6 Schizophrenia Nursing Care Plans

Impaired Verbal Communication

Patients with schizophrenia often experience impaired verbal communication due to various factors such as disorganized thinking, difficulty concentrating, and auditory hallucinations. These symptoms can interfere with the patient’s ability to express clearly and coherently, making it challenging to engage in meaningful conversations.

Nursing Diagnosis

• Impaired Verbal Communication

Related Factors

• 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

• The patient will express thoughts and feelings in a coherent, logical, goal-directed manner.
• The patient will demonstrate reality-based thought processes in verbal communication.
• The patient will spend time with one or two other people on structured activity-neutral topics.
• The patient will spend two to three 5-minute sessions with the nurse sharing observations in the environment within 3 days.
• The 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.
• The 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 Assessment and Rationales

1. 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.

2. Identify the duration of the psychotic medication of the client.
Therapeutic levels of an antipsychotic aid clear thinking and diminishes derailment or looseness of association.

3. Look for themes in what is said, even though spoken words appear incoherent (e.g., fear, sadness, guilt).
Often client’s choice of words is symbolic of feelings.

Nursing Interventions and Rationales

1. 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.

2. Keep the environment calm, quiet, and as free of stimuli as possible.
Keep anxiety from escalating and increasing confusion and hallucinations/delusions.

3. 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.

4. Use clear or simple words, and keep directions simple as well.
The client might have difficulty processing even simple sentences.

5. Use simple, concrete, and literal explanations.
Minimizes misunderstanding and/or incorporates those misunderstandings into delusional systems.

6. Focus on and direct the client’s attention to concrete things in the environment.
Helps draw focus away from delusions and focus on reality-based things.

7. 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.

8. When the client is ready, introduce strategies that can minimize anxiety and lower voices and “worrying” thoughts, teach the client to do the following:
Helping the client to use tactics to lower anxiety can help enhance functional speech.

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

9. Use therapeutic techniques (clarifying feelings when speech and thoughts are disorganized) to try to understand the client’s concerns.
Even if the words are hard to understand, try getting to the feelings behind them.