Nursing Care of a Client With Schizophrenia

Nursing Care of a Client With Schizophrenia

Nursing Diagnosis

Social isolation Related to: Inability to trust others; Regression; Weak ego development; Preoccupied in own private world (delusion or hallucination) Evidenced by: Withdrawal; Setting alone; Rejection to participate in activities; sad & dull affect; expressing feelings of being rejected and loneliness

Outcome (social Isolation) Long Term Goal: The client will develop satisfying relationship with others in the unit. Short Term Goals: Client will willingly attend activities accompanied by a trusted nurse within ( time) Client will spent time voluntarily with other clients and staff in group activities Client will express feeling of easiness to interact with other outside the hospital

Nursing Intervention (social Isolation) Interact with client on one- to- one basis several times each day to communicate caring, unconditional positive regard and acceptance tell the level of patient’s anxiety is lowered and client’s sense of self worth is increased

Nursing Intervention (social Isolation) • Stay with the client for a period of time that he\she can tolerate. During this time demonstrate • An attitude of patience, • Use of silence appropriately, • Avoid filling silence with trivial conversations, • Avoid making demands on the client that he can not meet eg; talking about your self or topics that concerns you, and which makes the client feel that he\she is expected to talk in return or to please you.

Communicate with the client by using : Open statements and questions, and give him\her time to respond, Avoid closed questioning, Attend to nonverbal communication that might indicate the client’s participation, ** Communicate through nonverbal eye-to-eye contact, leaning toward the client, touch with caution, Provision of physical care, food, games, walks, reading magazines. Nursing Intervention (social Isolation)

Help the client to make a choice of how many people he\she needs to interact with comfortably, for, some persons live their lives with just few close people and have no problem. Be with the client during the interaction with another client and provide positive reinforcement to enhance feeling of security & safety and self esteem Give recognition & positive reinforcement for the client’s attendance of the group activities to increase client’s self esteem Nursing Intervention (social Isolation)

After developing one-to-one relationship the nurse can introduce another member to the relationship according to client’s pace as in the following pyramid: one-to-one one-to-two nurse & client observe a group meeting interaction from outside Nursing Intervention (social Isolation)

nurse & client attend the group meeting nurse & client attend a group and participates by talking in the group client attends a group meeting alone with the nurse observing client attends the group meeting without the nurses presence. Nursing Intervention (social Isolation)

Help the client to express and discuss negative relationships from the past and how are they influencing current relations. Promote acceptance of painful stimuli. Discuss alternative ways other than withdrawal. Nursing Intervention (social Isolation)

Impaired verbal communication Related to: Panic anxiety, regression, withdrawal, unrealistic thinking Evidenced by: Loose association, neologism, word salad, clang association, echolalia, concrete thinking, poor eye contact

Outcome criteria (Impaired communication) Long Term Goal: Client will be able to communicate appropriately and comprehensibly with others The client will be able to communicate verbally with others in a socially acceptable manner by discharge Short Term Goals: Client will demonstrate the ability to speak in one topic, using appropriate words and intermittent eye contact for 5 minutes with the nurse

Nursing Interventions (impaired communication) • Assign one staff to communicate with the client to facilitate trust and consistency • Show acceptance • Attempt to decode client’s incomprehensible communication pattern by: • Seek validation and clarification about what you understood from the client’s words “is this what you mean ….”; or “I do not understand what you are saying can you repeat it again slowly” • Use the technique of verbalizing the implied with mute client’s to convey understanding & empathy e.g.; “That must be difficult time for you when …….”

Nursing Interventions (impaired communication) • When client is having concrete thinking do not use abstract phrases or cliches but provide explanation according to the client’s level of comprehension e.g.; “ pick up the spoon, scoop the rice into it, put it in your mouth” • Anticipate and fulfill client’s needs until functional patterns of communication returns • Orientation to reality by calling client by name, help client differentiate between what is real and what is not real

Self-care deficit RELATED TO : Inability to trust,Withdrawal,Regression to earlier stage of development, perceptual cognitive impairment, dependency, panic anxiety EVIDENCED BY: difficulty carrying out tasks associated with daily hygiene, dressing, grooming, eating, toileting

Outcome Criteria • Long Term Goal • The client will be able to perform activities of daily living (ADLs) in an independent manner by discharge. • Short Term Goals: • Client will verbalize a desire to perform ADLs by end of (time) • Client will carry ADLs with assistance by (time)

Nursing Intervention (self care) Assess client’s ability to carry activities of self care and do for him\her what he\her is not able to do. Provide assistance with self care needs as required. Client who are severely withdrawn may require total care by the nurse Make sure of safety & security measure during the performance of ADLs

Nursing Intervention (self care) • Develop a structured schedule in the unit for carrying ADLs & set limits to help client comply and maintain by the self care daily routine (morning care –bathing, cleaning face, brushing teeth, changing cloths, combing hair-, and before sleep care)

Nursing Intervention (self care) • Show the client how to perform activities with which he\she is having difficulty by giving concrete simple directions during performing self care • Use specific concrete communication with the client if he/she is suffering from concrete thinking, in order to show client what is expected, by providing step by step assistance in performing ADLs • Example: “Take your shirt off, put it in laundry, take this new shirt, put the shirt on, button the buttons , now take the comb and comb your hair”

Nursing Intervention (self care) If the client is soiling self, establish routine schedule for toileting needs, by assisting the client to go to the bath room on hourly bases or as needed, until he\she is able to fulfill needs without help. Encourage client to perform ADLs independently & Provide positive reinforcement each time the client performs self care independently to increase self esteem Help the client in choosing own clothes (teach him\her how to choose and wear)

Nursing Intervention (self care) Ignore the client’s failure in the attempt to help him self and assist with caring and without embracing the client. Creative ways need to be taken with client who are suspicious and refuse to eat such as allowing client to open own canned food or packaged food, eat from the same food of client, or help the client to prepare own food in kitchen

Disabled Family Coping • Related to: Difficulty coping with client’s illness • Evidenced by: Neglectful care of the client’s basic human needs or illness treatment; Extreme denial or prolonged over concern of client’s illness

Outcome Criteria • Long Term Goal: • Family members will take action to alert behaviors that contribute to dysfunctional coping • Short Term Goals: • Family will identify more adaptive coping strategies for dealing with client’s illness & treatment

Nursing Interventions (disabled family coping) • Help family to identify their functioning level by exploring: • Communication patterns • Interpersonal relationship between members • Role expectations • Sources of family stress as perceived by each member • Usual way of dealing with stressful situations and wither these ways are helpful • Problem solving skills • Availability of outside support system

Nursing Interventions (disabled family coping) • Provide knowledge for the family about: • Nature of illness: • Name of the diagnosis & Symptoms of illness (schizophrenia) • Ways for family to respond to behaviors associated with the illness • Progress & long term prognosis of the illness • Teach about medications effects & side effects and treatment compliance

Nursing Interventions (disabled family coping) • Provide knowledge for the family about: • Management of illness: • Connection of exacerbation of symptoms to times of stress • Develop a relapse prevention plan • Appropriate medication management • Importance of compliance to treatment • Teach to keep in touch with health care team members and supportive people

Nursing Interventions (disabled family coping) • Provide knowledge for the family about: • Management of illness: • Teach to avoid alcohol or drugs • Relaxation techniques • Social skill training • Daily living skills training • Support Services: • Financial assistance • Legal assistance

Nursing Interventions (disabled family coping) • Provide counseling sessions for family care giver to • lower emotional intra-family climate to help reduce stress & sense of burden • Anticipate and solve problems • Reduce expressions of frustration, anger and guilt of family members • Provide skill training sessions for family members to teach them healthy responses to the client’s bizarre behavior and communication patterns and in the events that the client become violent • Develop a plan of action to assist the family to respond adaptively in situations of crisis • Help family to develop recreational programs & desirable changes that enhances the quality of family life

Nursing Care of a Client With Schizophrenia