A nursing care plan for schizophrenia is an individualized plan of care to help patients manage their symptoms and maintain a healthy lifestyle. It involves understanding the patient’s needs and developing strategies and interventions to promote their well-being. The care plan typically involves an assessment of the individual’s medical condition, mental health, and social environment, as well as strategies to address symptoms such as hallucinations, delusions, and disorganized thoughts. Interventions include medication management, lifestyle modifications, monitoring for relapse, and support for caregivers. With a focus on improved quality of life and overall wellness, a nursing care plan for schizophrenia can provide essential support for those living with this condition.
Table of Contents
Schizophrenia – Nursing Diagnosis I
Alteration in thought processes related to the inability to trust, panic anxiety, evidenced by delusional thinking, inability to concentrate, impaired volition, and extreme suspiciousness of others.
Objective:
The patient will eliminate patterns of delusional thinking and demonstrate trust in others
| Interventions | Rationales |
| Convey acceptance of the patient’s need for the false belief, but that you do not share the belief. | The client must understand that you do not view the idea as real. Arguing or denying serves no useful purpose as delusional ideas are not eliminated by this approach; further, this may adversely affect the development of a trusting relationship. Discussions that focus on false ideas are purposeless and useless and may even aggravate the condition. |
| Do not argue or deny the belief. | To promote trust To prevent the client from feeling threatened |
| Reinforce and focus on reality. Discourage long discussions about irrational thinking. Instead, talk about real events and real people. | -do- |
| If the client is highly suspicious, the following interventions may help: use the same staff as far as possible; be honest and keep all promises avoid physical contact in the form of touching the patient, etc; avoid laughing, whispering, or talking quietly where the client can see but cannot hear what is being said; avoid competitive activities; use an assertive, matter-of-fact yet friendly approach | -do- |
Schizophrenia – Nursing Diagnosis II
Sensory-perceptual alteration: Auditory /visual, related to panic anxiety, withdrawal into self, evidenced by inappropriate responses, disordered thought processes, poor concentration, and disorientation.
Objective:
The patient will be able to define and test reality, eliminating the occurrence of hallucinations.
| Interventions | Rationales |
| Observe the client for signs of hallucinations (listening pose, laughing or talking to self, stopping in mid-sentence). | Early intervention may prevent aggressive responses to command hallucinations. |
| Avoid touching the client without warning. | The client may perceive touch as threatening and may respond in an aggressive manner. |
| An attitude of acceptance will encourage the patient to share the content of the hallucination with you. | This is important to prevent possible injury to the patient or others from command hallucinations. |
| Do not reinforce the hallucinations. Use “the voices” instead of words like “they” that imply validation. Say “Even though I realize the voices are real to you, I don’t hear any voices speaking.” | The client should know that you do not share false perceptions. |
| Help the client understand the connection between anxiety and hallucinations. | If the client can learn to interrupt rising anxiety, hallucinations may be prevented. |
| Try to distract the client away from the hallucinations and involve him in interpersonal activities and actual situations. | This is to bring the client back to reality. |
Schizophrenia – Nursing Diagnosis III
Social isolation is related to the inability to trust, panic anxiety, and delusional thinking, evidenced by withdrawal, sadness, dull affect, preoccupation with own thoughts, and expression of feelings of rejection of aloneness imposed by others.
Objective:
The patient will voluntarily spend time with other patients and staff members in group activities on the unit.
| Interventions | Rationales |
| Convey an accepting attitude by making brief, frequent contacts. Show unconditional positive regard. | This increases feelings of self-worth and facilitates trust. |
| Offer to be with the client during group activities that he finds frightening or difficult. Involve the client gradually in different activities on the unit. | The presence of a trusted individual provides emotional security for the client. |
| Give recognition and positive reinforcement for the client’s voluntary interaction with others. | Positive reinforcement enhances self-esteem and encourages the repetition of acceptable behavior. |
Schizophrenia – Nursing Diagnosis IV
Potential for violence, self-directed or directed at others, related to extreme suspiciousness, panic anxiety, catatonic excitement, rage reactions, command hallucinations, evidenced by physical violence, destruction of objects in the environment, self-destructive behavior, or active aggressive suicidal acts.
Objective:
The patient will not harm self or others.
| Interventions | Rationales |
| Maintain low-level stimuli in the client’s environment (low lighting, low noise, few people, simple decoration, etc.) | Anxiety level rises in a stimulating environment and may trigger off aggression. |
| Observe the client’s behavior frequently. Do this while carrying out routine activities. | Close observation is necessary so that intervention can occur if required, to ensure the client’s and others’ safety. To avoid creating suspicion in the individual. |
| Remove all dangerous objects from the client’s environment. | To prevent the client from using them to harm self or others in an agitated, confused state. |
| Redirect violent behavior with physical outlets for anxiety. | Physical exercise is a safe and effective way of relieving pent-up tension. |
| Staff should maintain a calm attitude toward the client. | Anxiety is contagious and can be transmitted from staff to clients. |
| Have sufficient staff available to indicate a show of strength to the client if it becomes necessary. | This shows the client evidence of control over the situation and provides some physical security for the staff. If the client is not calmed by “talking down” or the use of medications, restraints may have to be used as a last resort. |
| Administer tranquilizers as prescribed. The use of mechanical restraints may become necessary in some case | Impaired verbal communication related to panic |
Schizophrenia – Nursing Diagnosis V
Impaired verbal communication related to panic anxiety, disordered, unrealistic thinking, evidenced by loosening of associations, echolalia, verbalizations that reflect concrete thinking, and poor eye contact.
Objective:
The patient will be able to communicate appropriately and comprehensibly by the time of discharge.
| Interventions | Rationales |
| Attempt to decode incomprehensible communication patterns. Seek validation and clarification by stating “Is it what you mean …?” or “I don’t understand what you mean by that. Would you please clarify it for me?” | These techniques reveal how the patient is being perceived by others, while the responsibility for not understanding is accepted by the nurse. |
| Facilitate trust and understanding by maintaining staff assignments as consistently as possible. The techniques of VERBALIZING THE IMPLIEDis used with the client who is mute (either unable or unwilling to speak). For example, “That must have been a very difficult time for you when your mother left. You must have felt all alone.” | This approach conveys empathy and encourages the client to disclose painful issues. |
| Anticipate and fulfill client’s needs until functional communication pattern returns. | Self-care ability may be impaired in some patients who may need assistance initially. |
Schizophrenia – Nursing Diagnosis VI
Self-care deficit related to withdrawal, panic anxiety, perceptual or cognitive impairment, evidenced by difficulty in carrying out tasks associated with hygiene, dressing, grooming, eating, and toileting.
Objective:
The patient will demonstrate the ability to meet self-care needs independently.
| Interventions | Rationales |
| Provide assistance with self-care needs as required. Some patients who are severely withdrawn may require total care | Patient safety and comfort are nursing priorities. |
| Encourage the client to perform independently as many activities as possible. Provide positive reinforcement for independent accomplishments | Independent accomplishment and reinforcement enhance self-esteem and promote the repetition of desirable behavior. |
| Creative approaches may need to be used with the client who is not eating because he is suspicious of being poisoned (e.g., allow the client to open his own canned or packaged foods, etc.) If elimination needs are not being met, establish a structured schedule to help the client fulfill these needs until he is able to do so independently. | To ensure that self-care needs are met. |
Schizophrenia – Nursing Diagnosis VII
Ineffective family coping related to highly ambivalent family relationships, and impaired family communication, evidenced by neglectful care of the client, extreme denial, or prolonged over-concern regarding his illness.
Objective:
The family will identify more adaptive coping strategies for dealing with the patient’s illness and treatment regimen.
| Interventions | Rationales |
| Identify the role of the client in the family and how it is affected by his illness. Identify the level of family functioning. Assess communication patterns, interpersonal relationships between the members, problem-solving skills, and availability of support systems. | These factors will help to identify how successful the family is in dealing with stressful situations and areas where assistance is required. |
| Provide information to the family about the client’s illness, the treatment regimen, and the long-term prognosis | Knowledge and understanding about what to expect may facilitate the family’s ability to successfully integrate the schizophrenic patient into the system |
| Practice with family members, how to respond to bizarre behavior and communication patterns, and when the client becomes violent. | A plan of action will assist the family to respond adaptively in the face of what they may consider a crisis situation |
Evaluation
- A few questions that may facilitate the process of evaluation can be: • Has the patient established trust with at least one staff member?
- Is delusional thinking still prevalent?
- Are hallucinations still evident?
- Is the patient able to interact with others appropriately?
- Is the patient able to carry out all activities of daily living independently?
You May Also Like
100 Important Nursing Questions and Answers