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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
psychosis may be facilitated by gathering informa- tion utilizing the following types of questions: ■■ Has the patient established trust with at least one staff member? ■■ Is anxiety maintained at a manageable level? ■■ Is delusional thinking still prevalent? ■■ Is hallucinogenic activity evident? Does the patient share content of hallucinations, particularly if commands are heard? ■■ Is the patient able to manage escalating anxiety with adaptive coping mechanisms? ■■ Is the patient easily agitated? ■■ Is the patient able to interact with others appropriately? ■■ Does the patient voluntarily attend therapy activities? ■■ Is verbal communication comprehensible? ■■ Is the patient compliant with medication? Does the patient verbalize the importance of taking medication regularly and on a long-term basis? Does the patient verbalize understanding of pos- sible side effects and when to seek assistance from the physician? ■■ Does the patient spend time with others rather than isolating self? ■■ Is the patient able to carry out all activities of daily living independently? ■■ Is the patient able to verbalize resources for seek- ing assistance outside the hospital? ■■ Does the family have information regarding sup- port groups in which they may participate and from which they may seek assistance in dealing with their family member who is ill? ■■ If the patient lives alone, do they have a source for assistance with home maintenance and health management? Dr. Frese: Even though Freud’s theories about psychoanal- ysis and insight-oriented therapy have been shown in research to be not only not helpful in the treatment of people with schizophrenia but potentially harmful, these ideas continue to influence the thinking of health-care professionals. I would tell nurses to wean themselves away from psychoanalytic concepts in treating people with schizophrenia. There continue to be assumptions that something bad must have happened in this patient’s childhood, and the family is probably to blame. It’s not a good way to forge relationships and may prejudge or isolate the people that can provide invaluable support. Real People, Real Stories: Dr. Fred Frese—cont’d
So I would say to future nurses, don’t make assump- tions about me because you see a diagnosis or the kind of medication I’m on, and don’t try to blame anyone for my symptoms. Treat me with civility and respect, don’t respond to me with shock and disbelief, bullying, or laughing at me. Listening to the patient is the best way to establish and maintain a relationship. Even if the patient is saying something that doesn’t make any sense to you, the best response is, “That’s very interesting; tell me more.” To learn more about Dr. Frese, go to www.fredfrese.com.
Quality and Safety Education for Nurses (QSEN)
The Institute of Medicine (IOM), in its 2003 report Health Professions Education: A Bridge to Quality , chal- lenged faculties of medicine, nursing, and other health professions to ensure that their graduates have achieved a core set of competencies in order to meet the needs of the 21st-century health-care system. These competencies include providing patient-centered care, maintaining safety, working in interdisciplinary teams, employing evidence-based prac- tice, incorporating quality improvement , and utilizing informatics. Patient-centered care is foundational to the recovery model (see Chapter 10, “The Recovery Model”), which has been advanced as an import- ant framework for empowering clients with serious mental illnesses like schizophrenia. This model promotes active patient engagement in treatment with a focus on achieving their full recovery poten- tial. However, in order to maintain patient safety and because some patients lack insight about their need for treatment, decisions may need to be made for these patients in their best interest. Supporting the patient’s recovery necessitates the use of several resources and disciplines, which may include housing and financial assistance, medica- tion management, peer support, spiritual counsel, and case management services. It is essential that nurses working with this population have a good understanding of the available support services for patients with schizophrenia and that they effec- tively work within interdisciplinary teams to meet this patient’s complex needs.
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