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Reflection Questions

1 .

The nurse, Jorri, meets with an older adult client who will be discharged from the hospital later today. The discharge plan includes assisted outpatient treatment, mandated as a condition of the client’s release. The client, Edward, sits without speaking, arms crossed, looking down at the floor. The nurse opens a conversation:

Jorri: It seems to me you have something on your mind. If so, can we talk about it?

Edward: What’s there to talk about? All my decisions are made for me.

Jorri: Your decisions . . . ?

Edward: Yeah, like how I live when I get out of here. Going to therapy appointments every week and even having somebody come to my house to check on me. Like I’m not a grown man!

Jorri personally feels community care is appropriate for Edward, though Jorri can see Edward’s distress. Consider the QSEN competency regarding the limits and boundaries of therapeutic client-centered care. In this scenario, what knowledge, skills, and attitudes should the nurse consider to guide a response to the client?

2 .
How can nursing assessment increase safety with clients in mental health care?
3 .
Why is client safety a nursing priority, and what factors should nurses consider in assessing potential risks?
4 .
Give examples of how you would take action to meet nursing responsibilities associated with psychiatric advance directives in the categories of client teaching, client advocacy, and therapeutic relationship.
5 .
In a few sentences, describe nurses’ possible reactions to appointment of a guardian or conservator for a person living with mental illness, and offer strategies to address these.

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