How best to set limits?

[etaoinshrdluRN]

I am a new psych nurse with some background in EMS and working in a dementia unit. I've been at it only a few weeks and like it. However, I would love some tips on limiting manipulative patients as well as time management. My weakness is being loath to break off a therapeutic conversation, but in reality, I have only a few minutes to spare at a time.

I also need to get a better feel for an appropriate therapeutic relations ship with someone who is mentally ill, as opposed to a LTC resident, who does become something of a friend, many times.

Any good links? Thanks.

[Davey Do]

In reality, I have only a few minutes to spare.

I also need to get a better feel for an appropriate therapeutic relations ship with someone who is mentally ill who does become something of a friend, many times.

I broke down yor post in order to assimilate the given information and respond appropriately.

First, any relationship requires a Goal of Expectations. For example, if a Therapeutic Conversation is begun with the Limits and Boundaries established (e.g. in your words, "I have only a few minutes"), then the Expectations and Limits are set. This Approach has the advantage of decreasing assumptions and has the added benefit of reinforcement, if need be.

Second, it is a Wise Choice to separate Professional Relationships from Personal Relationships. We are, at all times in the Work Environment, A Nurse First. Once Emotions get involved in a Instrumental Relationship, Logic often gets lost. It's O.K. to empathize, sympathize, and even identify with Those We Serve. However, to allow a Customer, Client, or Patient to become our Friend is to jeopardize the Therapeutic Relationship and our Integrity.

Dave

[etaoinshrdluRN]

Thanks, Dave. To narrow it down a little further, I do feel capable of maintaining that necessary distance. What I am hoping for is to be able to be authentic, empathic and professional without seeming glib or uninterested. I find the sticky post on dealing with borderlines quite helpful in terms of dos and don'ts.

[Popwhizbangz, LPN]

Diplomacy often helps.

I had a lady recently who often talks endlessly, always bitter if anyone cuts her off (inevitable as she never lets them go otherwise), resentful of basically everyone she has ever worked with. I was failing over and over to gently disengage in our first meeting and didn't want to ruin rapport built up with validation of the difficulties, frustration, etc. she's been through over the years. Finally I said "Sadly, other, less interesting tasks than our discussion require my attention. Thank you for your time." Then I left.

Please note, I honestly like talking with folks, and the other duties on my plate truly were tedious, so I wasn't being at all dishonest. Also, that one time, the first time we met, I gave her more time than my usual - that first time sets their impression as someone willing to invest time and energy in them - once that impression is set, it generally takes much less to satisfy people subsequently. If you start off trying to give the minimum, you set an opposite impression, and folks often resent you, demand more, cooperate less, etc. In the end, you come out behind, you get less done with more frustration and unpleasantness, than if you'd gone out of your way to set a positive interpersonal tone from the start.

After that chat, we've got along fine, she's no longer agitated when I'm working, and now she's more than satisfied with occ. brief encounters, provided I provide some encouragement and a useful bit of advice here and there.

In general, what works with all people often works quite well in psych. Makes sense: patients are people, right?