- The client will interact with others in the
environment. - The client will express thoughts and feelings
in a safe and socially acceptable manner. - The client will participate in prescribed
therapeutic interventions.
Once the crisis or acute psychotic symptoms have
been stabilized, the focus is on developing the client’s
ability to live as independently and successfully as
possible in the community. This usually requires con-
tinued follow-up care and participation of the client’s
family in community support services. Prevention
and early recognition and treatment of relapse symp-
toms are important parts of successful rehabilita-
tion. Dealing with the negative signs of schizophre-
nia, which medication generally does not affect, is a
major challenge for the client and caregivers.
Examples of treatment outcomes for continued
care after the stabilization of acute symptoms are as
follows: - The client will participate in the prescribed
regimen (including medications and follow-
up appointments). - The client will maintain adequate routines
for sleeping and food and fluid intake. - The client will demonstrate independence in
self-care activities. - The client will communicate effectively with
others in the community to meet his or her
needs. - The client will seek or accept assistance to
meet his or her needs when indicated.
The nurse must appreciate the severity of schizophre-
nia and the profound and sometimes devastating ef-
fects it has on the lives of clients and their families. It
is equally important to avoid treating the client as a
“hopeless case,” someone who no longer is capable of
having a meaningful and satisfying life. It is not help-
ful to expect either too much or too little from the
client. Careful, ongoing assessment is necessary so
that appropriate treatment and interventions address
the client’s needs and difficulties while helping the
client to reach his or her optimal level of functioning.
Intervention
PROMOTING THE SAFETY OF
CLIENT AND OTHERS
Safety for both the client and the nurse is the priority
when providing care for the client with schizophre-
nia. The client may be paranoid and suspicious of the
nurse and the environment and may feel threatened
and intimidated. Although the client’s behavior may
be threatening to the nurse, the client also is feelingunsafe and may believe his or her well-being to be
in jeopardy. Therefore the nurse must approach the
client in a nonthreatening manner. Making demands
or being authoritarian will only increase the client’s
fears. Giving the client ample personal space usually
enhances his or her sense of security.
A fearful or agitated client has the potential to
harm self or others. The nurse must observe for signs
of building agitation or escalating behavior such as in-
creased intensity of pacing, loud talking or yelling, and
hitting or kicking objects. The nurse must institute
interventions to protect the client, nurse, and others in
the environment. This may involve administering
medication; moving the client to a quiet, less stimu-
lating environment; and, in extreme situations, tem-
porarily using seclusion or restraints. See Chapter 10
for a discussion of dealing with anger and hostility and
Chapter 14 for dealing with clients who are suicidal.ESTABLISHING A THERAPEUTIC
RELATIONSHIP
Establishing trust between the client and nurse also
helps to allay the fears of a frightened client. Initially
the client may tolerate only 5 or 10 minutes of con-
tact at one time. Establishing a therapeutic relation-
ship takes time, and the nurse must be patient. The
nurse provides explanations that are clear, direct,
and easy to understand. Body language should include
eye contact but not staring, a relaxed body posture, and
facial expressions that convey genuine interest and
concern. Telling the client one’s name and calling the
client by name are helpful in establishing trust as
well as reality orientation.
The nurse must assess carefully the client’s re-
sponse to the use of touch. Sometimes gentle touch
conveys caring and concern. At other times, the client
may misinterpret the nurse’s touch as threatening
and therefore undesirable. As the nurse sits near the
client, does he or she move or look away? Is the client
frightened or wary of the nurse’s presence? If so, that
client may not be reassured by touch, but frightened
or threatened by it.USING THERAPEUTIC COMMUNICATION
Communicating with clients experiencing psychotic
symptoms can be difficult and frustrating. The nurse
tries to understand and make sense of what the client
is saying, but this can be difficult if the client is hallu-
cinating, withdrawn from reality, or relatively mute.
The nurse must maintain nonverbal communication
with the client, especially when verbal communication
is not very successful. This involves spending time
with the client perhaps through fairly lengthy periods14 SCHIZOPHRENIA 313