Psych Patients with poor boundaries

  1. How do you deal with patients with poor boundaries? Setting limits and boundaries can be difficult especially when patients are not willing to listen or their illness prevents them from fully understanding the patient-nurse relationship. Any tips?
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    About CanadianNurse15, BSN, RN

    Joined: Nov '15; Posts: 14; Likes: 6


  3. by   NMorrisRN
    I'm interested to see what the response is to this post. I hope someone answers soon. As a new psych RN I need this tip as well.
  4. by   Whispera
    start by telling them what the boundaries are, telling them when they are inappropriate, and telling them what is appropriate. sometimes psych patients don't realize they aren't following social rules...that's part of some of their illnesses...
  5. by   Davey Do
    Quote from Whispera
    start by telling them what the boundaries are, telling them when they are inappropriate, and telling them what is appropriate.
    Yes. Be clear and concise, such as "There will be no physical displays of affection." Then, reinforce those boundaries through repetition. When the boundary is breached, take the offending Patient to the side, and repeat the boundary and the offense. Avoid lecturing or talking down to the Patient. Speak in a volume a notch above a whisper. This conveys confidential concern. Request the assistance of the Patient: "Look, I need your help here- there are rules we all have to adhere to and I need you to be an example. Can you do that for me?" Just about everybody wants to help and be an example.

    If the Patient has a devil-may-care attitude, or a if power play is sensed, another tact may be taken- Find out what the Patient wants and use that want as a bargaining tool. For example, a lot of Patients want discharged. "I'm going to show you the quickest way out of here" and then reinforce treatment and rule compliance. With difficult Patients, I've gone as far as to say, "Look, I can be your best friend or your biggest stumbling block. The choice is yours".

    These are merely two general examples of techniques found to be successful in manipulating your media to achieve a desired result. Of course there are many nuances to such interventions which come with time and experience. If you'd like to discuss any specific circumstances, CanadianNurse, I'm game!

    Best of luck to you!
  6. by   Elladora
    Simply put, be firm and consistent. My clients know I will fist bump them and that's it. I don't hug, shake hands, rub backs, anything like that. My only exception to that is I will give a hug on discharge day.

    A lot of my clients will try to push those boundaries but I gently remind them it's a no go.
  7. by   MMC.RN
    I am very firm and consistent especially dealing with the patient population I deal with (forensic adult males with mental illness). I work max security admissions so it's incredibly important to have boundaries especially since I am a female. I don't allow patients to touch me other than a fist bump, I always walk or stand my distance when talking with them and I typically will place myself in an area where I can get out if necessary. I don't discuss my personal life at all, although I will talk about mundane everyday subjects like sports, books, TV shows etc to build a therapeutic relationship and make them feel comfortable. I am nice, respectful, and therapeutic with my patients and am more than happy to talk with them although if they overstep there is no leeway and I firmly say that I don't discuss that with patients and I keep my personal life private. If they insist I halt the conversation and ask that they take what we call a, "chill time," in their room as they are being inappropriate.
  8. by   falcon123
    As others have similarly said, be "matter of fact" about the boundaries. Be clear, direct, and concise. Their illness often impacts their ability to make appropriate social decisions. Being lovingly firm is usually effective. If they still push the boundary, be firmer still. If they keep pushing the boundary, then get you supervisor and other staff members involved. You have a right to protect your personal space.