Personality Disorders: Assessment Domains and Interventions (Nursing)

00:01 So what domains do you think we need to be going over for our patient who has a psychiatric or personality disorder? Of course, we need to assess their emotional domain.

00:14 We need to assess how they're thinking their cognitive domain, we need to assess their social domain.

00:22 How are they at work? Are they going to school? How are their social interaction? We want to assess their spiritual domain.

00:30 And that is, whether there is a spiritual domain that is organized religion or maybe it's meditation, maybe they have a different spirituality.

00:42 Remember, we can always listen to someone who has a different belief system than we do.

00:50 We don't have to convince anyone to be like us.

00:53 We have to be able to hear who they are and allow them to go in the direction of their needs as long as it brings them towards recovery and safety.

01:05 And of course, we assess their physical domain.

01:09 So let's take a look at interventions.

01:11 What is the most important intervention that a nurse does with any patient who has a psychiatric disorder? We always assess for suicidality.

01:22 We always want to know if there are any ideations at all of a patient wanting to kill themselves by suicide.

01:31 It is important to ask it outright, "Are you thinking of killing yourself?" "Are you thinking of suicide?" You will not be putting this thought into the patient's head.

01:40 Instead, you will be giving an objective opportunity for a person to be able to say yes or no.

01:48 If the person says yes, you must go to the next level and make sure that you have a one-to-one or a constant observation.

01:58 And you must find out whether or not they have a plan and whether that plan is achievable.

02:05 We also want to make sure that we encourage that out patients attend group therapy.

02:12 Whenever there is group therapy, it may be that we have to have a smaller group for some of our clients.

02:18 But in the bigger picture, getting people back into being social, having appropriate social interactions is incredibly important.

02:30 We also need to be currently and persistently assessing for any changes and liability and emotion that might give in to anger or threat.

02:43 So remember our SAFE.

02:46 The first safe is safe surroundings.

02:49 The A is assess, always assess, constantly assess.

02:54 F is focused on the individual.

02:56 And E is evaluate, evaluate how the intervention is going.

03:02 We also want to assess if there is impulsivity going on.

03:07 And if this client has a high propensity towards self-mutilation.

03:12 Again, if we think that we can get a one-to-one or a constant observation.

03:20 We may need to contract with the patient.

03:25 Put a contract together about threatening behaviors, whether it is threatening to others or threatening to self.

03:33 Putting that contract together, either verbal or written really helps to guide this person towards their recovery.

03:43 Journaling is a wonderful intervention.

03:47 Not everyone likes to write.

03:49 And that is the real truth of the matter.

03:52 And so you may encourage journaling.

03:55 But there are just some people who do not want to write.

03:59 There are some apps that allow people to do one second a day, that's an app that I have often encouraged my patients to do one second a day.

04:10 But in the hospital, patients don't have their cellphones.

04:15 And in some institutions, they even have very limited access to pens and pencils.

04:22 So we have to think about what we're encouraging and whether we're giving them the tools to be able to do it.

04:29 If you are a nurse who's has the time in the day that you can sit with a patient, then you can actually allow self-reflection to go on just as part of your therapeutic interventions.

04:42 You want to be able to encourage people who have anger management problems or impulse problems.

04:49 You want to be able to do some psycho education with them on anger and impulse management.

04:56 And this can also be done in groups.

04:59 We also have to look at the thought patterns that patients have.

05:04 Sometimes those thought patterns really help them as children.

05:10 And it's okay for us to say, "Wow, being able to be really angry used to really protect you from your dad." And then just stop and say, "Isn't working for you now?" And let them start thinking about their own thought processes.

05:32 Remember, we want to get them to start feeding that good dog.

05:35 And it won't happen as long as they think that they are powerless.

05:40 Finally, being able to teach them some alternative coping behaviors.

05:46 Teaching them that there are more than one way to get home.

05:50 I did have one patient and I said, "You're on your way home, you've had a really long day, you know that you're having, you know, a barbecue in your backyard.

05:58 It's really wonderful.

05:59 And you get to the bottom of one of the streets that you normally take to get home, and there's a barricade up.

06:06 Do you just sit in your car until they remove the barricade? Do you go back to work when everyone else is going to be having burgers and dogs at your house?" And of course my patient said, "No, I find a different way to get home." Well, the way you are behaving right now is not working, is it? So let's think of a different way to get home.

06:29 It can be as easy as that without judgment.