It is the nurse

It is the nurse¶s responsibility to tell a client that secrets cannot be kept and also that any disclosures that reveal behavior that may be harmful to the client will need to be communicated to the appropriate professionals in the health care team. To de-escalate aggressive behavior, the nurse should manage the environment by persuading the client to move to another area. This will help prevent anxiety contagion and protect others. The nurse should also give the client clear instructions that are brief and assertive and should also negotiate options with the client. This shows the nurse¶s confidence and leadership and also avoids misunderstandings in regard to not knowing what to do. Negotiating options allows the client to feel that he or she has some room in exercising the options. The nurse must allow the client body space and should not stand closer than about 8 feet to the client. Standing close to the client will convey a threat. Social phobia focuses on a specific situation, such as the fear of speaking, performing, or eating in public. Clients with hypochondriacal symptoms focus their anxiety on physical complaints and are preoccupied with their health. It is most therapeutic for the nurse to empathize with the client¶s experience. Disagreeing with delusions may make the client more defensive and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate. If a client with severe anxiety is left alone, he or she may feel abandoned and become overwhelmed. Placing the client in a quiet room is also important, but the nurse must stay with the client. It is not possible to teach the client deep breathing exercises until the anxiety decreases. Systematic desensitization is a form of therapy used when the client is introduced to short periods of exposure to the phobic object while in a relaxed state. Gradually, exposure is increased, until the anxiety about or fear of the object or situation has ceased. Used for sexual aversion disorder. If a client is monopolizing the group, it is important that the nurse be direct and decisive. The best action is to suggest that the client stop talking and try listening to others. Democratic leadership is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff. In autocratic leadership, the leader retains all authority and is primarily concerned with task accomplishment. Situational leadership is a comprehensive approach that incorporates the leader¶s style, the maturity of the work group, and the situation at hand. Laissez faire is a permissive style of leadership in which the leader gives up control and delegates all decision making to the work group.