6 Schizophrenia Nursing Care Plans

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Schizophrenia Nursing Care Plans

Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, possible delusions and hallucinations, and emotional, behavioral, or intellectual disturbance.

Nursing Care Plans

Nursing management of schizophrenia involves recognizing schizophrenia, establishing trust and rapport, maximizing level of functioning, assessing positive and negative symptoms, assessing medical history and evaluating support system.

Here are six (6) nursing care plans for schizophrenia:

  1. Impaired Verbal Communication
  2. Impaired Social Interaction
  3. Disturbed Sensory Perception: Auditory/Visual
  4. Disturbed Thought Process
  5. Defensive Coping
  6. Interrupted Family Process
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Impaired Verbal Communication: decreased, reduced, delayed, or absent ability to receive, process, transmit, or use a system of symbols.

May be related to

  • Altered perceptions.
  • Biochemical alterations in the brain of certain neurotransmitters.
  • Psychological barriers (lack of stimuli).
  • Side effects of medication.

Possibly evidenced by

  • Difficulty communicating thoughts verbally.
  • Difficulty in discerning and maintaining the usual communication pattern.
  • Disturbances in cognitive associations (e.g., perseveration, derailment, poverty of speech, tangentiality, illogicality, neologism, and thought blocking).
  • Inappropriate verbalization.

Desired Outcomes

  • Patient will express thoughts and feelings in a coherent, logical, goal-directed manner.
  • Patient will demonstrate reality-based thought processes in verbal communication.
  • Patient will spend time with one or two other people in structured activity neutral topics.
  • Patient will spend two to three 5-minute sessions with nurse sharing observations in the environment within 3 days.
  • Patient will be able to communicate in a manner that can be understood by others with the help of medication and attentive listening by the time of discharge.
  • Patient will learn one or two diversionary tactics that work for him/her to decrease anxiety, hence improving the ability to think clearly and speak more logically.
Nursing InterventionsRationale
Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms.Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.
Identify the duration of the psychotic medication of the client.Therapeutic levels of an antipsychotic aids clear thinking and diminishes derailment or looseness of association.
Keep voice in a low manner and speak slowly as much as possible.High-pitched/loud tone of voice can elevate anxiety levels while slow speaking aids understanding.
Keep environment calm, quiet and as free of stimuli as possible.Keep anxiety from escalating and increasing confusion and hallucinations/delusions.
Plan short, frequent periods with a client throughout the day.Short periods are less stressful, and periodic meetings give a client a chance to develop familiarity and safety.
Use clear or simple words, and keep directions simple as well.Client might have difficulty processing even simple sentences.
Use simple, concrete, and literal explanations.Minimizes misunderstanding and/or incorporating those misunderstandings into delusional systems.
Focus on and direct client’s attention to concrete things in the environment.Helps draw focus away from delusions and focus on reality-based things.
Look for themes in what is said, even though spoken words appear incoherent (e.g., fearful, sadness, guilt).Often client’s choice of words is symbolic of feelings.
When you do not understand a client, let him/her know you are having difficulty understanding.Pretending to understand limits your credibility in the eyes of your client and lessens the potential for trust.
When client is ready, introduce strategies that can minimize anxiety and lower voices and “worrying” thoughts, teach client to do the following:

  • Focus on meaningful activities.
  • Learn to replace negative thoughts with constructive thoughts.
  •  Learn to replace irrational thoughts with rational statements.
  • Perform deep breathing exercise.
  • Read aloud to self.
  • Seek support from a staff, family, or other supportive people.
  • Use a calming visualization or listen to music.

 

Helping client to use tactics to lower anxiety can help enhance functional speech.
Use therapeutic techniques (clarifying feelings when speech and thoughts are disorganized) to try to understand client’s concerns.Even if the words are hard to understand, try getting to the feelings behind them.
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See Also


You may also like the following posts and care plans:

Mental Health and Psychiatric Care Plans


Care plans about mental health and psychiatric nursing:

Further Reading


Recommended books and resources:

  1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes
  2. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  3. Nursing Diagnoses 2015-17: Definitions and Classification
  4. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
  5. Manual of Psychiatric Nursing Care Planning
  6. Maternal Newborn Nursing Care Plans
  7. Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
  8. Maternal Newborn Nursing Care Plans

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