Anxiety Disorders and Stress Q 3
Mr. Johnson was recently admitted to a psychiatric unit because of severe obsessive-compulsive behavior. Which initial response by the nurse would be most therapeutic for him?
A. Accepting the client's ritualistic behaviors.
B. Challenging the client's need for rituals.
C. Expressing concern about the harmfulness of the client's rituals.
D. Limiting the client's rituals that are excessive.
Correct Answer: A. Accepting the client’s ritualistic behaviors
It is important to accept the client’s need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client. Initially meet the client’s dependency needs as necessary. Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more.
Option B: During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate panic level of anxiety. Encourage independence and give positive reinforcement for independent behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors.
Option C: Support and encourage the client’s efforts to explore the meaning and purpose of the behavior. The client may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition and acceptance of problems are important before a change can occur. Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones.
Option D: Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. Provide positive reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors.