I'll be honest, regardless of the patient, being nice goes a lot farther to prevent escalation than being curt or abrupt. A lot of nurses are rude, short, and demeaning to patients. They talk to them like children. Now, if you aren't getting very far with being nice, then you have to put your foot down and say "we aren't doing that....". There's a fine line and every patient is different. You can set limits all day with a manic bipolar, but it'll just be repeating yourself 100 times. They really don't listen or take what you say literally. They simply can't help be annoying.
Patients also pick up on naivety pretty quick. They will game you at every turn. Try to capitalize on your inexperience. For example, you're overwhelmed, busy, trying to keep up and not make mistakes. A patient will come up and say "You never gave me my Seroquel" or "The doctor told me to ask you for additional Ativan if I needed it". They really think we're stupid. NEVER pass a narc without documenting it, immediately before or after. Even in a code, if the patient is being held, always write that you signed out the Ativan and when it was given. I never pass a PRN without documenting at that moment. Scheduled meds I remember.
I wouldn't worry too much about setting boundaries for manics. They are rare and not much problem. Just annoying/needy/intrusive. The real problem children are borderlines and personality D/O NOS. Same with addicts/detox. They are the ones who escalate d/t refusal to get PRNs early, refusal to obtain the meds they want from providers, or trying to buck the staff rules.
The problem children in psych are:
1. Axis II (old DSM code for personaloty D/Os, mostly borderline/antisocial/cluster B)
3. Drug-induced psychosis (meth, bath salt, spice)
4. DD (developmentally delated, such as MR and Autism)
That's typically what you'll see most of unfortunately. True SMI (serious mental illness) patients, such as schizophrenia, bipolar D/O, schizoaffective, are usually pretty good and passive. They are also rare.
I worked emergency psych (petition) for a 18 months. I'd say we had 70% drug-induced, 15% Axis II, 7% SMI, 5% DD, and 3% bogus petitions. I often said, if it weren't for meth we'd have no patients.
Something I should add, patients will feign symptoms a lot. Mostly to obtain narcotics or to be sent to the ER. I'm extremely cynical and won't send them. Most nurses send them regardless. Most nurses are afraid to lose their license. I get it. I've sent patients when I wasn't sure. I'm just pretty intuitive. I told someone last week c/o chest the day before discharge that we'd keep and eye on him. IOW, he wasn't going to the ER. He was so mad. Tried to tell me he was puking. Ok, show me. He showed me some spit on the floor. Yeah, ok, MI...right. He was discharged and never brought up chest pain to the day shift. Basically, he didn't want to leave, so he wanted to sabotage his discharge.
It's common for them to sabotage their discharge. They will cut themselves, report increasing SI/HI, ect...
But don't be so fast as loose as me with somatic complaints. I'm pretty wise to the games and willing to take chances. Just letting you know they will play medical games, such as fake seizures a lot.