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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Defensive Coping

This nursing diagnosis is chosen related to the perceived lack of self-efficacy, perceived threat to self, and suspicious motives of others. This is characterized by a difficulty in reality testing of perceptions, difficulty maintaining relationships, hostility, and aggression.

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Nursing diagnosis

  • Defensive Coping

Here are the common related factors for defensive coping that can be a,  your “related to” in your schizophrenia nursing diagnosis statement:

  • Perceived lack of self-efficacy/vulnerability
  • Perceived threat to self
  • Suspicions of the motives of others

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:

  • Denial of obvious problems
  • Difficulty in reality testing of perceptions
  • Difficulty establishing/maintaining relationships
  • False beliefs about the intention of others.
  • Fearful
  • Grandiosity
  • Hostile laughter or ridicule of others
  • Hostility, aggression, or homicidal ideation
  • Projection of blame/responsibility
  • Rationalization of failures
  • Superior attitude towards others

Desired Outcomes

Expected outcomes or patient goals for defensive coping nursing diagnosis:

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  • Patient will avoid high-risk environments and situations.
  • Patient will interact with others appropriately.
  • Patient will maintain medical compliance.
  • Patient will identify one action that helps client feel more in control of his or her life.
  • Patient will demonstrate two newly learned constructive ways to deal with stress and feeling of powerlessness.
  • Patient will demonstrate learn the ability to remove himself or herself from situations when anxiety begins to increase with the aid of medications and nursing interventions.
  • Patient will demonstrate decreased suspicious behaviors regarding with the interaction with others.
  • Patient will be able to apply a variety of stress/anxiety-reducing techniques on their own.
  • Patient will acknowledge that medications will lower suspiciousness.
  • Patient will state that he/she feels safe and more in control with interactions with environment/family/work/social gatherings.

Nursing Interventions and Rationale

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

Nursing InterventionsRationale
Explain to client what you are going to do before you do it.Prepares the client beforehand and minimizes misinterpreting your intent as hostile or aggressive.
Assess and observe clients regularly for signs of increasing anxiety and hostility.Intervene before client loses control.
Use a nonjudgemental, respectful, and neutral approach with the client.There is less chance for a suspicious client to misinterpret intent or meaning if content is neutral and approach is respectful and non-judgemental.
Use clear and simple language when communicating with a suspicious client.Minimize the opportunity for miscommunication and misconstruing the meaning of the message.
Diffuse angry verbal attacks with a non defensive stand.When staff become defensive, anger escalates for both client and staff. a non-defensive and non-judgemental attitude provides an atmosphere in which feelings can be explored more easily.
Set limits in a clear matter-of-fact way, using a calm tone. Giving threatening remarks to Jeremy is unacceptable. We can talk more about the proper ways in dealing with your feelings.Calm and neutral approach may diffuse escalation of anger. Offer an alternative to verbal abuse by finding appropriate ways to deal with feelings.
Be honest and consistent with client regarding expectations and enforcing rules.Suspicious people are quick to discern honesty. Honesty and consistency provide an atmosphere in which trust can grow.
Maintain low level of stimuli and enhance a non-threatening environment (avoid groups).Noisy environments might be perceived as threatening.
Be aware of client’s tendency to have ideas of reference; do not do things in front of client that can be misinterpreted:

  • Laughing or whispering.
  • Talking quitely when client can see but not hear what is being said.
Suspicious clients will automatically think that they are the target of the interaction and interpret it in a negative manner (e.g., you are laughing or whispering about them).
Initially, provide solitary, noncompetitive activities that take some concentration. Later a game with one or more client that takes concentration (e.g., chess checkers, thoughtful card games such as ridge or rummy).If a client is suspicious of others, solitary activities are the best. Concentrating on environmental stimuli minimizes paranoid rumination.
Provide verbal/physical limits when client’s hostile behavior escalates: We cannot allow you to verbally attack someone here. If you cant held/control yourself, we are here in order to help you.Often verbal limits are effective in helping a client gain self control.
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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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