To establish a relationship with a severely withdrawn schizophrenic client being cared for at home

Question

by a supportive family, the most realistic plan would be for the community mental health nurse to

a. visit daily for 4 days, then every other day for 1 week; stay with client for 20
minutes, accept silence; state when the nurse will return.
b. arrange to spend 1 hour each day with the client, with the focus on asking
questions about what the client is thinking or experiencing; avoid silences.
c. visit twice daily; sit beside the client with hand on the client's arm; leave if the
client does not respond within 10 minutes.
d. visit every other day; remind the client of the nurse's identity; tell the client he
may use the time to talk or the nurse will work on reports.

Answer 1

A
Severe constraints on the community mental health nurse's time will probably not allow more time
than what is mentioned in option A, yet important principles can be used. A severely withdrawn
client should be met "at the client's own level," with silence accepted. Short periods of contact are
helpful to minimize both the client's and the nurse's anxiety. Predictability in returning as stated will
help build trust. Option B: An hour may be too long to sustain a home visit with a withdrawn client,
especially if the nurse persists in leveling a barrage of questions at the client. Option C: Twice-daily
visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be
threatening. Option D: Working on reports suggests the nurse is not interested in the client.