A client with paranoid schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church.
The psychiatric nurse notifies the local minister.


The psychiatric nurse has:

Choice A rationale:

1. Understanding OCD:

OCD is a chronic mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions).

Individuals with OCD feel compelled to perform rituals to relieve anxiety or prevent perceived harm, even if they recognize the behaviors as excessive or irrational.

Rituals can consume significant time and interfere with daily functioning.

2. Rationale for Choice A:

Acknowledges the client's needs: Planning for rituals demonstrates understanding and acceptance of the client's experience, fostering trust and rapport.

Reduces anxiety: Allowing time for rituals can temporarily reduce anxiety, making the client more receptive to other interventions.

Gradual approach: It's a stepping stone towards Exposure and Response Prevention (ERP), the gold-standard treatment for OCD.

Enhances control: Scheduling rituals can help the client feel more in control, reducing the urge to engage in them compulsively.

3. Addressing potential concerns:

Reinforcing rituals: While there's a possibility of temporarily reinforcing rituals, it's a necessary first step to build trust and engagement in therapy.

Interfering with treatment: Scheduling rituals is a part of a comprehensive treatment plan that includes ERP and other therapies to address the underlying causes of OCD.

4. Importance of individualized care:

The specific approach to planning for rituals should be tailored to the client's unique needs, preferences, and severity of symptoms.

Collaboration with the client is essential to ensure their active participation in treatment. I'll now address the rationales for the incorrect choices:

Choice B rationale:

Setting strict limits on behaviors can be counterproductive: Triggers anxiety and distress

Impedes trust and therapeutic alliance Diminishes sense of control

Heightens resistance to treatment

Choice C rationale:

Confronting the client about the senselessness of rituals is ineffective and potentially harmful: Exacerbates anxiety and shame

Alienates the client

Disregards the involuntary nature of OCD Undermines motivation for treatment Choice D rationale:

Isolating the client is unethical and detrimental:

Increases distress and loneliness Impedes therapeutic interactions Reinforces negative self-perceptions

Lacks evidence of efficacy in OCD treatment

Choice A rationale:

While a client's unwillingness to accept treatment can be a challenge, it does not, in and of itself, meet the criteria for involuntary hospitalization beyond the initial 72-hour hold.

Forced treatment without a clear and imminent risk of harm can violate a patient's autonomy and rights.

It's crucial for healthcare professionals to balance a patient's right to self-determination with the need to protect individuals from harm.

Choice B rationale:

A client's plan to move out of state, even if it's considered a disruptive decision, does not constitute grounds for involuntary hospitalization.

Individuals have the right to freedom of movement and to make choices about their life, even if those choices are perceived as unwise or problematic.

Choice C rationale:

This is the correct answer because it aligns with the fundamental principle of involuntary hospitalization: to protect individuals who pose a serious risk of harm to themselves or others due to a mental health condition.

This rationale is rooted in the ethical and legal obligation to prevent harm and ensure public safety.

Choice D rationale:

A client's dislike of a neighbor is not a valid reason for involuntary hospitalization. Personal opinions or feelings, even if negative, do not automatically translate into a risk of harm that would justify involuntary confinement.