[RachelLVN]

Right now I'm a med/surg nurse. I'm working on my RN and want to continue in med/surg for a few more years. Last semester I did my psych rotation for nursing school and loved it. The only thing is that maybe I am a little naive, but I am VERY easily manipulated, so I struggle with patients with borderline and such disorders. I love rehab, detox, etc., and also depression, schitzophrenia, bipolar, etc., but I'm just not sure I could deal with the manipulation! When I do catch onto what they are doing, it frustrates me to no end!

Did any of you deal with this in the beginning? How did you cope with it?

rlc

[rn/writer]

I hear what you're saying. After many years in psych, here are a few of the things I learned.

Assume everyone is trying to manipulate. That's not as cynical as it sounds. Everyone on a psych unit has psych issues. Some will knowingly try to play the game. Some will do it without being conscious of their behavior. To some extent, we all do a little of this. Which leads to the next thought.

Don't take it personally. It isn't. Even when it is, it isn't. If you weren't there, the behavior would be directed at the person taking your place. It's a waste of time and energy to get upset (with the patient or with yourself) over behavior that is part of the pathology.

Communicate with other staff. It's not easy to split staff members who have the same plan and who support each other. When my kids were growing up, we had a rule. If they ever tried to play one parent against the other, whatever they wanted was automatically turned down. No one ever tried it more than once.

Know your policies and procedures. Don't bend or break the rules without a darn good reason and back-up from a manager or a very compelling reason.

Build a repertoire of phrases that buy time--

Let me think about it.
I'll get back to you.
Let me talk to so-and-so.

If there is a point system, refer back to it. A patient asks for a point-related privilege. Don't say yes or no. Ask the patient if he has the points for the privilege and let him come up with the yes or no answer himself.

Reflect your concerns back to the patient when you think you're being manipulated. "Sounds like you want me to give you special treatment. What do you think the rest of the group would say about that?"

Probably the most important thing you can do is to get your thinking out of the "tug-of-war" frame of reference. The rule with a tug-of-war is "the only way to win is not to play." Period. So if someone wants to engage in a power struggle or even some good-natured cajoling, refuse to take the other end of the rope. You do that by calling them out. "Oh, I see you're trying to butter me up." Or, "I'm not going to argue with you." You do it with the use of humor. You do it with a time out of some sort. But the main thing is you do it. And you do it without anger or irritation. Easier said than done at times but, that's the most effective approach.

I'll see if I can think of some other things. Having worked other places besides psych, let me tell you, these skills transfer beautifully to other patients. They can even work on people outside the workplace.

I wish you well.

[Thanet]

When we have a manipulative client we will allocate nurse 'X' to grant any favours.

If the client comes to you and says nurse 'X' said I could do 'Y' then you say "Then Nurse 'X' can do it for you."

I hope that make sense.

P.S. I work in a locked ward.

[Daytonite]

When I went back for my BSN one focus of the program was on communication skills. We had to read
Games People Play: The Basic Handbook of Transactional Analysis by Eric Berne, M.D. We all learn to manipulate from the moment we are born. Little kids whose parents have let them get away with it are little masters of it. Watch a kid play two parents off each other to get what they want. They are absolutely brilliant at it. Because it is such an unconscious thing it makes it that much more difficult to recognize sometimes. However, now that you've identified it, you'll start looking out for it. Like any other nursing skill it takes practice to deal with it. People who manipulate are usually masters at it, so don't feel bad if they "get" you every once in a while. It's a game. You have to not get involved in their game. This also sometimes requires some assertive behavior on your part. That doesn't mean you have to be mean, you just have to be consistent and sure about how you are going to react.

When you realize you have been duped by a manipulator, you chalk it up to experience, learn not fall for the same ploy again, and move on. All talk with a patient should be considered therapeutic. Therapeutic communication skills take years to perfect. Do you want some weblinks on them? I have a few web links to powerpoint lectures from nursing programs on basic therapeutic communication skills as well as an assertiveness tutorial that I will post for you if you are interested in seeing them.

[mugg54]

All talk with a patient should be considered therapeutic. Therapeutic communication skills take years to perfect. Do you want some weblinks on them? I have a few web links to powerpoint lectures from nursing programs on basic therapeutic communication skills as well as an assertiveness tutorial that I will post for you if you are interested in seeing them.[/quote]


I would love for you to post these. I could use them too!

Thanks!

[mugg54]

Originally Posted by mugg54

All talk with a patient should be considered therapeutic. Therapeutic communication skills take years to perfect. Do you want some weblinks on them? I have a few web links to powerpoint lectures from nursing programs on basic therapeutic communication skills as well as an assertiveness tutorial that I will post for you if you are interested in seeing them.

I would love for you to post these. I could really use them too!

Thanks!

[mugg54]

Oops! Sorry Daytonite! I don't know how to post using your quote! I don't know how I put your quote in and it has my screename!

[nightmare]

Press the "quote"button on the posters post that you want to quote.You must have pressed your own post quote to get your name on it!( Hope that made sense!)

[Daytonite]

Here you go. . .

Therapeutic Communication

• http://www2.nemcc.edu/RLansdell/web/Communication%20test-taking%20strategies_files/frame.htm - a really nice slide show on therapeutic communication. Includes techniques, scenarios and blocks to communication.
• http://www.childbirths.com/euniversity/therapuetic.htm - Therapeutic Communication. A discussion about therapeutic communication that includes a nice listing of examples of appropriate open-ended responses to make to patients to get them to talk.
• http://faculty.mc3.edu/rbenfiel/NUR109/NUR109Communication/sld001.htm - Communication. A slide show (18 slides)
• http://www.education4skills.com/thecom/Contents.html - therapeutic communication skills tutorial – page of links to subjects covered
• http://monsoon.he.net/~eri/realaudio/therapeutic/thera.htm - a lecture series on therapeutic communication and the nursing process on CDs that you can access at this website from Education Resources, Inc. You need a real player to view the video.

Assertiveness

• http://changingminds.org/techniques/assertiveness/assertiveness.htm - assertiveness
• http://www.dlsweb.rmit.edu.au/toolbox/fmi/content/tutorial/assert/assert00.htm - this is a really nice online assertiveness tutorial from Australia. Click on the links to proceed through the tutorial. Includes sound clips of examples.
• http://www.gp-training.net/training/leadership/assertiveness/index.htm - assertiveness for doctors. An interesting site that links you into information about being assertive. Includes a list of books with information on assertiveness.