Psychotic Disorders: Initial Plan of Care for a Client Who Has Schizophrenia (RN QSEN - Patientcentered Care, Active Learning Template - System Disorder, RM MH RN 10.0 Chp 15)

 Provide a structured, safe environment (milieu) for the client to decrease anxiety and to distract

the client from constant thinking about hallucinations

 Promote therapeutic communication to lower anxiety, decrease defensive patterns, and

encourage participation in the milieu.

 Program of assertive community treatment (PACT): Intensive case management and

interprofessional team approach to assist clients with community‑living needs.

Depressive Disorders: Priority Findings to Share with Treatment Team (RN QSEN - Teamwork

and Collaboration, Active Learning Template - System Disorder, RM MH RN 10.0 Chp 13)

 Suicide risk: Assess the client’s risk for suicide and implement appropriate safety precautions.

 Self‑care: Monitor the client’s ability to perform activities of daily living and encourage

independence as much as possible.

 Communication: Make observations rather than asking direct questions, which can cause

anxiety in the client. For example, the nurse might say, “I noticed that you attended the unit

group meeting today,” rather than asking, “Did you enjoy the group meeting

Legal and Ethical Issues: Right to Refuse Treatment (RN QSEN - Patient-centered Care, Active

Learning Template - Basic Concept, RM MH RN 10.0 Chp 2)

 Freedom from harm related to physical or pharmacological restraint, seclusion, and any physical

or mental abuse or neglect

 A psychiatric advance directive that includes the client’s treatment preferences if an involuntary

admission is necessary

 Provision of care with the least restrictive interventions necessary to meet the client’s needs

without allowing him to be a threat to himself or others

Sexual Assault: Communicating with a Client (RN QSEN - Safety , Active Learning Template -

Basic Concept, RM MH RN 10.0 Chp 33)

 Perform a self‑assessment. It is vital that the nurse who works with the client who has been

sexually assaulted be empathetic, objective, and nonjudgmental. If the nurse feels emotional

about the assault due to some event or person in his own past, it can be better to allow another

nurse to care for the client.

 Perform an initial and ongoing assessment of the client’s level of anxiety, coping mechanisms,

and available support systems. The nurse should also assess for indications of emotional and/or

physical trauma.

 Provide a private environment for an examination with a specially trained nurse‑advocate, if

available. A sexual assault nurse examiner (SANE) is a specially trained nurse who performs such

examinations and collects forensic evidence.

Brain Stimulation Therapies: Transcranial Magnetic Stimulation (Active Learning Template -

Therapeutic Procedure, RM