Providing Care for Medical Patients with Psychiatric Issues: Defiance in Children

gena who is a patient in a psychiatric institute This is a topic that many people are looking for. cfiva.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, cfiva.org would like to introduce to you Providing Care for Medical Patients with Psychiatric Issues: Defiance in Children. Following along are instructions in the video below:
Welcome to do this not that im sooo self licensed clinical social worker and and behavioral health liaison manager for bjc behavioral health today. Were trying to understand feel confident and competent when providing care for young patients who exhibit defiance or engage in control struggles with us these kinds of issues can be time consuming. Frustrating and make the day seem to go on forever in this module.
Im hoping to give you ideas that may help you and your patient to experience. A better day with less negative energy. You want to provide complete compassionate exceptional care.
This can be really hard to do and it seems that youre providing it for someone who insists on getting in your way. Lets think about defiance as distinctly different from resistance or non compliance resistance can be related to anxiety or fear here. Were talking about defiance and control do a check on whats going on defiance is about a style or a way of responding to situations.
It could be but is not necessarily fear based look for a persistent pattern of wanting to be in control are refusing as a way to be in charge of situations regardless of what is going on or the behaviors are seeing really about whats going to happen or is it about whos in charge. Do you get the feeling that its going to be a long day with this patient. Thats a clue that points to defiance defiance and control issues largely appear in toddlers ages.
Two to four and in kids in their preteens and early teen years. These are the kids who challenge us or create confrontation or openly and boldly challenge and authority in ages two to four theyve learned the know word now theyre using it to test their environment and try to maintain their prestigious place in the world little ones. Resist restriction defiance is an attempt to keep the known world the way.
It was in adolescence with emerging new mental and physical abilities. Preteens and teens want to have a say about things when the world feels out of control. Like it can when children are hospitalized.
They want to control what happens and have their opinions considered this desire mixed with a lack of experience and a not yet fully developed brain results in defiance and control issues. But a child at any age can have this kind of style as health care givers in the moment of trying to provide care. You cant and dont really need to find out why the patient is defying you the key is to respond.
So that the patients physical and mental health needs are addressed focus instead on the intent or what the behaviors do for the patient never never never say that a child is a particular type of person you can say that the behavior is rude or that the action was mean. But never say that the kid is rude or mean or some other negative identity tag.

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gena who is a patient in a psychiatric institute-0

Avoid using positive labels as well for example. Youre so smart or youre a good boy dont allow your emotional response to the child. The patients reputation or past difficult interactions set the stage for getting through the next one dont take the childs words.
Personally dont avoid or ignore. A patients anger or threats. Dont challenge the patient or respond in kind by matching her attitude dont participate by calling names are getting physical.
Dont raise your voice argue or answer. In any way. That is confrontational demeaning insulting or abusive.
Dont create rewards and consequences on the fly doing so in the midst of defiance is an unsuccessful strategy avoid power struggles with the child. Theyre always lose lose situations. Okay.
Syria. Its time to go to physical therapy. Um.
No what do you mean no you have to go your doctor. Said. So im not going.
Thats all um. Yeah you are its time well you cant make me are we gonna replay yesterday. I went to therapy yesterday you werent even here no but you made a big fuss about it and you had to go anyway.
Didnt you im pretty sure you cant make me get up were going now leave me alone. Im not going fine.

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gena who is a patient in a psychiatric institute-1

Ill just tell the doctors that you wouldnt go. Whats that leave me alone. Im just checking on you i hate you jason you cant talk to me that way i dont care.
I wish you were dead jason. Why would you say that to me you apologize that was just plain mean no i hate you i swear im not gonna let you talk to me that way im gonna leave and when i get back i want an apology when the strategies you came in with are not successful or are not working rather than upping the ante are escalating consequential threats. Know that youve recognized something important give yourself a graceful exit wherein no one has won or lost like were going to take a break right now.
Ill be back give the patient an out with dignity as well leaving them feeling is that theyve lost some battle sets. The stage for the next. One confer.
Consult with the team about alternative effective strategies and debrief on those that didnt work. So. Well does a child have a behavioral health plan.
If not consider initiating one. Especially. If more procedures are needed prepare you are likely to know.
Which patients have this kind of style before you go in get strategies from others make some decisions. Ahead of time choose your battles. Consider alternatives.
Now or later. Or does it really need to be done think about offering the patient a selection of choices that are acceptable to you giving a child control over some parts of it can get cooperation from her think through your approach be clear about what you need to do or want from the patient and prepare to start positively and respectfully set up opportunities for or notice times. When the patient behaves well remind the patient of past successes.
If a potentially defiance. Provoking event for the patient is about to occur you can remind him about times.

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gena who is a patient in a psychiatric institute-2

When he made a good choice separate the inappropriate behavior from the patient in a i hate the behavior. But i believe in your ability to get through this kind of way so positive limits instead of saying dont talk to me that way say when youre ready to speak more nicely. I can go get you that coke so i have sarah in 15 for this shift.
Shes been pretty difficult several of us have had difficulty with her michele got really frustrated when she went to go down for therapy. Do we have any ideas. I know that she never made it to therapy cant keep that up do we know what doesnt work.
I know that sarah likes to have a say in everything when the kids are getting ready to play a game sarah works really hard at arranging. It to her liking maybe. Theres something about that i think so she seemed pretty satisfied that michele got so upset.
I think that was the intent not really about petey. You know okay well no battles today no one wins and no one loses thanks hi. Sara.
Its time to go to physical therapy. Oh. No i know.
Its not the best part of your day is it. But its time. Im not going.
Thats all lets see you do need to get physical therapy. Today. So lets figure out something together okay.
I just dont want to lets just skip. It shall we it looks like youre not ready for it right now how about i give you a little time to get ready what ill do ill give you 15 minutes to get ready and ill be back not going after pt how about weak.

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gena who is a patient in a psychiatric institute-3

Well pick out a dvd. I know we got new ones in today thanks for getting ready. Ill be back right about now youre deciding.
If shes going to drop the defiance and cooperate or not if she does compliment her on it and possibly offer her more choices. If she doesnt and persist with defiance. Its time to make an exit are you ready to go i went to therapy yesterday.
Leave me alone. Im not going well listen. Im gonna go to a couple other things im gonna left physical therapy.
Know that youre not ready right now. Theyre gonna come up here. And make a plan to get it done in this moment.
While the patient has not gone to pt it may seem as if shes won but heres what did happen a power struggle was avoided the nurse made a plan and tested it out and now we know two things the patient does not respond to the offer of giving her input or a reward for cooperating. And its clear that we need to revisit expectations and consequences. Whats up leave me alone.
Im just checking on you i hate you why do you say that i dont know its not a nice thing to say are you upset about something i dont care. I wish you would just just gonna have a car accident or something i dont like it when people talk to me like that especially you what do you know you know anything i know youve been really great to people like yesterday at lunch. When you were cheering up elizabeth.
Remember that you know i do it made me really happy when you made her smile like that i think thats the jason thats really inside there want to tell me whats going on if youre ready to talk like the real jason. I could get your snack and we could talk for a while a patient who is defiant and controlling can test our patience use up time and disrupt the day. But many times it can be managed or diffused remember.
Its not personal children like the rest of us want to influence and control what happens in their world. Sometimes the choices they make get in their own way your observations are very important. Whether its blood pressure or behavior.
Using what you notice and working to develop effective strategies can make everyones experience more positive. Remember you dont need to be a psychiatric professional to help a patient in this situation you just need to know what to do thanks for watching you .

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gena who is a patient in a psychiatric institute-4

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