Manipulation In Nursing

Manipulation is a dominant characteristic for people with antisocial personality disorder. When in hospital, the patient’s manipulation can be harmful to the nursing staff. Since the patient has the ability to manipulate a nurse, a precise care plan that is followed by all staff members must be implemented in order to decrease the unwanted behaviour and keep the hospital unit safe. In order to do this, the nurse must be able engage in clinical reasoning that will lead to the development of an effective care plan. Clinical Reasoning

Nurses engage in clinical reasoning in order to provide effective and consistent care. According to Kozier et al (2014) clinical reasoning is “the thought process used to assess a clients evolving situation

The ASPD patient will attempt to manipulate the nurse in order to gain access to certain privileges that could be harmful to the unit (ex. access to weapons, drugs, alcohol, interacting with vulnerable people etc). However, manipulation for patient’s with ASPD is not always about controlling another person. Some patients use manipulation was an “attempt to soothe internal feelings of fear” (outofthefog.com). Because these patients feel as though their feelings take precedence, they have a tendency to minimizes the feelings of others (outofthefog.com). Nevertheless, this behaviour is destructive and needs to be assessed by the nurse promptly.

When a patient uses manipulation it can have harmful effects that affect the nursing staff. This can result in nurses feeling vulnerable when working with these patients (Moran and Mason, 1996). Vulnerability can make the nurse feel as if they have no control over the situation. If the nurse loses that control, the patient will be able to manipulate the nurse and the situation they are in. However, if the nurse understands manipulation techniques used, they will be able to confront the patient

When the nursing staff are consistent with addressing manipulative behaviour, they create structure for the patient.

When structure is provided, changes in the patients behaviour can occur. (Austin and Boyd, 2015). Within clinical reasoning, the outcome that the nurse wants to achieve is the ability to change the behaviour. Setting limits can allow consistency that will give the patient structured care. Therefore when rules are given to the patient, they can begin to identify what behaviour is acceptable and unacceptable. This can hopefully be a skill the patient will be able to practice outside of the hospital setting. However, it can be argued that patients with ASPD have the lack of insight to changing their behaviour. According to Kaylor (1999), it is very difficult to change the behaviour of the ASPD patient as they do not understand the need to change their behaviour. If the patient lacks the insight into their own behaviour, then limit setting should not be effective. However, having a set of rules that the patient must follow does deter the patient from destructive behaviour such as manipulation while in hospital. This will lead to a safer hospital unit for both staff and patients. Measuring the Success of the Care