An adolescent patient who just completed a time-out for having slapped another patient complains, "The other patient started it, but I get punished. It's unfair.". An appropriate response from the nurse would be:
a. "Don't expect me to take your side in this. You received punishment because you were violent. It doesn't matter who started it. On this unit, violent behavior will always be punished.".
b. "Let's talk about that. Do you think you were asked to take a time-out because you ‘started it' or because your response was both out of control and violent?"
c. "You make a good point. We need to punish both of you in a similar fashion. Since I believe in fair play, I'll assign the other patient to a time-out as well.".
d. "Sounds to me as if you have really been bullied. I will have to discuss this with the staff. I'm pleased that you accepted the time-out like an adult.".
B
It is important that the patient identify his or her own inappropriate behavior. It is also important that the nurse deliver the time-out as a consequence in a matter-of-fact manner and not as a punishment. Behavior is altered more adaptively if the consequence (e.g., deduction of tokens, time-out to one's room) is delivered as a support to assist the patient to relearn adaptive ways to behave in problematic situations. The remaining options fail to address the issue of personal responsibility for one's own actions.
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