How would you respond to sarcasm and hostility of a borderline personality?

In a professional manner. Provide the treatment that she/he needs at the time.

I'm not sure what you are looking for by way of an assignment...

SJ

I had to write that paper about a fellow nurse....i failed that paper...but I was drinking beer when I wrote it.....passed the class...failed the paper....owell...yawn:chuckle

I'd respond with Haldol.

Seriously, though, its all about firmness and boundaries with many psych patients, particularly manipulative borderline ones. Provide the care they need in a professional way, set clear boundaries, and don't allow this patient to ruffle you. Or don't appear ruffled.

Sincerely,
BeckRN, psych RN and also new to allnurses!

Hi Aussie. I work in a small ER in northern Canada, with a large catchment area of people who live in economically challenging situations, so we deal with some people who are depressed and suicidal. First you need to follow Susan Jean's advice about the professional behaviour. It's not about you personally. These people typically have few or no coping abilities, so the dramatic action of a few swipes at their wrists is their way of asking for help, and of getting family members or significant others to be aware of their needs.

Set boundaries by stopping any disrespectful behaviours such as swearing or yelling. Speak quietly. Any escallation in voices only fuels the fire. Remind the patient that they are there for help and you are helping. Don't laugh about the person's "nutty" behaviour with other nurses at the desk - if they don't hear you, family or friends will.

Find out ahead of time what resources are available in your community such as Mental Health Associations and Crisis Lines to help people once they leave the hospital. Have them written down so that the person can take them with them when they leave - they won't remember much of what they say or you say.

Remember that you are in ER, and your job is not to fix their long term problems, but to get them out of ER in one piece. While they are there your job is not to take abuse - get security involved or get them into a locked room situation. Few people are effective at cutting their wrists due to the anatomy involved - if there isn't much blood they won't exsanguinate, and if there's a lot of blood, they'll get quiet soon enough. Remind them that they may not be able to use their hand in a functional manner in the future if they've cut tendons and don't accept your help - that usually quiets them down. It's also indicative that they want a future, they just don't know how to move forward.

I just hate in when there is lots of alcohol or recreational drugs involved - and these people really take some careful handling.

Once again, their hostility is not directed at you personally - so don't make it personal. Don't respond to their comments, be polite and firm. They may even appreciate the boundaries that you set once they cool down.

I hope this helps.