Evaluating Nursing Interventions for Schizophrenia

This assignment requires students to critically evaluate the impact of nursing interventions on patients with schizophrenia. It involves analyzing the literature on assessment tools, such as the Mental Status Examination, and treatment options like cognitive-behavioral therapy. The student must also consider patient-centered care approaches, such as promoting recovery-oriented practice and reducing social isolation. A detailed analysis of the references provided is expected, including articles from reputable sources like the American Psychiatric Association and the British Medical Journal.

Running head: MENTAL HEALTH NURSING
Mental health Nursing
Name of the Student
Name of the University
Author note

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Professional Experience Placement Analysis
The analysis deals with the mental health nursing care plan of Mr X based on the
assessment and the diagnosis of the consumer. As a part of the professional experience
placement, based on the analysis and the consumer issue identified the care plan involves set
goals expected outcomes, interventions and the outcome evaluation. The aim is to design the
individualised, person-centred and recovery-orientated nursing care (Gilburt, Slade, Bird, Oduola
& Craig, 2013).
Patient Introduction
Mr X has been diagnosed with Schizophrenia. He has the past of significant mental
health issues. He is lonely in life and socially isolated. He has poor housing and poverty is the
noticeable factor. He has the history of criminal records and association with anti-social peers.
The consumer has the history of the traumatic abuse throughout childhood. The patient is in good
terms with his grandmother. A reduced life expectancy is noticed in the patient. Due to early
onset of the disease, the patient is experiencing the adverse outcomes of the illness. His social
life is severely impacted as he is unable to socially interact with people and establish rapport.
The history of the patient also informs about the evidence of substance abuse. There is high
probability of the poor health and the social outcomes. He has inadequate access to the mental
health care. He is on medication currently. He has recently contracted scabies due to self-neglect.
Assessment
A detailed examination is important for the patient as per the nursing practice. For Mr X,
it is important to conduct physical and the mental state examination. Physical examination is to
obtain the subjective and objective data using the head-to-framework. The mental examination
will help achieve comprehensive description of the patient’s mental state. It will include the

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appearance, attitude, behaviours, mood and affect, speech, thought process, thought content,
perceptions, insight, judgment, and cognition. Since the patient is in vulnerable condition, a risk
assessment will also be conducted to identify the risk of self-harm (Norris, Clark & Shipley,
2016; Rothman, Solinger, Rothman & Finlay, 2012; Victorian Government Department of
Health, 2010).
Mental state examination
The patient has demonstrated the poor and unkempt appearance. Mr. X has demonstrated
several negative symptoms such as lack of goal directive behaviour, delusions, hallucinations,
and abnormal motor behaviours. The patient showed limited emotional expression and ability to
speak. His thought process is disorganized. He demonstrated poor hygiene. The patient’s
judgment is impaired. He is not aware of the illness. He is not complying with the therapy as
well as exploiting socioeconomic factor, which means poor insight. His social life is severely
impacted as he is unable to socially interact with people and establish rapport. There is high risk
of the patient entering into the criminal record. He seems to have negative social judgment
regarding trustworthiness. He has poor insight of the people and demonstrates apathy. His mood
and affect may be variable due to history of substance abuse. There is alteration in his perception
as he considered the staffs are starving him. There was no suicidal thought observed in the client.
The patient did show adverse cognitive outcomes.
Risk assessment
A risk assessment is a process to identify the hazard that can be caused by a person and
the consequence of hazard. It means there is risk to the patient as well as to the environment
(Victorian Government Department of Health, 2010). There is a risk to patient’s health due to
self-neglect, harm to others and he is also at risk of exploitation from others. Mr.X is at self-harm

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as he has poor hygiene and lack of self-care. However, there is no trace of attempt to suicide. He
is at risk of harming others considering his criminal history. He also has the history of substance
abuse along with evidence of disoriented thought and insight. He is at high risk of others as he
had experienced abused throughout childhood. There is the vulnerability of further abuse and
exploitations, both from peers and the family.
Physical health examination
The subjective and objective data demonstrated the skin infection scabies owing to poor
hygiene. There are no other wounds. Overall the patient has an unclean appearance from tip to
toe. Mr.X is also experiencing anhedonia. It is the inability to feel pressure. The patent has poor
eating habits and poor weight management. The patient is losing weight due to poor diet. He had
poor social relationship with family and peers. His musculoskeletal system may weaken with the
progress of Schizophrenia and poor self-care. There are no abnormal findings related to the
patient’s vital sign. The patient is, however, risk of range of medical conditions such as
cardiovascular disease and cancer, with the progress of an illness.
Diagnosis
It is registered by the psychiatrist based on the DSM-V criteria that the patient has
schizophrenia. According to the DSM-V criteria, the patient must have two of the following
symptoms: hallucinations, disorganized speech, delusions, catatonic behaviour, and negative
symptoms, to be diagnosed with schizophrenia (American Psychiatric Association, 2013).
Further, the criteria highlight about having at least one symptom. It is either presence of
disorganized speech, hallucinations and delusions. Further DSM-V criteria include continuous
signs of disturbance that must be persisting for at least 6 months, and during this period the
patient must experience at least 1 month of active symptoms. Along with it, there should also be

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social or problems with occupational deterioration over significant time. Lastly, the signs must
not be attributed to any other condition (American Psychiatric Association, 2013). Mr X had
demonstrated almost all of the symptoms.
On admission the nursing diagnosis for Mr. X using NANDA-I is Delusion. Delusion is
the mental disorder and is the idiosyncratic belief of an individual that may be contradicted by
rational argument (Wu & Shen, 2017). Mr. X had beliefs regarding persecution as he thinks that
the care team wants to starve him. The nursing diagnosis is disorganized speech. It is the
condition of speaking where a person losses connection and shifts from one topic to other. There
would be no connection with one thought and the next (Frith, 2014). .Further, the nurse has
diagnosed Mr.X with negative symptoms. These symptoms comprise of social withdrawal,
difficulty in taking care of themselves, inability to express emotions and inability to feel pressure
(Frith, 2014). Mr. X was unclean and unkempt in appearance. He demonstrated self-neglect
through his infections and poor eating habit. In Mr. X Further, diagnosis also showed the social
problem as he cannot establish rapport with the people. He experiences problem with
trustworthiness.
Expected outcome
For recovery of Mr., there is a need for SMART goals ((Specific, Measurable,
Achievable, Realistic and Timing). It will help design individualized, patient-centered and
recovery-oriented nursing care.
The first goal for the patient is to enhance the self- hygiene address the grooming self-
care deficit. The second goal is to improve nutrition, where nurse must provide well-balanced
diet. The long-term goal is to improve the social life and decrease the social isolation. In doing

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so, the nurse must avoid stimulated environment, ensure adequate sleep, therapeutic relationship
and provide relaxing therapy (Patel et al., 2014).
Interventions
In the first intervention, the nurse must provide education to the patient on good hygiene
and self-care habits. The nurse must provide food to the patient on clean plates and help in
proper grooming. It includes bathing on time, maintaining neat and clean clothes. Avoid body
odour and on the regular trim of nails and hair (Rajji Miranda & Mulsant, 2014). It will help
improve patient's image of self and increase self-esteem. It will also enhance the independent
nature of the client. The nurse maintains the privacy of the client during bathing and dressing to
respect the dignity.
In the second intervention, the nurse must collaborate with the dietitian to design a well-
balanced diet for Mr. X. The nurse must monitor the patient's nutritional status. Considering the
delusion the nurse must allow the patient to cook his food as it will help reduce delusion. It will
also promote self-dependency in client. Healthy eating will help improve his weight and muscle
strength. The nurse must also monitor if there is effect of medication on appetite (Sheffield et al.,
2014).
In the third intervention, the nurse must use self-therapeutic technique. The nurse must
establish rapport and trust with the client. The interaction with the patient would be positive with
calm gestures and positive facial expressions. The nurse would not be demanding and plan
simple activities for Mr. X. It will help promote client's self-esteem. The nurse must be patient
and honest with the consumer. The care must be as per the patient centered model for nurses

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(Adaji et al., 2017). The nurse would encourage and promote him to interact with friends,
encourage family involvement and provide social skills training (Linz & Sturm, 2013).
Outcome assessment
Using the subjective and objective data, the outcomes will be evaluated. In the subjective
data the records on personal hygiene, grooming and care can be recorded, and patents perception
on self-care can be assessed using open-ended questions. Further assessment includes mini-
mental state exam to rule out negative symptoms (Norris, Clark & Shipley, 2016). The expected
outcome is the improved physical appearance of the client. There may be proper Wight gain and
muscle strength of the client in two months of time. The client may show the positive
relationship with the people around him in the long term.
Conclusion
In conclusion, the nursing care plan for Mr. X was designed that addresses social
isolation and self-care deficits. As a part of the nursing process, the physical, mental and risk
assessment was conducted. The nursing interventions were appropriate as per the patient-centred
goals. The evaluation process will ensure if the nursing intervention is successful.

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References
Adaji, A., Melin, G. J., Campbell, R. L., Lohse, C. M., Westphal, J. J., & Katzelnick, D. J.
(2017). Patient-centered medical home membership is associated with decreased hospital
admissions for emergency department behavioral health patients. Population health
management.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (DSM-5®) [electronic resource]. Washington, D.C. : American Psychiatric
Publishing, 2013.
Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology press.
Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=oz24AwAAQBAJ&oi=fnd&pg=PP1&dq=schizophrenia+and+delusions+
&ots=o4MkiP4rDu&sig=6qfNekxDUT9jjDheDfaaQt-
aca0&redir_esc=y#v=onepage&q=schizophrenia%20and%20delusions&f=false
Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. (2013). Promoting recovery-oriented
practice in mental health services: a quasi-experimental mixed-methods study. BMC
Psychiatry, 13(1), 167. Retrieved from http://dx.doi.org/10.1186/1471-244x-13-167
Linz, S. J., & Sturm, B. A. (2013). The phenomenon of social isolation in the severely mentally
ill. Perspectives in psychiatric care, 49(4), 243-254. DOI: 10.1111/ppc.12010
Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American
Family Physician, 94(8).
Patel, K., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and Treatment
Options. Pharmacy And Therapeutics, 39(9), 638-645. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/

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Rajji, T. K., Miranda, D., & Mulsant, B. H. (2014). Cognition, function, and disability in patients
with schizophrenia: a review of longitudinal studies. The Canadian Journal of Psychiatry,
59(1), 13-17. https://doi.org/10.1177/070674371405900104
Rothman, M., Solinger, A., Rothman, S., & Finlay, G. D. (2012). Clinical implications and
validity of nursing assessments: A longitudinal measure of patient condition from
analysis of the Electronic Medical Record, BMJ open, 2(4), e000849
Sheffield, J. M., Gold, J. M., Strauss, M. E., Carter, C. S., MacDonald, A. W., Ragland, J. D., ...
& Barch, D. M. (2014). Common and specific cognitive deficits in schizophrenia:
relationships to function. Cognitive, Affective, & Behavioral Neuroscience, 14(1), 161-
174.
Victorian Government Department of Health. (2010). Statewide mental health triage scale
Guidelines. Retrieved from http://www.health.vic.gov.au/mentalhealth
Wu, Y. Y., & Shen, Y. C. (2017). Delusions of control in a case of schizophrenia coexisting with
a large cerebellar arachnoid cyst. Tzu-Chi Medical Journal, 29(2), 115. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509203/