Psychiatric Mental Health Nursing by Videbeck

20 CHILD ANDADOLESCENTDISORDERS 501

continued from page 500

The client may have no knowledge of the concept

of limits and how limits can be beneficial. The

client has an opportunity to ask questions when

manipulation is not needed. This allows the client

to hear about the relationship between aberrant

behavior and consequences.

The client may not know how to solve problems

constructively or may not have seen this behavior

modeled in the home.

The client’s abilities and skills will increase with

practice. He or she will experience success with

practice.

This allows the client to see what is expected in a

nonthreatening situation.

Clarification of expectations decreases the chance

that the client will misinterpret expectations.

As the client gains comfort with the skills

through practice, he or she will increase their use.

Success with others is more likely to occur once

the client has been successful with the staff.

Peer relationships are enhanced when the client

is able to interact as other adolescents do.

Peer feedback can be influential in shaping the

behavior of an adolescent.

Adolescents are reluctant to be vulnerable to

peers, and they may need encouragement to be

open and honest with their feelings.

All clients need to know how to prevent transmis-

sion of HIV and STDs. Because these clients may

act out sexually or use intravenous drugs, it is es-

pecially important that they be educated about

HIV infections.

Often adolescents with conduct disorders also

have substance abuse issues.

Teach the client about limit-setting and the need

for these limits. Include time for discussion.

Teach the client a simple problem-solving process

as an alternative to acting out (identify the prob-

lem, consider alternatives, select and implement

an alternative, evaluate the effectiveness of the

solution).

Help the client to practice the problem-solving

process with situations on the unit, then with sit-

uations the client may face at home, school, and

so forth.

Role-model appropriate conversation and social

skills for the client.

Specify and describe the skills you are

demonstrating.

Practice social skills with the client on a one-to-one

basis.

Gradually introduce other clients into the inter-

actions and discussions.

Assist the client to focus on age- and situation-

appropriate topics.

Encourage the client to give and receive feedback

with others in his or her age group.

Facilitate expression of feelings among clients in

supervised group situations.

Teach the client about transmission of human

immunodeficiency virus (HIV) infection and other

sexually transmitted diseases (STDs).

*Assess the client’s use of alcohol or other sub-

stances, and provide referrals as indicated.

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.