- Have the client’s psychotic symptoms dis-
appeared? If not, can the client carry out his
or her daily life despite the persistence of
some psychotic symptoms? - Does the client understand the prescribed
medication regimen? Is he or she committed
to adherence to the regimen? - Does the client possess the necessary func-
tional abilities for community living? - Are community resources adequate to help
the client live successfully in the community? - Is there a sufficient after-care or crisis plan
in place to deal with recurrence of symptoms
or difficulties encountered in the community? - Are the client and family adequately knowl-
edgeable about schizophrenia? - Does the client believe that he or she has a
satisfactory quality of life?
COMMUNITY-BASED CARE
Clients with schizophrenia are no longer hospitalized
for long periods. Most return to live in the community
with assistance provided by family and support ser-
vices. Clients may live with family members, inde-
pendently, or in a residential program such as a group
home where they can receive needed services without
being admitted to the hospital. Assertive Community
Treatment (ACT) programs have shown success in re-
ducing the rate of hospital admissions by managing
symptoms and medications; assisting clients with so-
cial, recreational, and vocational needs; and providing
support to clients and their families (McGrew, Wilson,
& Bond, 1996). The psychiatric nurse is a member of
the multidisciplinary team that works with clients in
ACT programs, focusing on the management of med-
ications and their side effects and the promotion of
health and wellness (O’Brien, 1998; Wilbur & Arns,
1998). Behavioral home health care also is expanding,
with nurses providing care to persons with schizo-
phrenia (as well as other mental illnesses) using the
holistic approach to integrate clients into the commu-
nity (Gibson, 1999; Rosedale, 1999). Although much
has been done to give these clients the support they
need to live in the community, there is still a need to
increase services to homeless persons and those in
prison with schizophrenia.
Community support programs often are an im-
portant link in helping persons with schizophrenia
and their families. A case manager may be assigned to
the client to provide assistance in handling the wide
variety of challenges that the client in community set-
tingsfaces. The client who has had schizophrenia for
some time may have a case manager in the commu-
nity. Other clients may need assistance to obtain a case
manager. Depending on the type of funding and agen-
cies available in a particular community, the nurse
may refer the client to a social worker or may directly
refer the client to case management services.
Case management services often include helping
the client with housing and transportation, money
management, and keeping appointments, as well as
socialization and recreation. Beebe (2002) found that
proactive telephone contact with clients in the com-
munity helped address clients’ immediate concerns
and avoid relapse and rehospitalization. The most
common concerns of client included difficulties with
treatment and aftercare, dealing with psychiatric
symptoms, environmental stresses, and financial is-
sues. Although the support of professionals in the
community is vital, the nurse must not to overlook
the client’s need for autonomy and potential abilities
to manage his or her own health.14 SCHIZOPHRENIA 321
◗ CLIENTTEACHING ANDMEDICATIONMANAGEMENT:ANTIPSYCHOTICS
- Drink sugar free fluids and eat sugar-free hard candy to ease the anticholinergic effects of dry mouth.
- Avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and
do little to relieve dry mouth. - Constipation can be prevented or relieved by increasing intake of water and bulk-forming foods in the diet
and by exercising. - Stool softeners are permissible, but laxatives should be avoided.
- Use sunscreen to prevent burning. Avoid long periods of time in the sun, and wear protective clothing. Photo-
sensitivity can cause you to burn easily. - Rising slowly from a lying or sitting position will prevent falls from orthostatic hypotension or dizziness due to
a drop in blood pressure. Wait until any dizziness has subsided before you walk. - Monitor the amount of sleepiness or drowsiness you experience. Avoid driving a car or performing other
potentially dangerous activities until your response time and reflexes seem normal. - If you forget a dose of antipsychotic medication, take it if the dose is only 3 to 4 hours late. If the missed dose
is more than 4 hours late or the next dose is due, omit the forgotten dose. - If you have difficulty remembering your medication, use a chart to record doses when taken, or use a pill box
labeled with dosage times and/or days of the week to help you remember when to take medication.