Recovery focused nursing care plan
Case Study 2: The client with schizophrenia
Schizophrenia is typified by disturbances – for at least a period of six months – in
sense of self, affect, thought content and form, social activity, psychomotor behaviour,
perception, interpersonal relationships, language, and volition (Marder, 2011; Kopelowicz,
2012). In the case study, the 25-year-old Bernard who has a diagnosis of schizophrenia
(295.9) has paranoid schizophrenia. The Recovery Focused Care Plan for him is as follows:
Consumers priority Identified
goals
/issues
Consumer’
s strengths
to address
these issues
Consumer and nursing
interventions
Persons
responsible
Time
frame
for
next
review
Hallucinations or
delusions – the client
reported increased paranoid
ideation during the previous
4/52 and he stated that they
are talking about him,
following him and watching
him. When the client is
asked what he means by
they, he is reluctant to
identify them and states that
they will also come to you.
In addition, this client was
initially diagnosed with
schizophrenia when he was
22 years old. He stated that
during this time, he was
hearing voices of a
commentary nature and was
also experiencing paranoid
ideation. Working as a
labourer at a building site,
he reported that he felt
somewhat paranoid
regarding his fellow
labourers and started
suspecting that they were
making plans to harm him
or his family. The client has
some lingering paranoia
ideas evident with regard to
his previous workmates at
the building site. However,
these paranoia ideas are
short-lived in their nature
and whenever they occur
they happen to be less
disturbing. Client exhibited
suicidal ideation.
Reduce
hallucinatio
ns and
delusions
Client can
attend
counselling
sessions for
hallucinatio
ns /
delusions.
Bernard can
take anti-
psychotic
medications
.
Prevent self-harm through
continuous assessment of
suicide potential.
Maintain a safe
environment.
Stay with the client when
he starts to hallucinate,
and direct him to tell the
voices he is hearing to go
away.
Do not argue with him
about his delusions or
hallucinations (Edwards et
al., 2011).
Tell the client that the
delusions or hallucinations
are symptoms of a
psychiatric disorder.
Acknowledge fear or
feelings
Try to keep the client
engaged
Do not express approval
Keep communication non-
judgmental and open
(Köhler et al., 2013).
Encourage client to
practice some techniques
of relaxation
Assist the client to control
delusions or hallucinations
by focusing on reality and
taking necessary
medications as prescribed.
Be tactful in approach
Utilize distractions,
hobbies, exercising, saying
stop (Davis et al., 2016).
Maintain consistency
Encourage and reassure
the client
Listen to the client and
respect his feelings
Clearly explain what you
are doing and the reason as
to why.
Assist him in identifying
the needs which may
underlie the hallucinations.
What other ways could
those needs be satisfied?
Hallucinations could
reflect needs for sexuality,
self-esteem, power and
anger (Beck, 2014).
Do not touch Bernard
without first informing
him exactly what you are
trying to do.
Do not tease or joke with
Bernard.
Assist Bernard to
differentiate between
reality and his own
thoughts. Confirm the
presence of delusions or
hallucinations. Identify
hallucinations or delusions
as being symptoms of the
disorder and tell him that
hallucinations or delusions
are present due to the
metabolic changes taking
place inside his brain.
Centre on the reality-
oriented facets of the
communication (Fleury et
al., 2013).
Administer antipsychotics
agents such as Risperdal,
Zyprexa and Gedon, as
prescribed. Inform
Bernard about the side
effects of the medicine, as
well as dose of
medication. Give emphasis
to the significance of
taking medicines
following discharge, even
when the symptoms have
totally gone away. Ask
Bernard to be committed
in taking the medicine
(Yamasaki et al., 2016).
The nurse
will provide
pharmacoth
erapy
intervention
.
Psychiatrist
will provide
non
pharmacoth
erapy
intervention
3
months
Activities of daily living –
the client is socially isolated
and withdrawn as he has
become more and more
insular and avoids social
contact, inclining to avoid
family and friends. He
described few activities or
interests outside the home.
He has not been able to
establish a new social circle
since he left university. He
experiences difficulties to
sleep and often lies in bed
worrying about his future
and his life. Since he
restarted medication, his
appetite has increased as he
consumes large meals and
adds snacks on top of the
meals. He does not feel like
doing any household chores
like he used to do
previously before he
relapsed.
Improve the
client’s
activities of
daily living
Bernard can
adhere to
treatment
regimen
aimed at
improving
his
activities of
daily living
Involve the client in group
and/or individual
interactions within the
hospital unit. This would
reduce the client’s
isolation and promote a
sense of self-worth.
Assess the ability of the
client to conduct activities
of daily living and pay
special attention to his
nutritional status (Loebel,
Lieberman & Alvir, 2013).
Provide supportive group
therapy that focuses on the
here-and-now, create
group norms which
discourage improper social
behaviour, and encourage
the client to test new social
behaviour.
Role-play particular
established social
behaviours. Promote
growth of relationships
amongst group members
by means of self-
disclosure and realness.
Encourage the members of
the group to confirm their
perceptions with other
people (Oya, Kishi &
Iwata, 2014).
Monitor patient’s
compliance with
medication routine.
Encourage the client to be
present at medication
group. Ask the client about
particular symptom
exacerbations and side
effects. Encourage the
client to go to regular
symptom management
groups.
Recognize the
environments wherein
social interactions are
impaired such as leisure,
living, working, and
learning.
Role-play different facets
of social interactions like
asking for something,
starting or terminating a
conversation, asking
somebody to take part in a
certain activity such as
going to watch a movie,
refusing a request, or even
interviewing for a job
(Wai Tong et al., 2016).
Give Bernard positive
feedback. Focus at most
on 3 behavioural
connections at a time.
Assist community
members and client’s
family to understand
Bernard and give him
necessary support. With
the permission of the
client, form an alliance
with the family.
Encourage members of his
family to attend a support
group (Chow 2012).
The nurse
will provide
pharmacoth
erapy
intervention
.
Psychiatrist
will provide
non
pharmacoth
erapy
intervention
Family
members
and
community
members
will be
understandi
ng to
Bernard and
give him
support
3
months
Problems with occupation
and activities – client has
problems at the workplace
as he does not relate well
with his workmates.
Working as a labourer at a
building site, he reported
that he felt somewhat
paranoid regarding his
fellow labourers and started
suspecting that they were
making plans to harm him
or his family. Some
workmates were making
fun of him and this made
him to become more and
more stressed, and
consequently had
disorganized actions and
thoughts.
Reduce
client’s
problems
with
occupation
and
activities
Bernard can
adhere to
treatment
regimen
aimed at
reducing his
problems
with
occupation
and
activities
Teach Bernard coping
skills which minimize
problems with occupation
and activities such as
talking to a trusted friend
at the workplace, going to
the gym, and phoning a
helpline (Loebel,
Lieberman & Alvir, 2013).
Encourage the client to
observe healthy habits that
will help to optimize
functioning such as
working well with others
at the building site,
maintaining a regular
pattern of sleep, and
maintaining medication
regimen. These are helpful
in keeping the patient in
remission (Kopelowicz,
2012).
Engage patient in reality-
oriented activities
involving human contact
such as outpatient day
care, sheltered workshops,
and inpatient social skills
training groups.
Reward positive behaviour
to assist Bernard improve
his functioning level
(Edwards et al., 2011).
The nurse
will provide
pharmacoth
erapy
intervention
.
Psychiatrist
will provide
non
pharmacoth
erapy
intervention
Family
members
and
community
members
will be
understandi
ng to
Bernard and
give him
support
3
months
Depressed mood, anxiety
and cognitive problems –
When he worked for his
uncle as a labourer at a
building site, Bernard
pointed out that other
labourers in the same site
began making fun of him
and this made him to feel
more and more stressed and
increasingly disorganized in
his actions and thoughts.
The client described themes
of hopeless, helplessness
and worthlessness. The
client described his mood as
being variable; he reported
of uncertainty for the future,
anxiety, and sadness.
Bernard experienced
escalating stress levels,
disorganized thinking and
behaviour. He has also
demonstrated mildly
depressed mood, and
decreased concentration.
Reduce
client’s
mood and
anxiety
Client can
comply
with anti-
depressant
medication.
Bernard can
stick to the
treatment
regime
Work with Bernard to find
the activities that are
helpful in reducing anxiety
and depressed mood and
distract him from
hallucinatory material.
Practice with him new
skills. If Bernard’s stress
and depression trigger
hallucinatory activity, he
may be more motivated to
find ways of removing
himself from stressful
environments or attempt
distraction techniques
(Steele, 2011).
Be alert for signs of
growing agitation, anxiety
or fear. May be indication
of hallucinatory activity
that could be really
frightening to Bernard,
and he may act upon
command hallucinations
for instance by harming
others or himself (Kohler
et al., 2013).
Intervene with seclusion,
one-on-one or
pharmacological/
medication treatments for
depression and stress.
Also use
psychotherapeutic and
somatic interventions and
psychoeducation.
Intervene before the
anxiety starts to increase.
If Bernard is already out of
control, utilize physical or
chemical restraints
following unit protocols
(Davis et al., 2016).
The nurse
will provide
pharmacoth
erapy
intervention
.
Psychiatrist
will provide
non
pharmacoth
erapy
intervention
3
months
RECOVERY FOCUSED NURSING CARE PLAN 2
References
Beck, J. (2014). Nursing process in psychiatric. Psychiatric Rehabilitation Skills, 42(6): 245-
256
Chow, S. (2012). Schizophrenia interventions. J Clin Psychiatry, 31(67): 90-112
Davis, K. N., Tao, R., Li, C., Gao, Y., Gondré-Lewis, M. C., Lipska, B. K., & … Hyde, T. M.
(2016). GAD2 Alternative Transcripts in the Human Prefrontal Cortex, and in
Schizophrenia and Affective Disorders. Plos ONE, 11(2), 1-15.