Which of the following interventions would be appropriate when working with a woman whose nursing diagnosis is Ineffective coping related to impaired impulse control as evidenced by impulsive self-injurious behavior? (Select all that apply.)
a. Assist the patient to develop a list of effective coping options to carry for future use.
b. Encourage her to use negative reinforcers (e.g., pain) to discourage undesired behavior.
c. Guide the patient to examine the advantages and costs of her present coping strategies.
d. Help her to practice the desired responses in role plays and later in real-life situations.
e. Teach the patient to "cue" herself to stop and think before taking undesired actions.
f. Consult with her psychiatrist about antianxiety medication to help reduce impulsiveness.
A, C, D, E
Persons who are impulsive may have difficulty identifying better alternatives in the heat of the moment. A list of more adaptive, preferred alternative responses—created ahead of time and carried with her—can be consulted when in crisis, compensating for the patient's difficulty with identifying better alternatives when under stress. Guiding the patient to identify advantages and disadvantages of available options can help her learn to make more adaptive choices when considering which actions to take in the future. Practice via role plays allows opportunity to refine one's plans and builds confidence in one's ability to enact the adaptive strategies identified. Later practice in real life also builds confidence and further hones skills. Interrupting the "impulse-action" pattern by cuing oneself to stop and consider before acting is very important to reducing impulsive behaviors. Rather than using negative reinforcers when "doing something wrong," positive reinforcers (such as rewarding oneself with a treat) are used to reinforce desired actions instead. Anxiety is not the main issue driving impulsive behavior, and antianxiety medications can be abused and in some cases can be disinhibiting, decreasing the patient's ability to control impulses rather than helping it.
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