Question 1

A nurse is preparing to form a group in an inpatient psychiatric setting for clients who have experienced trauma and determines that a small group would be best. In addition to the group leader, the nurse would anticipate including how many clients?

Accepted Answer

An ideal size for a small group is seven to eight clients. Clients with challenging behaviors should be carefully screened and assigned to smaller groups. Small groups (usually no more than seven to eight members) become more cohesive, are less likely to form subgroups, and can provide a richer interpersonal experience than large groups. Even though small groups cannot easily withstand the loss of members, they are ideal for clients who are highly motivated to deal with complex emotional problems (e.g., sexual abuse, eating disorders, or trauma) or for those who have cognitive dysfunction and require a more focused group environment with minimal distractions.

Question 2

While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets this behavior as reflecting which group role?

Accepted Answer

For any group to be successful, it must have members who assume task roles. The task role of information seeker is one in which the group member asks for clarification. The coordinator shows or clarifies the relationships among various ideas and suggestions. The recorder writes suggestions, keeps minutes, and serves as the group memory. The standard setter expresses the standards for the group to achieve.

Question 3

While leading a small group, a nurse sets up the ground rules at the beginning of the first meeting. One of the rules established is that the group will always start at the specified time, rather than waiting until everyone has arrived to begin. This rule reflects which group characteristic?

Accepted Answer

Norms establish acceptable group behaviors and encourage conformity of behavior among group members. Group cohesion is the closeness or sticking together of the group. Group think is the tendency of group members to avoid conflict and adopt a normative pattern of thinking that is often consistent with the ideas of the group leader. Group process is the development and culmination of the session-to-session interactions of the members that move the group toward its goals.

Question 4

In an initial group therapy session, a nurse observes that one group member continually tries to monopolize the conversation. The nurse interprets this behavior as reflecting what in the client?

Accepted Answer

When one group member continually tries to monopolize the conversation in an initial session, the client is most likely experiencing anxiety. The monopolizer does not reflect anger, rebellion, or fear.

Question 5

A nurse is leading a small group of hospitalized clients diagnosed with psychiatric disorders. One group member has asked for advice and often agrees with suggestions by other group members but then adds, "Yes, but . . ." to every suggestion offered. Which response by the nurse would be most appropriate?

Accepted Answer

With a client who agrees initially then continually says, "Yes, but . . .," the nurse should encourage that person to formulate his or her own solutions. The leader can serve as a role model of the problem-solving behavior for the other members and encourage them to let the member develop a solution that would work specifically for him or her. Telling the client to join a different group is demeaning and does not address the client's problem. Asking the client if he or she realizes the response, or telling the client to stop and think about why, could be threatening to the client's self-esteem.

Question 6

A client has been placed in an anger management group because the client has trouble controlling angry outbursts. The nurse interprets this as an example of what type of group?

Accepted Answer

Learning how to manage a medication regimen or control angry outbursts is often the aim of teaching (psychoeducation) groups. Psychoeducation groups are formally planned, and members are purposefully selected so that the focus of the group will help them work on a specific problem or knowledge deficit. Psychotherapy groups treat individuals' emotional problems and can be implemented from various theoretic perspectives, including psychoanalytic, behavioral, and cognitive. These groups focus on examining emotions and helping individuals face their life situations. Self-help groups are led by people who are concerned about coping with a specific problem or life crisis. These groups do not explore psychodynamic issues in depth. Supportive therapy groups are usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems.

Question 7

A nurse is leading a group in which members are encouraged to discuss their feelings and emotions. The group session is just starting when a client stomps into the room, slams a notebook on a table, and sits down. The client's affect is one of anger and hostility. Which response by the nurse would be most appropriate?

Accepted Answer

An effective group leader recognizes the effects of an individual's mood on the total group. Thus, an effective leader would realize that the client's intense anger could set the emotional tone of the entire group. If the purpose of the group is to deal with emotions, then choosing to discuss the member's problem at the beginning of the session would help limit the intense anger to the one person experiencing it. Keeping the focus off the client or asking the client to leave could disrupt the functioning of the group because the client's emotions can affect the entire group. Suggesting the client make a private counseling appointment may be appropriate later, after discussing the client's problem at the beginning of the session.

Question 8

A nurse is leading a group on an adolescent psychiatric unit. A new client in the group is from out of state. The new client's accent and way of dressing set the new client apart from the other clients, and it is obvious that the group, for the most part, dislikes this client. During the group session, the nurse has the members draw the emotion they are feeling and then has them present their drawings and explain them to the group. What would be the most effective way to address the group's dislike for the new client?

Accepted Answer

In some groups, members clearly dislike one particular member. This situation can be challenging for the leader because it can result in considerable tension and conflict. This person could become the group's scapegoat. The group leader may have made a mistake by placing the person in this particular group, and another group may be a better match. One solution may be to move the person to a better-matched group. Whether the person stays or leaves, the group leader must stay neutral and avoid displaying negative verbal/nonverbal behaviors that indicate that there is dislike for this specific member (or that indicate displeasure with the other members for their behavior). Often, the group leader can manage the situation by showing respect for the disliked member and acknowledging his or her contribution. Skipping the client nonverbally indicates negative feelings. Allowing the client to talk last isolates the client from the group. Demanding that the other group members tell why they dislike the client would demonstrate displeasure with the rest of the group for their behavior.

Question 9

A group of psychiatric-mental health nurses is reviewing information about the different types of groups. The nurses demonstrate understanding of the information when they identify which as a characteristic of a self-help group that differentiates itself from a supportive therapy group?

Accepted Answer

Self-help groups are led by people who are concerned about coping with a specific problem or life crisis. These groups do not explore psychodynamic issues in depth. Professionals usually do not attend these groups nor serve as consultants. Psychiatric nurses lead supportive therapy groups. Both types of groups focus on a specific problem.

Question 10

A nurse is preparing to lead an older adult group. Which would the nurse need to keep in mind when leading this group?

Accepted Answer

When working with older adult groups, the nurse may need to tailor the pace of the group meetings and place greater emphasis on using wisdom and experience, rather than learning new information. The nurse should also encourage the group to use life-review strategies, such as autobiography and reminiscence. When teaching new skills, the nurse should place them within the context of previous attempts to resolve issues and problems.

Question 11

A group of nurses is reviewing information about open and closed groups. The nurses demonstrate understanding of the information when they decide on forming an open group for which situation?

Accepted Answer

Because the duration of client hospitalization is relatively short, open groups are typical on inpatient units, such as an inpatient anger management group. Closed groups are more typical of outpatient groups that have a sequential curriculum, or psychotherapy groups. Examples include outpatient smoking cessation, psychotherapy, and psychoeducation groups.

Question 12

A nurse is deciding about the size of the group. The nurse determines that a large group would be best based on the understanding about which characteristic associated with a large group?

Accepted Answer

Large groups (more than 8 to 10 members) are effective for specific problems or issues, such as smoking cessation or medication information, and are often used in the workplace. Transference and countertransference issues usually do not develop in large groups. Group cohesiveness is less in larger groups. Larger groups also can be challenging because of the increased number of potential interactions and relationships that can form.

Question 13

While leading a group, a nurse leader says to a client, "This is the fourth time that you've changed the subject when we have talked about child abuse. Is something going on?" The nurse is using which technique?

Accepted Answer

The nurse's statement reflects confrontation, which helps individuals learn something about themselves, helps to reduce some forms of disruptive behavior, and helps members deal more openly and directly with one another. Support would be reflected in a statement such as, "We really appreciate your sharing that experience with us." Summarizing would be reflected in a statement such as, "So far we've discussed problems with . . ."; Clarification would be reflected in a statement such as, "What I heard you say was that you were feeling very angry right now. Is that correct?"

Question 14

A nurse leader has been observing the behavior of group members since the formation of the group. During the past few sessions, the leader has noticed a member often making derogatory statements about other members' issues and then attempting to take the credit for the work the group has achieved. The nurse leader interprets this behavior as indicating which role?

Accepted Answer

The aggressor deflates the status of others; expresses disapproval of the values, acts, or feelings of others; attacks the group or problem; jokes aggressively; and tries to take credit for the work. The group observer keeps records of various aspects of the group processes and interprets data to the group. The help-seeker attempts to gain sympathy from other group members by expressing insecurity, personal confusion, or depreciation of self beyond reason.

Question 15

Near the end of a medication group session, the nurse leader says, "Okay, we've talked about the client's medication problems and will be following up with the health-care provider." The nurse leader is using which technique?

Accepted Answer

The nurse leader's statement is an example of summarizing, which highlights the session's discussion and any problem resolution. Reflecting feelings is a technique that identifies the feelings being expressed and orients members to the feelings that may lie behind what is being said or done. Advice and suggestions is a technique of sharing expertise and knowledge and provides information to members that they can use after they have examined and evaluated it. Clarification is a technique that checks on the meanings of the interaction and communication.

Question 16

A nurse is acting as the leader of a newly formed group that is in the beginning stage of development. Which would the nurse expect to do? Select all that apply.

Accepted Answer

In the beginning stage of development, the nurse acknowledges each member; constructs a working environment; develops rapport with the members; begins to build a therapeutic relationship; and clarifies outcomes, processes, and skills related to the group's purpose. Members also begin to test whether they can trust one another and the leader. Working to develop norms, promoting sharing of feelings, and facilitating communication occur during the working phase.

Question 17

After conducting a review class for a group of psychiatric-mental health nurses about formal and informal roles of group members, the psychiatric-mental health clinical nurse specialist determines that the education was successful when the class identifies which as a formal role? Select all that apply.

Accepted Answer

Formal group roles include the leader and each member. Coordinator and information seeker, which are task roles, and harmonizer, which is a maintenance role, are considered informal roles.

Question 18

When leading a group, the nurse determines that several of the group members have assumed roles that may be interfering with the group's function. Which roles might be involved? Select all that apply.

Accepted Answer

The roles of self-confessor, dominator, and playboy are individual roles that members play to meet personal needs. These roles have nothing to do with the group's purpose or cohesion and can detract from the group's functioning. If individual roles predominate, the group may be ineffective. Follower and compromiser are maintenance roles. Elaborator is a task role.

Question 19

A psychiatric-mental health nurse is preparing to lead a medication group. Which would be most important for the nurse to assess? Select all that apply.

Accepted Answer

When planning a medication group, the nurse should assess a member's medication knowledge to determine what the individual would like to learn. People with mental illnesses may have difficulty remembering new information, so assessment of cognitive abilities is important. Assessing attention span, memory, and problem-solving skills gives valuable information that nurses can use in designing the group. The nurse should determine the member's reading and writing skills to select effective client education materials. Although an ideal group is one in which all members use the same medication, in reality, this situation is rare, and usually the group members are using various medications. However, the nurse should know which medications each member is taking, and to avoid violating patient confidentiality, the nurse needs to be careful not to divulge that information to other patients.

Question 20

A psychiatric-mental health nurse is planning to use reminiscence with a group of older adults. The nurse chooses this intervention for which reasons? Select all that apply.

Accepted Answer

Reminiscence, the thinking about or relating of past experiences, is used as a nursing intervention to enhance life review in older patients. Reminiscence encourages patients, either in individual or group settings, to discuss their past and review their lives. Through reminiscence, individuals can identify past coping strategies that can support them in current stressful situations. Patients can also use reminiscence to maintain self-esteem, stimulate thinking, and support the natural healing process of life review. Bibliotherapy aids in catharsis.

Quiz 14: Group Interventions