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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
Table 15–2 | CARE PLAN FOR THE PATIENT WITH SCHIZOPHRENIA—cont’d
OUTCOME CRITERIA
NURSING INTERVENTIONS
RATIONALE
Long-Term Goal ■■ Patient will perform ADLs in an independent manner and demonstrate a willing- ness to do so by time of discharge from treatment.
3. Because concrete thinking may be a symptom, explanations must be pro- vided at the patient’s concrete level of comprehension.
3.
Use concrete communication to show the patient what is expected and to minimize misinterpretation by the patient. Provide step-by-step instructions for assistance in performing ADLs. Exam- ple: “Take your pajamas off and put them in the drawer. Take your shirt and pants from the closet and put them on. Comb your hair and brush your teeth.”
4. These techniques may be helpful with the patient who is paranoid and may be suspicious about being poi- soned with food or medication. 5. A structured schedule will help the patient establish a pattern to develop a habit of toileting independently.
4. Creative approaches may need to be taken with the patient who is not eating, such as allowing patient to open own canned or packaged foods; family-style serving may also be an option. 5. If toileting needs are not being met, establish a structured schedule for the patient.
team approaches to the care of the patient with schizophrenia have been identified as essential to positive outcomes and recovery. Concept Care Mapping The concept map care plan is a diagrammatic teach- ing and learning strategy that allows visualization of interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments (see Chapter 6, “The Nursing Process in Psychiatric Mental Health Nursing”). An example of a concept map care plan for a patient with schizophrenia is pre- sented in Figure 15–2. Patient and Family Education The role of patient and family educator is import- ant in the psychiatric area, as it is in all areas of nursing. A list of topics for patient and family edu- cation relevant to schizophrenia is presented in Box 15–5. Evaluation In the final step of the nursing process, a reassess- ment is conducted in order to determine whether the nursing actions have been successful in achieving the objectives of care. Evaluation of the nursing actions for the patient with exacerbation of schizophrenic
Real Nurses, Real Advice
“The delusions, paranoia, and voices are very real to the patient with schizophrenia, so making sure not to devalue their experience is very important. It can also be a fright- ening experience so approaching slowly, staying at least an arm’s length away, and speaking in a calming voice lets them know that you are there to help. Many times they just want someone to listen and treat them like a person first instead of always seeing their illness first.” –Sarah Taylor, Psychiatric Nursing Supervisor
One way to reduce stigma is to become famil- iar with real people who suffer from this disorder rather than relying on fictitious representations (and sometimes misrepresentations) of this population in popular media. (See the “Real People, Real Stories” introduction to Dr. Fred Frese.) A case management model (see Chapter 6, “The Nursing Process in Psychiatric Mental Health Nurs- ing”) may be used to coordinate care. In general,
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