6 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 Social Interaction

Patients with a progressive form of the disease are increasingly socially isolated.

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Nursing Diagnosis

Impaired Social Interaction

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

  • Difficulty with communication
  • Difficulty with concentration
  • Exaggerated response to alerting stimuli
  • Feeling threatened in social situations
  • Impaired thought processes (delusions or hallucinations)
  • Inadequate emotional responses
  • Self concept disturbance (verbalization of negative feelings about self)

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 nursing care plan for schizophrenia:

  • Appears upset, agitated, or anxious when others come too close in contact or try to engage him/her in an activity
  • Dysfunctional interaction with others/peers
  • Inappropriate emotional response
  • Observed use of unsuccessful social interactions behaviors
  • Spends time alone by self
  • Unable to make eye contact, or initiate or respond to social advances of others
  • Verbalized or observed discomfort in social situations

Desired Outcomes

Expected outcomes or patient goals for impaired social interaction nursing diagnosis:

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  • Patient will attend one structured group activity within 5-7 days.
  • Patient will seek out supportive social contacts.
  • Patient will improve social interaction with family, friends, and neighbors.
  • Patient will use appropriate social skills in interactions.
  • Patient will engage in one activity with a nurse by the end of the day.
  • Patient will maintain an interaction with another client while doing an activity (e.g., simple board game, drawing).
  • Patient will demonstrate interest to start coping skills training when ready for learning.
  • Patient will engage in one or two activities with minimal encouragement from nurse or family members.
  • Patient will state that he or she is comfortable in at least three structured activities that are goal directed.
  • Patient will use appropriate skills to initiate and maintain an interaction.

Nursing Interventions and Rationale

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

Nursing InterventionsRationale
Assess if the medication has reached therapeutic levels.Many of the positive symptoms of schizophrenia (hallucinations, delusions, racing thoughts) will subside with medications, which will facilitate interactions.
Identify with client symptoms he experiences when he or she begins to feel anxious around others.Increased anxiety can intensify agitation, aggressiveness, and suspiciousness.
Keep client in an environment as free of stimuli (loud noises, crowding) as possible.Client might respond to noises and crowding with agitation, anxiety, and increased inability to concentrate on outside events.
Avoid touching the client.Touch by an unknown person can be misinterpreted as a sexual or threatening gesture. This particularly true for a paranoid client.
Ensure that the goals set are realistic;  whether in the hospital or community.Avoids pressure on the client and sense of failure on part of nurse/family.  This sense of failure can lead to mutual withdrawal
Structure activities that work at the client’s pace and activity.Client can lose interest in activities that are too ambitious, which can increase a sense of failure.
Structure times each day to include planned times for brief interactions and activities with the client on one-on-one basisHelps client to develop a sense of safety in a non-threatening environment.
If client is unable to respond verbally or in a coherent manner, spend frequent, short period with clients.An interested presence can provide a sense of being worthwhile.
If client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate.Client is free to choose his level of interaction; however, the concentration can help minimize distressing paranoid thoughts or voice.
If client is delusional/hallucinating or is having trouble concentrating at this time, provide very simple concrete activities with client (e.g., looking at a picture or do a painting).Even simple activities help draw client away from delusional thinking into reality in the environment.
If client is very withdrawn, one-on-one activities with a “safe” person initially should be planned.Learn to feel safe with one person, then gradually might participate in a structured group activity.
Try to incorporate the strengths and interests the client had when not as impaired into the activities planned.Increase likelihood of client’s participation and enjoyment.
Teach client to remove himself briefly when feeling agitated and work on some anxiety relief exercise (e.g., meditations,rhytmic exercise, deep breathing exercise).Teach client skills in dealing with anxiety and increasing a sense of control.
Useful coping skills that client will need include conversational and assertiveness skills.These are fundamental skills for dealing with the world, which everyone uses daily with more or less skill.
Remember to give acknowledgment and recognition for positive steps client takes in increasing social skills and appropriate interactions with others.Recognition and appreciation go a long way to sustaining and increasing a specific behavior.
Provide opportunities for the client to learn adaptive social skills in a non-threatening environment. Initial social skills training could include basic social behaviors (e.g., appropriate distance, maintain good eye contact, calm manner/behavior, moderate voice tone).Social skills training helps the client adapt and function at a higher level in society, and increases the client’s quality of life.
As the client progresses, provide the client with graded activities according to the level of tolerance e.g., (1) simple games with one “safe” person; (2) slowly add a third person into “safe”.Gradually the client learns to feel safe and competent with increased social demands.
As the client progresses, Coping Skills Training should be available to him/her (nurse, staff or others). Basically the process:

  • Define the skill to be learned.
  • Model the skill.
  • Rehearse skills in a safe environment, then in the community.
  • Give corrective feedback on the implementation of skills.
Increases client’s ability to derive social support and decrease loneliness. Clients will not give up the substance of abuse unless they have alternative means to facilitate socialization they belong.
Eventually engage other clients and significant others in social interactions and activities with the client (card games, ping pong, sing-a-songs, group sharing activities) at the client’s level.Client continues to feel safe and competent in a graduated hierarchy of interactions.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

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Other care plans for mental health and psychiatric nursing:

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]
Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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