A nurse is planning care for a group of clients on a mental health unit. Which of the following actions should the nurse plan to take to create a therapeutic environment?

Choice A reason:
The nurse's response is therapeutic because it clearly communicates the expectations of the treatment setting in a firm yet non-confrontational manner. By stating "it is time for group therapy and we expect everyone to attend," the nurse is providing structure and clarity, which can help orient the client to the reality of the situation and the routine of the therapeutic environment.

Choice B reason:
While the nurse's response does include a statement of understanding, it does not primarily demonstrate empathy. Empathy would involve acknowledging the client's feelings and concerns more directly, rather than focusing on the expectations of the therapy session.

Choice C reason:
Reflection is a therapeutic communication technique where the nurse repeats or paraphrases what the client has said to show that they are listening and to encourage further discussion. In this case, the nurse does not use reflection but rather responds with a statement of expectation.

Choice D reason:
The nurse's response does not set limits on manipulative behavior, as there is no indication that the client's behavior is manipulative. The client expresses a delusional belief, and the nurse addresses this by redirecting the client to the scheduled group therapy session.

Choice A Reason:
A client exhibiting psychotic behavior may not be the best candidate for group therapy initially, as they might be experiencing delusions, hallucinations, or disorganized thinking that could disrupt the group process and might not be able to participate effectively. Individual therapy might be more appropriate until the client's symptoms are better managed.

Choice B Reason:
A client who was admitted 5 hours ago for acute mania is likely still experiencing heightened levels of energy, impulsivity, and possibly erratic behavior. They may not be able to engage in group therapy effectively and could benefit from stabilization before participating in a group setting.

Choice C Reason:
A client who has been taking lithium for 2 weeks for depression is likely to have achieved some level of stabilization of their mood. Lithium is a mood stabilizer used to treat bipolar disorder and depression, and after 2 weeks, the client may be ready to engage with others in a therapeutic group setting.

Choice D Reason:
A client who is in a manic state, similar to the client in choice B, may not be suitable for group therapy due to potential disruptive behavior and difficulty focusing on the group process. It's important for the client to receive individual attention to manage the mania before joining group therapy.
Question 43