Schizophrenia And Nursing Interventions: A Case Study

Schizophrenia and Nursing Interventions
Schizophrenia, a chronic and immobilizing condition defined as a psychiatric disease affects approximately 1% of the world’s population (Harris, Nagy & Vargaaxis, 2011). It is known to decrease the standard life expectancy by ten years due to its dire effects on morbidity and mortality, ranking it to be among the ‘top ten causes of disability adjusted life years” (Zigmond, Rowland & Coyle, 2015). The disease presents itself most commonly in young adults, and remains with them throughout the rest of their lifespan (Crisp, Taylor, Douglas & Rebeiro). An estimate of 5-6% of schizophrenia sufferers commit suicide, another 20% attempt suicide, which has been speculated to be the cause of lower life expectancy
of people with schizophrenia (America Psychiatric Association, 2013, p104). With schizophrenia being the most prevalent mental health illness, it weighs largely on the mental health community (Biddle, Mutrie & Gorely, 2015).
Symptoms of this disease are grouped into the following categories: positive symptoms, negative symptoms and cognitive impairment (Zigmond, Rowland & Coyle, 2015). Positive symptoms are those that most individuals do not experience and are considered to be additional to everyday experiences, such as hallucination and delusions (disordered thoughts and speech) (Perese, 2012). The additional positive symptoms include: bizarre behaviours that are asymptomatic of the patients’ normal nature, and also the patient’s reference of their life events that can lead to understanding their cause and delusions (Videback, 2014). On the other hand, negative symptoms include behaviours that are absent or lacking in the schizophrenia patient (Harris, Nagy & Vardaxis, 2011). This can include: reduced speech or alogia, blunt or flat affect, reduce in social interactions and feeling of anhedonia (Harris, Nagy & Vardaxis, 2011). Symptoms of cognitive impairment include deficits in attention and memory, learning difficulties as well as issues with executive functioning (reasoning, problem-solving, planning) (Perese, 2012; Zigmond, Rowland & Coyle, 2015). However according to the DSM-IV, to be diagnosed with schizophrenia, at least two of these symptoms should be noted within one month period: delusions, hallucinations, disorganised speech or catatonic behaviour and any of the negative symptoms presented earlier (APA, 2013).
One the major issue with the symptoms such as hallucinations, delusions and disorganised behaviour is the effect it can have on the general population (Zvonkovic & Lucas-Thompson, 2015). This is concerning because these behaviours may be presented as both threatening and dangerous, leading to negative psychological impacts (Zvonkovic & Lucas-Thompson, 2015). Zvonkovic & Lucas-Thompson (2015) highlights this negative psychosocial impact as: decreased self-esteem, decreased social interaction, social isolation, complications in sustaining relationships and difficulty finding employment. Individuals suffering from schizophrenia display ‘delayed help-seeking behaviour’ as a result of limited choices in life (Harrison & Gill, 2010).
Mental health nurses play an important role when caring for a patient with schizophrenia. Whilst conducting numerous assessments which include counselling, physical therapy and monitoring medications, they also try to improve the quality of life (QoL) of mental health patients. Nursing interventions majorly exist for the purpose of improving of quality of life in patients, increasing patient independence and allowing an increase in positive psychosocial interactions. Three interventions that mental health nurses may use in delivering care for schizophrenic patient are: training in enhancing social skills, delivering thoroughly all the available information and explaining antipsychotic medications, and importantly suggesting family therapy. The aim of these three interventions focus on improving the quality of life of patients diagnosed with schizophrenia, and together easing the physical symptoms and psychological impacts of the disease.
In patients suffering with schizophrenia, one of the key symptoms noted is the deterioration of ‘self’ where the patients displayed their difficulty in perceiving the difference between what was their body, and what wasn’t, leading to them behaving in abnormal and bizarre ways (Videbeck, 2014). This made building relationships with people as considered normal, very difficult, justifying the social isolation that patients with schizophrenia face (Rastad, Martin & Asenlof, 2014). It is also further stated that when schizophrenic patients were asked what would help improve their quality of life, many responded that they desired for a normal life (Rastad, Martin & Asenlof, 2014). Social skills training delivered by mental health nurses aims to allow patients to act and respond appropriately in social contexts by providing corrective behaviour changes which is grounded by three key ideas of receiving, processing and expressing (Perese, 2012). During the training these skills are implemented by the provision of education, rehearing or practising correct social behaviour, role modelling, positive reinforcement, feedback, use of simple phrases such as “maintain eye contact”, “node your head”, “Listen attentively” and other similar reminders (Perese, 2012; Videback, 2014). These techniques have been observed to have positive results, as the patients were able to apply the taught skills successfully in a social context (Markwick, Smith & Mick, 2014). It has also been noted by Pan, Mellor, McCabe, Hill, Tan & Xu (2011) that one of the most effective treatments to delivery to schizophrenic patients has to have a fine line between pharmacotherapy and ‘psychosocial rehabilitation”, therefore the nurses aim to implement both adequate social skills training sessions with the patients and together deliver appropriate antipsychotic medication.
Schizophrenic patients have not always been noted to be amongst the most adhere towards medications, with only an average of 50% of patients taking their prescribed antipsychotic medications (Perese, 2012). According to Videbeck (2014), medication are vital in controlling the positive symptoms of schizophrenia (such as hallucinations and delusions), however these medications are found to have little to no effect on the negative and cognitive symptoms. Furthermore, Videbeck (2014) also noted that taking antipsychotic medications regularly by patients can help regulate their ordinary lives, whereas failure to sticking to the strict medication regimens is found to be one of the primary causes of relapses in schizophrenic symptoms which correlates to the increase of readmission rates in psychiatric institutes. The traditional model of care with its concept of adherence to taking medications is noted to be unreasonable since it places the blame in failing to adhere on the patients. Instead, the collaborative care is engaged in allowing the patients to be in control of taking their medications. Hence, it is vital that the nurses encourage adherence to medication regimens by empowering the patients to take the medications themselves instead of being forced to doing so. This is done by educating them on why antipsychotic medications are beneficial, and training on problem solving techniques if the reason for not taking medication is to do with forgetfulness or disorganisation (Liersh-Surmskis, Moxham & Curtis, 2014, p. 117; Perese, 2012). Even simply discussing the barriers to medications with the patient is proven to be effective in medication management (Videback, 2014). During this discussion, many issues such as lack of carers, financial difficulty, lack of transport to help get medications, and lack of knowledge of when and why to take antipsychotics can be brought up and together resolved according to what best fits the patients’ lifestyle (Liersh-Surmskis, Moxham & Curtis, 2013).
Family therapy is considered to be one of the most important and effective intervention for schizophrenic patients that could be carried out, with the nurses’ aim to include and help the family cope with the member diagnosed with schizophrenia in their lives.
As schizophrenia remains with the person during their entire lifespan, as the patients ages, the family of the patient should be willing to continue caring for them (Kumar, Suresha, Thirthalli, Arunachala & Gangadhar, 2015). Therefore providing education to the patient’s carers, family and friends is highly important through developing clear action plans in preparing them for any crisis that may occur in the future (Townsend, 2006). Schizophrenia not only impacts the patient suffering with it, but also the family. Harvey & O’Hanlon (2013) draws attention to how families of schizophrenic patients have increased anxiety, depression, social isolation and decreased QoL. Furthermore, it also mentions how 50% of Australian carers themselves also display psychiatric symptoms. Family therapy is found to be helpful in averting large amounts of stress and teaching families to recognise that the way they might want to assist their schizophrenic family member may not be the most helpful (World Health Organisation, 2004). Even though family therapy has been proven to be useful in helping families cope with a member of their family diagnosed with schizophrenia, it is not a nursing intervention that is regularly carried out and
recommended, therefore encouraging family therapy is vital (Harvey & O’Hanlon, 2013).
Schizophrenia, a psychiatric disease that affect an estimate of 1% of the global population which presents with many symptoms and can consequently lead to negative psychosocial impact to the sufferer. It also presents with high prevalence rates of morbidity and mortality. Therefore, it is important for nurses to implement suitable interventions for patients suffering with schizophrenia because the stigma faced by these patients can lead to a decrease in quality of life. Interventions such as training in enhancing social skills, delivering thoroughly all the available information and explaining antipsychotic medications, and importantly suggesting family therapy that are discussed above are essential in improving the well being of the patient and helping their families understand and cope with their schizophrenic family member.
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