A man with severe mental illness has difficulty with boredom, ...

[humphriesbr@me.com]

A man with severe mental illness has difficulty with boredom, feels that attending the day program does not challenge him, and wishes to earn money. Which of the following options would be most appropriate for addressing these issues?
 
  a. Involve him in volunteer work at the consumer-run clubhouse program at the mental health center.
  b. Help the patient apply for services at the state's Bureau of Vocational Rehabilitation.
  c. Rapidly pace him in a competitive job of his choosing, accompanied by a coach on the job site.
  d. First involve the patient in prevocational training, then in employment in a sheltered workshop.

Question 2

A patient with obsessive-compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work, then comes home on the lunch hour and spends more than an hour rechecking faucets, stove burners, appliances, window
 
  and door locks, and so forth. The checking continues after work and during the evening. The patient spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent. Which of the following nursing diagnoses should the nurse consider for this patient? Select all that apply. a. Ineffective role performance related to time spent in rituals
  b. Impaired cognition related to obsessive-compulsive disorder
  c. Ineffective coping as evidenced by use of compulsive behavior
  d. Social isolation related to excessive use of time to perform rituals
  e. Defensive coping relative to feelings of superiority to others
  f. Self-care deficit related to excessive time spent in rituals

[Brummell1998]

Answer to Question 1

C
The option associated with the greatest likelihood of achieving successful, sustained competitive employment is the supported employment model, which involves rapidly placing the patient in a competitive employment position, accompanied by on-site job coaching and support that coordinates with the employer to provide needed support and on-the-job training. Contrasted to volunteer work, competitive employment would be more challenging and provide income. Placing the patient in the job first, then giving individualized training and coaching support in the field describes the supported employment model that is now an evidence-based practice. Research has not supported the Bureau of Vocational Rehabilitation model, which involves prevocational training followed by sheltered employment before moving on to competitive employment. Clubhouse programs are helpful for many patients but do not have as high a success rate for achieving competitive employment.

Answer to Question 2

A, C, D, F
The patient demonstrates ineffective role performance, ineffective coping, social isolation related to time spent on rituals, and self-care deficits as seen in the problems she is having maintaining grooming and succeeding at work because of the extensive amount of time she spends managing anxiety in ritualistic behaviors. Those areas of concern represent appropriate potential nursing diagnoses. The patient is not reported to exhibit impaired cognition or feelings of superiority.

[humphriesbr@me.com]

TYSM

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