Page 2281 - Saunders Comprehensive Review For NCLEX-RN

▪ Determine what the client considers to be her or his wants and feelings.

▪ Listen closely to what the client is saying.
▪ Avoid verbal struggles: agree or agree to disagree.
▪ Provide the client with clear options that deal with the client’s behavior.
▪ Offer choices and optimism.
▪ Assist the client with problem solving and decision making regarding options.
▪ Debrief the client and staff.

Manipulative Behavior

▪ Set clear, consistent, realistic, and enforceable limits, and communicate expected
behaviors.
▪ Be clear about consequences associated with exceeding set limits and follow
through with consequences in a nonpunitive manner, if necessary.
▪ Discuss the client’s behavior in a nonjudgmental and nonthreatening manner.
▪ Avoid power struggles with the client (avoid arguing with the client).
▪ Assist the client in developing means of setting limits on own behavior.

Box 65-7

Interventions for Depressed Clients

Risk for Harm

▪ Assess for homicidal and suicidal ideation.
▪ Provide safety from suicidal actions (be certain that there are no harmful objects
in the environment).
▪ Do not leave the client alone for extended periods.
▪ If the client has a suicidal plan, place on one-to-one supervision.
▪ Form a “no-suicide contract” with the client as appropriate.

Activities

▪ Use gentle encouragement to participate in activities of daily living and unit
therapies.
▪ Do not push decision making or the making of complex choices or decisions that
the client is not ready for.
▪ Provide achievable activities in which the client can achieve success (focus on
strengths).
▪ Begin the client with one-to-one activities.
▪ Provide activities for easy mastery to increase self-esteem and help in alleviating
guilt feelings and activities that do not require a great deal of concentration
(simple card games, drawing).

2281