Violent Borderlines

  1. What is a therapeutic response, in a acute setting, to a violent, attention seeking borderline?
  2. Visit Leahr profile page

    About Leahr

    Joined: Apr '04; Posts: 56; Likes: 14
    psychiatric unit RN
    Specialty: Telemetry, LTC, Psych

    29 Comments

  3. by   lifecycle1898
    The Therapeutic thing would be to stop looking for an automatic response. Also think of your patients as people instead of labels and don't jump to conclusions about motivation for behavior. You've already attached some very negative labels that are not consistent with being therapeutic.
  4. by   UM Review RN
    Quote from lifecycle1898
    The Therapeutic thing would be to stop looking for an automatic response. Also think of your patients as people instead of labels and don't jump to conclusions about motivation for behavior. You've already attached some very negative labels that are not consistent with being therapeutic.

    Please forgive me as I'm not a psych nurse, but how else is she supposed to describe the behaviors? With a borderline personality, she'd be at it for hours.
  5. by   Jules A
    Quote from Angie O'Plasty, RN
    Please forgive me as I'm not a psych nurse, but how else is she supposed to describe the behaviors? With a borderline personality, she'd be at it for hours.
    Lol, I'm probably going to get flamed also but I was going to suggest lots of PRNs.
  6. by   inthesky
    First, is this person actually violent or do he/she have a reputation of violence? We get a lot of people here with all sorts of HI who respond really well to a calm environment and respect. There are patients in which one of our techs remember as violent from his old job at the more acute facility in town and most of them are not problems here due to staff attitude. If pleasantness, respect, and calm redirection and therapeutic redirection fail, call the doc for a strong PRN. To that occasional patient, we sadly just sedate the living crap out of him giving him all the PRNs he desires, until we find openings in the acute anger to implement therapeutic direction and decrease PRNs/sedation or until we petition him and send him to another more acute facility >_<.
  7. by   inthesky
    Also, a calm response can really extinguish irrational anger. A week or so ago, a (non-psychotic) patient approached me telling me that he was about to freak out and hurt people. I noticed a lack of posturing and that he was still at the reasoning stage of tension. I calmly walked him to his room out of the stimulation and away from the other patients (and of course having a clear pathway to the open door), leaned in a relaxed manner against the cabinet (out of his reach) and discussed his feelings. He appeared more relaxed and agreed to take a PRN by mouth or IM and wait for me to call the doctor and for pharmacy order processing. About a half hour later, I gave him some zyprexa zydis, he thanked me, he slept a bit, and crisis averted. The doctor chose not to order IMs or ativan because he suspected borderline antisocial drug seeking. Of course this calm scenario doesn't always work. >_< This patient was not psychotic and denied actual desire to hurt others.
  8. by   Leahr
    The patient has a history of violence and threatened to "kick our asses" if she sees me or some other staff members. She shoved another patient and punched a hole in the wall. We have been setting solid boundaries and staff has been staying on the same page as far as her treatment plan. Prn's have helped, too.
  9. by   Leahr
    Lifecycle-Your reply is not helpful.
    Last edit by rn/writer on May 1, '09 : Reason: Removed unhelpful comment.
  10. by   algebra_demystified
    Quote from Leahr
    Lifecycle-Your reply is not helpful.
    Agreed. Nurse sounded naive.
    Last edit by rn/writer on May 1, '09 : Reason: Removed deleted unhelpful comment from quote.
  11. by   Thunderwolf
    going back to the original post:

    Quote from leahr
    what is a therapeutic response, in a acute setting, to a violent, attention seeking borderline?


    my response:

    i do not perceive this opening question as a blanket "labeling" regarding all people suffering with borderline personality disorder. in the past, as a previous licensed counselor and as a psych cns, i have personally treated and intervened with some individuals with bpd who were both violent and attention seeking.

    the opening question is a legitimate one....asking for an appropriate response regarding these certain individuals who demonstrate/threaten both of these tendencies.

    verdict rendered.

    moving on.
  12. by   Leahr
    In the sky--sounds like you handled it well.
  13. by   inthesky
    thanks =) What I did there would probably not work with your patient >_<. Your patient sounds like she belongs in jail or forensic psych. I hope you, your staff, and patients were not injured!
  14. by   lifecycle1898
    Quote from Leahr
    Lifecycle-Your reply is not helpful.
    I what worked in Psych for 30 years. I currently work at UCLA's NPI, I've also worked at Atascadero, Metropolitan and Fairview State Hospitals. I've worked in Geri psych, child, adolescent, adult, ECT, substance abuse, Eating disorders, forensics and developmental disabled. I've been around long enough to remember when that Diagnosis did not exist and seen it evolve into the trash heep for Nursing that it's become today.
    Last edit by rn/writer on May 1, '09 : Reason: Removed deleted unhelpful comment from quote.

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