Running head: THERAPEUTIC COMMUNICATION PROJECT

Therapeutic Communication Project

Judy Dickey and Tracy Riddle
NRSG 126
02/17/2014

Schizophrenia

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Diagnosis of Schizophrenia
There has been some disagreement in relation to the theory surrounding
Schizophrenia. There are two universal factors that appear to be gaining
acceptance among clinicians (Towsend, 2014). Firstly, they have come to believe
that when a patient is diagnosed with schizophrenia disorders there is probably not
a standardized cause for the disease but instead may result from a combination of
genetic predisposition, biochemical dysfunction, physiological factors, and
psychosocial stress (Towsend, 2014). Secondly, there is no single treatment that
cures this disorder but effective treatment can be achieved through comprehensive
and multi-disciplinary therapy that may include pharmacotherapy and various forms
of psychosocial care (Towsend, 2014).
People with schizophrenia vary broadly in their behavior as they struggle with
an illness outside their control. In active stages, those affected may ramble in
illogical sentences or react with uninhibited anger or violence to a professed threat
(Santorelli, 2013). People with schizophrenia may also encounter moderately
unreceptive phases of the illness in which they seem to lack personality, movement,
and feeling flat affect and may alternate between these phases (Santorelli, 2013).
Their behavior cannot always be predictable.
There are positive and negative symptoms of schizophrenia. Positive
symptoms have a tendency to reflect an alternation or distortion of normal mental
functions, whereas, negative symptoms imitate a reduction or lose of normal
functions (Towsend, 2014). Most patients exhibit a mixture of both symptoms. The
patient may experience delusions, paranoia, hallucinations, and group words
randomly, without any logical connection word salad which would be indicative of
positive schizophrenia symptoms. Deteriorated appearance, impaired social

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interaction or isolation and regression would be indicative of negative schizophrenia
symptoms. Positive symptoms are associated with normal brain structures on a CT
scan and patients often have reasonably effective responses to treatment.
Negative symptoms however have been found to be problematic to treat, do not
respond as well to antipsychotics, and appear to be the most detrimental because
they cause the patient to be inactive and unmotivated. The nurse should familiarize
themselves with these symptoms in order to accomplish an appropriate assessment
and care plan for a patient who suffers with schizophrenia disorders.
The following behaviors are examples of when it may become appropriate for
a family member, spouse, or a loved one to contact a doctor if uncertainties of
possible Schizophrenia disorder symptoms arise:
1. Have an abrupt change in behavior, such as declining to eat because you
think someone has poisoned your food.
2. Have incidents that don't ordinarily occur, such as hearing someone call
out your name when no one is there.
3. Have a difficulties taking care of basic needs, such as bathing, or become
mix up doing simple chores or tasks.
4. Show forewarning signs of suicide, such as speaking about death or
passing long periods of time alone.
5. Show signs of schizophrenia, such as speaking to people who aren't
existent or crediting things that you know are false.
6. Show the initial signs of reversion, such as finding it hard to concentrate
or withdrawing from other people.
http://www.emedicinehealth.com/schizophrenia-health/article_em.htm

Scenario

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The patient is a 19 y.o., white female. The patient lives at home with mother.
The patients mother works second shift and comes home to find patient in living
room sitting on the couch staring into space with no expression on her face and
does not express any acknowledgement of mother arriving home. The patient is
impassive verbally and physically, when the mother tries to talk to her, and it
appears as if the patient cannot hear or see her. The mother continues to try to get
patient to respond to her, when the patient suddenly turns her face towards the
door way and appears scared with wide-eyes, a wrinkled forehead, and frown on her
face although her verbal communication is unrecognizable and rapid. Progression
of patients behavior becomes aggressive and defensive toward the delusional
figure and her mother feels the necessity to call 911.
The patient appears in ER with evident delusional signs and symptoms of
seeing, hearing, and responding to voices, and is unable to respond effectively to
questions asked by HCPs. The patient is unable to disassociate between real and
delusional existences due to preoccupation of delusional disturbances. The patient
displays mistrust and paranoia verbally toward HCPs. She also responds to her
apparent hallucination figure angrily and belligerently with verbal expression. The
patient is observed sitting in chair rocking back and forth vigorously, arms hanging
to the side.

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Good Therapeutic Technique

The nurse is performing an initial assessment with the patient after reading
admission notes in the chart. The Nurse then enters the room and introduces
herself. The patient is sitting in chair.
1. Nurse: Tell me what is going on right now? How are you feeling?
Pt.: I told him to leave me alone, but he keeps telling me to go into the
kitchen.
Nurse: Is the voice telling you why they want you to go into the kitchen?
2. Pt.: He said I need to get something to protect myself because people are
coming to hurt me.
Didnt you hear him tell me to watch out for you? Pt. is looking up and face
is turned to empty side of the room with concerned look on her face and then
turns to me with scared look on her face.
Nurse: I didnt hear anyone but you, there is no one in the room but us.
3. Pt.: My mom is the one I need to look out for, she is watching me from that
hole in the wall over there. Pt. looks over to the wall on the right side of the
room pointing at a light socket.
Nurse: I know that you mom is in the waiting room right now, so I dont think
could be possible and I am not seeing any hole in that wall.
4. Pt.: Whatever, I am wasting valuable time, I need to go. Appears to be
getting anxious and annoyed.

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Nurse: Do you feel like I am not understanding how you feel? Where is it
that you need to go?
5. Pt.: I dont really feel like going anywhere. Pt. looks down to the floor, hand
forehead.
Nurse: Im sure all of this has been very upsetting for you, you seem to be
very tired.
Pt.: Yes, I am really tired. Pt. shaking head, making eye contact with the
nurse.
6. Pt.: I think I need to lay down, would that be ok?
Nurse: Yes, of course you can lay down, I will be here for you in case you
need anything.
Pt.: You will stay here will me?
Nurse: Yes, if that is ok.
Pt.: I would like that. Smiles, closes eyes, appears relaxed.

1. Encouraging Description of Perceptions

Asking the client to verbalize what is being perceived can give clarification to
behaviors the pt. is displaying when pt. is experiencing hallucinations.
2. Presenting Reality
When a pt. has a misperception of the environment, the nurse needs to clarify the
reality of the situation especially when the pt. becomes scared of the perceived
hallucination.
3. Voicing Doubt
Expressing uncertainty as to the reality of the pt.s perceptions by stating facts may
bring actuality of a situation to surface.

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4. Verbalizing the Implied
Placing the words the pt. expressed indirectly into a clear statement can clarify
what the pt. may really be trying to state.
5. Making Observations
Letting the pt. know how you are perceiving them may allow for them to reflect on
your perception and give them further insight to how they are feeling
physically/mentally
6. Offering Self
Making one-self available helps pt. feel that they matter and that you care about
them

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Reference
Healthwise. (2012, January 1). Schizophrenia:healthwise medical information.
Retrieved from eMedicianhealth:
http://www.emedicinehealth.com/schizophrenia-health/article_em.htm
Santorelli, N. (2013, April 26). Schizophrenia Types and Symptoms. Retrieved from
WebMD: http://www.webmd.com/schizophrenia/guide/schizophreniasymptoms
Towsend, M. C. (2014). Essentials of Psychiatric Mental Health Nursing (6th ed.);
concepts of care in evidence-based practice. Philadelphia, PA: F.A. Davis
Company.

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