COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Psychiatric Nursing Interventions POLICY NUMBER: 1309
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1 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Psychiatric Nursing Interventions POLICY NUMBER: 1309 Effective Date: August 31, 2006 SUBJECT: APPROACHES FOR PASSIVE-AGGRESSIVE (NEGATIVISTIC) OR MANIPULATIVE BEHAVIOR 1. PURPOSE: The purpose of this policy is to assist the nursing staff member with the Individual who is exhibiting passive-aggressive (negativistic) or manipulative behavior and to provide a uniform approach to evaluation, intervention, and treatment. 2. POLICY: Each Individual exhibiting passive-aggressive (negativistic) or manipulative behavior shall receive appropriate individualized treatment to alleviate those symptoms in a structured, safe, and secured environment. Each Individual diagnosed with passiveaggressive (negativistic) or manipulative behavior shall have an individualized nursing care plan with short and long-term goals, which shall be compatible with the Master Treatment Conference goals. 3. GENERAL INFORMATION: It is especially important to remember your professional role when working with Individuals who manifest passive-aggressive (negativistic) or manipulative behavior. It is neither necessary nor particularly desirable for the Individual to like you personally. It is not your purpose to be a friend to him. Maintaining your professional role with the Individual will be a firm basis on which to establish a therapeutic relationship in the best interest of the Individual. 4. DEFINITIONS: Passive-aggressive (negativistic) - behavior is a type of indirect expression of feelings whereby a Individual does not express aggressive (angry, resentful, etc.) feelings verbally, but denies these feelings and reveals them instead through behavior. This behavior may be indicative of a personality disorder "characterized by use of passive behavior to express hostility. The behavior includes obstructionism, pouting, procrastination, stubbornness, intentional inefficiency, and criticism and scorn of authority. These individuals are unaware that on going difficulties are the results of their own behavior. -1-
2 Manipulative behavior - is characterized by the Individual's attempts to control his interactions and relationships with others, often to satisfy some immediate desire or need; or to avoid discomfort, change, or growth. Individual's who manifest manipulative behavior may have little genuine motivation to change their ways of relating to others and of dealing with situations in general. In seeking treatment, the Individual may want to get out of a bind, crisis, or stressful situation (employing manipulative behavior with regard to treatment). Examples of abnormalities may include: -Denial of problems or feelings -Lack of insight -Resistance to therapy; preoccupation with other Individuals problems, with staff members, or with unit dynamics to avoid dealing with his own problems -Inability or refusal to express emotions directly -Manipulation of staff, family, and other Individuals -Playing one person against another -Attempting to gain special treatment or privileges -Attention-seeking behavior -Somatic complaints -Intellectualization or rationalization of problems -Seductive behavior or sexual acting out -Refusal to participate in activities -Dependency -Low self-esteem/ low self-confidence -Forgetfulness -Covert aggressive behaviors are chosen over self-assertive behaviors -Procrastination -Stubbornness 5. PARTIAL LISTING OF POTENTIAL NURSING DIAGNOSES: Manipulative behavior related to: -Anger, hostility or resentment -Fear of vulnerability Disturbance in interpersonal communication related to: -Decreased ability to express feelings Lack of insight related to: -Denial of problems -Denial of feelings such as anger -Resistance to change -Low self-esteem -Early rejection by significant other -2-
3 Denial of problems or feelings related to: -Fear of feelings -Feelings unacceptable to the Individual -Fear of dependency or inadequacy -Feelings of helplessness Powerlessness related to: -Interpersonal interaction -Lifestyle of helplessness -Difficulty connecting own passive-resistive (negativistic) behaviors with hostility or resentment Resistance to treatment related to: -Lack of insight Low self-esteem related to: -Feelings of worthlessness -Guilt 6. INDIVIDUAL OUTCOME/GOALS: The Individual will be expected to: -Verbalize increased insight into their behavior -Express feelings verbally and non-verbally -Express anger and hostility in a non-destructive manner -Develop or increase feelings of self-worth -Demonstrate decreased manipulative, attention-seeking, and/or passive-aggressive (negativistic) behaviors -Participate in the treatment program and activities -Communicate directly and honestly with other Individuals and staff about self and personal feelings -Decrease somatic complaints -Establish and maintain mature, non-manipulative relationships and patterns of dealing with other people and situations 7. IMPLEMENTATION AND INTERVENTION: Deal effectively with the Individual who uses passive-aggressive (negativistic) and manipulative behavior in interactions, relationships, and life situations: A. Be consistent. Set clear limits for expected behavior. Do not debate, -3- A. To deal effectively with and to decrease passive-aggressive (negativistic) and
4 argue, or bargain with Individual. B. Be direct and confrontational if necessary. Enforce all hospital policies and regulations. manipulative behaviors B. Explain; DO NOT apologize for enforcing hospital policies and regulations. Decrease manipulation of staff members: A. Do not discuss yourself or other staff members with this Individual. Set limits on frequency and length of interactions with Individual. B. Withdraw your attention if Individual begins saying that you are "the only staff member I can talk to... or the only one who understands" and so forth. A. Sharing information about yourself or others is inappropriate. To decrease manipulative behaviors. B. If you are "the only one" the Individual may be too dependent or may be flattering as a basis for manipulation. Decrease the Individual's denial of problems, promote their insight: A. Discuss the Individual's behavior with him in a non-judgmental manner. B. Help identify the results and the dynamics of their behavior and relationships. A. To decrease denial of problems and increase effectiveness of therapy and increase insight. B. Reflection and feedback can be effective in increasing insight. Decrease the Individual's attention-seeking behavior, acting out, and secondary gains: A. Withdraw your attention when Individual refuses to be involved in activities or other therapies or when the Individual's behavior is otherwise inappropriate. A. It is important to minimize attention given to unacceptable behaviors. Withdrawing attention can be more effective than negative reinforcement in decreasing unacceptable behaviors. -4-
5 Promote healthy and appropriate adult behavior and interactions; promote the Individual's self-esteem: A. Give attention and support when Individual exhibits appropriate behaviors. A. To reinforce healthy and appropriate adult interaction. Decrease the Individual's somatic complaints: A. When the Individual voices somatic complaint, treat the issue immediately then tell the Individual that you will discuss other things; do not engage in lengthy conversations about physical complaints or physical condition. B. Observe and note patterns in somatic complaints. A. Treating the somatic complaint in a matter-of-fact consistent manner will minimize reinforcement of attention seeking behavior. B. To decrease somatic complaints as passive aggressive symptoms. 8. EVALUATION: Documentation should reflect: 1. Individuals current status and progress towards meeting nursing objectives and plans. 2. Changes in Individual condition. 3. Nursing interventions for unusual or sudden behavior changes. 4. Response to treatment program. 5. Attendance and participation in scheduled groups. 6. Response to medication. 7. Effect illness has on eating, sleeping, hygiene, elimination, and behavior. 8. Individual education. -5-
Effective Date: August 31, 2006
COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Psychiatric Nursing Interventions POLICY NUMBER: 1312 Effective Date: August 31, 2006 SUBJECT: CONVERSION DISORDER 1. PURPOSE: This policy
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ANGER MANAGEMENT CHECKLIST. by Frank D. Young Ph.D., R. Psych.1[1]
![ANGER MANAGEMENT CHECKLIST. by Frank D. Young Ph.D., R. Psych.1[1]](/thumbs/79/79305317.jpg "ANGER MANAGEMENT CHECKLIST. by Frank D. Young Ph.D., R. Psych.1[1]")
ANGER MANAGEMENT CHECKLIST by Frank D. Young Ph.D., R. Psych.1[1] As soon as you become aware that you may be angry, begin to break the short circuit to aggression by using these questions and methods: