Treatment outcomes may include the following:

 The client will be safe and free from significant injury.

 The client will not harm others or destroy property.

 The client will demonstrate increased control of impulsive behavior.

 The client will take appropriate steps to meet his or her own needs.

 The client will demonstrate problem-solving skills.

 The client will verbalize greater satisfaction with relationships.

Intervention
*Nursing Interventions for patients with borderline disorder are brief
hospitalization in order for the clientele to share their difficulties and in
order to manage stressors.

Promoting Client’s Safety

*Client might resort to harm oneself during the process. Therefore their
safety is of top priority.
*Due to the exaggeration of handling stress or problems, self inflicted
damage might occur. Though sometimes, when successful in gaining
ones patients trust, they might open up, given the neutrality of the
nurse as patient shares his/her thought.
No-self-harm contract-clients promise to not engage self-harm and report
to the nurse if the client losing control and also promise to himself or herself
to be safe.
*if patient is calm and positive thinking, the nurse should always observe for
self-harm behavior. The focus is on identifying mood and affect, level of
agitation, distress and circumstance surrounding the incident.
 If the client do injure themselves, the nurse should assess the injury and

need for treatment in a calm, matter-of-fact manner. Lecturing and

chastising clients is punitive and has no positive effect on self-harm
behaviors. Deflecting attention from the actual physical act is usually
desirable.

Promoting therapeutic relationship

*the nurse must provide structure and limit setting in the therapeutic
relationship.
Clinical setting-seeing client in a scheduled appointment
Hospital setting-the nurse should send some time with the client working on
issues and coping strategies.
Establishing boundaries in relationships
-clients can easily misinterpret the nurses genuine interest and
caring as a personal friendship, and the nurse may feel flattered by
a clients compliment. The nurse must be quite clear about
establishing the boundaries of the therapeutic relationship to
ensure that neither the clients nor the nurses boundaries are
violated. For example:
Client: “You’re better than my family and the doctors. You
understand me more than anyone else.”
Nurse: “I’m interested in helping you get better, just as the other
staff members are.”
Teaching effective communication skills
Basic communication skills: eye contact, active listening, taking
turns talking, validating the meaning of another's communication
and using “I” statement( I think, I will, I need)
Teaching this by engaging role-playing with the clients
Giving feedback to the client’s nonverbal behaviors: ” I noticed you
were looking at the door when discussing your feelings .”
Helping clients to cope and to control emotions
 Giving clients journal to write their feelings and will be a

discussion during therapy.

 Decreasing impulsivity and learning delay

gratification(walking, talking or listening to music)

Reshaping thinking patterns
 Cognitive restructuring-is a technique useful in changing

patterns of thinking by helping clients to recognize negative

thoughts and replace them with positive patterns of thinking.
 Thought stopping-is a technique to alter the process of

negative or self-critical thought patterns such as ”I’m dumb,

I'm stupid ” and the patient says “STOP” in a loud voice to
stop the negative thoughts
 Positive self-talk-the client reframes negative thoughts into

positive ones: ”I made a mistake, but its not the end of the
world. Next time, ill know what to do.”
(continue)
 Decastastrophizing- is a technique that involves learning to

assess situations realistically rather than always assuming a

catastrophe will happen. The nurse asks: “So what is the worst
thing that could happen?” or ”How likely do you think that is?” or
“How do you suppose other might deal with that? ”
Structuring the client’s Daily Activities
 Clients can make a written schedule that includes appointment,

shopping, reading the paper, and going for a walk. The written
schedule also allows the burse to help clients to engage in more
healthful behaviors such as: exercising, planning, cooking.
Evaluation
 As with any personality disorder, changes may be small and slow.

The degree of functional impairment of clients with borderlines

personality may vary widely. Clients with severe impairment may be
evaluated in terms of their ability to be safe and to refrain from
self-injury. Generally, when clients experiences fewer crises less
frequently over time, treatment is effective.
HISTRIONIC PERSONALITY DISORDER
-is characterized by a pervasive pattern of excessive emotionality and
attention seeking. It is found in 1% to 3% of the general population, but in as
much as 10% to15% of inpatient populations. Clients often seeks assistance
for depression, unexplained physical problems, and difficulties with
relationships. However, clients do not see how their own behaviors has an
impact on their current difficulties. This disorder is diagnosed more
frequently in females than in males.
Characteristics of the client:
 Overdress

 Flirtatious behavior

 Emptions: expressive, gregarious, and effusive

 Mood shifts(from laughing uproariously to sobbing)

 Highly praises to a person or object

ex:” he is the most wonderful doctor! He is so fantastic! He change my life. ”

praising the doctor that she met once or twice
 Highly suggestible and agrees to anyone

 Fabricating unbelievable stories for attention

 They may embarrass family members/friends by flamboyant and

inappropriate public behavior hugging and kissing to newly met

person
Nursing Interventions
 The nurse gives clients feedback about their social interactions with

others and nonverbal behaviors. Ex.: ”when you embrace and kiss
other people on first meeting them, they may interpret your
behavior in a sexual manner. It would be more acceptable to stand
at least 2 feet away from them and to shake hands . ”
 Encouraging clients to use assertive communication, such as “I”

statement
 Teaching social skills through role play

 Provide nonthreatening environment

 Outline topics of discussion appropriate for casual acquaintances

NARCISSISTIC PERSONALITY DISORDER
Is characterized by a pervasive pattern of grandiosity (in fantasy of
behavior), need for admiration, and lack of empathy. It occurs in 1% to
6% of the general population. 50 – 75 % of people with this diagnosis
are men. Narcissistic traits are common in adolescence and do not
necessarily indicate that a personality disorder will develop in
adulthood. Individual psychotherapy is the most effective treatment,
and hospitalization is rare unless comorbid conditions exist for which
the clients requires inpatient treatment.
NURSING INTERVENTION
 Using self-awareness skills

 Nurse must not internalize such criticism or taking it personally

 Teaching comorbid medical or psychiatric conditions

 Self-care skills in a matter of fact manner