In this brief guide, we will discuss everything you need to know about a Nursing diagnosis for schizophrenia, and other related concepts of Nursing and schizophrenia, like nursing plans for self-care deficit in schizophrenia and disturbed thought process nursing diagnosis.
Nursing Diagnosis for Schizophrenia
Nursing diagnosis for schizophrenia will be dependent on what features or symptoms the patient is showing and these diagnoses are based either on the Diagnostic and Statistical Manual (DSM 5) or the International Classification of Mental and Behavioral Disorders (ICD 10).
Psychiatric nursing diagnosis of schizophrenia is not very different from that of a psychiatrist or clinical psychologist, and in most inpatient situations this diagnosis will be made just once, and in an in-patient facility where the patient suffering from schizophrenia is admitted, and nurses are usually the ones who deal with the patient the most.
Nursing in psychiatric facilities involves a different approach than that of the Hospice or hospital-based setting, as it involves the person to be familiar and able to work with the symptoms of the mind as well.
Patients with schizophrenia may sometimes be unresponsive, catatonic, not social, or they may not be able to communicate their problems adequately because they have trouble organizing their thoughts.
This makes the Nursing job that much harder because a nursing diagnosis for schizophrenia patients is what drives all the future nursing plans as well.
Nursing plans for Schizophrenia
While it is not possible to go into all the details of all possible nursing plans for schizophrenia, as they are often tailored to specific individuals according to their unique symptoms, here are some of the common strategies that may be used:
Incoherence in speech is assessed, and the professional assess whether it may be chronic or sudden
The professional identify the duration for which the antipsychotic medication has been taken or will be taken, as this determines the possibility of clear thinking or derailment in thought or looseness of association.
The professional who is taking care of nursing plans in schizophrenia also needs to have specific ways of talking to the patients, and often need to use a low voice, as it has been seen that a high-pitched/loud tone of voice can elevate anxiety levels.
The environment needs to be kept as calm, quiet, and as free of stimuli as possible, which will also keep the anxiety from escalating.
The nursing plans will often keep short, frequent periods with a client throughout the day, instead of long sessions all at once, as these will keep the patient more involved and interested in the process.
Shorter and periodic meetings also allow the patient to develop familiarity and safety.
The language used with patients must be clear or simple and any instructions or directions must not be such that the patient has difficulty processing them.
Any time the patient needs help or needs something explained about their treatment, there should be simple, concrete, and literal explanations.
The nursing plans for schizophrenia must focus on bringing the patient’s attention to concrete things in the environment instead of on the delusional systems that they may be more inclined to be engaged in.
The nursing staff may also want to look for themes in what is said even though the patient’s spoken words appear incoherent, because that may be the only way to truly understanding what the patient is feeling.
The patient suffering from schizophrenia may not always be able to read cues, so if the nursing staff is having trouble understanding them they need to tell them clearly that they are having difficulty understanding, this also allows trust to build.
Strategies to minimize anxiety and “worrying” thoughts, must be taught when the patient is starting to feel a little better and the more florid symptoms are abating as a result of the pharmacological treatment.
To help the patient minimize their levels of anxiety once the psychosis has reduced, these steps may be followed and these strategies could be taught to the patient:
- Refocus their attention on meaningful activities.
- Teach them to replace negative thoughts with constructive thoughts.
- Teach them to replace irrational thoughts with rational statements.
- Teach deep breathing exercises.
- One may read to the patient or ask them to read aloud to themselves.
- Support may be sought from staff, family, or other supportive people.
- Calming visualization or music might be used.
A diagnosis of schizophrenia may be made based on either the DSM 5 or the ICD 10, and usually this diagnosis may be made by a psychiatrist who prescribes the drugs based on a clinical interview, or by a clinical psychologist, who may also use rating scales to elicit some features.
According to the international classification of disorders (ICD 10), there are many subtypes of schizophrenia, but all of them include symptoms and features from these 9 core categories, and this makeup all the signs, symptoms, and features of schizophrenia:
- “thought echo, thought insertion or withdrawal, and thought broadcasting;
- delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception;
- hallucinatory voices giving a running commentary on the patient’s behavior, or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body;
- persistent delusions of other kinds that are culturally inappropriate and completely impossible, such as religious or political identity, or superhuman powers and abilities (e.g. being able to control the weather, or being in communication with aliens from another world);
- persistent hallucinations in any modality, when accompanied either by fleeting or half-formed delusions without clear affective content, or by persistent over-valued ideas, or when occurring every day for weeks or months on end;
- breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech, or neologisms;
- catatonic behavior, such as excitement, posturing, or waxy flexibility, negativism, mutism, and stupor;
- “negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses, usually resulting in social withdrawal and lowering of social performance; it must be clear that these are not due to depression or to neuroleptic medication;
- a significant and consistent change in the overall quality of some aspects of personal behavior, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.”
Most nursing plans for schizophrenia will focus chiefly on helping the patient navigate through the disorganized thought patterns mentioned above, and delusional content they may suffer from.
Delusional Perception, which refers to assigning sinister or wrong meaning to objects around the person, is another thing that a patient with schizophrenia might suffer from, and this is also something that nursing plans might help with.
Disturbed thought process Nursing Diagnosis
A disturbed thought process nursing diagnosis may be made in schizophrenia when it is determined that the patient is suffering from highly disorganized thought patterns that need to be put at the center of the interventions that psychiatric nursing staff may undertake.
In order to make a disturbed thought process diagnosis, the following chief symptoms must be present:
- Incorrect interpretation of stimuli, whether they are focused inward or outward
- Cognitive deficits or cognitive distortions may be seen in the mental status examination
- Delusions or delusional perception
- Distractibility or lack of attention or concentration
- Hallucinations or altered perception
- Inappropriate social behavior or blunted affect
- Lack of consensual validation
- Obsessions or compulsions, or any other ritualistic behavior
Nursing plans for disturbed thought processes are likely to be based on these particular symptoms as well, and here are some of the possible outcomes that may be outlined at the beginning of a nursing plan for disturbed thought processes in schizophrenia or any other mental illnesses:
- Re-establishing the reality orientation and communication patterns of the patient
- Bringing about the recognition of any acute changes in thinking/behavior.
- Enabling the patient to recognize and clarify possible misinterpretations of the behaviors and verbalization that they experience from others.
- Helping the patient identify situations that occur before hallucination/delusions to control these symptoms better.
- Teaching the patient coping strategies to deal with effectively with hallucinations/delusions.
- Helping the patient to take part in unit activities.
- Helping the patient to get to a point of expressing delusional material less frequently.
- Improving the interaction of the patient with staff and other patients in the therapeutic community setting.
Nursing Care Plan for Self-Care Deficit in Schizophrenia
A typical nursing care plan for self-care deficit in schizophrenia may involve the following main characteristics:
- The ability to recognize schizophrenia and following the characteristic signs and symptoms of schizophrenia in the patients, like speech abnormalities, thought distortions, poor social interactions).
- A process to establish trust and rapport, and making sure that the nursing staff does not tease or joke with patients.
- The nursing staff needs to go in with the attitude of expectation that the patient is going to put them through rigorous testing periods.
- There must always be a formal introduction and an explanation of the staff’s purpose.
- An assessment must be made of the patient’s ability to carry out activities of daily living.
- The positive or psychotic symptoms of the patient must be assessed, especially command hallucinations or any presence of fragmented, poorly organized, well-organized, systematized, or extensive system of beliefs that are not supported by reality. Assess for pervasive suspiciousness that may indicate delusions or delusional perception.
- Assess negative symptoms
- Assess medical and family history and figure out what kind of support system the patient has in place.
- Teach the patient and their family about the importance of medication adherence.
- Teach the family and friends who will be dealing with the patient about Expressed emotions.
In this brief guide, we discussed everything one needs to know about a Nursing diagnosis for schizophrenia, and other related concepts of Nursing and schizophrenia, like nursing plans for self-care deficit schizophrenia and disturbed thought process nursing diagnosis and plans.
Schizophrenia is a debilitating illness and psychiatric nursing offers some of the best possibilities for the rehabilitation of people suffering from schizophrenia, which means that nursing plans are extremely important to patients suffering from this disorder.
The disturbed-thought processes in schizophrenia and symptoms like delusions may not always respond to medication right away and therefore a human intervention may be more necessary at least in the initial phases.
Please feel free to reach out to us with any questions or comments you may have about nursing plans for mental illnesses or nursing plans for schizophrenia specifically.
Frequently Asked Questions (FAQs): Nursing Plans for Schizophrenia
What is a nursing diagnosis for schizophrenia?
A nursing diagnosis for schizophrenia may be based on the DSM 5 or ICD 10 criteria for schizophrenia, which may include information about hallucinations, delusions, catatonia, altered perception of other types, or disorganized thought process.
A nursing diagnosis for schizophrenia will often focus on the patient’s speech and other thought related problems that hamper daily living and usually, the idea will be to make them function better in their day to day life.
Which is a nursing diagnosis?
A nursing diagnosis is a part of the nursing process and it helps to make nursing plans for the patients depending on what symptoms have been decided upon in the diagnosis.
A nursing diagnosis may typically integrate patient involvement, as well as factors about the support system or the medication regimen the patient is on, to help with the process of recovery.
Is loneliness a nursing diagnosis?
No, Loneliness is not a nursing diagnosis but some research has recommended that Loneliness should replace Social Isolation as the primary nursing diagnosis in the NANDA International taxonomy.