A nurse in a mental health clinic is assessing a client who was brought in by her adult daughter stating that her mother has not been able to leave her home for weeks because she is afraid to be outdoors alone.
The nurse should anticipate planning care for managing which of the following phobias?

Choice A rationale:

Supporting the client's wish to refuse prescribed medications directly aligns with the ethical principle of autonomy. Autonomy, in the context of healthcare, grants individuals the right to make informed decisions about their own bodies and treatment plans, even if those decisions go against medical advice. It's crucial to respect a client's autonomy, even when they have a mental illness, as long as they have the capacity to make informed decisions. Key points to elaborate on:

Capacity to make informed decisions: Assess if the client can understand the risks and benefits of refusing medication, as well as the potential consequences of their decision.

Informed consent: Ensure the client has received comprehensive information about their diagnosis, treatment options, and potential risks and benefits, enabling them to make an informed choice.

Balancing autonomy with beneficence: While autonomy is paramount, nurses also have a duty of beneficence, which means acting in the client's best interests. Engaging in open discussions about the rationale for medication, exploring potential concerns, and offering alternative treatment options can help balance autonomy with beneficence.

Mental illness and decision-making: Acknowledge that mental illness can sometimes impact decision-making abilities. However, this does not automatically negate a client's right to autonomy. Careful assessment and ongoing communication are essential.

Advocacy: Nurses can play a vital role in advocating for clients' autonomy, ensuring their voices are heard and their wishes respected within the healthcare system.

I'll continue with rationales for other choices in the following responses, aiming for approximately 1000 words in total, as instructed.

Choice A: Limit the amount of time available to interact with others

While the client's behavior may indirectly limit their interactions with others by occupying their time, this is not the primary function of their actions. The core motivation lies in reducing anxiety, not social avoidance.

Choice B: Manipulate and control others' behaviors

Although the client's cleaning may influence others to tidy up, this is not a deliberate attempt to control their behavior. The primary drive stems from the client's internal need for order and cleanliness, not a desire to dictate the actions of others.

Choice C: Focus attention on meaningful tasks

While the act of cleaning can be productive and contribute to a pleasant environment, it's not the primary function or intention behind the client's behavior. Their actions are primarily driven by the need to quell anxiety, not necessarily to accomplish meaningful tasks.

Choice D: Decrease anxiety to a tolerable level

This is the most accurate rationale for the client's behavior. Individuals with OCD engage in compulsions, like excessive cleaning, to alleviate the intense anxiety associated with their intrusive thoughts and obsessions. In this case, the act of picking up after others provides the client with a sense of order and control, thereby reducing their anxiety to a manageable level.

Elaboration:

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Individuals with OCD experience significant anxiety due to their obsessions and feel compelled to engage in compulsions to manage that anxiety.

In the scenario presented, the client's constant cleaning behavior likely stems from an obsession with order and cleanliness. This obsession triggers anxiety when the environment is perceived as messy or disorderly. The act of picking up after others serves as a compulsion, a ritualistic behavior performed to reduce the anxiety caused by the obsession. By restoring order and cleanliness, the client temporarily alleviates their anxiety and achieves a sense of control over their environment.

It's important to recognize that the client's cleaning behavior, while seemingly productive, is primarily driven by their internal need to manage anxiety, not by a genuine desire to help others or maintain a tidy environment. This understanding is crucial for the nurse to effectively support the client and guide them towards healthier coping mechanisms for managing their OCD symptoms.