4.

Disturbed Thought Process

Disturbed thought process as a nursing diagnosis for schizophrenia. Patients usually
exhibit disturbed perception and delusions that greatly affect their thought process.

Nursing diagnosis
Disturbed Thought Process: Disruption in cognitive operations and activities.

Related Factors

Here are the common related factors for disturbed thought process that can be as your
“related to” in your schizophrenia nursing diagnosis statement:

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 Chemical alterations (e.g., medications, electrolyte imbalances).

 Inadequate support systems.
 Overwhelming stressful life events.
 Possibility of a hereditary factor.
 Panic level of anxiety.
 Repressed fears.

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and
symptoms) that could serve as your “as evidenced by” for this nursing care plan for
schizophrenia:

 Delusions
 Inaccurate interpretation of environment
  Inappropriate non-reality-based thinking
 Memory deficit/problems
 Self-centeredness

Desired Outcomes

Expected outcomes or patient goals for disturbed thought process nursing diagnosis:

 Patient will verbalize recognition of delusional thoughts if they persist.

 Patient will perceive the environment correctly.
 Patient will demonstrate satisfying relationships with real people.
 Patient will demonstrate decrease anxiety level.
 Patient will refrain from acting on delusional thinking.
 Patient will develop trust in at least one staff member within 1 week.
 Patient will sustain attention and concentration to complete task or activities.
 Patient will state that the “thoughts” are less intense and less frequent with the
help of the medications and nursing interventions.
 Patient will talk about concrete happenings in the environment without talking
about delusions for 5 minutes.
 Patient will demonstrate two effective coping skills that minimize delusional
thoughts.
 Patient will be free from delusions or demonstrate the ability to function
without responding to persistent delusional thoughts.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific
explanation for the disturbed thought process (nursing diagnosis for schizophrenia):

Nursing Interventions Rationale

 Important clues to underlying fears and
Attempt to understand the significance of these beliefs
issues can be found in the client’s
to the client at the time of their presentation.
seemingly illogical fantasies.

Recognizing the client’s perception can

Recognizes the client’s delusions as the client’s
help you understand the feelings he or
perception of the environment.
she is experiencing.

Identify feelings related to delusions. For example:

 If client believes someone is going to harm

him/her, client is experiencing fear. When people believe that they are
 If client believes someone or something is understood, anxiety might lessen.
controlling his/her thoughts, client is
experiencing helplessness.

When the client has full knowledge of

Explain the procedures and try to be sure the client
procedures, he or she is less likely to
understand the procedures before carrying them out.
feel tricked by the staff.

Interact with clients on the basis of things in the When thinking is focused on reality-
environment. Try to distract client from their delusions based activities, the client is free of
by engaging in reality-based activities (e.g., card delusional thinking during that time.
games, simple arts and crafts projects etc). Helps focus attention externally.

Suspicious clients might misinterpret

touch as either aggressive or sexual in
Do not touch the client; use gestures carefully. nature and might interpret it as
threatening gesture. People who are
psychotic need a lot of personal space.

Arguing will only increase client’s

Initially do not argue with the client’s beliefs or try to defensive position, thereby reinforcing
convince the client that the delusions are false and false beliefs. This will result in the
unreal. client feeling even more isolated and
misunderstood.

Encourage healthy habits to optimize functioning: All are vital to help keep the client in
remission.
  Maintain medication regimen.
 Maintain regular sleeppattern.
 Maintain self-care.
 Reduce alcohol and drug intake.

The client’s delusion can be distressing.

Show empathy regarding the client’s feelings; reassure
Empathy conveys your caring, interest
the client of your presence and acceptance.
and acceptance of the client.

Teach client coping skills that minimize “worrying”

thoughts. Coping skills include:

 Going to a gym.
 Phoning a helpline. When client is ready, teach strategies
client can do alone.
 Singing or Listening to a song.
 Talking to a trusted friend.
 Thought-stopping techniques.

During acute phase, client’s delusional

Utilize safety measures to protect clients or others, if thinking might dictate to them that they
the client believe they need to protect themselves might have to hurt others or self in
against a specific person. Precautions are needed. order to be safe. External controls might
be needed.

5. Defensive Coping
This nursing diagnosis is chosen related to the perceived lack of self-efficacy, perceived
threat to self, and suspicious motives of others. This is characterized by a difficulty in
reality testing of perceptions, difficulty maintaining relationships, hostility, and
aggression.

Nursing diagnosis
  Defensive Coping: Repeated projection of falsely positive self-evaluation
based on a self-protective pattern that defends against underlying perceived
threats to positive self-regard.

Related Factors

Here are the common related factors for defensive copingthat can be a, your “related to”
in your schizophrenia nursing diagnosis statement:

 Perceived lack of self-efficacy/vulnerability

 Perceived threat to self
 Suspicions of the motives of others

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and
symptoms) that could serve as your “as evidenced by” for this nursing care plan for
schizophrenia:

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 Denial of obvious problems

 Difficulty in reality testing of perceptions
 Difficulty establishing/maintaining relationships
 False beliefs about the intention of others.
 Fearful
 Grandiosity
 Hostile laughter or ridicule of others
 Hostility, aggression, or homicidal ideation
 Projection of blame/responsibility
 Rationalization of failures
 Superior attitude towards others
Desired Outcomes

Expected outcomes or patient goals for defensive copingnursing diagnosis:

 Patient will avoid high-risk environments and situations.

 Patient will interact with others appropriately.
 Patient will maintain medical compliance.
 Patient will identify one action that helps client feel more in control of his or
her life.
 Patient will demonstrate two newly learned constructive ways to deal with
stress and feeling of powerlessness.
 Patient will demonstrate learn the ability to remove himself or herself from
situations when anxiety begins to increase with the aid of medications and
nursing interventions.
 Patient will demonstrate decreased suspicious behaviors regarding with the
interaction with others.
 Patient will be able to apply a variety of stress/anxiety-reducing techniques on
their own.
 Patient will acknowledge that medications will lower suspiciousness.
 Patient will state that he/she feels safe and more in control with interactions
with environment/family/work/social gatherings.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific
explanation for defensive coping (nursing diagnosis for schizophrenia):

Nursing Interventions Rationale

 Prepares the client beforehand and
Explain to client what you are going to do before
minimizes misinterpreting your intent as
you do it.
hostile or aggressive.

Assess and observe clients regularly for signs of

Intervene before client loses control.
increasing anxiety and hostility.

There is less chance for a suspicious client

Use a nonjudgemental, respectful, and neutral to misinterpret intent or meaning if content
approach with the client. is neutral and approach is respectful and
non-judgemental.

Minimize the opportunity for

Use clear and simple language when
miscommunication and misconstruing the
communicating with a suspicious client.
meaning of the message.

When staff become defensive, anger

escalates for both client and staff. a non-
Diffuse angry verbal attacks with a non defensive
defensive and non-judgemental attitude
stand.
provides an atmosphere in which feelings
can be explored more easily.

Set limits in a clear matter-of-fact way, using a Calm and neutral approach may diffuse
calm tone. Giving threatening remarks to escalation of anger. Offer an alternative to
Jeremy is unacceptable. We can talk more about verbal abuse by finding appropriate ways to
the proper ways in dealing with your feelings. deal with feelings.

Suspicious people are quick to discern

Be honest and consistent with client regarding
honesty. Honesty and consistency provide
expectations and enforcing rules.
an atmosphere in which trust can grow.

Maintain low level of stimuli and enhance a non- Noisy environments might be perceived as
threatening environment (avoid groups). threatening.

Be aware of client’s tendency to have ideas of Suspicious clients will automatically think
reference; do not do things in front of client that that they are the target of the interaction and
can be misinterpreted: interpret it in a negative manner (e.g., you
are laughing or whispering about them).
  Laughing or whispering.
 Talking quitely when client can see but
not hear what is being said.

Initially, provide solitary, noncompetitive

If a client is suspicious of others, solitary
activities that take some concentration. Later a
activities are the best. Concentrating on
game with one or more client that takes
environmental stimuli minimizes paranoid
concentration (e.g., chess checkers, thoughtful card
rumination.
games such as ridge or rummy).

Provide verbal/physical limits when client’s hostile

behavior escalates: We cannot allow you to
Often verbal limits are effective in helping a
verbally attack someone here. If you cant
client gain self control.
held/control yourself, we are here in order to help
you.

6. Interrupted Family Process

The presence of a mental disorder such as schizophrenia greatly has an impact on the
roles and interaction within the family.

Nursing Diagnosis

Interrupted Family Process: Change in family relationships and/or functioning.

Related Factors

Here are the common related factors for interrupted family process that can be as your
“related to” in your schizophrenia nursing diagnosis statement:

 Developmental crisis or transition.

 Family role shift.
 Physical or mental disorder of a family member.
 Shift in health status of a family member.
  Situational crisis or transition.

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and
symptoms) that could serve as your “as evidenced by” for this nursing care plan for
schizophrenia:

 Changes in the expression of conflict in the family

 Changes in communication patterns
 Changes in mutual support
 Changes in participation in decision making
 Changes in participation in problem-solving
 Changes in stress reduction behavior
 Knowledge deficit regarding community and health care support
 Knowledge deficit regarding the disease and what is happening with ill family
member (might believe the client is more capable than they are)
 Inability to meet the needs of family and significant others (physical,
emotional, spiritual)

Desired Outcomes

Expected outcomes or patient goals for interrupted family process nursing diagnosis:

 Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact in
case.
 Family and/or significant others will state and have written information
identifying the signs of potential relapse and whom to contact before discharge.
 Family and/or significant others will state that they have received needed
support from community and agency resources that offer education, support,
 coping skills training, and/or social network development (psychoeducational
approach).
 Family and/or significant others will state what medications can do for their ill
family member, the side effects and toxic effects of the drugs, and the need for
adherence to medication at least 2 to 3 days before discharge.
 Family and/or significant others will name and have a complete list of
community supports for ill family members and supports for all members of the
family at least 2 days before the discharge.
 Family and/or significant others will attend at least one family support group
(single family, multiple family) within 4 days from onset of acute episode.
 Family and/or significant others will be included in the discharge planning
along with the client.
 Family and/or significant others will meet with nurse/physician/social worker
the first day of hospitalization and begin to learn about neurologic/biochemical
disease, treatment, and community resources.
 Family and/or significant others will problem-solve, with the nurse, two
concrete situations within the family that all would like to discharge.
 Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact.
 Family and/or significant others will demonstrate problem-solving skills for
handling tensions and misunderstanding within the family member.
 Family and/or significant others will have access to family/multiple family
support groups and psychoeducational training.
 Family and/or significant others will know of at least two contact people when
they suspect potential relapse.
 Family and/or significant others will discuss the disease (schizophrenia)
knowledgeably:
o Know about community resources (e.g., help with self-care activities,
private respite).
o Support the ill family member in maintaining optimum health.
o Understand the need for medical adherence.
Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific
explanation for interrupted family process (nursing diagnosis for schizophrenia):

Nursing Interventions Rationale

Family might have misconceptions and

Assess the family members’ current level of misinformation about schizophrenia and
knowledge about the disease and medications treatment, or no knowledge at all. Teach
used to treat the disease. client’s and family’s level of understanding
and readiness to learn.

Inform the client family in clear, simple terms

about psychopharmacologic therapy: dose, Understanding of the disease and the
duration, indication, side effects, and toxic treatment of the disease encourages greater
effects. Written information should be given to family support and client adherence.
the client and family members as well.

Identify the family’s ability to cope (e.g.,

Family’s need must be addressed to stabilize
experience of loss, caregiver burden, needed
the family unit.
supports).

Rapid recognition of early warning symptoms

Teach the client and family the warning
can help ward off potential relapse when
symptoms of relapse.
immediate medical attention is sought.

Provide information on disease and treatment

Meet family members’ needs for information.
strategies at the family’s level of understanding.

Provide an opportunity for the family to discuss

Nurses and staff can best intervene when they
feelings related to ill family member and
understand the family’s experience and needs.
identify their immediate concerns.

Provide information on client and family Schizophrenia is an overwhelming disease for

community resources for the client and family both the client and the family. Groups, support
 after discharge: day hospitals, support groups, groups, and psychoeducational centers can
organizations, psychoeducational programs, help:
community respite centers (small homes), etc.
 Access caring
 Access resources
 Access support
 Develop family skills
 Improve quality of life for all family
members
 Minimizes isolation

References and Sources

Here are references and sources for schizophrenia:

 Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997). A comparative study

of elderly patients with schizophrenia and bipolar disorder in nursing homes
and the community. Schizophrenia Research, 27(2-3), 181-190. [Link]