Nursing Interventions in Schizophrenia

Self-Assessment: Working with Schizophrenic Clients

Peer group supervision
Client's intense emotions produce similar emotions in the nurse Willingness for nurse to discuss feelings and behaviors with supervisors decreases defensive behaviors

Team approach to decrease staff burnout Periodic reassessments of

Treatment outcomes Client's strengths and weaknesses

Assessment of the Client

Safety of client and others

Medical history and recent medical workup Positive, negative, cognitive, and mood symptoms Current medications and compliance to treatment Family response/support system

Potential Nursing Diagnoses

Risk for self-directed or other-directed violence Disturbed sensory perception Disturbed thought processes Impaired verbal communication Ineffective coping Compromised or disabled family coping

Outcome Criteria
Acute phase
Client safety and medical stabilization

Maintenance phase
Adherence to medical regimen Understanding schizophrenia

Participation of client and family in psychoeducational activities

Stabilization phase
Target negative symptoms Anxiety control

Relapse prevention

Planning of Appropriate Interventions

Acute phase
Possible hospitalization
Ensure client safety Provide symptom stabilization

Maintenance and stabilization phases

Psychosocial education Relapse prevention skills

Interventions: Basic Level

Acute phase Administer antipsychotic medication as prescribed Observe client behavior closely Set limits on inappropriate behavior Do not touch without warning Offer foods that are not easily contaminated Supportive counseling Milieu management Family psychoeducation

Interventions: Basic Level

Continued

Maintenance and stabilization phases

Health teaching Health promotion and maintenance

Milieu Therapy
Safety

Potential for physical violence due to hallucinations or delusions

Priority is least restrictive safety technique Verbal de-escalation Medications Seclusion or restraints Activities Provide support and structure Encourage development of social skills and friendships

Counseling: Communication Guidelines

Hallucinations
Hearing voices most common Approach client in nonthreatening and nonjudgmental manner Assess if messages are suicidal or homicidal Initiate safety measures if needed Client anxious, fearful, lonely, brain not processing stimuli accurately Focus on the clients feelings and present reality

Communication Guidelines

continued
Delusions

Be open, honest, matter-of-fact, and calm Have client describe delusion Avoid arguing about content Focus on feelings Present reasonable doubt Validate part of delusion that is real

Communication Guidelines

continued

Associative looseness Do not pretend that you understand Place difficulty of understanding on yourself Look for reoccurring topics and themes Emphasize what is going on in the client's environment Involve client in simple, reality-based activities Reinforce clear communication of needs, feelings, and thoughts

Client Teaching Coping Techniques for Schizophrenia

Distraction Interaction Activity Social action Physical action

Client and Family Teaching

Learn all you can about the illness. Develop a relapse prevention plan. Avoid alcohol and drugs. Learn ways to address fears and losses. Learn new ways of coping. Comply with treatment. Maintain communication with supportive people. Stay healthy by managing illness, sleep, and diet.

CLIENT AND FAMILY TEACHING

Teach about schizophrenia and available mental health agencies for support at the local and national level (NAMI AND NIMH). Develop a relapse prevention plan. Teach about medication and treatment compliance. Teach to avoid alcohol or drugs. Teach to keep in touch with supportive people. Teach to keep healthy stay in balance.

Loose Association
Definition - thinking haphazard, illogical, and confused. Connections in thought are interrupted. Example: I cant go to the zoo, no money, Oh... I have a hat, these members make no sense, manWhats the problem?
Back

Neologism

Definition: Words a person makes up that have meaning only for that person, it is often part of a delusional system. Example: I am afraid to go to the hospital because the norks are looking for me.
Back

Clang Association

Definition: The meaningless rhyming of words, often in a forceful manner. Example: Rain, pain, bang, clang.
Back

Echolalia
Definition - mimicking or imitating the speech of another person. Example: The nurse says to the patient, Tell me your name. The patient responds, Tell me your name, tell me your name.
Back

Word Salad

Definition: Mixture of words and phrases that have no meaning. Example: I am fineapple pieno salefurniture storetake it slowcellar door
Back

BE FAMILIAR WITH: thought broadcasting - the belief that ones thoughts can be heard by others

Back

Thought Insertion
thought insertion - the belief that thoughts from other people are being inserted into ones mind
BACK

BE FAMILIAR WITH:

thought withdrawal - the belief that thoughts have been removed from ones mind by an outside agency.

Back

Delusions of Being Controlled

Delusions of being controlled belief that ones body or mind is controlled by an outside agency
BACK