Nursing Care Plan (NCP) for Personality Disorders
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Outline
Lesson Objectives for Nursing Care Plan (NCP) for Personality Disorders
- Understanding Personality Disorders:
- Define personality disorders and recognize them as enduring patterns of inner experience and behavior that deviate significantly from cultural norms.
- Differentiate between the three clusters of personality disorders (Cluster A, B, and C) based on DSM-5 classification.
- Identification of Personality Disorder Traits:
- Identify common traits associated with various personality disorders, such as impulsivity, emotional instability, social withdrawal, or rigid thinking.
- Understand how these traits impact the individual’s functioning and relationships.
- Recognition of Cluster-Specific Characteristics:
- Differentiate between Cluster A, B, and C personality disorders, understanding the distinctive features and behaviors associated with each cluster.
- Recognize how these characteristics may present challenges in providing care and support.
- Communication and Therapeutic Approaches:
- Explore effective communication strategies and therapeutic approaches when working with individuals with personality disorders.
- Understand the importance of establishing trust, setting boundaries, and promoting a therapeutic alliance.
- Collaborative Care and Multidisciplinary Approach:
- Emphasize the significance of collaborative care involving multiple healthcare professionals, including psychiatrists, psychologists, social workers, and nurses.
- Recognize the role of a multidisciplinary approach in addressing the complex needs of individuals with personality disorders.
Pathophysiology Personality Disorders
Personality disorders are characterized by enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual’s culture, are pervasive and inflexible, have an onset in adolescence or early adulthood, are stable over time, and lead to distress or impairment. These disorders are categorized into three clusters:
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- Cluster A (Odd or Eccentric Disorders): Includes paranoid, schizoid, and schizotypal personality disorders.
- Cluster B (Dramatic, Emotional, or Erratic Disorders): Includes antisocial, borderline, histrionic, and narcissistic personality disorders.
- Cluster C (Anxious or Fearful Disorders): Includes avoidant, dependent, and obsessive-compulsive personality disorders.
- The exact pathophysiology is not fully understood, but it is believed to involve a combination of genetic, biological, and environmental factors.
Etiology of Personality Disorders
- Genetic and Familial Factors:
- Genetic predisposition plays a role in the development of personality disorders.
- Individuals with a family history of personality disorders may be at a higher risk, suggesting a genetic component.
- Early Childhood Experiences:
- Adverse Childhood Experiences (ACEs) during early childhood, such as trauma, neglect, or inconsistent caregiving, can contribute to the development of personality disorders.
- Disruptions in attachment and bonding may impact the formation of healthy interpersonal relationships.
- Neurobiological Factors:
- Abnormalities in neurotransmitter systems, such as serotonin and dopamine, have been implicated in personality disorders.
- Neurobiological dysregulation may contribute to mood instability, impulsivity, and other symptoms associated with certain personality disorders.
- Environmental Stressors:
- Chronic exposure to environmental stressors, including socio-economic challenges, interpersonal conflicts, or life transitions, can contribute to the manifestation of personality disorders.
- Stressful life events may trigger or exacerbate existing vulnerabilities.
- Psychosocial and Cultural Influences:
- Cultural and societal factors play a role in shaping personality development and influencing behavioral norms.
- Societal expectations and cultural context may contribute to the expression of specific personality traits or influence the perception of what is considered maladaptive behavior.
Desired Outcomes for Individuals With Personality Disorders
- Improved Interpersonal Functioning:
- Enhance the individual’s ability to engage in and maintain positive and healthy interpersonal relationships.
- Develop effective communication skills and appropriate social behaviors to navigate various social situations.
- Enhanced Coping Strategies:
- Foster the development and utilization of adaptive coping mechanisms.
- Encourage the individual to manage stress, regulate emotions, and cope with challenges in a constructive and healthy manner.
- Increased Emotional Regulation:
- Improve emotional regulation and reduce impulsive or intense emotional responses.
- Develop strategies for recognizing and managing emotions to prevent disruptions in daily functioning and relationships.
- Stabilized Mood and Behavior:
- Achieve greater stability in mood and behavior, reducing the frequency and intensity of mood swings, impulsivity, or disruptive behaviors.
- Establish a sense of predictability and consistency in daily life.
- Enhanced Quality of Life:
- Improve overall quality of life by addressing the impact of personality disorder symptoms on various life domains.
- Facilitate the individual’s ability to pursue personal and professional goals, leading to a more fulfilling and satisfying life.
Personality Disorders Nursing Care Plan
Subjective Data:
- Desire to be in control over people
- Difficulty disagreeing with others
- Low self-esteem or lack of confidence
- Envy of others
- Easily influenced by others
- Feelings of emptiness
- Anxiety
- Lack of interest in activities or relationships
Objective Data:
- Poor control of money
- Inability to discard worthless/broken objects/hoarding
- Clingy or submissive behavior
- Shyness
- Arrogance
- Lack of remorse
- Lying or stealing
- Hostility, aggressive behavior
- Odd or eccentric behavior
Nursing Assessment of Nursing Care Plan (NCP) for Personality Disorders
- Behavioral Observation:
- Observe and document the individual’s behavior, including patterns of interaction with others, reactions to stress, and responses to environmental stimuli.
- Note any signs of impulsivity, aggression, withdrawal, or self-harming behaviors.
- Interpersonal Relationships:
- Assess the quality of interpersonal relationships, both past and present, to understand how the individual interacts with family, friends, and peers.
- Explore difficulties or challenges in forming and maintaining relationships.
- Emotional Regulation:
- Evaluate the individual’s ability to regulate emotions and manage emotional distress.
- Assess for mood swings, intense emotional reactions, or difficulties expressing emotions appropriately.
- Self-Perception and Identity:
- Explore the individual’s self-perception, self-esteem, and identity.
- Assess for distorted self-image or unstable sense of identity, which are common features in certain personality disorders.
- Coping Mechanisms:
- Identify coping mechanisms used by the individual to deal with stress and challenges.
- Assess the effectiveness of coping strategies and whether they contribute to adaptive or maladaptive outcomes.
- History of Trauma or Adverse Experiences:
- Inquire about a history of traumatic events, neglect, or adverse childhood experiences.
- Understand the impact of past experiences on the development of personality patterns and coping mechanisms.
- Motivation for Change:
- Explore the individual’s motivation and readiness for change.
- Assess their willingness to engage in therapeutic interventions and collaborate on treatment goals.
- Impact on Daily Functioning:
- Evaluate the impact of personality disorder traits on daily functioning, including work, school, and self-care.
- Identify areas of impairment and challenges in meeting personal and professional responsibilities.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess the client’s neurological status | Determine if there are other conditions present and get a baseline |
| Observe and identify behaviors and set clear limits with consequences | Helps to set and maintain structure and limits that develop feelings of security and safety |
| Be consistent when interacting with the client and in routine care | Changes in consistency threaten the structure of care and open up the opportunity for the client to use manipulative behaviors or tactics. The client may be resistant to change, so consistency helps encourage new thought processes. |
| Approach and interact with a calm, respectful, supportive and stable attitude | Personal insecurities or emotions can cause tension or power struggles with the client. Professionalism helps improve the client’s treatment and therapy and avoid negative behaviors. |
| Discuss with the client their plans and goals; help distinguish between positive, realistic goals and unrealistic goals | Help the client regain control of reality and become more focused.
Helps the client understand their capabilities .Set realistic, short term goals for the client and offer recognition for attaining those goals
Helps the client realize their abilities and limitations. Encouragement improves self-esteem and cooperation. |
| Provide realistic feedback and evaluations | Manipulative behavior may ensue without honest, realistic interpretations of behavior or therapy progress and may negatively impact the treatment. Helps discern areas of improvement and areas that still need work |
| Enforce limits and consequences, and discourage hostile or aggressive behaviors | Helps reinforce the structure and discourage inappropriate behaviors. Maintains the safety of clients and others. |
| Discuss alternative ideas or ways of thinking | Helps the client develop coping skills for emotions or feelings |
| Monitor and encourage positive social interaction with others in a safe environment | Help clients develop positive social skills and healthy interactions. Offers an opportunity to learn new ways of dealing with social situations. |
| Teach clients relaxation techniques and deep breathing exercises | Help clients control anxiety and manage situations independently to reduce symptoms. |
| Provide resources and support for family members | Help family members learn to cope with the effects of the client’s disorder and develop effective communication skills. |
Nursing Evaluation of Nursing Care Plan (NCP) for Personality Disorders
- Behavioral Changes:
- Assess changes in observable behaviors, including improvements in interpersonal interactions, emotional regulation, and impulse control.
- Look for signs of reduced maladaptive behaviors and an increased ability to cope with stress.
- Adherence to Safety Plan:
- Evaluate the individual’s adherence to the safety plan, especially in managing crises and preventing self-harm.
- Monitor the effectiveness of crisis intervention strategies and adjustments made to the safety plan.
- Skill Utilization:
- Assess the utilization of coping skills and strategies taught during skill-building sessions.
- Evaluate whether the individual is applying learned skills to manage daily stressors and navigate challenging situations.
- Functional Improvement:
- Measure improvements in daily functioning, including the ability to meet personal and professional responsibilities.
- Evaluate whether the structured routine implemented has positively impacted the individual’s overall functioning.
- Collaborative Care Outcomes:
- Collaborate with the multidisciplinary team to assess overall treatment outcomes.
- Evaluate the effectiveness of interventions provided by various healthcare professionals in addressing the comprehensive needs of the individual.
References
https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview
https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
https://www.hopkinsmedicine.org/health/conditions-and-diseases/personality-disorders
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Transcript
Hey everyone. Today, we’re going to be creating a nursing care plan for personality disorders. So let’s get started. All right, we’re going to get started with the pathophysiology. So personality disorder is a term that covers several different types of mental disorders that cause unhealthy patterns of thinking, functioning and behaving. These are categorized into three clusters. According to the behavior cluster of disorders, schizoid and schizotypal exhibit odd or eccentric thinking. Behavior cluster B disorders, antisocial, borderline, and narcissistic exhibit dramatic, unpredictable, and overly emotional behaviors. Cluster C disorders, obsessive compulsive and avoidant, exhibit anxiety and fear. Nursing considerations: going to assess neurological function, monitor behaviors, set clear boundaries, and encourage positive interaction. Desired outcomes: the client will develop the ability to set realistic goals, identify realistic personal strengths, demonstrate a reduction in violent or manipulative behaviors, and demonstrate coping skills for anxiety.
So we’re going to go ahead and get into our care plan. We have some subjective data and we have some objective data. So things that we’re going to see in these patients, one of the things is going to be low self-esteem and anxiety. Some other things you may see with these patients: they may be arrogant, poorly control of money, and have a lack of remorse. Some others that you’ll see are the desire to be in control of other people, difficulty disagreeing with low self-esteem, lack of confidence, envy of others, easily influenced, and feelings of emptiness. Some other objectives being the inability to discard worthless or broken objects or possible hoarding, shyness, hostility, and that odd or eccentric behavior.
So interventions, we want to make sure we’re going to first assess the client’s neurological status. So we’re going to do a neuro assessment. We want to determine if there are any other conditions present and get a baseline for this patient. Another invention we’re going to be doing is observe and identify behaviors and set clear limits with consequences. This helps set and maintain the structure and limits that develop feelings of security and safety for the patient. We want to make sure that we’re being consistent when we’re interacting with the client and routine care; so making sure we’re consistent with the patient. Changes in the consistency will threaten the structure of the care and open up the opportunity for the client to use manipulative behaviors or tactics. The client may be resistant to change, so consistency helps encourage new thought processes. Another intervention we want to discuss with the client are their plans and goals, and help distinguish between some positive, realistic goals and unrealistic goals. So we’re going to talk about goals; this is going to help the client regain control of reality and become more focused. It’s also going to help the client understand their capabilities. Set realistic, short-term goals for the client and offer and recognition for obtaining these goals. It’s also going to help the client realize their abilities and maybe some of their limitations, offer encouragement, and improve their self-esteem and cooperation in the process. Another invention we’re going to be doing is making sure we’re enforcing limits and consequences. And we want to make sure we’re discouraging hostile or aggressive behaviors; this is going to help reinforce the structure and discourage inappropriate behaviors by the patient. It’s also going to maintain the safety of the clients as well as others around you. Another intervention, we want to make sure we discuss alternative ideas or ways of thinking. This is going to help the client develop coping skills for emotions or feelings that they have. We’re also going to monitor and encourage positive social interaction with others in a safe environment. This is going to help the clients develop positive social skills and healthy interactions. It’s going to offer an opportunity to learn new ways of dealing with social situations.
So we’re going to go over some key points. So this covers several different types of mental disorders that cause an unhealthy pattern of thinking, functioning and behaving. The cause is unknown, but it’s believed to be triggered by genetic and environmental influences. So some subjective and objective data. What you’ll see in these patients is they may have some low self-esteem, anxiety, lack of interest, desire to be in control, odd eccentric behavior, lack of remorse, arrogance, lying, or stealing. We’re going to make sure we’re assessing their neurological function at baseline. Observe any behaviors, making sure we’re setting those boundaries with those patients. And we want to discuss their plans and their goals. We’re going to set those boundaries, discuss alternative ways of thinking, encouraging positive, social interactions with others. And there you have a completed care plan.
We love you guys. Go out, be your best self today and, as always, happy nursing.
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Nursing Care Plans
Concepts Covered:
- Basics of NCLEX
- Test Taking Strategies
- Central Nervous System Disorders – Brain
- Lower GI Disorders
- Pregnancy Risks
- Labor Complications
- Immunological Disorders
- Infectious Respiratory Disorder
- Respiratory Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Substance Abuse Disorders
- Cognitive Disorders
- Shock
- Hematologic Disorders
- Cardiac Disorders
- Anxiety Disorders
- Vascular Disorders
- Gastrointestinal Disorders
- Noninfectious Respiratory Disorder
- Emergency Care of the Cardiac Patient
- Neurologic and Cognitive Disorders
- Peripheral Nervous System Disorders
- Urinary Disorders
- Oncology Disorders
- Respiratory System
- Integumentary Disorders
- Integumentary Disorders
- Liver & Gallbladder Disorders
- Acute & Chronic Renal Disorders
- EENT Disorders
- Musculoskeletal Disorders
- Cardiovascular Disorders
- Endocrine and Metabolic Disorders
- Depressive Disorders
- Disorders of Pancreas
- Disorders of the Posterior Pituitary Gland
- Personality Disorders
- Eating Disorders
- Renal and Urinary Disorders
- Male Reproductive Disorders
- Urinary System
- Upper GI Disorders
- EENT Disorders
- Renal Disorders
- Disorders of the Thyroid & Parathyroid Glands
- Hematologic Disorders
- Disorders of Thermoregulation
- Microbiology
- Infectious Disease Disorders
- Postpartum Care
- Prenatal Concepts
- Newborn Complications
- Neurological
- Bipolar Disorders
- Central Nervous System Disorders – Spinal Cord
- Newborn Care
- Female Reproductive Disorders
- Trauma-Stress Disorders
- Postpartum Complications
- Labor and Delivery
- Musculoskeletal Disorders
- Sexually Transmitted Infections
- Psychotic Disorders
- Emergency Care of the Neurological Patient
- Musculoskeletal Trauma
- Somatoform Disorders
- Neurological Trauma
- Neurological Emergencies
- Psychological Emergencies
