[catlvr]

Hi, I am a new LPN (graduated 8/07), working in a residential rehab for addidcted mothers/pregnant women. It is a great job, since I get to help them learn to care for themselves and their children. I'm the only nurse there, and have 21 clients and about 25 kids - it's a big caseload! My main responsibilities are safe med administration, helping the client detemmine if they or their child needs to go to the doctor/ER, and teaching. I like most aspects of this, although the OB stuff really scares me, since most of our pregnant clients are on methodone, and are high risk since most have had no prenatal care prior to coming to our facility. I'm fortuante to have some great OB nurses just a phone call away, and a free pass to call 911 if I feel uncomfortable with the client's state.

Anyway - I have total respect for these women who are trying to get their lives back. I enjoy talking to them, helping them work thru their medical problems and find resources, and teaching them how to care for their kids without being in constant crisis mode. EXCEPT - we have a new client who has boderline personality disorder and I find it very difficult to deal with her. I'm not as good at re-direction as I should be, and I know from observation that she's very manipulative. It is a real struggle for me, so I'd appreciate any tips/help that you can offer. All of our clients have some form of psych disease in addition to their drug use, and I have no problems with that; but this borderline client is driving me nuts.

TIA,

e

[natania]

I'm not sure her "psych disease" is the problem... maybe you just don't like her. (You can't like everyone, can you?) Anyway, maybe you can learn by looking at how others who DO get along with her manage.

[PsychNurseWannaBe]

Hi E,

First I like to say that it is a good thing that you recognize that you are struggling with a client. It will help raise your awareness to analyze the situation and drive you to look for solutions.

It is hard to say what types of TC you should use because each client is different and each client acts differently throughout the day. Just try to maintain a non-judgmental professional attitude with the client and do not allow them to manipulate the situation. Clients with BPD are sometimes described as being great when things are good; however, they can be very negative when something isn’t going their way. For example, if they are doing well and you attempt to set limits, the person may become quite hostile and negative or they may try to make you feel guilty. The purpose to their behavior is to try to get you to change your mind.

My advice is to research the disorder to learn how to use appropriate therapeutic communication. Working with clients who have BPD can be a daunting task because they have unstable patterns with social relationships. Consistency and setting limits is key for being successful!

Regardless of the person’s disorder, remember to treat them with dignity and respect. If you are struggling, speak to a coworker in a private enclosed space such as the nursing unit. It is OK to feel the need to vent. It is best to let it out there, than to blow up at the client.

Here are some links to help you.

http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml
http://www.emedicine.com/med/topic3472.htm
http://www.nlm.nih.gov/medlineplus/personalitydisorders.html

Also consider the following nursing diagnoses:

Anxiety
Disturbed Thought processes
Ineffective Coping
Powerlessness
Spiritual distress
Impaired social interaction

I wish you all the best!

~Psych

[catlvr]

Originally Posted by natania

I'm not sure her "psych disease" is the problem... maybe you just don't like her. (You can't like everyone, can you?) Anyway, maybe you can learn by looking at how others who DO get along with her manage.

Yes, that is quite possible that I don't like her behavior, attention seeking, and constant self-centered approach. I normally have empathy for every client, and that is why this is such a struggle for me; I really have to brace myself with a pep talk about how she may be frightented or lonely, and that is why she acts as she does. I'll take your good suggestion and observe others to see how they deal with her.

Thanks, e