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UNIT 3 ■ Care of Patients With Psychiatric Disorders
Table 15–2 | CARE PLAN FOR THE PATIENT WITH SCHIZOPHRENIA—cont’d
NURSING DIAGNOSIS: IMPAIRED VERBAL COMMUNICATION RELATED TO: Panic anxiety, regression, withdrawal, disordered and delusional thinking EVIDENCED BY: Loose association of ideas, neologisms, word salad, clang association, echolalia, verbalizations that reflect concrete thinking, poor eye contact OUTCOME CRITERIA INTERVENTION RATIONALE
Short-Term Goal ■■ Patient will demonstrate the ability to remain on one topic using appropri- ate, intermittent eye con- tact for 5 minutes with the nurse or therapist. Long-Term Goal ■■ By time of discharge from treatment, the patient will demonstrate ability to carry on a verbal communica- tion in a socially acceptable manner with health-care providers and peers.
1. These techniques reveal how the patient is being perceived by oth- ers and convey the nurse’s desire to establish meaningful communication.
1.
Attempt to decode incomprehen- sible communication patterns.
Seek validation and clarification by ask- ing, “Is it that you mean . . .?” or “I don’t understand what you mean by that. Would you please explain it to me?” 2. Maintain staff assignments as consis- tently as possible.
2. This facilitates trust and understanding between patient and nurse. 3. This approach conveys empathy and may encourage the patient to disclose thoughts and feelings.
3.
The technique of verbalizing the implied is used with the patient who is struggling to communicate thoughts and feelings. Example: “That must be frightening to worry that others are wiretapping your house.”
4. Patient safety and comfort are nursing priorities.
4. Anticipate and fulfill patient’s needs until functional communication pattern returns. 5. Orient patient to reality as needed. Call the patient by name. Validate those aspects of communication that help differentiate between what is real and not real. 6. Explanations must be provided at the patient’s level of comprehen- sion. Example: “Pick up the spoon, scoop some mashed potatoes into it, and put it in your mouth.”
5. These techniques may facilitate res- toration of functional communication patterns in the patient. 6. Because concrete thinking may be a symptom, abstract phrases and clichés must be avoided because they are likely to be misinterpreted.
NURSING DIAGNOSIS: SELF-CARE DEFICIT RELATED TO: Withdrawal, regression, panic anxiety, perceptual or cognitive impairment, inability to trust EVIDENCED BY: Difficulty carrying out tasks associated with hygiene, dressing, grooming, eating, toileting OUTCOME CRITERIA NURSING INTERVENTIONS RATIONALE
Short-Term Goal ■■ Patient will verbalize a desire to perform activities of daily living (ADLs) by end of 1 week.
1. Patient safety and comfort are nurs- ing priorities.
1. Provide assistance with self-care needs as required. Some patients who are severely withdrawn may require total care. 2. Encourage the patient to perform as many activities as possible inde- pendently. Provide positive reinforce- ment for independent accomplishments.
2. Independent accomplishment and positive reinforcement enhance self-esteem and promote repetition of desirable behaviors.
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