A nurse in an emergency department is caring for a client who recently experienced partner violence.

Exhibits

The nurse is reviewing the client’s medical record at discharge. For each finding, specify whether the finding indicates a potential improvement in or a worsening of the client’s physical or psychological status.

Choice A reason: Assertiveness training is typically used to help individuals communicate more effectively and assert their needs and rights while respecting others. However, for someone with narcissistic personality disorder (NPD), this approach may not address the core issues of grandiosity and lack of empathy.

Choice B reason: Response prevention therapy is often used in the treatment of obsessive-compulsive disorder to help prevent the individual from engaging in compulsive behaviors. It is not typically indicated for NPD, as it does not address the underlying issues of self-esteem and empathy.

Choice C reason: Schema-focused therapy is designed to help individuals with NPD by identifying and changing deeply ingrained patterns of thinking and behavior, known as schemas, that are often maladaptive. This therapy can help address the root causes of NPD, such as feelings of inadequacy and the need for admiration, making it a suitable recommendation for someone with NPD³.

Choice D reason: Cognitive behavioral therapy (CBT) can be effective for a range of mental health disorders by helping individuals recognize and change negative thought patterns. While CBT can be beneficial for someone with NPD, schema-focused therapy is often preferred because it goes deeper into the personality structure and addresses the specific challenges of NPD³.

Choice A Reason: The belief that a partner will not be violent in the future can be a form of denial or wishful thinking, especially without any evidence of change or intervention. It is not uncommon for individuals in abusive relationships to hope for change, but without concrete actions, such as therapy or other interventions, this hope does not indicate an improvement in the client’s situation.

Choice B Reason: Agreeing to an appointment with a social worker is a positive step towards addressing the situation and seeking help. Social workers can provide support, resources, and guidance, which can be crucial for someone experiencing partner violence. This choice indicates a potential improvement in the client’s psychological status as it shows a willingness to engage with support services.

Choice C Reason: A decrease in reported pain levels can indicate physical improvement. Pain scales are subjective but provide a measure of the client’s comfort and can reflect healing or the effectiveness of pain management strategies.

Choice D Reason: Requesting help to develop a safety plan is a proactive step in ensuring personal safety and preparing for potential future incidents of violence. It shows the client’s awareness of the risks and a desire to protect themselves, which is a positive indicator of psychological improvement.

Choice E Reason: While claiming responsibility for the physical altercation may seem negative, it can also be seen as the client’s attempt to make sense of the situation. It is important to note that responsibility for violence lies with the perpetrator, not the victim. However, recognizing the dynamics of the relationship and the events leading up to the violence can be part of the healing process and taking control of one’s life.