" Prior to nursing school, I recognized that I have codependent issues, and I worked on them for several years and continue to do so. I no longer worry about what people think of me, but I must still present as a people pleaser, based on how people react to me – that is part of my problem. So, I am working on becoming more assertive and confident in my reactions to people."
Self-awareness is always a good place to start. We need to know ourselves, our strong and weak points, in order to grow and develop and effectively deal with the Mentally Ill.
"I need to exert my authority, but I feel like if you meet anger with anger, it escalates the situation."
I found this to be true, in that the like-energy will esculate the situation.
What would have been a good response? How about “A, we’re just asking you to leave the dayroom for 15 minutes so we can take report. You can come back here then.”
You gave an appropriate resonse, in that your statement gives clear, concise gudelines. You're also making the Patient privy to some information so nothing is vague. I like to initially use the line, "I need your help." Very few people do not like to "help" if they can. We all need to feel like we're needed. I often get a response of a look of surprise, as if they are saying, "What? You need MY help? What can I do for you?" I continue, by saying something like, "We need to use this room for report, so could you assist us by making sure confidentiality is not breached..." Have them move chairs, or some other small task, to make them feel as though they are a part of the process.
If the soft approach doesn't work, then I tend to lay down the law: "We need to use this room for a confidential report. You need to leave so we can get on with our business. If you refuse or otherwise act inappropriately, you will need to deal with the ramifications of your actions or inactions."
These two examples are both ends of the spectrum. The soft approach is a sugar-coated manipulation technique. The law approach is a reality check. The appropriate approach usually lies somewhere within the spectrum and you'll know which way you will need to lean by accurately reading the Patient.
"My colleague said “She was just faking it!” (which I think she had suspected already, this just confirmed it). What would be a therapeutic response to this behavior?"
Hopefully your colleague didn't make this statement in the presence of the Patient. That would not have been therapeutic. I could critique the statement and give you rationales, but, instead will answer your question:
These People are Mentally Ill. Expect inappropriate behavior from them. Inappropriate behavior is a classic symptom of Mental Ilness. I would suggest your response to be one of a concept called "Being Lovingly Indifferent". We care about our Patients, but we do not invest in them emotionally. Be professional, factual, and document the outcome of your interventions.
My question: should we call her on her BS ”?
Our job as Medical Professionals does not have within its guidelines to be a Judge, Jury, or Executioner. We Assess, Plan, Implement, and Evaluate Care. Taking a subjective statement from the Patient, obtaining Facts, and determining the best route of action is a typical Nursing Process. The Psychiatrist and Therapist need to be informed of the Patient's behavior. Be factual, concise, and objective in your reporting.
I could have discussed these situations with you 'til the cows come home, elizabethgrad09. I would have like to point out more that you're doing right, and discuss some points at a greater length, but my time and energy are finite.
Generally, I want you to know I truly appreciate your actions in dealing with Menatlly Ill Patients and the fact that you are endeavoring to grow as a Person and a Professional.
My very best to you.