Boyd 8e

789

CHAPTER 37 • Mental Disorders of Childhood and Adolescence

Clinical Judgment Nursing Care Plan 37.1 Continued

Jamie shows improved attention and decreased distractibility. Mother and teacher attest to Jamie’s decreased impulsive behavior. Jamie identifies alternative responses such as walking away until it is his turn. Jamie demonstrates more understanding of motives and behaviors of others.

Improve school performance.

Move to front of classroom as an aid to attention. Encourage participation in structured activities. Inquire about social skills group at school, if available. Encourage participation in community activities.

Increase Jamie’s capacity to recognize the effects of his behavior on others. Increase frequency of acting on these alternative approaches.

Improve acceptance by peers.

Priority Hypothesis: Difficulty Parenting

Important Characteristics

Associated Considerations

Verbalizes discouragement and inability to handle situation with Jamie

Chronicity of ADHD More-than-average childrearing issues

Planning Recovery and Wellness Outcomes

Initial

Discharge

Verbalize frustration at trying to raise a child with ADHD alone. Identify positive methods of interacting with and disciplining Jamie that will support the parent–child relationship as well as meet Jamie’s development needs.

Identify coping patterns that decrease the sense of frustra tion and increase parental competence. Initiate a collaborative relationship with the schoolteacher. Identify sources of support in the community and begin to access these resources.

Taking Action: Nursing Interventions

Intervention

Rationale

Ongoing Assessment

Assess mother’s discouragement and feelings about parenting, identifying specific problem areas. Refer mother to Community Mental Health Center for free parenting class.

Helping the mother verbalize her feelings and identify problem areas helps in formulating problem-solving strategies. Parent training based on clear direc tives and rewards can be effective for decreasing impulsive and disruptive behavior. Parent groups such as Children and Adults with Attention-deficit Disorder (CHADD) can be sources of support and information. Assess effectiveness of medication and other interventions; need feedback from teachers.

Assess the severity of the issues with which she is living.

Monitor mother’s level of confidence and perceived change in Jamie’s behavior.

Refer mother to self-help organization.

Determine whether contact was made and whether it was helpful.

Make contact with school to enhance collaboration with mother.

Determine whether mother has been able to contact teacher.

Evaluation

Outcomes

Revised Outcomes

Interventions

After four sessions, Lillian expresses her frustrations, but she has begun to identify different ways of relating to Jamie and his developmental needs. Through attending the parenting class and joining a support group, Lillian begins to change her coping pat terns, decrease her frustrations, and increase her parental competence. Lillian initiates a collaborative relation ship with Jamie’s teacher.

None

None

Complete parenting class; attend at least two support group meetings each month.

If necessary, refer for additional parent counseling.

Lillian and teacher mutually develop and implement behavior plans for home and school.

Have mother observe in the class room; have mother visit highly structured classroom.

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