need to be clear. It will be necessary to refer to these limits frequently, because it is to be expected that the client will test these limits repeatedly.|
|Expand limits by clarifying expectations for clients in a number of settings.||When time is taken in initial meetings to clarify expectations, confrontations, and power struggles with clients can be minimized and even avoided.|
|In a respectful, neutral manner, explain expected client behaviors, limits, and responsibilities during sessions with nurse clinician. Clearly state the rules and regulations of the institution, and the consequences when these rules are not adhered to.||From the beginning, clients need to have explicit guidelines and boundaries for expected behaviors on their part, as well as what client can expect from the nurse. Clients need to be fully aware that they will be held responsible for their behaviors.|
|Monitor own thoughts and feelings constantly regarding your response to the PD client. Supervision is strongly recommended for new and seasoned clinicians alike when working with PD clients.||Strong and intense countertransference reactions to PD clients are bound to occur. When the nurse is enmeshed in his or her own strong reactions toward the client (either positive or negative), nurse effectivess suffers, and the therapeutic alliance might be threatened.|
|Collaborate with the client, as well as the multidisciplinary team, to establish a reward system for compliance with clearly defined expectations.||Tangible reinforcement for meeting expectations can strenthen the client’s positive behaviors.|
|Assess need for and encourage skills training workshop.||Skils training workshops offer the client wats to increase social skills through role play and interactions with others who are learning similar skills. This often acts as a motivating factor where positive feedback and helpful suggestions are readily available.|
|Problem solve and role play with client acceptable social skills that will help obtain needs effectively and appropriately.||Over time, alternative ways of experiencing interpersonal relationships might emerge. Take one small skill that client is willing to work on, break it down into small parts, and work on it with the client.|
|Understand that PD clients in particular will be resistant to change and that this is symptomatic of PDs. This is particularly true in the beginning phases of therapy.||Responding to client’s resistance and seeming lack of change in a neutral manner is part of the foundation for trust. In other words, the nurse does not have a vested interest in the client “getting better.”. The nurse remains focused on the client’s needs and issues in any event.|
|Intervene in manipulative behavior.
||Client will test limits, and, once they understand that the limits are solid, this understanding can motivate them to work on other ways to get their needs met. Hopefully, this will be done with the nurse clinician throughout problem-solving alternative behaviors and learning new effective communication skills.|
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Mental Health and Psychiatric Care Plans
Care plans about mental health and psychiatric nursing: