Schizophrenia Case Study Essay

As per Morrison-Valfre (2013), schizophrenia is described as “a condition associated with disturbing thought patterns, behaviours, and loss of contact with reality to the point at which it impairs functioning”. The psychotic disorder affects approximately 1% of individuals worldwide, resulting in 2.5 million Americans suffering from the mental ailment (Morrison-Valfre, 2013, p.362). Individuals experiencing schizophrenia suffer from many different types, including catatonic, disorganized, paranoid, undifferentiated, and residual schizophrenia (Morrison-Valfre, 2013, p.362). When schizophrenia is diagnosed, individuals suffer from severe adverse effects such as hallucinations, illusions, altered internal sensations, negative self-perception,

delusions, inappropriate emotional effect, little impulse and anger control, and poor emotional relationships (Morrison-Valfre, 2013, p.364).
In reference to the case study provided, a client with schizophrenia has been admitted to the health-care facility I work at as a registered practical nurse.

Due to medication compliance, and improved symptoms of abated hallucinations and nonviolent behaviours, the nurse and health care team decided to discharge the patient. When the patient received the news of discharge, concern was expressed through the patient asking to stay “a little bit longer”. As a registered practical nurse, it is believed that in order to successfully help the patient get over his fear of discharge it would be beneficial to further discuss reasoning’s behind not wanting to return home, and follow up with the appropriate health

teaching.
As the patient is diagnoses with paranoid schizophrenia, it does not come as a surprise that fear is associated with a change relating to the medical condition. Paranoia is associated with schizophrenia (Morrison-Valfre, 2013, p.364). With this side effect
prevalent in the patient’s condition, an interruption in daily routine such as a hospital discharge can promote this paranoia. It is possible the patent felt at ease with the help of the nurses and health care staff regarding his disease process, and the thought of going home without constant care can promote an anxiety. It would be important as the nurse assigned to this patient to explain the effectiveness of medications relating to his medical condition, and how to spot early signs and symptoms of schizophrenia relapse. As per Morrison-Valfre (2013), there are many phases of schizophrenia, including a remission stage. Although the patient may feel a relief or improvement of schizophrenia symptoms (remission), each stage can be re-encountered (Morrison-Valfre, 2013, p.365). A patient can feel at ease with their mental health disorder due to improved treatment and medication compliancy, but can easily backtrack into a prior stage of schizophrenia. This can come as a frightening thought for mental health patients due to the unpredictability of the disorder. Developing a good nurse-client relationship and advocating for the client through successful health teaching would be the best starting approach in trying to encourage the patient in hospital discharge.
Additionally, helping the client and client’s family understand at-home treatment options that may help lessen the chances of schizophrenia relapse can relieve anxiety the patient may be experiencing about returning home. Firstly, it is beneficial for schizophrenia patients to refrain from smoking and excessive alcohol use as it can jeopardize the patient’s mental health recovery (Schizophrenia Society of Canada, 2011). Diet and exercise also play a major roll in the improvement of generalized health levels. Consumption of fatty acids may be beneficial as there has been proven research regarding consumption of omega-3 fatty acids (found in fish oil) in improving brain health and
outcomes for individuals living with mental illness (Schizophrenia Society of Canada, 2011). Following medication administration compliancy is one of the biggest factors in management of schizophrenia as nearly half of schizophrenia patients fail to take medications (Tsuang, Glatt, & Faraone, 2011). This results in progression of schizophrenia symptoms, and mental disorder relapse. Explaining what each drug does, and ensuring that the patient understands the importance of taking the medication to improve and prevent schizophrenia progression is important. If the patient doesn’t follow their medication routine, relapse is commonly experienced (Morrison-Valfre, 2013, p.366).
Considering further teaching for the patient, use of the nursing process would be beneficial. Upon assessment, it was determined that the patient is expressing fear and unwillingness to return home from the hospital setting relating to his schizophrenia. Although the patient has shown significant improvement in reduction of signs and symptoms, and an increased compliancy with medication administration, there is still unwillingness to return home at the current moment. Assessing these observations, it was thought that the primary nursing diagnosis for the patient is fear related to hospital discharge, as evidence by patient stating “I am not ready to be discharged yet. I think I need to stay a bit longer”, secondary to admitting diagnosis of paranoid schizophrenia.
Having considered the patients primary nursing diagnosis, it was thought that the patient would meet specific goals through interventions carried out by the nurse in order to successfully overcome the nursing diagnosis. These goals were outlined being the patient will maintain medication compliancy and demonstrate an absence of schizophrenia symptoms following discharge. Additionally the patient will verbalize
personal fears, and demonstrate an absence or reduction in fear. Through carful evaluation and implementation of interventions, it was expected that each goal would be fulfilled.
Having looked at specific nursing interventions to utilize with the patient, it was though that targeting the reasoning’s behind the patient’s unwillingness to be discharged was important. Secondary to this, health teaching to help the patient better understand the situation would be valuable. Initially, establishing a successful nurse-patient relationship is important in helping the patient trust the nurse. If the patient doesn’t believe in the nurse or the information coming from the nurse, he would most likely not want to follow the healthcare regimen (Morrison-Valfre, 2013, p.368). Showing acceptance and understanding in the patient’s thoughts regarding discharge is important in allowing the patient to communicate and express personal feelings. This also decreases patient anxiety levels relating to the nursing diagnosis (Morrison-Valfre, 2013, p.368). If the patient continues to display unwillingness to return home, discussing the possibility of an assisted living home would be beneficial as there would be constant care. This also decreases the amount of acute psychotic episodes related to the patient’s schizophrenia (Morrison-Valfre, 2013, p.368).
During further discussion and evaluation of the patient’s fear of discharge, an appropriate intervention to carry out includes assessing the source of the patients fear (Ackley & Ladwig, 2014, p. 354). Doing so could bring up underlying reasoning’s behind the patients fear, and provide an opportunity to address them with the patient. Exploring the underlying feelings of fear can help the client confront unresolved conflicts or discrepancies, and develop coping abilities (Ackley & Ladwig, 2014, p. 354). Doing
this along with the appropriate health teaching regarding the reasoning’s for discharge can help the patient better understand and accept the idea of going home.
In conclusion, it was thought that the patient was expressing unwillingness and fear in relation to discharge from the health-care facility that he had been admitted to.

With the admitting diagnosis of paranoid schizophrenia, paranoia is expected from this individual due to their mental ailment. With the change in environment of leaving the health-care facility, the patient may experience anxiety and paranoia with the idea of having to now self-care for the mental health disorder. Appropriate health teaching was thought to be an important intervention to implement with the patient in order for the individual to understand how to best avoid schizophrenia relapse. With an occurrence in relapse, most of the progress made while hospitalized may be

lost.
Furthermore, it was thought that it was important that the patient understood how each medication prescribed works and how it is important for their body specifically. Although the patient was demonstrating medication compliancy, it was still important that health teaching was provided in order for the patient to understand how important each medication is and uphold this compliancy. It was hoped with the trusting relationship the nurse and client developed, and with the appropriate health teaching, the patient would open up to discharge planning and continue to follow medication routine.
Having looked specifically at this assignment relating to my future nursing practice, I believe that the information can be used in the future. With mental health being more recognized and accepted in society, nurses are certain to see more patients with mental health disorders. Having background knowledge in this field will come as an advantage due to the disorders progression having a major focus on the thought process
of the patient. Use of therapeutic communication and explanation of this knowledge in mental health can help aid the patient through the difficult process.
Having looked specifically on the topic schizophrenia, knowledge in the field will come as an advantage due to the unpredictability of the disease. Since a cure for schizophrenia is unknown (Morrison-Valfre, 2013, p.366), it is important to let the patient know that it can be controlled. With the side effects of paranoia, hallucinations, illusions, negative self-perception, inappropriate emotional effect, and little impulse and anger control (Morrison-Valfre, 2013, p.364), patients can become quite agitated and confused when trying to comprehend the mental disorders pathological process. Helping the patient in a comforting way by explaining the information gained from this assignment will hopefully help them better understand what is happening in relation to their schizophrenia and how it could be improved.