For the patient with ritualistic hand washing and an identified outcome expectation of Use of effective coping patterns, the nurse should: (Select all that apply.)
a. allow the patient to set her own hand-washing schedule.
b. encourage the patient to participate in unit activities.
c. encourage the patient to discuss hand washing in all groups.
d. teach relaxation techniques to be used in lieu of rituals.
e. restrict the ritual to demonstrate that anxiety subsides without it.
f. gradually increase the intervals between permitted washing.
B, D, E, F
Obsessive-compulsive patients become overly involved in their rituals; therefore, participation in normal unit activities is promoted. Allowing the patient to determine her own frequency or schedule of ritual behavior is not therapeutic (it could compete with or replace participation in unit activities). Similarly, recurrent focus on the ritual, in groups or other interactions, is also discouraged because it would displace coverage of other important content (such as the patient's feelings, coping techniques). All interventions to relieve anxiety are included in the treatment of obsessive-compulsive disorder so that the patient has other alternatives for controlling anxiety herself and the need for the compulsive behaviors can gradually be reduced. The technique of response prevention, wherein the ritualistic behavior is prevented so that the patient learns that anxiety will subside even without the behavior, is also therapeutic. This technique subsequently involves having the patient gradually lengthen the interval between the compulsive actions.
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