Managing Disruptive Patients _ ________________________________________________________________
HEALTHCARE PROFESSIONAL INTERVENTIONS AND RATIONALE FOR MANAGING PATIENTS’ MANIPULATIVE BEHAVIORS
Independent Healthcare Professional Interventions
Rationale
Establish a trusting relationship.
Establishing a trusting relationship is as difficult as it is vital. • Deception is a way of life for the patient who uses manipulation, but every healthcare professional intervention is based on the foundation of a trusting healthcare professional-patient relationship. • It may be the first trusting relationship that the patient has ever had in their life. Allow time for trust to develop. Patients cannot be helped to find more adaptive ways of living if they do not recognize their current behavior as a problem and take responsibility for the circumstances in which they find themselves. Inconsistent caretaking is at the root of the development of maladaptive manipulation as a coping mechanism in early childhood. • The goal of manipulation is to somehow make the environment safe and secure. • Knowing what to expect decreases the patient’s anxiety and helps them learn to trust others and the environment. • In addition, consistency reduces the patient’s opportunity to divide the staff by manipulating them. Consistency is vital to ensuring that the patient cannot manipu- late by “splitting” the staff – all team members should provide input in setting goals. Short-term goals include the following: • Recognize and verbalize feelings of anxiety, frustration, or powerlessness. • Recognize instances of manipulative behavior. • Gain insight into the effect of manipulative behavior on others. • Distinguish between wants and needs and learn to delay immediate gratification of both. • Verbalize acceptance of responsibility for own actions. • Limit manipulative behavior and determine and practice alternative methods of gratifying needs. Long-term goals include assisting the patient to achieve the following: • Determine and express needs in a clear, direct manner that does no harm to others. • Demonstrate responsibility for their own actions. Table 5 continued on next page
Help patients recognize their manipulation and potential causes of their behavior.
Provide a consistent environment.
Formulate short- and long-term goals to ensure that every member of the staff carries out the care plan as consistently as possible.
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