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Key Topics
Developing a Recovery Focused Nursing Care Plan [RFNCP].
- A Recovery Focused Nursing Care Plan based on the care of a consumer described in one of
scenarios.
- A Recovery Focused Nursing Care Plan based on the care of a consumer described in one of
scenarios.
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ConsumersPriority |
IdentifiedGoals/Issues |
The consumer’s strengths toaddress theseissues. |
Consumer and Nursing Interventions |
Person/sResponsible |
Timeframe |
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The first issue that needs to be addressed, in case of Jack, is the correction of the delusionary thought processes and help the patient out from the situation
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On the HONO scale, the severities of the symptoms are determined and the action plans for the treatment of the patients are decided. In case of Jack, the delusion and the hallucinations scores a 4 on the HONO scale, which means that it is a severe problem and has been causing unvarying distress and harm to Jack, during the last 72 hours (the rating period inthe hospital). The delusion, as reported by Jack, is a continuous source of threat and fear and is the main cause behind his restlessness and bouts of desire to commit suicide. The constant stress and worry that he is subjected to, owing to his delusions are also responsible, in parts, for the complex schizophrenic situation that he is suffering from.
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Jack enjoyed watching television and reading before his first incidence of psychotic illness. He was also a good student and enjoyed his literary activities in the University. He had lots of friends and enjoyed activities like swimming and similar such co-curricular, which can serve as effective de-stressors in his case. His literary expertise and knowledge can be tapped to explain him the reasons for his suffering from delusions and he can be made to feel more normal and sane (Townsend, 2013). The interactions with the psychological counsellors and the nurses might help him in communicating his fears and thus, reducing the stress levels. Since he loved watching television, this can be used as an effective mode to counteract his fears and stop him from experiencing hallucinations. Jack is educated and well-aware of his surroundings. He also exhibited perfect recent and past memories, during the psychological test. This can also be used to his advantage. He can maintain notes after his bout of psychosis or hallucination, regarding the series of events or talk which triggered the hallucination. He can then be assisted and counselled to carefully avoid such circumstances which might trigger his hallucinations or delusions and the incidence could thus, be regulated.
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The nurses need to be compassionate while dealing with Jack and they require to gain his trust fully, before administering him any treatment or medication, since Jack is very suspicious of unknown people and thinks that they are messengers from the ‘Warlords’ who have came to torture and kill him. The nurse must take his permissions before touching him or giving him any medicines, so that he starts believing in their good intentions (Arbabshirani et al., 2013.). The nurse would also require building up a good rapport with Jack and helping him in situations when he hallucinates. The nurse must not argue about the hallucinations or delusions but must be able to link it with reality, like the nurse can state that he/she cannot experience any sounds or vision while also conveying the fact that they know these hallucinations are real to him (Caqueo Urízar et al., 2014). This would help Jack to slowly understand that these are hallucinations that affects him solely and motivate him to overcome these hindrances.
The nurses can also engage Jack in activities that he enjoyed doing before falling ill, like swimming or other games, which might take his mind off from the hallucinations and he would tend to be less delusional. Keeping the mind busy wards off the tendency of hallucinating, in overcoming fear and in establishing connections with reality.
Outcome: The outcomes of all these interventions would be that Jack would be able to manage his levels of stress and would hallucinate less; this would help in controlling his schizophrenic problems to a great extent.
Jack can be assisted to take notes of the activities which tended to decrease his chances of hallucinating, like listening to music or reading; engaging in these activities would help Jack in his speedy recovery and normalising of the situations.
The nurse and the counsellors need to explain to jack the necessity of being patient in dealing with the impairments and not to be demotivated about inabilities to concentrate in tasks. He, rather should be introduced to some meditation and yoga regimen, which would improve his concentration powers, help him believe in his own capabilities and resume his studies.
Outcome: Jack would become more self-confident and engaging in reading activities would help in reducing the stress levels and keep him effectively engaged (which would prevent delusions and hallucinations from occurring).
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The responsible persons for the implementation of the nursing care plan for this issue will be the nurse handed the duty to oversee the treatment procedures for Jack. The counsellors would provide assistance in this regard, to help the nurses identify the areas where the action plan needs to focus on, for providing effective treatment to the patient.
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Jack is expected to build trust in at least one of the care workers and nurses within a week after he being admitted in the health facility
He is expected to exhibit less delusions and hallucinations, owing to his engagements in activities, starting from one to two months after the start of the treatment procedure and the conditions are expected to improve with the passage of time.
Jack is also expected to exhibit reduced stress levels, within a month from the start of the treatment procedures
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The second issue that needs to be addressed in case of Jack are his problems in daily living activities. Problems in managing the daily activities comes second in the list since if his delusions are not cured, he will not be able to manage his daily chores, even with expert assistance and guidance.
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The issue of problems in managing the personal activities by Jack scored a 3 on the HONO scale, which means that the problems had caused significant distress and harm to Jack in the past 72 hours.
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Jack avoided socializing with people with the fear that they were agents from the ‘Warlord’ who had been sent to torture and kill him.
Owing to his conditions of schizophrenia, Jack tended to forget the memories from his childhood. He identified this forgetfulness as a side effect of the medications he was being administered and thus, avoided all his medicines, which worsened his condition further.
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Jack, after his illness, lost all social contacts and became a loner. He can be helped to re-form social contacts within the care facilities, with the counsellors and the nurse, which would help him in conveying and communicating his fears and insecurities and thus, serve as a means to distress. This would possible aid his speedy recovery.
The care practitioner needs to explain the complications he is suffering from, the medication regimen he is expected to follow and the side effects of the same. The awareness of the conditions and the effects he is likely to face would motivate Jack to continue his treatment.
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The person responsible for delivering the required treatment to Jack, in this case, will be the counsellors and the medical care practitioners. The nurses will assist in carrying out the instructions and the procedures as stated by the counsellors and the doctors.
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Socializing with the individuals in the health centre and overcoming the suspicious nature would require a number of counselling but could be initiated from a time of around one month.
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Jack is having problem with occupation and activities. As depicted in the case study, Jack is having problem with his concentration levels and his dwindling concentration and focus was making it impossible for him to study and remember things. He was a student of significant merit and loved his lessons, so his incapability hit him hard and he got demotivated
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The issue with the inabilities to carry out the occupation and activities was rated 3 on the HONO scale which revealed the fact that the problem was significantly hampering the well being of Jack
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Jack was well-read and understood the implication of him suffering from schizophrenia. This, in parts made dealing with the disorder easier and it became easier for the doctor to impress upon him the need to comply to the medication regimen.
Jack’s readiness to resume his normal life with friends and the University acted as a buffer to instigate him to undertake the treatments and regain his health
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The nurses would have to help him with Yoga and other practices that would help boost his concentration power and help him with his reading endeavours. This would further encourage him to read and focus on the studies rather than hallucinating or thinking about the delusions. This would play a role in improving his conditions.
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The designated nurse would be responsible for delivering the care practise to Jack and Jack would be responsible for practicing the exercises and diligently catering to the instructions of the nurse.
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This is expected to take time; around a month or two should be sufficient from improving the concentration power and skills efficiently.
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Reference List
Andrade, C. (2013). Transcranial direct current stimulation for refractory auditory hallucinations in schizophrenia. The Journal of clinical psychiatry, 74(11), e1054-8.
Arbabshirani, M. R., Kiehl, K., Pearlson, G., & Calhoun, V. D. (2013). Classification of schizophrenia patients based on resting-state functional network connectivity. Frontiers in neuroscience, 7, 133.
Caqueo Urízar, A., Miranda Castillo, C., Lemos Giráldez, S., Lee Maturana, S. L., Ramírez Pérez, M., & Mascayano Tapia, F. (2014). An updated review on burden on caregivers of schizophrenia patients. Psicothema, 26(2).
Dipasquale, S., Pariante, C. M., Dazzan, P., Aguglia, E., McGuire, P., & Mondelli, V. (2013). The dietary pattern of patients with schizophrenia: a systematic review. Journal of psychiatric research, 47(2), 197-207.
Emsley, R., Chiliza, B., Asmal, L., & Harvey, B. H. (2013). The nature of relapse in schizophrenia. BMC psychiatry, 13(1), 50.
Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychological medicine, 45(7), 1343-1361.
Keltner, N. L. (2013). Psychiatric nursing. Elsevier Health Sciences.
Lu, S. F., Lo, C. H. K., Sung, H. C., Hsieh, T. C., Yu, S. C., & Chang, S. C. (2013). Effects of group music intervention on psychiatric symptoms and depression in patient with schizophrenia. Complementary therapies in medicine, 21(6), 682-688.
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., ... & Sivaramalingam, B. (2014). Interventions for enhancing medication adherence. The Cochrane Library.
Putkonen, A., Kuivalainen, S., Louheranta, O., Repo-Tiihonen, E., Ryynänen, O. P., Kautiainen, H., & Tiihonen, J. (2013). Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatric Services, 64(9), 850-855.
Townsend, M. C. (2013). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
Volavka, J. (2013). Violence in schizophrenia and bipolar disorder. Psychiatria Danubina, 25(1), 0-33.
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