A patient with borderline personality disorder has cut her wrists. The physician orders daily dressing changes for the lacerations. The nurse performing this care should:
a. encourage the patient to vent anger and aggression.
b. provide care in a matter-of-fact manner.
c. be kindly, sympathetic, and concerned.
d. offer to listen to the patient's feelings about cutting.
B
A matter-of-fact approach does not provide the patient with inadvertent positive reinforcement for self-injurious behavior. The goal of providing emotional consistency is supported by this approach. All other options provide positive reinforcement of the behavior. Discussion of feelings should occur apart from episodes of self-mutilating behavior and related nursing care. Sympathy is not therapeutic in general; overtures of kindness and concern can evoke fears of abandonment, and even when this is not a concern, can reinforce self-injurious behavior if they are provided during response to self-mutilating behavior.
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