Foundations for Practice

1. Explain a situation that you would expect a client to utilize the following defense mechanisms:

· Repression: A traumatized soldier has no recollection of the details of a close brush with death.
· Denial: A smoker concludes that the evidence linking cigarette use to health problems is scientifically worthless.
· Projection: A woman who dislikes her boss thinks she like her boss but feels that the boss doesn't like her.
· Rationalization: A student watches TV instead of studying, saying that "additional study wouldn't do any good anyway."
· Displacement: After parental scolding, a young girl takes her anger out on her little brother.
· Sublimation: A surgeon turns aggressive energies and deep desires to cut people into life-saving acts.
· Isolation: a bank teller appears calm and cool while frustrating a robbery but afterward is tearful and tremulous.
· Regression: An adult has a temper tantrum when he doesn't get his way

2. Explain the 5 Stages of emotional response to dying according to Kubler-Ross and include a phrase that represents a typical client statement for that stage.
a) Denial- can’t believe a terminal diagnosis/loss
b) Anger- lashes out at others
c) Bargaining- negotiates for more time
d) Depression- sad because can’t change the situation
e) Acceptance- recognizes reality and plans for the future

3. Discuss the proper procedure and necessary interventions when using restraints. When all other less restrictive means have been tried to prevent a client from harming self or others, the following must occur in order for seclusion or restraint to be used:
◯ The treatment must be ordered by the primary care provider in writing.
◯ The order must specify the duration of treatment.
◯ The provider must rewrite the order, specifying the type of restraint, every 24 hr or the frequency of time specified by facility policy.
◯ Nursing responsibilities must be identified in the protocol, including how often the client should be:
■ Assessed (including for safety and physical needs), and the client’s behavior documented ■ Offered food and fluid
■ Toileted
■ Monitored for vital signs
◯ Complete documentation includes a description of the following:
■ Precipitating events and behavior of the client prior to seclusion or restraint
■ Alternative actions taken to avoid seclusion or restraint
■ The time treatment began
■ The client’s current behavior, what foods or fluids were offered and taken, needs provided for, and vital signs
■ Medication administration
An emergency situation must be present for the charge nurse to use seclusion or restraints without first obtaining a provider’s written order. If this treatment is initiated, the nurse must obtain the written order within a specified period of time (usually 15 to 30 min).

4. Explain the difference between voluntary and involuntary commitment to a mental health facility. Discuss the legal rights of a client who is involuntarily committed to an inpatient mental health facility.
Voluntary commitment – The client or client’s guardian chooses commitment to a mental health facility in order to obtain treatment. A voluntarily committed client has the right to apply for release at any time. This client is considered competent, and so has the right to refuse medication and treatment.
Involuntary (civil) commitment – The client enters the mental health facility against her will for an indefinite period of time. The commitment is based on the client’s need for psychiatric treatment, the risk of harm to self or others, or the inability to provide selfcare.
The need for commitment could be determined by a judge of the court or by another agency. The number of physicians, which is usually two, required to certify that the client’s condition requires commitment, varies from state to state. Those who are involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing