Question

Which is a priority nursing intervention for a client with narcissistic personality disorder? A. Encourage acceptance of intensive therapy. B. Eliminate bizarre fantasies. C. Minimize potential for self harm. D. Promote verbalization of feelings about self.

Short answer

The priority nursing intervention for a client with narcissistic personality disorder is to promote verbalization of feelings about self (Option D).

Step-by-step solution

Understanding Narcissistic Personality Disorder

The first step is to understand the characteristics and behaviours associated with Narcissistic Personality Disorder (NPD). People with NPD often have an inflated sense of self-importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.

Identifying the Priority in Nursing Intervention

Nursing interventions prioritize the safety and well-being of the patient while respecting their psychological needs. Interventions should be aimed at managing symptoms, increasing the client's ability to build relationships, and promoting self-awareness without challenging self-esteem directly.

Evaluating the Options

Option A, encouraging acceptance of intensive therapy, may be important but not always the immediate priority. Option B, eliminating bizarre fantasies, is not specific to narcissistic personality disorder. Option C, minimizing potential for self-harm, would be a priority if self-harm is a current risk. Option D, promoting verbalization of feelings about self, aligns with therapeutic interventions for NPD and helps clients gain insight into their behaviors.

Determine the Best Answer

Considering the importance of therapeutic communication and the need to foster self-awareness without eliciting defensive responses, promoting verbalization of feelings about self (Option D) is often the most appropriate nursing intervention for someone with NPD.

Key concepts

Narcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is characterized by a long-standing pattern of grandiosity, a need for admiration, and a lack of empathy for others. Individuals with NPD often present with an exaggerated sense of self-importance, a preoccupation with fantasies of success and power, and a belief that they are unique and can only be understood by other special people. Understanding the complexity of this condition is vital for nursing professionals when developing care plans.

Therapeutic approaches for NPD typically focus on psychological therapy, where patients are encouraged to explore the underlying causes of their narcissistic behaviors and learn healthier ways of relating to others. Due to the nature of the disorder, patients might react defensively to feedback, so a nuanced approach is essential in promoting self-awareness while maintaining patient dignity.

Therapeutic Communication

Therapeutic communication is a cornerstone of effective nursing practice, especially when caring for clients with mental health disorders like NPD. It involves active listening, empathy, and a supportive approach to help the patient feel understood and valued.

Use of Open-Ended Questions

Open-ended questions invite the patient to discuss their feelings and foster a therapeutic alliance, creating a safe environment for the patient to express themselves without feeling judged.

Reflecting and Clarifying

Reflecting and clarifying can help patients gain insight into their behavior and emotional state, which is particularly beneficial for those with NPD in helping them understand the impact of their actions on others.

Patient Safety

Ensuring patient safety is a fundamental responsibility in nursing practice. When dealing with NPD, healthcare professionals must be vigilant about the potential for self-harm or aggressive behaviors towards others.

Assessing Risk

Regularly assessing risk and implementing precautionary measures when any harm is indicated is critical. This not only ensures the physical safety of the patient but also provides a framework for a stable therapeutic environment.

Building Trust

Establishing trust with the patient can contribute significantly to a safe and positive treatment outcome, whereby the patient feels secure enough to engage in the therapeutic process without resorting to harmful behaviors.

Nursing Education

The ever-evolving field of mental health necessitates ongoing nursing education to adequately address the complexities of conditions like NPD. Education programs are crucial for preparing nurses to recognize the signs and symptoms of personality disorders, and to effectively engage in therapeutic communication.

Continued Learning

Continued learning opportunities, such as workshops, seminars, and clinical supervision, are important for nurses to stay updated on the latest evidence-based interventions and therapeutic strategies. Through quality nursing education, care providers can develop the skills required to deliver person-centered care and to navigate the challenges of mental health nursing with confidence and competence.