Alzheimer’s Delirium and Dementia Q 61
The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolonged stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
A. Managing his hallucinations
B. Medication teaching
C. Social skills training
D. Vocational training
Correct Answer: C. Social skills training
Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Provide opportunities for the client to learn adaptive social skills in a non-threatening environment. Initial social skills training could include basic social behaviors (e.g., appropriate distance, maintain good eye contact, calm manner/behavior, moderate voice tone). Social skills training helps the client adapt and function at a higher level in society, and increases the client’s quality of life.
Option A: If client is delusional/hallucinating or is having trouble concentrating at this time, provide very simple concrete activities with client (e.g., looking at a picture or doing a painting). Even simple activities help draw the client away from delusional thinking into reality in the environment. If the client is very withdrawn, one-on-one activities with a “safe” person initially should be planned; learn to feel safe with one person, then gradually might participate in a structured group activity.
Option B: Although medication teaching may also be part of the program offered in a day treatment, the nurse is referring to the client in this situation because of his need for socialization skills. Use clear or simple words, and keep directions simple as well. The client might have difficulty processing even simple sentences. Use simple, concrete, and literal explanations; Minimizes misunderstanding and/or incorporating those misunderstandings into delusional systems.
Option D: Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service. As the client progresses, Coping Skills Training should be available to him/her (nurse, staff, or others). Increases client’s ability to derive social support and decreases loneliness. Clients will not give up the substance of abuse unless they have alternative means to facilitate socialization.