Comprehensive exams for Mental Health Q 107
Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse’s interpersonal communication with the client and specific nursing interventions must be:
A. Clearly identified with boundaries and specifically defined roles.
B. Warm and non-threatening.
C. Centered on clearly defined limits and expression of empathy.
D. Flexible enough for the nurse to adjust the plan of care as the situation warrants.
Correct Answer: D. Flexible enough for the nurse to adjust the plan of care as the situation warrants.
A flexible plan of care is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and is in control of himself at various times, the nurse must be able to adjust nursing care as the situation warrants. Ensure that the goals set are realistic; whether in the hospital or community. Avoids pressure on the client and sense of failure on part of the nurse/family. This sense of failure can lead to mutual withdrawal.
Option A: The nurse’s role should be clear; however, the boundaries or limits of this role should be flexible enough to meet client needs. Structure activities that work at the client’s pace and activity. Structure times each day to include planned times for brief interactions and activities with the client on one-on-one basis. Helps the client to develop a sense of safety in a non-threatening environment.
Option B: Because a client with schizophrenia fears closeness and affection, a warm approach may be too threatening. Avoid touching the client. Touch by an unknown person can be misinterpreted as a sexual or threatening gesture. This particularly true for a paranoid client. Keep the client in an environment as free of stimuli (loud noises, crowding) as possible. The client might respond to noises and crowding with agitation, anxiety, and increased inability to concentrate on outside events. The client can lose interest in activities that are too ambitious, which can increase a sense of failure.
Option C: Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the client’s situation may change without warning. Teach the client to remove himself briefly when feeling agitated and work on some anxiety relief exercise (e.g., meditations,rhythmic exercise, deep breathing exercise). Teach client skills in dealing with anxiety and increasing a sense of control. Useful coping skills that the client will need include conversational and assertiveness skills. These are fundamental skills for dealing with the world, which everyone uses daily with more or less skill.