Schizophrenia: Nursing Interventions

by Brenda Marshall, EdD, MSN, RN

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    00:00 When we're thinking about nursing interventions, and when we're looking at our nursing diagnoses, we want to be able to be focused on our patient.

    00:11 We need to keep ourselves observing them.

    00:14 We have to see if they are, as I said before responding to internal stimuli, which would be their hallucinations, voices, auditory, things that are not happening in the world around them, but are happening in their mind and therefore being realized by them as a real threat to them.

    00:36 We want to be able to engage the person in conversations.

    00:40 Rather than arguing with them, telling them, "No, there's nothing here.

    00:45 There's no other person here." We want to stop and we want to listen, we want to hear what they're saying.

    00:52 We want to find out if they're having auditory hallucinations.

    00:55 What are those voices saying? We need to know if those voices are command voices.

    01:01 If they're saying to hurt them or to hurt us.

    01:05 It's imperative to ask what are the voices saying.

    01:10 We also want to make sure that we are contacting with them, we are contacting, we are able to say, "I'm here for you." "Is there something that you need?" And you are going in and making sure.

    01:24 Now if you are working on a psychiatric floor, you probably have an every 15 minute check.

    01:31 And so that is mandatory.

    01:35 But with someone like this, you may want to be seeing them more frequently.

    01:40 If they don't want to come out of their room, you may want to be walking by the door.

    01:44 You might want to be able to have a constant observation on them, if you think they're going to hurt themselves.

    01:53 You also need to respect boundaries.

    01:56 Of course, you don't want to step in on a person, you want to recognize what a personal space is, especially with somebody who is paranoid and who has delusions.

    02:08 Especially with someone who feels as though she has been raped, violated by a cab driver, by staff members.

    02:18 You want to make sure that you start to be the person that protective factor who's going to reestablish those boundaries for her.

    02:27 So that she has a sense of a little bit more control over her environment.

    02:32 And speaking about environment, let's make sure that the environment is not overwhelming for the person.

    02:39 Let's reduce whatever stimuli in the environment that we possibly can.

    02:45 It's important for us also as we make our therapeutic relationship with our patients, that we are making sure that we know what their physical and their safety needs are.

    02:57 And to work out with them, how we can make sure that those are maintained.

    03:03 We want to be attentive to any of their requests, and whether it's verbal or nonverbal.

    03:09 I mean, if there's somebody who's you know, scratching their hair, we might want to go over and say, "Hey, is it time for a shower? Would you like to take a shower?" Let's see what we can figure out.

    03:21 Not always, people won't always ask for what they need.

    03:25 You may have to ask them.

    03:27 "What can I do for you?" It doesn't hurt and it goes a long way.

    03:33 You want to make sure that you can be trusted.

    03:35 How do you establish trust with a patient who has a psychiatric disorder? The same way you establish trust with anyone else, you are true to your word, you don't make promises you can keep, you listen nonjudgmentally.

    03:49 And you provide them information with hope, not advice.

    03:55 Finally, you don't want to have a threatening stance.

    03:59 You don't want to use aggressive words.

    04:01 What do we mean by a threatening stance? You do not want to go over to somebody like this.

    04:07 This is terribly threatening and closed.

    04:10 You don't want to do the the finger thing.

    04:12 "I don't know about you, but I don't like when people start telling me what to do." We also want to make sure that our words are delivered because tone matters, how loud you're speaking matters, the facial expression you have.

    04:29 So you can say to somebody, "You're beautiful." Or you can say, "You're beautiful." It's going to be taken completely different ways.

    04:38 And so you have to be cognizant of your own self and understand how you could be threatening.

    04:45 If a person is sitting down, you want to sit with them.

    04:48 You don't want to stand over them.

    04:50 You don't want to rush up to somebody.

    04:52 You want to respect that distance.

    04:54 And you want to keep your hands open and relaxed when you're talking to your clients and patients.

    About the Lecture

    The lecture Schizophrenia: Nursing Interventions by Brenda Marshall, EdD, MSN, RN is from the course Schizophrenia (Nursing).

    Included Quiz Questions

    1. The client that is sitting alone, staring at the wall, laughing to themselves.
    2. The client that suddenly starts telling another client, who was not talking, to stop yelling at them.
    3. The client who is laughing at a funny movie.
    4. The client that is yelling at another client, who took the tv remote that they were using.
    1. “Thank you for telling me this. Can you tell me more about it?”
    2. “Why don’t you watch some television to take your mind off this.”
    3. “That’s impossible. You’re experiencing a hallucination; it isn’t real.”
    4. “I’m going to call the government and tell them to stop so you can get some rest.”
    1. Ask the client to provide more details about the voices, and ask the client if they intend on acting on what the voices are asking them to do.
    2. Increase the frequency of routine client check-ins for this client and encourage the client to alert nursing staff if they feel unsafe or need support.
    3. Tell the other clients that the client is experiencing command hallucinations and to alert the nurse if anything happens.
    4. Put the client in mechanical restraints so that the client cannot act on the voices.
    1. The student nurse who approaches the client who is responding to internal stimuli with their hands on their hips and tells the client to be quiet.
    2. The student nurse who tells the client to keep their room door open continuously and follows them around the unit.
    3. The student nurse who guides the client to an area away from other clients and gently asks them if they need help buttoning up their pants that are falling down.
    4. The student nurse that apologizes and adjusts the volume of their voice after the client covers their ears and tells the student nurse that they are too loud.

    Author of lecture Schizophrenia: Nursing Interventions

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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