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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
Table 15–2 | CARE PLAN FOR THE PATIENT WITH SCHIZOPHRENIA—cont’d
NURSING DIAGNOSIS: DISTURBED THOUGHT PROCESSES RELATED TO: Inability to trust, panic anxiety, possible hereditary and biochemical factors EVIDENCED BY: Delusional thinking; inability to concentrate; impaired volition; inability to problem-solve, abstract, or conceptualize; extreme suspiciousness of others OUTCOME CRITERIA NURSING INTERVENTIONS RATIONALE
Short-Term Goal ■■ By the end of 2 weeks, patient will recognize and verbalize that false ideas occur at times of increased anxiety. Long-Term Goals ■■ By time of discharge from treatment, patient’s verbaliza- tions will reflect reality-based thinking with no evidence of delusional ideation. ■■ By time of discharge from treatment, the patient will be able to differentiate between delusional think- ing and reality.
1. Patient must understand that you do not view the idea as real.
1. Convey acceptance of patient’s need for the false belief but indicate that you do not share the belief. 2. Do not argue or deny the belief. Use reasonable doubt as a thera- peutic technique: “I understand that you believe this is true, but I personally find it hard to accept.” 3. Reinforce and focus on reality. Although initially encouraging the patient to describe their thoughts may help to understand the patient’s experience, discourage long rumi- nations about the irrational thinking. Talk about real events and real people. 4. If patient is highly suspicious, the follow- ing interventions may be helpful: a. Use same staff as much as possible; be honest and keep all promises. b. Avoid physical contact; ask the patient before touching to perform a proce- dure, such as taking a blood pressure. c. Avoid laughing, whispering, or talking quietly where patient can see but cannot hear what is being said. d. Provide canned food with can opener or serve food family style. e. Mouth checks may be necessary fol- lowing medication administration to verify whether the patient is actually swallowing the pills. f. Provide activities that encourage a one-to-one relationship with the nurse or therapist. g. Maintain an assertive, matter-of-fact, yet genuine approach.
2. Arguing with the patient or denying the belief serves no useful purpose; these beliefs are very real to the patient delu- sional ideas are not eliminated by this approach, and the development of a trusting relationship may be impeded. 3. Repeated discussions that focus on the false ideas are purposeless and useless and may even aggravate the psychosis. 4. To decrease patient’s suspiciousness: a. Familiar staff and honesty promote trust. b. Patients with suspicious ideation often perceive touch as threatening and may respond in an aggressive or defensive manner. c. Patients may have ideas of refer- ence and believe they are being talked about. d. Suspicious patients may believe they are being poisoned and refuse to eat food from an individually prepared tray. e. Suspicious patients may believe they are being poisoned with their medication and attempt to discard the tablets or capsules. f. Competitive activities may exacer- bate suspicious ideation. g. Patients with suspicious ideation are prone to distrust and are hyper- vigilant of people’s behavior and communication. Approaches that are overly directive or cheerful may increase the patient’s suspiciousness.
Continued
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