Psychiatric Mental Health Nursing by Videbeck

20 CHILD ANDADOLESCENTDISORDERS 493

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The external stimuli that exacerbate the client’s

problems can be identified and minimized. Like-

wise, any that positively influence the client can

be effectively used.

The client’s ability to deal with external stimula-

tion is impaired.

The client must hear instructions as a first step

toward compliance.

The client’s ability to comprehend instructions

(especially if they are complex or abstract) is

impaired.

Repetition demonstrates that the client has accu-

rately received the information.

The likelihood of success is enhanced with less

complicated components of a task.

The client’s opportunity for successful experiences

is increased by treating each step as an opportu-

nity for success.

The client’s restless energy can be given an ac-

ceptable outlet, so that he or she can attend to

future tasks more effectively.

The client must understand the request before he

or she can attempt task completion.

If the client is unable to complete a task indepen-

dently, having assistance will allow success and

will demonstrate how to complete the task.

The amount of intervention gradually is de-

creased to increase client independence as the

client’s abilities increase.

IMPLEMENTATION

Nursing Interventions *denotes collaborative interventions Rationale

Identify the factors that aggravate and alleviate
the client’s performance.

Provide an environment as free from distractions
as possible. Institute interventions on a one-to-one
basis. Gradually increase the amount of environ-
mental stimuli.

Engage the client’s attention before giving instruc-
tions (i.e., call the client’s name and establish eye
contact).

Give instructions slowly, using simple language
and concrete directions.

Ask the client to repeat instructions before be-
ginning tasks.

Separate complex tasks into small steps.

Provide positive feedback for completion of
each step.

Allow breaks during which the client can move
around.

Clearly state expectations for task completion.

Initially assist the client to complete tasks.

Progress to prompting or reminding the client to
perform tasks or assignments.

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