- Ineffective Coping related to lack of motivation to change behaviours and dysfunctional family systems as evidenced by Manipulative behaviours, anger and hostility
- Risk for Other-Directed Violence related to Ineffective impulse control and Patterns of aggressive anti-social behavior as evidenced by aggressive or impulsive behavior
- Risk for Self-Mutilation related to disturbed interpersonal and Irresistible urge for self-directed violence as evidenced by Irresistible urge for self-directed violence
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: -Verbalizes an inability to cope and handle stressors -Complaints of secondary concerns from lack of coping (sleep disturbances, fatigue, lack of appetite) Objective Data: -Not caring for basic needs (poor grooming and hygiene, not eating nutritionally adequate meals) -Behaviors that impede progress (defensive speech, making excuses, manipulation) -Inability to handle life responsibilities and activities of daily living -Use of drugs, alcohol, or medication as coping mechanisms -Multiple acute illnesses or chronic pain -Depression | Ineffective Coping related to Lack of motivation to change behaviours and dysfunctional family systems as evidenced by Manipulative behaviours, anger and hostility | Patient will identify their disruptive behaviors and how they prevent them from coping effectively. Patient will verbalize appropriate coping strategies and resources to prevent ineffective coping. Patient will express confidence in handling their stressors and when to ask for help. | 1. Set behavioral limits. Patients with ASPD will test boundaries and may not follow rules. Strict adherence to rules must be set from the beginning and consequences for not adhering must be instituted to prevent future behaviors. 2. Help the patient gain insight. Patients with ASPD often will not take responsibility for their actions. Attempt to educate on normalized societal behaviors and how and why consequences are required for inappropriate actions. 3. Consistently approach the patient in all interactions. This enhances feelings of security and provides the patient with structure. Exceptions tend to encourage manipulative behavior. 4. Provide positive reinforcement. Providing positive reinforcements for acceptable coping behavior will keep the patient motivated to repeat appropriate behaviors. 5. Assist the patient in developing problem-solving skills. Encourage group therapy sessions as this setting mimics how the patient must behave in society. Patients may be more inclined to listen and consider feedback from peers than authority figures. | Patient identified their disruptive behaviors and how they prevent them from coping effectively. Patient verbalized appropriate coping strategies and resources to prevent ineffective coping. Patient expressed confidence in handling their stressors and when to ask for help. |
| Subjective Data: Verbalizes aggressive behaviour Objective Data: -History of childhood abuse -History of cruelty to animals -History of destruction to property -Substance abuse -Dysfunctional thought process -Patterns of aggressive anti-social behavior | Risk for Other-Directed Violence related to Ineffective impulse control and Patterns of aggressive anti-social behavior as evidenced by aggressive or impulsive behavior | Patient will stop all forms of abuse. Patient will refrain from verbal outbursts and aggressive or impulsive behavior. Patient will identify factors/feelings that lead to violent behavior. | 1. Minimize personal risk. The nurse should minimize their personal risk and ensure their safety when interacting with a patient with antisocial personal disorder through the following actions: Use nonthreatening body language Maintain a safe distance from the patient Do not touch them without permission Do not turn your back to them Do not allow them to block access to an exit Do not wear items or accessories that can be grabbed 2. Remove all potential weapons from the patient’s surroundings. Preventive strategies are important in keeping other patients and staff safe and reducing the risk of violence. Chairs, desks, tables, writing utensils, and more can become weapons. 3. Maintain a calm environment. Maintaining a calm environment reduces the risk of aggression and violence. Speak calmly and slowly and keep stimulation low to reduce anxiety. 4. Redirect possible violent behaviors into physical activities. Encourage physical activities like walking or jogging if possible. The goal is to utilize activities that distract while draining excess energy, reducing the risk of other-directed violence. 5. Instruct on expected behaviors. If admitted to an inpatient psychiatric unit, instruct on behaviors that are expected and not accepted. Reinforce positive behavior. Learned coping skills, combined with adherence to appropriate unit behavior, can serve as a model for behavior in the outside world. 6. Keep the patient in a private room. The patient who is violent or threatens violence toward others must be kept in a single room. If violent behavior occurs, move the patient to a private area to decompress and ensure the safety of others. 7. Use restraints if necessary. If the patient becomes violent, physical or chemical restraints may be necessary to deescalate the situation and keep patients and staff safe. 8. Encourage recognition of triggers. Assist the patient in recognizing triggers or situations that upset them or cause them to become violent. The nurse can then offer techniques to cope or respond in a healthier manner, such as physically leaving the situation, breathing techniques, or thought stopping. 9. Report violence as necessary. If a patient expresses a desire or plan to harm another person, the nurse is legally required (depending on state laws) to warn that person or alert law enforcement. | Patient stopped all forms of abuse. Patient refrained from verbal outbursts and aggressive or impulsive behavior. Patient identified factors/feelings that lead to violent behavior. |
Subjective Data: Verbalizes about Distastefulness in life Objective Data: -Ineffective impulse control -Substance abuse -Dysfunctional thought process -Inability to release tension in other ways -Irresistible urge for self-directed violence | Risk for Self-Mutilation related to Disturbed interpersonal and Irresistible urge for self-directed violence as evidenced by Irresistible urge for self-directed violence | Patient will remain free from self-injury. Patient will demonstrate interventions to stop triggers and urges to self-mutilate. Patient will verbalize other appropriate methods to cope with anger. | 1. Establish a trusting relationship with the patient. Establishing trust is an important aspect of all patient care, especially when caring for patients with a mental health disorder and the sensitive topic of self-mutilation. A trusting relationship can help the patient feel safe and allow them to verbalize their feelings and concerns. 2. Remove harmful objects from the environment. When caring for the patient in the inpatient setting, ensure there are no objects that could be used to self-harm. 3. Instruct on trigger identification and coping strategies. The nurse can assist the patient in identifying the situations and emotions that trigger the urge to self-mutilate. Once known, the nurse can assist with employing healthier coping strategies such as impulse control training, deep breathing, or relaxation techniques. 4. Encourage the patient to adhere to mental health counseling. Mental health treatment, such as cognitive behavioral therapy, can help patients with antisocial personality disorder manage their symptoms and reduce the risk of self-mutilation. | Patient remained free from self-injury. Patient demonstrated interventions to stop triggers and urges to self-mutilate. Patient verbalized other appropriate methods to cope with anger. |