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Tara, an intake nurse and coworker of yours, tells you about Mr. S

Tara, an intake nurse and coworker of yours, tells you about Mr. S, a 52-year-old patient with a history of psychiatric disorders that have largely been mitigated with medication and therapy. He came in wanting antibiotics for a cold he’s had for a couple weeks.

Mr. S told Tara, “Everything was going so well, but recently I’ve just been feeling so weak and depressed, and now I have this cold that I haven’t been able to shake for almost 3 weeks. I’m falling apart. If I could get over the cold, I might have a whole different outlook on things.”

Tara asked whether he’d experienced any stressful event recently. He replied, “No, things have been going really well for at least 6 months since my therapist got my medications right, and I even kept going to therapy regularly after getting more stable. I haven’t been for the last 3 months, but that’s only because my schedule has been full with really good things. I was promoted into a position that I didn’t get a few years ago, and that was just 3 weeks after getting married. I’d been extremely happy until this stupid cold. I love my job; I love my wife; I have no reason to complain. But I just feel awful.”

​Tara tells you that she suspects that his cold is either interacting with his medications or that he’s probably suffering from lack of sleep because of the terrible cough keeping him up. She agrees with Mr. S that getting over the cold would probably “work wonders for his psyche.” She told Mr. S that once he is over the cold, he should resume his therapy sessions, which seemed to be beneficial.


1. Do you agree with Tara’s assessment? Why or why not?2. Tara is a little annoyed when you disagree with her assessment. “My friend, Donna, is the biggest inspiration in my life. She graduated college by 20 and went right for her MBA at the same time she was setting up her own photography business. She planned her entire wedding with zero help from her husband, and after the wedding she crashed with a serious cold for her entire honeymoon. It was no fun, but as soon as she got better it was back to life, back to work, and she wasn’t all depressed about it.” Why might Donna’s situation be different from that of Mr. S?











Colleen, a psychiatric mental health RN, is leading a therapeutic group for inpatients who have a history of alcohol abuse. The group is in the orientation phase, and members are still getting to know one another. Even at this early stage, however, Colleen recognizes behavior and personality traits of two members, in particular, that could pose potential problems in the group. One member, Howard, comes across as extremely negative and fairly aggressive. At times, he directly criticizes and belittles other members. When one group member discusses his wife’s disapproval of his drinking, Howard replies in disgust, “I don’t understand spineless guys like you who let women run your life. No wonder you can’t quit drinking.” When not confronting members directly, Howard makes dismissive and disparaging sounds or gestures. Other members seem offended by his behavior. Another member of the group, Fatima, has not spoken at all, except when directly asked a yes-or-no question. She does not seem unpleasant or unhappy to be in the group, but she keeps her eyes down, as though she’s afraid to be “called on.”


1. What term describes the type of group behavior Howard is demonstrating? How might Colleen address this behavior most effectively?2. Fatima is what type of group member? How is this best addressed? Should Colleen leave Fatima alone since she is not disrupting the group or causing any trouble? Or should Colleen be more proactive with this member?3. The members of Colleen’s group are inpatients. What bearing, if any, should this have on your suggestions above for Colleen in addressing member behavior? How might this affect Colleen’s overall leadership style for this group?















Last year Jennifer, her husband Ted, and their 10-year-old son Charlie were on vacation, 540 miles from home. Their teen-aged daughter Grace stayed home because she was taking an Advanced Placement college course at a local university for the summer. After a day of museum hopping and two beaches, Jennifer, Ted, and Charlie were pretty worn out. Jennifer was driving back to the hotel while both Ted and Charlie slept, when her sleeping husband’s cell phone went off, and without thinking, she reached to turn it off to keep the phone from waking her husband. In this brief lapse of attention she veered into the margin of oncoming traffic. Jennifer and her son Charlie were airlifted to a nearby hospital in critical condition. Jennifer’s husband died at the scene.

​Jennifer and Charlie were both hospitalized—Charlie for a week, and Jennifer for 3 weeks. As soon as Ted’s twin sister, Elise, arrived to fly back home with Charlie, Jennifer insisted that her family and friends back home move forward with a funeral for Ted. She didn’t think it was fair to Grace, Charlie, and Ted’s parents and siblings to have to wait for her, “… especially,” she said, “since this was all my fault.” Elise didn’t say much in response, but nodded and flew home with Charlie.

On the day of Ted’s funeral, Jennifer is alone 540 miles from home. The nursing staff, staff psychologist, and hospital chaplain rarely see her cry. Instead she works hard to stay “strong” and upbeat, asking instead about everyone else in her family and expressing concern about their grief and recovery. Ten days later, she is physically strong enough to travel and returns home. The psychiatric nurse on duty has urged her to seek grief counseling as soon as she gets home.

At home, Ted’s sister Elise has already talked to Charlie and Grace about staying with her for several months “… and maybe longer …” to help since Jennifer will have a long physical recovery.

Grace, in particular, is angry and trying not to blame her mother. She makes it clear she wants Elise there as a barrier. That night, Jennifer takes too many pain pills; later she feels ashamed, calls a suicide hotline, and admits that she wishes she had been the parent that died. She is diagnosed with severe depression and is hospitalized again on suicide watch. Three days later she is released to home, and she is deeply ashamed and apologetic to her sister-in-law and her children, commenting that she used to be the “strong, cheerful” parent in the family and now she “is just a failure and a mess.”


1. In addition to psychotherapy and grief counseling, what sort of additional psychoeducational teaching should the psychiatric-mental health nurse offer to help the whole family at this time?