Author Question: A psychiatric clinical nurse specialist works with a defendant as a competency evaluator. A staff ... (Read 286 times)

cdr_15 · **on:** Jul 19, 2018

A psychiatric clinical nurse specialist works with a defendant as a competency evaluator. A staff member asks, Why are you spending so much time with that defendant? You spend one-to-one time and write volumes.

Usually, we give defendants some medication and return them to court. Select the clinical nurse specialist's most appropriate response.

a. My role is to be an advocate for the defendant, so I have to know him well and build a trusting relationship.
b. My focus is providing intensive psychotherapy to ensure the defendant becomes competent before returning to court.
c. The specialized assessments I make on behalf of the court require very lengthy and detailed interviews, so it takes a lot of time.
d. I spend the time observing, assessing, and documenting competency, writing a report, and preparing expert testimony for the court.

Question 2

An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused by severe sexual abuse. One day this inmate sees a person with characteristics similar to the perpetrator, has a flashback, and then attacks the person.

Correctional officers place the inmate in restraint. The correctional nurse should anticipate that the inmate would react to restraint by:

a. committing to counseling to reduce the incidence of flashbacks.
b. becoming less likely to assault others during future flashbacks.
c. gradually calming and returning from the flashback to reality.
d. becoming more frightened, agitated, and combative.

wfdfwc23 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: D
The competency evaluator has to determine the patient's current competence to act on his own behalf during his trial; without competency, the inmate cannot stand trial. Determining competency goes well beyond the mental status, functional, and risk assessments most psychiatric nurses are accustomed to and are very complex and time-consuming. A complete formal report is prepared for the court and all pertinent details addressed in anticipation of questioning by officers of the court. The evaluator represents the court, not the patient. Interviews of the inmate are only a portion of the evaluator's work. Evaluators help the court determine competency but do not intervene to increase the patient's competency.

Answer to Question 2

ANS: D
The correctional nurse recognizes that events occurring in the present reality are likely to be incorporated into a flashback, leading the inmate to become more frightened and desperate to escape. Even if no longer experiencing a flashback, persons will likely reexperience their original trauma if restrained, including the emotions experienced during that trauma, leading to increased fearfulness and resistance to the jail restraints. Restraints are not likely to calm the individual or reduce aggressiveness but instead increase the sense of helplessness and desperation.