EAQ's ch 34 therapeutic groups

Which statement made by the nurse leader is associated with issues addressed during the working phase of group development? a. "Today we will be focusing on improving communication skills." b. "I get the sense that you all don't agree with what was just said." c. "Everyone will get an opportunity to express their feelings about what I said." d. "It appears that several of you agree about how to respond to a rude co-worker." e. "We need to identify people you can talk with when the group work is completed."

a, b, c, d All groups go through developmental phases. In the working phase, the group leader's role is to encourage focus on problem solving consistent with the purpose of the group. As group members begin to feel safe within the group, conflicts may be expressed, which should be viewed by the group leader as a positive opportunity for group growth. It is important for the leader to guide and support conflict resolution. Through successful resolution of conflicts, group members are empowered to develop confidence in their problem-solving abilities and better support one another in their individual efforts to grow and change. Determining post termination goals is not addressed during the working phase. p. 613

Which statement demonstrates that the characteristics of successful group planning have been addressed? a. "Here is a printed list of the group's objectives." b. "Were do you think we should meet each week?" c. "We usually refer to this group as Life Style Changes" d. "How does each of you plan to get to the meeting site each week?" e. "Who wants to be responsible for reminding members of the meeting?"

a, b, c, e To develop a successful group, planning should include a description of specific characteristics, including the following: name and objectives of the group, physical setting configuration , and description of leader and member responsibilities. Transportation to and from meetings is not a responsibility of the group and is not typically planned for unless on a one-to-one patient basis. p. 611

The nurse is leading a health education group. What is the nurse likely to discuss with the group? a. Appropriate nutrition for pregnant women b .Use of condoms and other safe sex practices c. Common side effects of chemotherapy agents d. Proper exercises for those with chronic arthritis e. Overview of the mechanism of the action of antidepressants

a, b, d a health education group, the group leader may discuss general health topics. These include topics such as nutrition, sex education and exercise. Medication education groups discuss about specific drugs or medication. These groups may discuss the use of medications, their side effects, and mechanisms of action. p. 616, Table 34.5

A patient's history includes depression, anxiety, and self-medication with alcohol and marijuana. The patient has been admitted for inpatient evaluation. Which therapeutic groups might best help this patient? a. Dual diagnosis group b. Support and self-help c. Psychoeducational group d. Dialectical behavior treatment e. Therapeutic community meetings

a, b, e A patient with comorbid depression, anxiety, and substance abuse has a dual diagnosis. Therapeutic community meetings can also help a patient with a dual diagnosis, as there are often several groups that a patient might attend during an inpatient stay. Support and self-help groups may begin in the hospital and are easily transferrable due to their prolific nature to outpatient settings. Psychoeducational groups do not specifically target substance use or abuse issues. Dialectical behavior treatment is not as appropriate for this scenario. Test-Taking Tip: If the directions are not completely clear to you, ask the examiner in charge of the session to explain exactly what is required. p. 616

Which functions represent informal individual roles by members of a group? a. Dominator b. Help seeker c. Standard setter d. Information seeker e. Recognition seeker

a, b, e Informal roles group members often assume may or may not be helpful to group development. Individual roles do not help the group but instead relate to specific personalities, personal agendas, and desires for having needs met by shifting the group's focus to them. Dominator, help seeker, and recognition seeker are examples of individual roles. Maintenance roles, such as the standard setter, keep the group together, help each person feel worthwhile and included, and create a sense of group cohesion. Task roles, such as the information seeker, keep the group focused on its main purpose and get the work done. p. 614, Table 34.3

The nurse follows existential theory while conducting group therapy for patients with obsessive compulsive disorder. Which appropriate action does the nurse take according to the theory? a. Helps patients to focus on their feelings to promote self-learning b. Demonstrates how to respond to stressful conditions c. Encourages patients to interact with each other to develop trust d. Helps and encourages patients to resolve the conflicts among themselves

a. According to existential or gestalt theory, the nurse helps the members to acknowledge their problems and promotes self-learning. It helps to improve the patients' decision-making ability. According to interpersonal theory, the nurse should act as a role model. It helps the patient to reduce anxiety by showing an appropriate response to stressors. According to the theory of group process, the nurse encourages the patient to interact with other members of the group. It helps patients learn how to effectively share their feelings. According to psychodynamic theory, the nurse encourages the patient in resolving conflicts. It enhances the problem-solving ability of the patient. p. 615, Table 34.4

When a group member notices another member crying and suggests, "It looks as though you need the floor to tell us what is so upsetting to you," the behavior being demonstrated is which of the following? a. Altruism b. Ventilation c. Universality d. Reality testing

a. Altruism involves putting another's needs before one's own. p. 612, Table 34.1

The leader opens the discussion at the first meeting of a new group. Which comment would be appropriate for this phase? a. "Let's begin by establishing the ground rules for our group." b. "Let's start by asking each person here to define his or her problems." c. "I would like each person to explain why you are attending this group." d. "Bringing family members to our group will help us achieve our goals."

a. Establishing ground rules helps to build trust in a group and set the group's norms and expectations. This is an appropriate leader behavior in the orientation phase. Members of a new group have not established trust and would be unwilling to define their problems. Visitors would alter the group's identity and jeopardize trust. p. 613

What is the group leader's responsibility in the termination phase? a. Encouraging group members to reflect on progress made. b. Removing him- or herself from the group so they can function independently. c. Allowing members to exchange contact information so they may remain as a support for each other. d. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

a. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify post termination goals. Contact with other members in the group outside of the group is not therapeutic and usually is discouraged. The group leader does not remove him- or herself from the group process. Group members do not fill out evaluation forms in group therapy. p. 613

These comments are made by members of a group. Which comment best contributes to the group's cohesiveness? a. "We started out talking about losses, but we have strayed from that subject." b. "No one in this group wants to hear anything else about failed romantic relationships." c. "I need to talk about how my problems developed and get some ideas for solving them." d. "We aren't making progress because our group leader has as many problems as we do."

a. "We started out talking about losses, but we have strayed from that subject" represents an observation about the group's process and content. The speaker is summarizing, which contributes to the group's cohesiveness and effectiveness. The other options are nonfunctional behaviors, such as controlling, dominating, blaming, and blocking. p. 612, Table 34.1

The nurse is co-leading a therapeutic outpatient group. What difference does the nurse note in an outpatient group compared to an inpatient group? a. There are few external influences. b. The leader decides the group norms. c. There is little time for group cohesion. d. The level of ego function is heterogenous.

a. The boundary of an outpatient group is well maintained, so there are few external influences. Their activity is not controlled by external factors. Inpatient group is a subsystem within a larger system of the health care facility. Many other hospital activities may influence the group. The outpatient group is a more stable group. Since members do not change often, there is more time that the group members spend with each other. The group norms evolve over time rather than the leader deciding the norms. Since the patients in an outpatient group spend more time together than in an inpatient group, there is sufficient time for group cohesion to develop normally. The inpatient group may have some hesitant members who are more or less forced into the group because they are admitted to the health care facility. The outpatient group, however, is made up of motivated, self-referred individuals whose level of ego function is homogenous. p. 613, Table 34.2

A strategy the group leader may use to encourage a nonparticipating member to speak during a session is to share which of the following with the patient? a. "What you are thinking is very important to the group." b. "Your opinions about what just happened are important." c. You are letting the group down when you fail to contribute." d. "You must be feeling safe enough to enter the discussion by now."

a. The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions. Telling the patient that what he or she is thinking is very important to the group is a nonthreatening way to encourage the patient to contribute. Telling the patient that he or she is letting the group down, that his or her opinions of what just happened are important, and that he or she should be feeling safe enough to share are more threatening and may place the patient on the defensive and encourage further withdrawal. p. 618

When planning a group therapy, what does the group leader need to keep in mind about the place where the group shall meet? a. The seats should be arranged close to each other. b. A small room should be a better setting than a huge room. c. The configuration of the physical setting should be changed often. d. A classroom seating arrangement should be the preferred arrangement.

a. When seats are arranged close to each other, it promotes intimacy and facilitates active group interaction. A large room may not encourage intimacy, but a small room may be overcrowded and add to discomfort and anxiety. The size of the room should depend on the size of the group. Arranging the chairs in a circle may be better than a classroom setting. It conveys equality among all present and allows the members to see each other. The configuration of the physical setting should be consistent and should not be changed often. When the physical setting is consistent, the patients get used to it and begin to feel comfortable in the surroundings and may open up better. p. 612

In the context of group therapy, what term is used for recurring ideas or feelings expressed by the members that share a common thread? a. Group norm b. Group theme c. Group content d. Group process

b. During group discussions, members may express ideas or feelings that recur and share a common thread. This is referred to as the , which provides a direction to the group. Group content refers to all that is said in the group. Group norm is the term for the group-specific rules that develop over time. These are the expectations of behaviors from the group members. Group process refers to how the group's members work together towards a common aim. It describes the dynamics of interaction among the members. p. 612, Box 34.2

The nurse is conducting group therapy for patients with attention deficit hyperactivity disorder (ADHD). The nurse learns that the patients have conflicts among them and encourages them to resolve their conflicts. Which phase of the group development is indicated from the nurse's actions? a. Working phase b. Orientation phase c. Termination phase d. Stabilization phase

b. In group therapy, group development is categorized into three phases based on the specific roles and challenges that the nurse faces. In the working phase, the patients interact with each other and express their conflicts. The nurse should guide and support the members to resolve the conflicts and improve the patients' problem-solving abilities. In the orientation phase, the nurse encourages the patients to interact with each other and makes them feel comfortable. In the termination phase, the nurse identifies the progress of the patients and encourages them to acknowledge their progress. The nurse should encourage the patients to openly address their feelings. The stabilization phase is not a part of group development; it is part of the treatment model. In the stabilization phase, the health care professionals encourage the patients to regularly take their medications and check for signs of toxicity and adherence to medication. p. 613

When a patient is encouraged to talk with others who have had similar problems, the nurse is suggesting which of the following? a. Milieu group b. Support group c. Time-limited group d. Cognitive-behavioral group

b. Support groups are composed of members who have had or are currently sharing similar experiences, such as a bereavement group or a group of women with breast cancer. This is the only group with the focus on a shared problem; cognitive-behavioral, time-limited, and milieu are incorrect groups. p. 617, Box 34.4

A nurse manager instructs the nurse to conduct group therapy for outpatients with obsessive compulsive disorder (OCD). Which appropriate action does the nurse follow while conducting group therapy? a. The nurse encourages the patients to be in contact after therapy. b. The nurse conducts the therapy for the patients for a period of 2 years. c. The nurse frequently rotates the members of the group for each therapy. d. The nurse selects the patients with different levels of ego to form a group.

b. The group composition, needs, and treatment differ for outpatient and inpatient groups. Group therapy is given for an extended period of 2 years, or as long as required, for outpatients. It helps to achieve effective treatment outcomes. For outpatients, group therapy members having similar ego functioning and a homogenous level of thinking are selected to form a group. It helps to avoid conflicts among the group members and to encourage the members to support each other. The members of the group should be advised not to be in contact with the other group members after therapy as it can lead to personal involvement. The members of outpatient group therapy are stable and don't change therapies as they are self-referred and motivated. The members of inpatient group therapy change for every meeting due to their uncertain and contradictory behavior. p. 613, Table 34.2

The group phase most influenced and managed by the leader is which of the following? a. Working b. Orientation c. Termination d. Post-termination

b. The group leader often is most directive in the orientation phase, in which roles and ground rules are set. Working, termination, and post-termination phases are member directed. p. 613

When evaluating members of a therapeutic group, what statement by a member does the nurse identify as being consistent with monopolizing behavior? a. "No, I do not have anything to say at the moment." b. "Please keep quiet and just listen to what I am saying." c. "My headache is irritating and simply refuses to go away." d. "What makes you believe that I should listen to your advice?"

b. A monopolizing member does not give anybody else a chance to be heard. Such a member is extremely talkative. In an attempt to deal with anxiety, the person may monopolize the group with one's own compulsive speech. A complaining member may continually bring somatic problems such as a nagging headache to the group and still reject any help. A silent member prefers to stay silent and observe others during any group discussions. A demoralizing member may talk angrily to the leader and show no concern for others. Such a member shows hostile behavior. pp. 617-618

The nurse recognizes that which of the following describes a closed group? a. Will demonstrate cohesiveness b. Will discuss topics that will be restricted c. Will not add new members once it is formed d. Has a membership that is limited to one gender

c. A closed group is one to which no members are added once the group has begun. Discussing topics that will be restricted, having a membership that is limited to one gender, and demonstrating cohesiveness may or may not be characteristics of the group. p. 612, Box 34.3

While conducting group therapy for patients in the working phase, the nurse observes some progress in the group interaction. What observation by the nurse indicates that the group can now share what they have learned? a. Group members can identify others' mistakes perfectly. b. They feel good and say, "We are ready for the next level." c. They show some confidence and start supporting each other. d. They share their views on how they have progressed during the phase.

c. In the working phase, the group leader encourages the group members to share their differences and growth is based on conflict resolution and how the group members learn to support each other. That helps to improve the members' individual confidence. When members complain about others in the group, by pointing out their errors, it is not a sign of growth. It is not the members who decide if they are ready for the next phase of the group therapy. It is the leader who decides that. The group members' opinion about their own progress is not as important as the leader's observation of a change and ability to resolve conflicts and support others. p. 613

Which statement is not true regarding self-help and support groups? a. People who have had a particular problem can help others with the same problem. b. Self-help and support groups are designed to serve people with a common problem. c. Professional leadership is inappropriately expensive for treatment of minor problems. d. Promotion of dialogue, self-disclosure, and encouragement can produce change in members.

c. Self-help and support groups do not exist to address minor problems. Problems successfully treated by self-help and support groups include addictions, eating disorders, and adjustment to life changes caused by major illnesses. Being able to help others with the same problem, promoting of dialogue, self-disclosure, and encouragement, and self-help and support groups designed to serve people with a common problem are true statements regarding self-help groups. p. 616, Table 34.5

The phase of group therapy in which the group deals with feelings associated with separation and loss is called what? a. Working b. Orientation c. Termination d. Post termination

c. During termination, the group members must face the fact that they are at a parting of the ways. Unresolved feelings associated with other terminations and separations may surface and need to be addressed. This is the only stage where such group work is done; orientation, working, and post termination are incorrect. p. 613

A primary healthcare provider instructs the nurse on how to conduct group therapy for psychiatric patients. Which appropriate action does the nurse follow for effective group therapy? a. The nurse arranges the seats in rows of different height. b. The nurse plans similar group activities for the outpatients and inpatients. c. The nurse includes the patients having common psychiatric illness in a group. d. The nurse makes small groups and conducts activities in a large, spacious room.

c. Patients with similar mental illnesses should be in the same group to help the nurse plan the most appropriate group activity for them. The patients can share their life experiences, feelings and concerns. The nurse should conduct group activities in appropriate surroundings. The nurse should not conduct therapy for a small group in a spacious room, as the nurse cannot concentrate on the patients, and the patients may become distracted. The seating arrangements for the group must be done in a circle, as it conveys equality among the members of the group and the leader. Arranging the seats at different heights can make the patient feel different from other members of the group. The nurse should not follow similar group activities for outpatients and inpatients, as the needs of inpatients are significantly different from the outpatients. p. 611, Box 34.1

In group therapy for patients with bipolar disorders, when one member leaves the group, another is added to maintain the number of members at 15. How does the nurse describe the membership of the group? a. Subgroup b. Closed group c. Homogeneous group d. Heterogeneous group

c. Sometimes group therapy is planned for outpatients by careful selection based on particular characteristics among the group members, such as a similar diagnosis. Such a group is homogeneous. A subgroup is a smaller group that is isolated within a larger group. For example, within a creative group focusing on music, there may be different subgroups which focus on instrumental and vocal music. Membership in a closed group is restricted. New members are not added if others leave. Such groups are helpful where there is fixed schedule to follow and addition of a new member may disrupt the group's functioning. Heterogeneous groups generally consist of members with many differences. An exercise group with members from different age groups who may be obese or thin, hypertensive or arthritic or diabetic, is an example of a heterogenous group. p. 612, Box 34.3

When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as which of the following? a. Altruistic b. Universality c. Subgrouping d. Contingency seeking

c. Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group. p. 612, Box 34.3

A patient diagnosed with borderline personality disorder who is attending a court-ordered therapy group projects an angry affect. The patient doesn't speak much, but when he or she does it is usually to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this? a. Remove the patient from the group because he or she is disrupting the group process for other participants. b. Spend one entire group session focused on the patient and try to get him or her to open up to other members in depth. c. Respond neutrally to the patient's comments, ask for group feedback, and talk to him or her privately to form a connection. d. Confront the patient firmly each time he or she makes a rude comment and let the patient know he or she will be taken out of group if this behavior continues.

c. The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger to form a connection with the patient, which may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile patient. p. 618

A therapeutic group leader notices that while one member in the group talks at length about his own personal life, the others get bored and drift off. What statement by the leader is most appropriate in such a situation? a. "Why do you talk so much? Are you nervous about something?" b. "You are talking for a long time. Now please give others a chance." c. "You have been talking for 20 minutes now. Others are getting bored." d. "I feel you have a lot to say, but we must give others a chance as well."

d. The excessively talkative member is monopolizing the group by talking at length. The member will feel less defensive when the leader uses "I feel . . ." sentences rather than "You are . . ." sentences. Telling the member right away that others are getting bored by such lengthy talks may seem like the leader is putting the blame on the member. The member may become defensive if the nurse confronts him directly in a group setting and asks about his nervousness. When the nurse tells the member to give others a chance, the member may stop talking at length. But starting the sentence with "You are talking . . ." may make the member feel defensive as the member might think the nurse is accusing him of wrongdoing. p. 617

The nurse is conducting group therapy for patients with schizophrenia. During group therapy, the nurse finds and connects various ideas and suggestions for conducting effective therapy. Which nursing function does this indicate? a. Orienter b. Evaluator c. Recorder d. Coordinator

d. The nurse has to play different roles and perform different functions while being a part of the group therapy. The role of coordinator is to find and connect various ideas and suggestions for conducting effective group therapy for the patients. The function of the orienter is to document the progress of the patients in the group therapy and to check whether the goals of the treatment are achieved. The evaluator evaluates the work done by the members of the team and directs them to reach the objectives. The recorder acts as a memory of the group and keeps notes of the patients' behavior and progress. p. 614, Table 34.3

An advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic or the member's behavior and makes no comment unless asked a direct question. This is an example of what style of leadership? a. Autocratic b. Authoritarian c. Democratic d. Laissez-faire

d. A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and don't allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making. p. 615