Question

An individual with borderline personality disorder approaches the nurse and asks to be allowed additional time in the exterior courtyard outside of the allotted hours. The patient states her favorite nurse on another shift allows her to do so. Which of the following is the best

A. The nurse should allow the patient to go outside as this will strengthen the therapeutic relationship.
B. The nurse should allow the patient to go outside or she may become upset and destabilize the milieu.
C. The nurse should explain to the patient that courtyard hours are posted and she may utilize them at the next scheduled time.
D. The nurse should ask the patient which nurse is breaking the rules.

Answer 1

The nurse should explain that courtyard hours must be adhered to and the patient can access the courtyard during the next allotted time. This maintains consistency and fairness in care. Unlike Tyre's experience of having no autonomy, the nurse must exercise professional judgment and uphold facility rules.

Step-by-step explanation:

The best response for the nurse when an individual with borderline personality disorder requests additional time in the exterior courtyard outside of the scheduled hours is to remain consistent with the established rules and guidelines of the facility. The nurse should explain to the patient that courtyard hours are posted and that the patient may utilize them at the next scheduled time. This approach helps maintain consistent boundaries and expectations, which is crucial for managing patients with borderline personality disorder.

Consistency in care and adherence to established rules is essential in a therapeutic environment, especially for individuals with personality disorders. Allowing the patient to break the rules based on claimed exceptions could lead to feelings of unfairness among other patients and potentially destabilize the treatment milieu. It is important to handle such situations professionally, respecting the rules while also showing understanding and empathy.

In comparison to Tyre's work situation, the nurse must demonstrate professional boundaries and provide consistent care despite the individual pressures that may be present. Unlike Tyre, who had little autonomy and felt unappreciated, the nurse's decision should reflect both their autonomy in maintaining professional standards and a commitment to the wellbeing of all patients.