Nursing Interventions in Schizophrenia

1
Nursing Interventions in Schizophrenia
2
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

3
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

4
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

5
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

6
Planning of Appropriate Interventions

• Acute phase
• Possible hospitalization
• Ensure client safety
• Provide symptom stabilization
• Maintenance and stabilization phases
• Psychosocial education
• Relapse prevention skills

7
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

8
Interventions Basic Level Continued

• Maintenance and stabilization phases
• Health teaching
• Health promotion and maintenance

9
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

10
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

11
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

12
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

13
Client Teaching Coping Techniques for
Schizophrenia

• Distraction
• Interaction
• Activity
• Social action
• Physical action

14
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.

15
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.

16
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
17
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
18
Clang Association

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

Back
19
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
20
Word Salad

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

Back
21
BE FAMILIAR WITH

• thought broadcasting - the belief that ones
  thoughts can be heard by others

Back
22
Thought Insertion

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

BACK
23
BE FAMILIAR WITH

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

Back
24
Delusions of Being Controlled

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

BACK