# Situation: The nurse works on a 30-bed acute psychiatric unit of a general hospital. The interprofessional team includes psychiatrists, nurses, a psychologist, a social worker, an occupational therapist and trained nursing attendants. The team meets every morning. A 33-year-old man with schizophrenia is stable after 3 weeks of treatment. Before discharge, the team wants him to relearn budgeting, preparing simple meals and following a daily work routine. Which team member is MOST directly responsible for this training?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse works on a 30-bed acute psychiatric unit of a general hospital. The interprofessional team includes psychiatrists, nurses, a psychologist, a social worker, an occupational therapist and trained nursing attendants. The team meets every morning.

A 33-year-old man with schizophrenia is stable after 3 weeks of treatment. Before discharge, the team wants him to relearn budgeting, preparing simple meals and following a daily work routine. Which team member is MOST directly responsible for this training?

## 보기

1. The clinical psychologist
2. The psychiatric social worker
3. The attending psychiatrist
4. The occupational therapist **✔ 정답**

**정답: 4**

## 해설

Occupational therapists assess and train functional skills: daily-living tasks such as cooking, budgeting and laundry, and work skills and routines that support independence. The nurse reinforces these skills in the milieu and the team shares the goals, but the skill training itself is the occupational therapist's core contribution.

## 심화 해설

Role of the occupational therapist in functional skills training

The correct answer is the occupational therapist. In an acute psychiatric unit, preparing a stable patient with schizophrenia for discharge requires a deliberate focus on instrumental activities of daily living (IADL)—the higher-level tasks that support independent community living. Budgeting, meal preparation, and following a daily work routine are all IADLs, not basic self-care tasks such as bathing or dressing. The occupational therapist is the team member whose core professional role is to assess and train exactly these functional skills.

Occupational therapy assessment tools such as the Domestic and Community Skills Assessment (DACSA-3) are specifically designed to evaluate IADL performance in people with mental health conditions. This reflects the profession’s central focus: translating clinical stability into real-world competence in home, community, and work settings [1]. The training described in the scenario—relearning budgeting, simple meal preparation, and a daily work routine—falls squarely within this domain.

The distinction among team members is important for the licensure examination. The clinical psychologist primarily addresses cognitive assessment, insight-oriented therapy, and symptom-focused interventions such as cognitive-behavioral approaches. The psychiatric social worker focuses on discharge placement, family support, financial entitlements, and linkage to community resources—arranging the environment rather than training the skill itself. The attending psychiatrist leads diagnosis, pharmacologic management, and overall treatment planning. None of these roles centers on the structured, activity-based retraining of daily-living skills.

Key point! The nurse reinforces IADL skills in the therapeutic milieu and shares the team’s goals, but the formal skill training—with task analysis, graded practice, and environmental adaptation—is the occupational therapist’s distinct contribution.

Evidence supports the effectiveness of this role in schizophrenia care. A systematic review of IADL interventions found that people with schizophrenia often present with deficits in independent living, education, working, and socializing, and that targeted IADL interventions are used to improve functioning in these areas. [2] A meta-analysis of randomized controlled trials further demonstrated that occupational therapy has a measurable impact on psychiatric symptoms and social functioning in patients with schizophrenia . These findings reinforce that occupational therapy is not merely diversional activity; it is a structured, evidence-informed intervention aimed at functional recovery.

A historical comparison clarifies the scope of practice. In a randomized trial comparing psychosocial occupational therapy with social skills training for outpatients with persistent schizophrenia, the occupational therapy condition involved broader community functioning activities, while the skills training condition was delivered by paraprofessionals using a manualized protocol . This does not diminish the occupational therapist’s role; rather, it shows that occupational therapy encompasses a wide range of functional domains, including the IADL and work-routine training described in this scenario. The team may share goals, but the assessment and training methodology belongs to occupational therapy.

| Team member | Primary responsibility in discharge planning | Role in budgeting, meal prep, work routine |
| --- | --- | --- |
| Occupational therapist | Assess and train IADL and work skills | Direct training, task grading, environmental adaptation |
| Clinical psychologist | Cognitive and emotional assessment, therapy | May address motivation or cognitive barriers, not skill training |
| Psychiatric social worker | Discharge placement, entitlements, family support | Arranges resources, does not train the skill |
| Attending psychiatrist | Diagnosis, medication, overall plan | Prescribes treatment, delegates functional training |

Watch out! Do not confuse the nurse’s role in reinforcing skills with the occupational therapist’s role in training them. The nurse practices these skills with the patient during daily routines on the unit, but the structured assessment, activity analysis, and graded training protocol are the occupational therapist’s core domain. In a question asking who is most directly responsible for the training, the answer is the occupational therapist.References (research sources)

- [1]Updating and validating the Domestic and Community Skills Assessment.Research articleWoodroffe N, Webster KE, Bowman S. (2026) · DOI: 10.1111/1440-1630.70100

- [2]Effectiveness of IADL interventions to improve functioning in persons with Schizophrenia: A systematic review.Meta-analysis/systematic reviewJohn A, Gandhi S, Prasad MK, Manjula M (2022) · DOI: 10.1177/00207640211060696

## 임상 시나리오

Occupational Therapy for Discharge ReadinessTargeting IADL Competence in Inpatient Psychiatry
The occupational therapist is the team member most directly responsible for training instrumental activities of daily living (IADLs) such as budgeting, simple meal preparation, and following a daily work routine. These higher-level functional skills are distinct from basic self-care and are essential for independent community living after discharge.

While the nurse reinforces these skills in the therapeutic milieu and the entire team shares the goals, the formal skill assessment and training is the occupational therapist's core contribution. Their work translates clinical stability into real-world competence in home, community, and work settings.

CautionDo not confuse the occupational therapist's role with that of the psychiatric social worker, who focuses on discharge placement, family support, and community resource linkage rather than direct hands-on skill training. Similarly, the clinical psychologist addresses cognitive and symptom-focused interventions, not functional task training.

## 핵심 개념

- **IADL (Instrumental Activities of Daily Living)** — Higher-level self-care tasks required for independent community living, including budgeting, meal preparation, medication management, and work routines, as opposed to basic ADLs like bathing and dressing.
- **Occupational Therapist** — A rehabilitation professional whose core role is assessing and training functional skills, including IADLs and work skills, to support independence in home, community, and work settings.
- **Interprofessional Team** — A collaborative group of healthcare professionals from different disciplines who meet regularly to plan and coordinate patient care, with each member contributing distinct expertise.
- **Discharge Planning** — The process of preparing a patient for transition from an inpatient setting to the community, including ensuring the patient has the necessary skills, resources, and support systems in place.
- **Schizophrenia** — A chronic psychiatric disorder characterized by disturbances in thought, perception, emotion, and behavior, often requiring long-term treatment and functional rehabilitation.

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