Joe Peron, a 15-year-old client, is admitted to the behavior medicine unit for inappropriate behavior in school. He was brought to the facility because of a violent outbreak at school against his peers. The principal has suspended him for an undetermined period. Since his admission, Joe has been condescending and sarcastic to staff members, flirting with the female adolescents, and overbearing and belittling to the younger clients. He displays a superior attitude toward the male adolescents. This behavior has not endeared him to the staff, because he is having a negative influence on the therapeutic milieu. Groups are difficult, because he tends to dominate the conversation, interrupt the other participants, and laugh at their reflections. He’s been diagnosed with oppositional defiant disorder (ODD) and posttraumatic stress disorder (PSTD). In the 5 days he has been in the unit, he has had three angry outbursts, throwing chairs and shouting obscenities. After the outbursts he verbalizes minimal regret. “I can’t control my anger; it comes on too fast, and it’s not my fault, anyway,” he tells Tom Warren, a nurse on the unit.
Joe comes from a splintered home. His mother gave him neglectful and sometimes abusive care. She spent most of her time on the street, working as a prostitute to support her drug habit. Occasionally she brought him with her while she was working. His father, also a drug addict, abandoned the family when he was 4. When he was 5, his mother died of an accidental overdose of heroin. Joe now lives with a supportive but increasingly frustrated foster family. He participates in one positive activity, soccer. He says he is a good soccer player, but the other members do not like him. He cannot identify any friends.
Mr. Warren and other staff members meet to discuss Joe and develop an integrated plan of care. The working group consists of the advanced psychiatric mental health nurse practitioner, physician, nurses, and mental health staff members. They all realize that they must make a concerted effort to help Joe learn to manage his anger, because their current interventions have not been successful. Tom reminds the others that they must address Joe’s self-esteem issues as well as his anger. Joe often appears depressed.
Nurse’s Personal Perspective
High risk for violence: other directed related to lack of impulse control, traumatic childhood as manifested by
Ineffective coping related to impulsive behavior as manifested by
Low self-esteem related to inability to control impulses as manifested by
Short-Term and Long-Term Goals
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