A community psychiatric nurse is conducting an initial assessment at the home of a client with severe obsessive-compulsive disorder (OCD). The client's spouse reports that the client must arrange all living room furniture in specific geometric patterns before sitting down, a process that takes hours and causes extreme exhaustion. As the nurse and spouse are talking, the client begins moving a heavy armchair to start the ritual. Which nursing action is most appropriate at this early stage of the therapeutic relationship?
- AQuestion the client about what they fear will happen if the chair is left in its original position.
- BEducate the client on how the constant physical exertion is detrimental to their overall health.
- Allow the client to complete the furniture arrangement without interruption.Answer
- DInstruct the spouse to gently but firmly hold the chair in place to prevent the ritual.
Answer
Allow the client to complete the furniture arrangement without interruption.
In the initial stages of treating a client with obsessive-compulsive disorder (OCD), compulsions serve as the primary mechanism to reduce overwhelming anxiety. Preventing the client from completing a ritual before they have learned new, effective coping strategies will strip away their only defense and can trigger a severe panic attack. Therefore, the most appropriate initial action is to allow the ritual while establishing a trusting therapeutic alliance. Later in the treatment process, the nurse and client will work collaboratively to gradually set limits on the time spent performing these behaviors.
Step-by-Step Solution
Key Concept
Management of Compulsions in Early Treatment of OCD
Estimated Time:1m 30s