During the morning community meeting, a client with psychosis becomes agitated, making loud threats to no one in particular, but the other clients appear increasingly uncomfortable. What action should the nurse facilitator take?
1. Address the client by name and say, "It sounds as if you are experiencing something very disturbing. Please go see the nurse who may be able to help you."
2. Direct the client by saying, "You need to sit quietly and listen until it's your turn to talk."
3. Accompany the client to his or her room so that the client can de-escalate.
4. Say to the group, "You all appear frightened by this behavior. What should we do about it?"
1
Rationale: The client's thought process is preventing the client from receiving any benefit from group and could escalate if not properly attended to. In this scenario, it is not appropriate for the client to remain in the group, and the behavior must be addressed prior to asking the group for input. As the group facilitator, it would not be appropriate to leave the group.
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