6 Schizophrenia Nursing Care Plans

Schizophrenia Nursing Care Plans
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In this guide are nursing care plans for schizophrenia including six nursing diagnosis. Nursing care plan goals for schizophrenia involves recognizing schizophrenia, establishing trust and rapport, maximizing the level of functioning, assessing positive and negative symptoms, assessing medical history and evaluating support system.

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.

The most common early warning signs of schizophrenia are usually detected until adolescence. These include depression, social withdrawal, unable to concentrate, hostility or suspiciousness, poor expressions of emotions, insomnia, lack of personal hygiene, or odd beliefs.

Nursing Care Plans

Here are six (6) nursing diagnosis for schizophrenia that you can use for your nursing care plan (NCP):

  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

Impaired verbal communication as a nursing diagnosis for schizophrenia. The patient’s speech content and patterns are being assessed because they usually exhibit poor communication function.

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Nursing Diagnosis

  • Impaired Verbal Communication

Related Factors

Here are the common related factors for impaired verbal communication that can be as your “related to” in your schizophrenia nursing diagnosis statement:

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

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

  • 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

Expected outcomes or patient goals for impaired verbal communication nursing diagnosis:

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  • 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 Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for impaired verbal communication (nursing diagnosis for schizophrenia):

Nursing Interventions Rationale
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. A 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 the 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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References and Sources

Here are references and sources for schizophrenia:

  • Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Research27(2-3), 181-190. [Link]

See Also

You may also like the following posts and care plans:

Mental Health and Psychiatric Care Plans

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Care plans about mental health and psychiatric nursing:

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