The sibling of a patient who was diagnosed with a serious mental ...

[karen]

The sibling of a patient who was diagnosed with a serious mental illness asks why a case manager has been assigned. 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's needs are met.
  c. The case manager can focus on social skills training and esteem building in the real world where the patient lives.
  d. Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money.

Question 2

A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center.
 
  Which intervention should be the team's initial focus?
 
  a. Teach appropriate health maintenance and prevention practices.
  b. Educate the patient about the importance of treatment adherence.
  c. Help the patient obtain employment in a local sheltered workshop.
  d. Interact regularly and supportively without trying to change the patient.

[djpooyouma]

Answer to Question 1

ANS: 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 sibling might see as a disadvantage). Case managers operate in the community, but this is not the primary advantage of their services.

Answer to Question 2

ANS: D
Given the history of treatment nonadherence and the difficulty achieving other goals until psychiatrically stable and adherent, getting the patient to accept and adhere to treatment is the fundamental goal to address. The intervention most likely to help meet that goal at this stage is developing a trusting relationship with the patient. Interacting regularly, supportively, and without demands is likely to build the necessary trust and relationships that will be the foundation for all other interventions later on. No data here suggest the patient is in crisis, so it is possible to proceed slowly and build this foundation of trust.

[karen]

TYSM

[ghepp]

Thanks for the timely response, appreciate it