Author Question: A middle-class family is talking with the nurse about the impact a seriously mental ill son has had ... (Read 58 times)

washai · **on:** Jul 19, 2018

A middle-class family is talking with the nurse about the impact a seriously mental ill son has had on the family. Insurance has only partially covered treatment expenses, and the family has spent much of their savings to care for him.

The patient's younger sister mentions she feels lost because her parents are so focused on her brother that it seems as though they have no time for her. The parents are concerned that when the siblings move out and they themselves become aged, there will be no one to care for the patient. Which response would be most helpful? a. Acknowledge their concerns, and indicate that you will consult with the treatment team about ways to bring the patient's symptoms under better control.
b. Give them the names of financial advisors and banks that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
c. Refer them to crisis intervention services to learn ways to manage caregiver stress, and provide the titles of some helpful books for families of SMI persons.
d. Discuss the benefits of participating in National Alliance on Mental Illness programs, and discuss ways to help the son become more independent.

Question 2

The brother of a patient who is seriously mentally ill asks why the patient has been assigned a case manager. The nurse's reply should cite the major advantage of the use of case management as:

a. The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible..
b. Case managers coordinate services and help with accessing them, making sure the patient gets what he needs..
c. The case manager can focus on social skills training and esteem building out in the real world where he lives..
d. Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money..

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

Answer to Question 1

D
The family has raised a number of concerns, but the major issues appear to be the effect caregiving has had on the family and their concerns about the patient's future. The National Alliance on Mental Illness (NAMI) offers support, education, resources, and access to other families who have experience with the issues now facing this family. In particular, NAMI can help address caregiver burden and planning for the future needs of SMI persons. Improving the patient's symptom control and general functioning can help reduce caregiver burden but would likely be a slow process, whereas NAMI involvement could benefit them on a number of fronts, possibly in a shorter time period. The family will need more than financial planning help as their issues go beyond the financial. The family is distressed but not in crisis, and crisis intervention is not really an appropriate resource for the longer-term issues and needs affecting this family.

Answer to Question 2

B
The case manager helps the patient gain entrance into the system of care, can coordinate multiple referrals that so often confuse the seriously mentally ill person and his family, and can help overcome obstacles to access and treatment participation. Case managers do not usually possess the credentials needed to provide psychotherapy or function as therapists. Case management promotes efficient use of services in general, but only ASSERTIVE COMMUNITY TREATMENT (ACT) programming has been shown to reduce hospitalization (which the brother might see as a disadvantage). Case managers operate in the community, but this is not the primary advantage of their services.