NEED ADVICE Male Borderline!!!

caliotter3 · May 3, 2015

Many times I have observed experienced nurses acting as if that type of person were not standing there, bothering them.

Meriwhen, ASN, BSN, MSN, RN · May 3, 2015

Set boundaries/limits on his behavior, then everyone needs to enforce them consistently. Make sure those boundaries are passed along in shift report so everyone is aware of them. Borderline personality disorder patients frequently engage in staff-splitting, and if he can get away with something with one staff member, he'll try it on other staff.

verene, MSN · May 3, 2015

Set boundaries/limits on his behavior, then everyone needs to enforce them consistently. Make sure those boundaries are passed along in shift report so everyone is aware of them. Borderline personality disorder patients frequently engage in staff-splitting, and if he can get away with something with one staff member, he'll try it on other staff.

This! I work with a patient with borderline on a regular basis, the rules needs to be consistent and the staff needs to work together as a team. Communication between different shifts needs to happen so that staff know what is actually going on vs what the patient is saying to cause hard feelings between staff.

I've found when this patient gets too pushy simply stating "I will not discuss this subject anymore." and then completely ignoring them works fairly well. Try to keep as calm and as indifferent as possible in the face of their behavior. Outwardly keep it polite but distant. The manipulative behavior and non-stop button slamming internally winds me up like nothing else, but showing that it gets to me just gives this person what they want.

NightOwlPsyRN · May 3, 2015

I agree with the comments above, setting firm boundaries and limits are key. I'm not sure if your facility is able to put client's on behavioral plans, but I find that it works pretty well. It's a contract between client/therapist/psychiatrist/charge nurses stating that the client cannot demonstrate a list of stated inappropriate behaviors...and states that with good behaviors come privileges, and inappropriate behaviors having privileges taken away.

Davey Do · May 3, 2015

Great Inquiry/Responses! My heart goes out to you, wingding.

I've informed the Patient, after Boundaries have been crossed, that they are "Persona Non Grata". Unless, of course, they're in Respiratory or Cardiac Arrest or Profusely Bleeding from One or Several Orfices.

I even went as far with one Borderline Female Patient to inform her that I felt Harrassed. She avoided me.

Another Borderline Patient started her Umpteenth Request with, "I'm not trying be a Pain, but..." and I broke in with, "You don't have to try. You're a Natural!"

Sometimes Humor works too.

wingding · May 4, 2015

Thanks everyone!!! Escpecially to Meriwhen who brought me back to what I know but was too close & too worked up to remember!!! Saturday we did a little better, I was able to keep distance, shortened conversations & did a lot of "I am not discussing this any further, please step away from the desk". Sunday he was a more experienced nurse's patient & I directed him back to her, reinforced everything she said - when she said no & he came to me I reminded him his nurse just told him no - the answer was no & turned around & walked away. He went to every staff that came on the floor, lab people, house supervisor, complaining how mean the last one was to him. He tried intimidation, manipulation, wear them down by bugging them technique, guilt, threats to sue. When he said he was going to report it all, I told him I wish he would so our supervisors would understand fully. He kind of skulked away on that one. Thank you all for reminding me how to handle this type of pt. I can remember when it is female borderline, but the males just seem so much more intense & I don't see it as often. Just know that each of your points were used this weekend & I was able to finally regain my sanity. I am grateful!

greenbeanio · May 5, 2015

We use a behavior plan, refer all questions and concerns to their contact person who sets a time to meet with the pt for a finite length of time that is not extended. And encourage the pt to write down all of their concerns so that they can be addressed within the time allotted.