Georgina’s new patient, Mr. Ryder, has been in residential…

Question Georgina’s new patient, Mr. Ryder, has been in residential…  Georgina’s new patient, Mr. Ryder, has been in residential treatment for his schizophrenia for 8 years. She meets with Mr. Ryder’s family, who say they believe he has become more listless and withdrawn over the past year.      When she asks an aide to bring Mr. Ryder to join the session, she learns he has been in restraints due to a “temper tantrum.” The family is dismayed, and his brother speaks.      “We understand that Bill can be difficult, but he just seems to be in restraints more and more frequently these days, and we think that has something to do with his increasing listlessness and withdrawal. We’d like to ask that, moving forward, he be restrained as minimally as possible. Is that something we can work on?”      Georgina observes that Mr. Ryder does not speak, although clinical notes indicate that he does understand what is said to him. He averts his eyes when Georgina attempts to make eye contact. His previous nurse recorded that he is “unpredictable” and that he “becomes suddenly, inexplicably violent.”       “Bill wasn’t always like that,” his sister says. “When we’re with him and when he still lived at home, he would rock and shout, yes, but if we spoke calmly and told him firmly to lower his voice, he would. He never attacked us or anything. We know they get overworked here, but we see that sometimes they are immediately rough and impatient with Bill, and he gets aggressive.”      “Also,” his brother says, “Bill used to take good care of himself. He knows how to bathe and dress better than this.”      As Georgina talks to Mr. Ryder and his family and as the assessment gets more in-depth, she begins to have a feeling he may not need restraints nearly as often as he’s been getting them and that he needs to be challenged to return to a previous level of self-care.       “Bill, would you like to be restrained less often?”      “Yes,” he says.      “Do you think you could work on not being so angry if someone speaks to you more harshly than you’d like?”      “Maybe so,” he says. For the first time in their session, Bill makes eye contact with Georgina.      “Okay, let’s work on this,” she says.After the family leaves, she asks Bill if there is anything more she can do for him. “I want my own toothbrush,” he says, “and a comb, and Dial soap.” In his room, she sees that his toothbrush is kept locked up and that someone else has been in charge of his grooming. She speaks with Mr. Ryder’s doctor, and together they guide the team in challenging Bill to take more control of his self-care. The family and team agree to try it, though they are skeptical. When they talk to Bill, he glances out the window, but they see the first hint of a smile. What model do you think most applies to Mr. Ryder’s new treatment plan? What is your rationale for choosing this model? Health Science Science Nursing NURSING 101 Share QuestionEmailCopy link Comments (0)