Schizophrenia Nursing Care Plan

Appearance:

Behaviour:

Mood:

Affect:

Speech:

Thought form:

Thought content: 

Perception:

Cognition: memory (short term & long term), concentration, orientation to time place & person:

Insight:

Judgment

Risk (need to identify 4 risks related to the client interviewed in the video trigger)

Identify 4 risks.

You are also required to complete a care a nursing care plan for the video client addressing the highest priorities problem/ need (one problem) as identified by you as follows:

• Need/ priority problem
• Explain why the nominated need/problem is of a high priority to your client?
• Goal (what you would hope to achieve as a result of your interventions)?
• Three (3) nursing interventions/strategies to support the client in meeting his/her goal, with a rationale for each intervention

You are required to provide a comprehensive written feedback (a critique) of the nurse’s interaction with the client, identifying four (4) positive and two (2) negative elements of this interaction. Please provide feedback on the process of the interactions between the nurse and the client (example: The nurse used silence appropriately while waiting for the client to respond).

Risk Identification and Intervention

• Appearance: The patient Dimitrie appeared to be quite young with lean body structure. He appeared physically healthy and well groomed; he was wearing a black t-shirt with loose fitted shirt and a pant and had combed his hair. He had a habit of biting his nails, which showed that he lacked good hygiene. Dimitrie had long black hair with thin black moustache. He was wearing spectacles and had no notable characteristics such as tattoos or piercing. Dimitrie was not sitting in a very poised manner, instead was changing his body-posture quite frequently.
  
  
• Behaviour: Dimitrie was very confused and not comfortable in front of the nurse, he looked quite distressed. The nurse was trying to develop a good rapport with the patient and was continuously asking him questions in order to understand his problem and concern. Dimitrie was not responding to the nurse in an effective way due to his mental health condition. He was responding in a haphazard way to the questions’ that the nurse was asking him. He had poor psychometric skills, where he could not control his mind and his emotions; hence, he lacked good coordination and balance. He had a very confused attitude and his behaviour was quite complex due to his health condition.
  
  
• Affect: Dimitrie had a very restricted emotional response. He was not responding effectively to the questions’ that the nurse was asking him. He had a delayed response towards every question of the nurse and was not very open about his emotions. He was very restricted and reserved and could not open up to the nurse. He lacked in efficiently expressing his thoughts and feelings to the nurse and just answered her questions with no clear outcome. Dimitrie was very confused regarding his thoughts and responses. He was taking time to understand what exactly he has to say to the nurse.
  
  
• Mood: Dimitrie had a very fluctuating mood and response. He was feeling very distressed and could not really open up with the nurse. He was facing a major problem in controlling his mood as he was getting continuously distracted and disturbed by some background noise that he could hear around him. His mood was fluctuating very quickly and could not focus properly. Dimitrie could explain his problems to the nurse but in a haphazard manner with no clear emotions. He lacked in explaining the depth and intensity of his emotions to the nurse and could not convey his feelings properly.
  
  
• Speech: Dimitrie was facing a major issue in speaking fluently. He was not replying confidently to the questions’ asked by the nurse. His tone and volume of speaking was very low and lacked confidence. Dimitrie was not very specific while speaking to the nurse and was very slow and sluggish in responding and conveying his thoughts and emotions to the nurse. His flow of speaking was very discontinuous and unclear. He was taking time to complete his sentence and he was unclear with his words. Dimitrie was taking a pause before speaking and in middle of his conversations and was repeating words.
  
  
• Thought Form: Dimitrie was unable to frame his ideas and thoughts properly. He was very confused in expressing his thoughts and ideas. Dimitrie had a very vague approach in framing his ideas together. Dimitrie had a weak association between his thoughts and his mind and he lacked logical thought process. There was no continuity in explaining his thoughts to the nurse and he was very unclear with his thought form. Dimitrie was very restricted and blocked in explaining his thoughts and he kept on pausing and getting distracted while responding about his feelings and thoughts to the nurse.
  
  
• Thought Content: Dimitrie was facing major delusion in explaining about his actual thinking. He could not explain clearly to the nurse regarding what was exactly going in his mind. He lacked in providing any detailed information to the nurse and he was only answering in a very reluctant manner with no clear idea and thought. The nurse was continuously asking him questions to understand what exactly was going in his mind but he lacked clear idea and perception about his thoughts. Dimitrie was not a very social kind of a person and lack in speaking fluently, which made it difficult for the people to understand what was exactly going in his mind and what was he exactly thinking.
  
  
• Perception: Dimitrie was facing an auditory hallucination that was continuously distracting him and his thoughts. He could not complete his sentence and focus properly as he was suffering from complete hallucination that was distracting his peace of mind. Even while answering to the nurse he was very distressed and distracted by those hallucinated voices.
  
  
• Cognition and Intellectual Functioning: Dimitrie lacked proper concentration as some hallucinated voices were distracting him. He could recall his memory and happenings that took place in his life but was not at all confident. His calculation skill was good as he could answer to the question of the nurse correctly but gain he lack confidence and stated that those background voices were distracting him and not allowing him to think effectively.  Dimitrie had knowledge about what was happening around him but his ability to concentrate or be attentive was very bad.
  
  
• Insight and Judgement: Dimitrie was aware about his health condition and knew that he was suffering from schizophrenia were he lost his ability to think and behave. He was also aware that his friend bought him to the nurse for check-up, as his mental health was getting bad day by day. When the doctor ask him that if he was aware of his health condition he accepted that he was suffering from a mental health disorder but he was not aware of the consequences that can occur due to his mental health disorder.

The four identified risk related to the client Dimitrie, interviewed in the video includes the following:

• Worsening of psychological health condition because of inconsistence to medicines and auditory hallucination

As seen in the video, dimitrie was facing from long-term auditory hallucination stating that random voices were distressing and distracting him, which disturbs his focus and concentration (Ribe et al., 2015). When the nurse asked him that why did he discontinued his medications in Japan, dimitrie replied that he was there for just 3 months and once his medicines was over he was not concerned to buy his medicines as he could not understand Japanese writing. This statement by dimitrie showed that he was inconsistent in taking his medicines, which was effecting his health even more.

• Danger of hurting or injuring others

It was noted and seen in the video that dimitrie tried to harm him and others. He explained that he would never harm him even if the hallucinating voice asked him to do so but will harm others who will try to attack him. Hence, it was predicted that he had self-destructive factor in his conduct (Silverstein et al., 2015).

• Risk of societal isolation

Dimitrie was at high risk of social seclusion, as his acquaintances lived in suburb and he did not visit them very frequently. He also stated that he did not communicate much with his family and friends and was mostly alone most of the time. Dimitrie also state that, as he was not included in his family he was suffering from feeling of lowliness and danger of depression, mental ill health and negative confidence (Giacco et al., 2016).

• Absence of mental peace

As dimitrie was hearing some hallucinated voices, he was continuously getting distracted and diverted. He could not focus properly or could speak to anyone normally (Erickson, Ruffle & Gold, 2016). His mental peace of mind was lost and as his health was further deteriorating, he could face some major consequence in the future.

The major risk or issue that the patient was suffering was schizophrenia, a condition were the patient was hearing some background hallucinated voices, which was continuously distracting him and effecting his mental health (Meehl, 2017). This mental health disorder was getting worse day-by-day and required immediate concern.

The patient was suffering from major effects of schizophrenia, where he could not control his thoughts and lost balance between his mind and thought activity. Dimitrie mentioned that he used to always hear those voices and could not focus on anything; he also stated that he was in danger of getting into depression, mental ill health and suffered negative confidence, which were considered as the major impact of schizophrenia (Whalley et al., 2015). He used to get distracted from his work and was secluded from family and friends.

Positive Elements of Nurse Interaction

The ultimate goal will be to develop an effective nursing care plan with proper nursing intervention for schizophrenia to help dimitrie in recovering from his mental health condition as soon as possible with effective care approach to distract him from hallucinated voices that he used to listen and help him to lead a normal life (Bighelli et al., 2018).

The nursing intervention and rationale developed for the patient are described as follows:

Intervention	Rationale
Keep the environment of the patient calm and quiet and free from any external stimuli (Yesufu-Udechuku et al., 2015).	Maintain anxiety from accelerating and increasing misunderstanding or confusion and hallucinations (Farholm & Sørensen, 2016). Patient might respond with agitation to any external stimuli such as crowding and loud noise that will increase his incapability to concentrate
Avoid any physical touch to the patient and use a neutral and respectful approach (Cheng & Schepp, 2016).	Physical touch from an unknown person can instigate the patient as a form of threatening or sexual gesture. There are minimum chances for the patient to misinterpret the intention of the doctor if the approach is neutral and respectful (Tan, Lee & Lee, 2018).
Recognize and understand the patients’ delusions or hallucinations from their point of view and assess the sign of growing anxiety level in the patient (Barut et al., 2016).	Recognizing or understanding the patients’ point of view or perception can help the doctor to understand and determine their feelings that they are experiencing (Vanderwaal, 2015). Intervene the patient before he/she loses their control completely.

 

The positive elements of the nurse interaction with the patient are as follows:

• The nurse could understand in detail about the auditory hallucinations and the frequency of those hallucinations that the patient was suffering or going through as the nurse herself witnessed the patient getting distracted by some hallucinating voices while he was answering to her questions.
• The nurse understood that the patient was scared of living alone was affected more when he is alone or not involved anywhere as the patient mentioned that he could not sleep peacefully.
• The interaction between the nurse and patient allowed the nurse to understand that the patient could remember everything and had no such memory loss issue as he could remember the name of medicine and could easily finish the calculation that the nurse asked him to do.
• The interaction helped the nurse to understand what exactly those hallucinated voices were trying to say or communicate to the patient as the patient mentioned that those voices were always criticizing him and he was scared of those voices. The nurse also understood that the patient needed proper medication as the patient stated that medication could help him to get out of this problem.

The negative elements of the nurse interaction with the patient are as follows:

• The patient was not responding and answering properly to the question’s’ that nurse was asking him, he was responding only in bits and parts hence, the nurse had to take huge efforts to communicate and understand the problem that the patient was suffering.
• As the nurse was asking too many questions to the patient, he was getting irritated and anxious of continuously listening to her.

References

Barut, J. K., Dietrich, M. S., Zanoni, P. A., & Ridner, S. H. (2016). Sense of belonging and hope in the lives of persons with schizophrenia. Archives of psychiatric nursing, 30(2), 178-184.

Bighelli, I., Salanti, G., Huhn, M., Schneider?Thoma, J., Krause, M., Reitmeir, C., ... & Furukawa, T. A. (2018). Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta?analysis. World psychiatry, 17(3), 316-329.

Cheng, S. C., & Schepp, K. G. (2016). Early intervention in schizophrenia: a literature review. Archives of psychiatric nursing, 30(6), 774-781.

Erickson, M. A., Ruffle, A., & Gold, J. M. (2016). A meta-analysis of mismatch negativity in schizophrenia: from clinical risk to disease specificity and progression. Biological psychiatry, 79(12), 980-987.

Farholm, A., & Sørensen, M. (2016). Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies. International journal of mental health nursing, 25(3), 194-205.

Giacco, D., Palumbo, C., Strappelli, N., Catapano, F., & Priebe, S. (2016). Social contacts and loneliness in people with psychotic and mood disorders. Comprehensive psychiatry, 66, 59-66.

Meehl, P. E. (2017). Schizotaxia, schizotypy, schizophrenia. In Schizophrenia (pp. 21-46). Routledge.

Mental Health Assessment: Dimitrie. (2019). Retrieved from https://www.youtube.com/watch?v=xgo8jvIJAQU&feature=youtu.be&app=desktop

Ribe, A. R., Laursen, T. M., Charles, M., Katon, W., Fenger-Grøn, M., Davydow, D., ... & Vestergaard, M. (2015). Long-term risk of dementia in persons with schizophrenia: a Danish population-based cohort study. JAMA psychiatry, 72(11), 1095-1101.

Silverstein, S. M., Del Pozzo, J., Roché, M., Boyle, D., & Miskimen, T. (2015). Schizophrenia and violence: realities and recommendations. Crime psychology review, 1(1), 21-42.

Tan, B. L., Lee, S. A., & Lee, J. (2018). Social cognitive interventions for people with schizophrenia: a systematic review. Asian journal of psychiatry, 35, 115-131.

Vanderwaal, F. M. (2015). Impact of motivational interviewing on medication adherence in schizophrenia. Issues in mental health nursing, 36(11), 900-904.

Whalley, H. C., Hall, L., Romaniuk, L., Macdonald, A., Lawrie, S. M., Sussmann, J. E., & McIntosh, A. M. (2015). Impact of cross-disorder polygenic risk on frontal brain activation with specific effect of schizophrenia risk. Schizophrenia research, 161(2-3), 484-489.

Yesufu-Udechuku, A., Harrison, B., Mayo-Wilson, E., Young, N., Woodhams, P., Shiers, D., ... & Kendall, T. (2015). Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. The British Journal of Psychiatry, 206(4), 268-274.