of all administration times so the client can cross off
each time he or she has taken the medications.
Clients may have practical barriers to medication
compliance such as inadequate funds to obtain expen-
sive medications, lack of transportation or knowledge
about how to obtain refills for prescriptions, or inabil-
ity to plan ahead to get new prescriptions before cur-
rent supplies run out. Clients usually can overcome all
these obstacles once they have been identified.
Sometimes clients decide to decrease or discon-
tinue their medications because of uncomfortable or
embarrassing side effects. Unwanted side effects are
frequently reported as the reason clients stop taking
medications (Marder, 2000). Interventions, such as
eating a proper diet and drinking enough fluids, using
a stool softener to avoid constipation, sucking on hard
candy to minimize dry mouth, or using sunscreen to
avoid sunburn, can help to control some of these un-
comfortable side effects (see Table 13-2). Some side
effects, such as dry mouth and blurred vision, im-
prove with time or with lower doses of medication.
Medication may be warranted to combat common
neurologic side effects such as extrapyramidal side
effects or akathisia.
Some side effects, such as those affecting sexual
functioning, are embarrassing for the client to re-
port, and the client may confirm these side effects
only if the nurse directly inquires about them. This
may require a call to the client’s physician or primary
provider to obtain a prescription for a different type
of antipsychotic.
Sometimes a client discontinues medications be-
cause he or she dislikes taking them or believes he or
she does not need them. The client may have been
willing to take the medications when experiencing
psychotic symptoms but may believe that medication
is unnecessary when he or she feels well. By refusing
to take the medications, the client may be denying the
existence or severity of schizophrenia. These issues
of noncompliance are much more difficult to resolve.
The nurse can teach the client about schizophrenia,
the nature of chronic illness, and the importance of
medications in managing symptoms and preventing
recurrence. For example, the nurse could say, “This
medication helps you think more clearly” or “Taking
this medication will make it less likely that you’ll
hear troubling voices in your mind again.”
Even after education, some clients continue to
refuse to take medication; they may understand the
connection between medication and prevention of re-
lapse only after experiencing a return of psychotic
symptoms. A few clients still do not understand the
importance of consistently taking medication and
even after numerous relapses continue to experience
psychosis and hospital admission fairly frequently.Evaluation
The nurse must consider evaluation of the plan of
care in the context of each client and family. Ongoing
assessment provides data to determine if the client’s
individual outcomes were achieved. The client’s per-
ception of the success of treatment also plays a part
in evaluation. Even if all outcomes are achieved, the
nurse must ask if the client is comfortable or satis-
fied with the quality of life.
In a global sense, evaluation of the treatment of
schizophrenia is based on the following:320 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
◗ NURSINGINTERVENTIONS FORCLIENTS
WITHSCHIZOPHRENIA- Promoting safety of client and others and right to
privacy and dignity - Establishing therapeutic relationship by estab-
lishing trust - Using therapeutic communication (clarifying
feelings and statements when speech and
thoughts are disorganized or confused) - Interventions for delusions:
Do not openly confront the delusion or argue
with the client.
Establish and maintain reality for the client.
Use distracting techniques.
Teach the client positive self-talk, positive think-
ing, and to ignore delusional beliefs. - Interventions for hallucinations:
Help present and maintain reality by frequent
contact and communication with client.
Elicit description of hallucination to protect client
and others. The nurse’s understanding of the
hallucination helps him or her know how to
calm or reassure the client.
Engage client in reality-based activities such as
card playing, occupational therapy, or listen-
ing to music. - Coping with socially inappropriate behaviors:
Redirect client away from problem situations.
Deal with inappropriate behaviors in a nonjudg-
mental and matter-of-fact manner; give factual
statements; do not scold.
Reassure others that the client’s inappropriate
behaviors or comments are not his or her fault
(without violating client confidentiality).
Try to reintegrate the client into the treatment
milieu as soon as possible.
Do not make the client feel punished or shunned
for inappropriate behaviors.
Teach social skills through education, role mod-
eling, and practice. - Client and family teaching (see the display)
- Establishing community support systems
and care