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Medical Diagnoses: Risk for self or others 

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders

I

Evaluation

Goals

Interventions

Risk for self or other- directed violence r/t impulsivity and impaired judgment and persuasive disregard for the rights of others AEB risk-taking behaviors, irritability, anger and aggressiveness, conflict with authority, history of previous violence, and impulsive, explosive behavior

    

    

Long-Term Goal:

Client will identify impulse behaviors and demonstrate appropriate self-control behaviors to refrain from harming self and others by [date].

     

     

Short-Term Goal:

Client will displace anger to meaningful activities, refrain from verbal outbursts, and display no aggressive activity [date]

Long-Term Interventions:

1.) Assist clients to identify precipitants of dysfunctional mood, differentiating what can and cannot be changed. Help them identify available resources and personal strengths. Teach new problem-solving and coping skills. (Foley, 2010).

Rationale: Knowledge of precipitants helps clients develop strategies to prevent mood changes. Using personal strengths and abilities enhances feels of control.

2.) Develop a behavioral management plan that is implemented consistently among all healthcare providers. Communication of rules, expectations, and consequences should be addressed as well as limitations on intrusive, interruptive behaviors. Provide consistent consequences for both desired and undesired behaviors and praise the desired behaviors (Foley, 2010).

Rationale: Consistency about rules and expectations reduce power struggles and promote feelings of security for clients. Positive feedback for desired behaviors helps reinforce them. 

3.) Have client keep an anger diary and discuss alternative responses together. Teach cognitive behavioral techniques for self- evaluation from the client (Ackley, & Ladwig, 2008).

Rationale: Clients with anger management difficulties may not be aware of changes and cues that they are becoming angry or of a time delay in the stimulus to their angry response. By using cognitive behavior techniques and reviewing the diary with staff, the client can identify though processes leading u to anger and the space between the stimulus and response.

     

     

Short-Term Interventions:

1.) Identify stimuli that initiate violence and the means of dealing with the stimuli, such as walking away. (Ackley, & Ladwig, 2008).

Rationale: Assisting the client to identify situations and people that upset him provides information needed for problem solving. The client can then identify alternative responses: leaving the stimulus, initiating a distracting activity, or responding assertively rather than aggressively.

     

2.) Emphasize that the client is responsible for his choices and behavior. Introduce descriptions of possible effects of a client’s aggressive/violent behavior on others (Ackley, & Ladwig, 2008).

Rationale: In many cases clients operate from a worldview that perceives others as instruments of the clients’ gratification. Clients must gain that they are dealing with other human beings who experience pain. Clients’ behaviors influence how others respond to them.

     

3.) Redirect possible violent behaviors into physical activities such as doing pushups and sit-ups (Ackley, & Ladwig, 2008).

Rationale: Activities that distract while draining excess energy help to build a repertoire of alternative behaviors for stress reduction.

    


Long-Term:

Evaluation of this goal is set for [date]. The client has demonstrated progress toward this goal by identifying that he now knows when he is becoming angry and what usually results when he does not control his impulses. He has also demonstrated less aggressive behaviors towards his peers during conflicts.

     

Short-term:

Evaluation of this goal was set for [date]. The client has accomplished this goal by using meaningful physical activities whenever he gets angry, refraining from verbal outbursts by explaining his feelings first, and not getting into aggressive activity.

1.) The client stated that by knowing the way his body feels when he gets in aggressive moods, he can to stop and think about what his next move is going to be instead of acting out on impulse. He also said that he knows that instead of punching or pushing a peer, he can go to the staff to talk about the situation.

2.) The client discussed a time when he did not follow the rules during gym time and consequentially he lost gym privileges for the rest of the week and did not receive his points for the day. He stated that he knows he deserves the punishment, and from now on he will be patient and follow the rules.

3.) The client had just found out about a death in his family, and shortly following had an altercation with a peer where he was shoved. He demonstrated self-control behaviors by putting his hands up, taking a few steps backward, and explaining to the peer why he was upset and that he did not want to fight. They both apologized and moved on.

     

     

  

     

     

     

     

     

     

     

     

     

1.) The client verbally expressed stimuli that triggered his violence: not being able to get his way, being wrong, having everyone tell him what to do.

2.) The client expressed that he wants to be able to control his temper and that he knows all of the clients in the facility are under stress. He stated that some people clash so it is best to avoid them or try to decrease their triggers as well as his own to promote a better environment.

3.) The client has gone to his room to do pushups and sit-ups whenever his temperament has escalated.



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