The nurse, Jorri, meets with an older adult client who will be discharged from the hospital later today. The discharge plan includes assisted outpatient treatment, mandated as a condition of the client’s release. The client, Edward, sits without speaking, arms crossed, looking down at the floor. The nurse opens a conversation:

Jorri: It seems to me you have something on your mind. If so, can we talk about it?

Edward: What’s there to talk about? All my decisions are made for me.

Jorri: Your decisions . . . ?

Edward: Yeah, like how I live when I get out of here. Going to therapy appointments every week and even having somebody come to my house to check on me. Like I’m not a grown man!

Jorri personally feels community care is appropriate for Edward, though Jorri can see Edward’s distress. Consider the QSEN competency regarding the limits and boundaries of therapeutic client-centered care. In this scenario, what knowledge, skills, and attitudes should the nurse consider to guide a response to the client?

How can nursing assessment increase safety with clients in mental health care?

Why is client safety a nursing priority, and what factors should nurses consider in assessing potential risks?

Give examples of how you would take action to meet nursing responsibilities associated with psychiatric advance directives in the categories of client teaching, client advocacy, and therapeutic relationship.

In a few sentences, describe nurses’ possible reactions to appointment of a guardian or conservator for a person living with mental illness, and offer strategies to address these.