P20 · Trouble controlling impulses
Actual Emotions and mind
Definition
The person acts without thinking in ways that risk harm.- Mental illness
- brain injury
- substance use
- stress
- Acts before thinking
- breaks rules
- risky actions
📋 Scenario
A patient leaves the ward repeatedly without telling staff.
Subjective (S): "I just wanted some fresh air."
Objective (O): Leaves the ward repeatedly; acts on urges; ignores rules.
Assessment tools for this scenario: CP-MIND Mood & Mind Screen
Validated scales to consider: PHQ-9, GAD-7, C-SSRS
**CarePath diagnosis:** Trouble controlling impulses related to mental illness, as evidenced by acts before thinking and breaks rules.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Set clear limits. | Clear, consistent limits show what is expected and keep him safe, because acting on urges without boundaries can lead to harm. |
| Teach coping. | Teaching ways to pause and manage urges, such as delaying or using a calming activity, gives him a safer choice in the moment. |
| Reward self-control. | Positive feedback for self-control strengthens the behavior and builds confidence, which works better than punishment. |
| Supervise. | Supervision lowers the chance of unsafe leaving, such as wandering off the ward, while he is still learning to control urges. |
| Give medicine as ordered. | Ordered medicine may reduce impulsive urges linked to mental illness, and giving it as prescribed supports safety and treatment. |
**Expected outcomes**
- No unsafe leaving.
- Uses a plan to manage urges.
- Follows ward rules for 48 hours.
**Linking the data to the diagnosis**
The patient who leaves the ward repeatedly says, "I just wanted some fresh air." The nurse notes that he acts on urges and ignores rules, so poor impulse control is already causing unsafe behavior and is an actual problem. The plan aims for no unsafe leaving, use of a plan to manage urges and following ward rules for 48 hours. Staff set clear limits, supervise, teach coping skills and give medicine as ordered.
CarePath diagnosis
Trouble controlling impulses related to mental illness, as evidenced by acts before thinking and breaks rules.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Set clear limits. | Clear, consistent limits show what is expected and keep him safe, because acting on urges without boundaries can lead to harm. |
| 2. Teach coping. | Teaching ways to pause and manage urges, such as delaying or using a calming activity, gives him a safer choice in the moment. |
| 3. Reward self-control. | Positive feedback for self-control strengthens the behavior and builds confidence, which works better than punishment. |
| 4. Supervise. | Supervision lowers the chance of unsafe leaving, such as wandering off the ward, while he is still learning to control urges. |
| 5. Give medicine as ordered. | Ordered medicine may reduce impulsive urges linked to mental illness, and giving it as prescribed supports safety and treatment. |
Expected outcomes
- No unsafe leaving.
- Uses a plan to manage urges.
- Follows ward rules for 48 hours.
Linking the data to the diagnosis
The patient who leaves the ward repeatedly says, "I just wanted some fresh air." The nurse notes that he acts on urges and ignores rules, so poor impulse control is already causing unsafe behavior and is an actual problem. The plan aims for no unsafe leaving, use of a plan to manage urges and following ward rules for 48 hours. Staff set clear limits, supervise, teach coping skills and give medicine as ordered.