Nurses need to have a solid understanding of nursing diagnoses and nursing care plans. The interventions you perform for your patients will have a tremendous impact on their health outcomes and how they cope with their sickness.
A serious medical condition that you may encounter during your career is schizophrenia. This mental illness can be detrimental to a person’s quality of life and cause tremendous upheaval in their lives and families.
Understanding a bit more about this disease and the types of nursing interventions that can be used to help care for these patients can help you better prepare for your future as a nurse. Here is what you need to know about taking care of patients with schizophrenia.
What is schizophrenia? Symptoms to know
Schizophrenia is a psychiatric disorder that impacts a person’s ability to think clearly. It can result in impairments such as losing touch with reality, psychosis, hallucinations, and disorganized thinking.
Schizophrenia impacts less than 1% of the population. Doctors and researchers continue to look for better treatments to help patients improve their quality of life and lessen the recurrence of symptoms. This illness appears to impact both men and women at equal rates and occurs at similar rates worldwide.
Symptoms of schizophrenia are typically grouped into three categories. Positive symptoms are symptoms experienced by patients that do not occur in people with typical brains. Negative symptoms are those traits lacking in patients that a member of the typical population would have. Finally, the third category would be disorganized symptoms.
Some of the symptoms of schizophrenia include:
- Hearing voices
- Seeing things that are not there
- Experiencing paranoia or intense suspiciousness about everything
- Having a distorted perception of the world
- A greatly diminished ability to initiate plans
- Trouble speaking and expressing themselves
- Having a diminished capacity to express emotion
- Disorganized and disordered thinking
- Trouble speaking and a hindered ability to verbalize and express oneself coherently, a poverty of speech
- Difficulties with logical thinking and therefore problem-solving
- Abnormal behavior and movements
Symptoms often first appear for patients around early adulthood. Since this disorder can cause impaired cognition through problems with thinking, concentration, and memory, there is often a noticeable decline in academics — which hinders those preparing to enter adulthood. Many people also find social situations increasingly challenging as the disorder emerges.
Although schizophrenia does not generally manifest until young adulthood, many believe the causes likely begin much earlier. Scientists haven’t found one main cause of the disorder, but changes in the brain’s neurotransmitters, environmental factors, and genetics have all been named as potential contributing factors.
Determining a nursing diagnosis for schizophrenia
Diagnosing schizophrenia, like other mental health disorders, is done using the guidelines found in the DSM-5. The DSM stands for the Diagnostic and Statistical Manual of Mental Disorders.
This manual says that practitioners qualified to diagnose patients should see at least two of the following symptoms for a minimum of a month before making the diagnosis:
- Hallucinations, including visual and auditory hallucinations
- Disorganized speech
In addition to watching for these symptoms, practitioners must also take essential steps to make sure that no other potential disorders could cause these symptoms. They will complete a thorough psychiatric evaluation to check for evidence of any other mental health disorders and gauge the patient’s presenting symptoms. The evaluation will look for signs of other mental illnesses, such as bipolar disorder or other causes of psychotic episodes.
To check for other possible causes, a thorough diagnosis of schizophrenia will also include a comprehensive physical exam. During the physical exam, the medical professional will also run lab tests to check for drugs or medical conditions that could cause symptoms mistaken for schizophrenia. Symptoms like disturbed sensory perception and impaired social interaction should all be carefully evaluated as a part of this process. This exam may also include brain imaging, such as a CT scan or an MRI.
As a nurse, you will also make nursing diagnoses that will inform your care plan.
Your diagnosis might include:
- Impaired social interaction
- Disturbed auditory and/or visual sensory perception
- Disturbed thought processing
- Impaired verbal communication
- Defensive coping
- Interrupted family processes
Creating a Schizophrenia nursing care plan
A nursing care plan details the steps that you will take as a registered nurse to help patients diagnosed with schizophrenia. These care plans will target specific desirable outcomes, helping patients better cope with certain symptoms.
To determine the type of nursing care plan you’ll follow for a given patient, consider the type of symptoms that the patient suffers from the most. For example, one patient may find their impaired verbal communication to be the most disruptive. They may struggle tremendously with an inability to communicate with those around them. Another patient may be most disrupted by the paranoia and psychosis that plagues them.
As a nurse, you will need to carefully evaluate the patient. Look over the list of nursing diagnoses we gave you above to see which ones your patient meets the criteria for. This diagnosis will help you determine the types of interventions that will make the biggest difference. You can then prioritize the actions in your care plan.
Identifying these key symptoms and nursing diagnoses can help you determine the nursing care plan that will best suit this specific patient.
Schizophrenia nursing care plan example
As an example, let’s consider a patient who has been struggling with verbal communication. Schizophrenia has made it extremely difficult for them to use typical communication patterns and engage with others. They might also struggle with delusions and hallucinations, which may further isolate them from others in their lives.
In this particular situation, your nursing care plan will focus on helping the patient better manage their symptoms and improve their communication. First, break down each step you’ll follow to create a well-structured care plan.
- Establish a baseline. To establish a baseline of the patient’s current condition, begin by providing the patient with an assessment of their ability to think and communicate. You will evaluate them for disturbed thought processes.
- Develop a medication routine. You will recognize that the right dosage of psychiatric medications can help patients think more clearly and improve their overall cognitive function. Therefore, make sure the patient receives the right medicines at the correct dosage and at the proper intervals as prescribed.
- Create an effective environment. You will seek to encourage a comfortable environment for the patient that minimizes the aggravation of symptoms. Therefore, focus on creating a calm, quiet space with minimal stimuli where the patient can feel more at ease. Similarly, when communicating with a patient personally, speak in a low tone and articulate slowly to avoid causing any agitation for the patient.
- Educate the patient and their support system. Provide concrete education for the patient and their family to improve their mutual understanding and communication. You might help them uncover healthy coping mechanisms to help them stay calm, guide them through self-care tasks and important daily routines, and improve their ability to function. You might help them feel more comfortable with eye contact and other social customs.
As your patient receives this care, continue to communicate with the rest of the healthcare team. Monitor the patient’s condition to see how well they respond to your interventions, and watch for signs of side effects from the medication. This will help you know how to make adjustments moving forward.
Schizophrenia nursing interventions
Nursing interventions for patients with schizophrenia can take a variety of different formats. The interventions will depend upon the symptoms experienced by the patient and their degree of severity. Overall, all interventions focus on improving the quality of life for the patient. You want to help them better cope with their symptoms and gain more independence and autonomy.
- Medical interventions: Nurse practitioners can prescribe medications, which means that they may also prescribe psychiatric drugs for schizophrenic patients. Many patients are prescribed some type of antipsychotic medication. These medications work to reduce psychotic symptoms. Registered Nurses also often help make sure patients take the medications in the proper dosage and time. They also help observe the patient to properly document any signs of negative interactions to adjust dosages as needed.
- Psychosocial interventions: Nurses also help with various psychosocial interventions. Since many patients have trouble with social withdrawal and impaired social interaction, nursing interventions can help them manage these situations. Mental health nursing can include various types of therapy and social skills training. Nurses may help patients learn different therapeutic techniques, such as providing opportunities for socialization. They will also help patients develop coping skills so they can better manage their stress.
- Educational interventions: Nurses will also help with educational needs. This might include working with both the patient and their family members or caregivers to understand the disorder better. Finding effective strategies for calming the patient if they become agitated and helping them improve their communication skills is also an aspect of nursing interventions. You have to teach family members how to avoid inadvertently causing an escalation of the problem at hand while also showing them how to help the patient feel calmer.
- Monitoring and assessing the patient: Finally, many nursing interventions for schizophrenic patients will involve monitoring and assessing the individual. Assessing the patient at various parts of their treatment plan can help you note changes in the patient’s condition that might be significant for your nursing diagnosis and the rest of the care team.
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