MENTAL HEALTH PROMOTION
Psychiatric rehabilitation has the goal of recovery for
clients with major mental illness that goes beyond
symptom control and medication management (see
Chapter 4). Working with clients to manage their own
lives, make effective treatment decisions, and have
an improved quality of life—from the client’s point
of view—are central components of such programs.
Willinsky and Pape (2002) identify mental health
promotion as strengthening the client’s ability to
bounce back from adversity and to manage the in-
evitable obstacles encountered in life. Strategies in-
clude fostering self-efficacy and empowering the
client to have control over his or her life; improving
the client’s resiliency or ability to bounce back emo-
tionally from stressful events; and improving the
client’s ability to cope with the problems, stress, and
strains of everyday living. See Chapter 7 for a full
discussion of resiliency and self-efficacy.
In Australia, a pioneering service has been de-
veloped to work with young people with emerging
psychotic illness. The emphasis is on early, intensive,
and integrated biological, psychological, and social
interventions in the 2 years after the onset of treat-
ment. The main aims of the project include reduced
duration of untreated psychosis; expert treatment of
the first episode of psychosis; reduced duration of ac-
tive psychosis in the first episode and beyond; and
maximized recovery, reintegration, and quality of life
(McCann, 2001).
An initiative of early detection, intervention,
and prevention of psychosis (EDIP) has been estab-
lished in Portland, Oregon (Korn, 2001). This project
works with primary care providers to recognize pro-
dromal signs that are predictive of later psychotic
episodes such as sleep difficulties, change in appetite,
loss of energy and interest, odd speech, hearing
voices, peculiar behavior, inappropriate expression of
feelings, paucity of speech, ideas of reference, and
feelings of unreality. Once these high-risk individu-
als are identified, individualized intervention is im-
plemented including education, stress management,
and/or neuroleptic medication. Treatment also in-
cludes family involvement, individual and vocational
counseling, and coping strategies to enhance self-
mastery. Interventions are intensive, using home vis-
its and daily sessions if needed.
The Harvard Mental Health Letter (2001) an-
nounced that research is about to begin on the pro-
phylactic drug treatment of genetically vulnerable
relatives of clients with schizophrenia who seem to
be showing early signs of the disorder such as mild
negative symptoms and abnormal brain functioning.
There is the hope that it may be possible not only to
prevent the most debilitating consequences of schiz-
ophrenia but also to stop them from developing in the
first place.SELF-AWARENESS ISSUES
Working with clients with schizophrenia
can present many challenges for the nurse. They have
many experiences that are difficult for the nurse to
relate to such as delusions and hallucinations. Sus-
picious or paranoid behavior on the client’s part may
make the nurse feel as though he or she is not trust-
worthy or that his or her integrity is being questioned.
The nurse must recognize this type of behavior as part
of the illness and not interpret or respond to it as a
personal affront. Taking the client’s statements or be-
havior as a personal accusation only causes the nurse
to respond defensively, which is counterproductive to
the establishment of a therapeutic relationship.
The nurse also may be genuinely frightened or
threatened if the client’s behavior is hostile or ag-
gressive. The nurse must acknowledge these feelings
and take measures to ensure his or her safety. This
may involve talking to the client in an open area
rather than a more isolated location or having an ad-
ditional staff person present rather than being alone
with the client. If the nurse pretends to be unafraid,
the client may sense the fear anyway and feel less
secure, leading to a greater potential for the client to
lose personal control.
As with many chronic illnesses, the nurse may be-
come frustrated if the client does not follow the med-
ication regimen, fails to keep needed appointments, or
experiences repeated relapses. The nurse may feel as
though a great deal of hard work has been wasted or
that the situation is futile or hopeless. Schizophrenia
is a chronic illness, and clients may suffer numerous
relapses and hospital admissions. The nurse must
not take responsibility for the success or failure of
treatment efforts or view the client’s status as a per-
sonal success or failure. Nurses should look to their
colleagues for helpful support and discussion of these
self-awareness issues.Points to Consider when Working
With Clients With Schizophrenia- Remember that although these clients often
suffer numerous relapses and return for re-
peated hospital stays, they do return to living
and functioning in the community. Focusing
on the amount of time the client is outside
the hospital setting may help decrease the
frustration that can result when working
with clients with a chronic illness. - Visualize the client not at his or her worst,
but as he or she gets better and symptoms
become less severe.
322 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS