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Original Question
FACULTY-LED DISCUSSION: CASE STUDY WITH CLINICAL JUDGMENT QUESTIONS Assign students to work in small groups to review the case study below and respond to the discussion questions. Case Study: Andy, 35 years old, was admitted to the psychiatric unit due to substance use disorder. While on the unit, Andy has been occasionally shouting out obscenities and being confrontational with other clients. Andy has stated that in the past he has gotten into “a little trouble because of his temper.” He mentions that the drugs were helpful in stopping him from getting angry and hurting someone. The nurse has observed Andy becoming more agitated and pacing. Group 1 1. Recognize Cues (Assessment) What assessment data indicates that the client is becoming angry and may become aggressive? What are the subtle changes in the client’s behavior that may need to be defused or addressed? 2. Analysis Clues (Analysis) What client findings are of most concern? What is the immediate concern of the interprofessional team when they observe the behaviors that Andy is displaying? What are the client’s needs at this moment? Group 2 3. Prioritize Hypotheses (Analysis) Based on the nurse’s knowledge of the behaviors Andy is displaying what is the priority for both Andy and the unit? What are the top three priority problems for the client? Provide a rationale for your decision on the rank order. Group 3 4. Generate Solutions (Planning) Identify a client outcome for each of the three priority problems. 5. Take Actions (Implementation) What priority nursing action should take place to ensure a safe environment for everyone? What educational nursing actions would be significant? Case Study: The nurse was able to de-escalate the situation and remove Andy from the environment. Andy was able to talk with the nurse about how he was feeling. 6. Evaluate Outcomes (Evaluation) What response by the client indicated that the nursing goal was met? How would you modify the plan of care if the client outcomes were not met? Discussion Questions You notice on the unit that there is a client who appears to be bullying another client. How would you handle this situation? What is the connection between unit culture and the increase or decrease in anger or aggressive outburst of clients? Provide a rationale Reflection Questions Reflect upon a time you felt very angry and may have been aggressive. Did you notice what you were doing prior to becoming angry and aggressive? Was it difficult for you to stop the behaviors? How would you feel taking care of a child who has been a victim of sexual abuse? How would you feel if a family member came into visit who was known to be stealing money from the client’s bank accounts?
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