Mental health articles

The psychiatric nurse who works on a children and adolescent unit will be
responsible for caring for children who have mental and personality disorders
that lead to disruptive behavior. Behavior can be controlled by using the following
strategies:
• Create a token environment: A token environment is one where acceptable
behavior is rewarded with a token that can be exchanged for a privilege.
The token can be an object such as a coin or points on a daily record.
A privilege is something that is desired by the child, like watching a movie
or additional free time.
• Set expectations: All children on the unit must understand what acceptable
and unacceptable behavior is. Furthermore, they should know the rewards
for acceptable behavior and the consequences for unacceptable behavior.
• Authoritative care: Each child is expected to accept responsibilities for
self-care and chores. The child should also be encouraged to make some
decisions on their own.
• Positive feedback: The nurse should consistently engage the child, offering
emotional support and nurturing. Encourage the child to express feelings;
and listen carefully to what the child says. Be sure to provide positive
feedback to indicate when the child is performing acceptable behavior.
• Time-out: The child must be given a time-out when the child displays disruptive
behavior such as tantrums, yelling, hitting, or destroying property. A
time-out requires that the child be immediately removed to the time-out
room. Time-outs should be immediate and last a relatively short period of
time, usually until the child calms down. The time-out is then seen as a consequence
for unacceptable behavior. Tell the child why the child is in timeout.
Don’t talk to the child while in time-out. After time-out is over, discuss
with the child alternative ways the child can behave. If the child leaves before
time-out is over, then revoke 5 minutes of privileges for every minute that the
child leaves time-out early. Always return the child to the time-out room.
• Remove privilege: Revoking a privilege is done for a short time period. For
example, the child will not be permitted to watch one movie. If the child
acts up a second time, then revoke a different privilege. Never increase
the time period of a revoked privilege. Avoid revoking a privilege that a
child has already earned. The earned privilege is a reward for previously
acceptable behavior.

• Refuses time-out: A child must be physically assisted to the time-out
room if the child refuses to go voluntarily.
• Out of Control: A child who is emotionally and physically out of control
must be placed in a therapeutic hold to prevent the child from self-injury
and injuring others. A therapeutic hold is a technique of restraining the
child in a way that the child has limited range of motion of arms and legs
while not injuring or causing the child any pain. In extreme situations, the
child is placed in seclusion or is physically restrained. Seclusion is when a
child is placed in a relatively bare room until the child regains self-control
or medication calms the child. Restraint is where the child’s arms and legs
are tied to a bed using leather straps.
• Mess caused by disruptive behavior: The child must clean the mess that
the child caused during the child’s disruptive behavior after the child
leaves time-out.

Tags: adolescent, children, psychiatric nurse