Around 2.2 million people in America have Schizophrenia. About 4.3 to 8.7 million people are affected in India and there are 6 to 12 million people in China who are suffering from it. The prevalence rate for this condition is pretty scary and if you aren’t fully aware of how you should manage patients diagnosed with it, you can end up compromising their health and safety.
As a nurse, here are the three important nursing care plan interventions you can start with.
1Disrupted Sensory Perception (Auditory/Visual)
May be related to:
- Altered sensory perception
- Biochemical factors
- Chemical alterations
- Neurologic changes
- Psychologic stress
Usually evidenced by:
- Altered speech pattern
- Inability to concentrate
- Disoriented
- Incongruent responses
- Hallucinations
- Talking, murmuring or laughing to self
- Frequent blinking of the eyes and frowning
- Observable change in sensory alertness
Desired Outcomes:
- Expresses thoughts and feelings in a coherent and logical manner
- Demonstrates increased ability to concentrate
- Maintains role performance
- Reports lesser episodes of hallucinations
- Maintains social relationship
- Practices stress reduction techniques
- Verbalizes experiencing less stress
| Nursing Interventions | Rationale |
| Acknowledge that the voices and sightings are real to the client but clearly state that you do not hear or see them. | Stating to the client that you do not sense or perceive the voices and sightings will help the client become uncertain of the validity of what he/she sees or hears. |
| Look into how the hallucinations are experienced by the client. | Exploring the hallucinations with the client will help him/her gain a sense of being empowered, thus improving the chances of the client being able to manage his/her hallucinations. |
| Whenever possible, decrease environmental stimuli. | This will decrease the potential for anxiety which can trigger hallucinations. Decreased stimuli will help the client calm down. |
| Make conversations simple, basic and reality-based. Avoid bombarding the client with multiple ideas. Instead, help the client to focus on one idea at a time. | The client’s thought process might be disorganized. A basic and reality-based conversation will help the client to focus. |
| Involve the client in reality-based activities such as drawing or listening to music. | Being engaged in reality-based activity provides a healthy diversion and prevents the client from acting out his/her hallucinations. |
| Stay with the client when he/she starts to hallucinate. Guide him/her to tell the “voices” to go away. Repeat this often and in a tone that is matter-of-fact. | There are instances when clients can learn to push away or disregard the voices when they are given repeated instructions. |
| If voices predispose a client to self-harm or harming others, take the necessary environmental precautions. Be sure to follow the given protocol on this. | Clients usually obey hallucinatory commands even those involving killing self or others. The proper intervention will help save lives. |
| Intervene with medication (as needed) or one on one seclusion when appropriate. Be sure to follow the protocol. | This will prevent the client’s level of anxiety from escalating, thereby keeping the patient from being out of control. |
| Guide the client in identifying activities that help reduce his/her anxiety. | This will help the client lessen his/her anxiety, while also helping the nurse to build rapport with the client. |
2Impaired Social Interaction
May be related to:
- Difficulty communicating coherently
- Decreased ability to concentrate
- Inappropriate stimuli response
- Anxiety in social situations
- Impaired thought processes involving delusions and/or hallucinations
- Deficient emotional responses
- Disturbance in self-concept (expressing negative feelings about self)
Usually evidenced by:
- Inability to make eye contact
- Inability to begin or respond to social conversations
- Inappropriate emotional response
- Prefers to be alone
- Exhibits behavior or verbalizes discomfort in social situations
- Noted use of ineffective social interactions
Desired Outcomes
- Expresses an interest in starting social coping skills training
- Engages in one simple activity (such as card game) with the nurse
- Interacts with another client while doing an activity
- Improved social interaction with family and friends
- Expresses being comfortable in certain structured group activities
- Uses appropriate skills to initiate and maintain interaction with others
| Nursing Interventions | Rationale |
| Identify with client symptoms he/she experiences when he/she begins to feel anxious around others. | Identification of the symptoms of anxiety will help decrease agitation and aggression of the client. |
| Avoid touching the client. | This particularly applies to a paranoid client. Touch, especially by an unknown person, can be misinterpreted as sexual or viewed as threatening by the client. |
| Minimize stimuli (avoid loud noises or crowding) as much as possible. | Noise and a huge crowd might result in the client feeling agitated and anxious. |
| Structure activities based on the client’s pace and abilities. | The client might be disinterested in activities that he/she finds overwhelming. This will then lead to an increased sense of failure. |
| Structure times that include planned brief interactions and activities with the client on a one-on-one basis. | This will help the client develop a sense of safety in a non-threatening environment. |
| Check if the medications have reached therapeutic levels. | Many symptoms of schizophrenia subside with medications. This, in turn, helps facilitate interactions. |
| If the client is extremely paranoid, solitary or one-on-one activities are appropriate. Said activities must require a degree of concentration. | The client has the freedom to choose his/her level of interaction. However, encouraging him/her to concentrate can help minimize distressing paranoid thoughts or hallucinations. |
| Encourage the client to use coping skills particularly conversational and assertiveness abilities. | This will help the client develop the fundamental skills in socializing. |
| Remember to give praise or recognition for positive steps the client takes in increasing social skills. | Recognition and appreciation encourage the client to sustain and increase specific social behavior. |
| Involve the client in social skills training. | This type of training helps the client to adapt and function in the society thereby increasing his/her quality of life. |
3Interrupted Family Process
May be related to:
- Physical or mental disorder of a family member
- Situational crisis
- Developmental crisis
- Shift in the family role
Usually evidenced by:
- Altered communication patterns in the family
- Changes in stress reduction behavior
- Lack of mutual support
- Knowledge deficit on community and healthcare support
- Knowledge deficit on the disease
Desired Outcomes
- Family shows knowledge in identifying the signs of potential relapse
- Family recounts in detail the early signs and symptoms of relapse
- Family expresses that they have received appropriate community support
- Family attends at least one family support group
- Family shows involvement in the discharge planning together with the client
- Family exhibits improved communication patters as evidenced by the discussion on problem-solving
| Nursing Interventions | Rationale |
| Assess the family’s level of knowledge about the disease. | Family members might have misconceptions about the disease. This might lead to their inability to deal with the situation. |
| Discuss clearly with the client’s family the course of treatment such as psychopharmacologic therapy. Written information should also be given to the client and his/her family. | This will foster family support and improve client adherence to treatment. |
| Determine the family’s coping abilities (e.g. role of a caregiver; experience of loss). | This helps stabilize the family unit. |
| Provide health teachings to the client and his/her family (e.g. signs and symptoms of relapse) | This helps the family to recognize early warning symptoms which is vital in preventing relapse. |
| Provide an opportunity for the family to discuss feelings related to the ill member of the family. Try to identify their immediate concerns. | Being able to express how they feel will help the family in coping with the situation. This will also enable the nurse to properly help the family in their struggle to cope. |
| Provide information to client and family regarding community resources and organizations. | Knowing about community resources and organizations will help the client and his/her family to cope with the situation. This will minimize isolation. |
These care plans are very easy to apply. We hope that they’ll be helpful with your own patients.
Source:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
