they are not the cause of schizophrenia. Participating
in organizations such as the Alliance for the Mentally
Ill may help families with their ongoing needs.
Teaching Self-Care and Proper Nutrition.Because of
apathy or lack of energy over the course of the illness,
poor personal hygiene can be a problem for clients
who are experiencing psychotic symptoms as well as
for all clients with schizophrenia. When the client is
psychotic, he or she may pay little attention to hy-
giene or be unable to sustain the attention or concen-
tration required to complete grooming tasks. The
nurse may need to direct the client through the nec-
essary steps for bathing, shampooing, dressing, and
so forth. The nurse gives directions in short, clear
statements to enhance the client’s ability to complete
the tasks. The nurse allows ample time for grooming
and performing hygiene and does not attempt to rush
or hurry the client. In this way, the nurse encourages
the client to become more independent as soon as pos-
sible—that is, when he or she is better oriented to re-
ality and better able to sustain the concentration and
attention needed for these tasks.
If the client has deficits in hygiene and grooming
resulting from apathy or lack of energy for tasks, the
nurse may vary the approach used to promote the
client’s independence in these areas. The client is most
likely to perform tasks of hygiene and grooming if they
become a part of his or her daily routine. Establishing
a structure with the client that incorporates his or her
preferences has a greater chance for success than if
the client waits to decide about hygiene tasks or per-
forms them randomly. For example, the client may
prefer to shower and shampoo on Monday, Wednes-
day, and Friday when getting up in the morning. This
nurse can assist the client to incorporate this plan into
the client’s daily routine, which leads to it becoming a
habit. The client thus avoids making daily decisions
about whether or not to shower or if he or she feels like
showering on a particular day.
Adequate nutrition and fluids are essential to
the client’s physical and emotional well-being. Care-
ful assessment of the client’s eating patterns and
preferences allows the nurse to determine if the client
needs assistance in these areas. As with any type of
self-care deficit, the nurse provides assistance as long
as needed then gradually promotes the client’s inde-
pendence as soon as the client is capable.
When the client is in the community, factors
other than the client’s illness may contribute to in-
adequate nutritional intake. Examples include lack
of money to buy food, lack of knowledge about a nu-
tritious diet, inadequate transportation, or limited
abilities to prepare food. A thorough assessment of
the client’s functional abilities for community living
will help the nurse to plan appropriate interventions.
See the section below on community-based care.
Teaching Social Skills.Clients may be isolated from
others for a variety of reasons. The bizarre behavior
or statements of the client who is delusional or hal-
lucinating may frighten or embarrass family or com-
munity members. Clients who are suspicious or mis-
trustful may avoid contact with others. Other times,
clients may lack the social or conversation skills they
need to make and maintain relationships with oth-
ers. Lastly, a stigma remains attached to mental ill-
ness, particularly for clients for whom medication
fails to relieve the positive signs of the illness.
The nurse can help the client develop social skills
through education, role modeling, and practice. The
client may not discriminate between the topics suit-
able for sharing with the nurse and those suitable for
using to initiate a conversation on a bus. The nurse
can help the client learn neutral social topics appro-
priate to any conversation such as the weather or
local events. The client also can benefit from learning
that he or she should share certain details of his or
her illness, such as the content of delusions or hallu-
cinations, only with a health care provider.
Modeling and practicing social skills with the
client can help him or her experience greater success
in social interactions. Specific skills, such as eye con-
tact, attentive listening, and taking turns talking,
can increase the client’s abilities and confidence in
socializing. Nursing interventions for clients with
schizophrenia are summarized in the display.Medication Management.Maintaining the medica-
tion regimen is vital to a successful outcome for clients
with schizophrenia. Failing to take medications as
prescribed is one of the most frequent reasons for re-
currence of psychotic symptoms and hospital admis-
sion (Marder, 2000). Clients who respond well to and
maintain an antipsychotic medication regimen may
lead relatively normal lives with only an occasional re-
lapse. Those who do not respond well to antipsychotic
agents may face a lifetime of dealing with delusional
ideas and hallucinations, negative signs, and marked
impairment. Many clients find themselves somewhere
between these two extremes. See Client Teaching and
Medication Management: Antipsychotics.
There are many reasons why clients may not
maintain the medication regimen. The nurse must
determine the barriers to compliance for each client.
Sometimes clients intend to take their medications
as prescribed but have difficulty remembering when
and if they did so. They may find it difficult to adhere
to a routine schedule for medications. Several meth-
ods are available to help clients remember when to
take medications. One is using a pill box with com-
partments for days of the week and times of the day.
Once the box has been filled, perhaps with assistance
from the nurse or case manager, the client often has
no more difficulties. It is also helpful to make a chart14 SCHIZOPHRENIA 319