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Psychotic Disorders: Initial Plan of Care for a Client Who Has Schizophrenia (RN QSEN -
Patient-centered Care, Active Learning Template - System Disorder, RM MH RN 10.0 Chp 15)
ï‚· Provide a structured, safe environment (milieu) for the client to decrease anxiety and to
distract the client from constant thinking about hallucinations
ï‚· Promote therapeutic communication to lower anxiety, decrease defensive patterns, and
encourage participation in the milieu.
ï‚· Program of assertive community treatment (PACT): Intensive case management and
interprofessional team approach to assist clients with community‑living needs.
Depressive Disorders: Priority Findings to Share with Treatment Team (RN QSEN -
Teamwork and Collaboration, Active Learning Template - System Disorder, RM MH RN
10.0 Chp 13)
 Suicide risk: Assess the client’s risk for suicide and implement appropriate safety
precautions.
 Self‑care: Monitor the client’s ability to perform activities of daily living and encourage
independence as much as possible.
ï‚· Communication: Make observations rather than asking direct questions, which can
cause anxiety in the client. For example, the nurse might say, “I noticed that you
attended the unit group meeting today,†rather than asking, “Did you enjoy the group
meeting
Legal and Ethical Issues: Right to Refuse Treatment (RN QSEN - Patient-centered Care,
Active Learning Template - Basic Concept, RM MH RN 10.0 Chp 2)
ï‚· Freedom from harm related to physical or pharmacological restraint, seclusion, and any
physical or mental abuse or neglect
 A psychiatric advance directive that includes the client’s treatment preferences if an
involuntary admission is necessary
 Provision of care with the least restrictive interventions necessary to meet the client’s
needs without allowing him to be a threat to himself or others
Sexual Assault: Communicating with a Client (RN QSEN - Safety , Active Learning
Template - Basic Concept, RM MH RN 10.0 Chp 33)
 Perform a self‑assessment. It is vital that the nurse who works with the client who has
been sexually assaulted be empathetic, objective, and nonjudgmental. If the nurse feels
emotional about the assault due to some event or person in his own past, it can be
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