1.

Impaired Verbal Communication

Impaired verbal communication as a nursing diagnosis for schizophrenia. The patient’s
speech content and patterns are being assessed because they usually exhibit poor
communication function.

Nursing Diagnosis

 Impaired Verbal Communication: decreased, reduced, delayed, or absent ability

to receive, process, transmit or use a system of symbols.

Related Factors

Here are the common related factors for impaired verbal communication that can be as
your “related to” in your schizophrenia nursing diagnosis statement:

 Altered Perceptions.
 Biochemical alterations in the brain of certain neurotransmitters.
 Psychological barriers (lack of stimuli).
 Side effects of medication.

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 care plan:

 Difficulty communicating thoughts verbally.

 Difficulty in discerning and maintaining the usual communication pattern.
 Disturbances in cognitive associations (e.g., perseveration, derailment, poverty
of speech, tangentiality, illogicality, neologism, and thought blocking).
 Inappropriate verbalization.
Desired Outcomes

Expected outcomes or patient goals for impaired verbal communication nursing

diagnosis:

 Patient will express thoughts and feelings in a coherent, logical, goal-directed

manner.
 Patient will demonstrate reality-based thought processes in verbal
communication.
 Patient will spend time with one or two other people in structured activity
neutral topics.
 Patient will spend two to three 5-minute sessions with nurse sharing
observations in the environment within 3 days.
 Patient will be able to communicate in a manner that can be understood by
others with the help of medication and attentive listening by the time of
discharge.
 Patient will learn one or two diversionary tactics that work for him/her to
decrease anxiety, hence improving the ability to think clearly and speak more
logically.

Nursing Interventions and Rationale

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

Nursing Interventions Rationale

Establishing a baseline facilitates the

Assess if incoherence in speech is chronic or if it is
establishment of realistic goals, the
more sudden, as in an exacerbation of symptoms.
foundation for planning effective care.
 Therapeutic levels of an antipsychotic aids
Identify the duration of the psychotic medication of
clear thinking and diminishes derailment
the client.
or looseness of association.

A high-pitched/loud tone of voice can

Keep voice in a low manner and speak slowly as
elevate anxiety levels while slow speaking
much as possible.
aids understanding.

Keep anxiety from escalating and

Keep environment calm, quiet and as free of stimuli
increasing confusionand
as possible.
hallucinations/delusions.

Short periods are less stressful, and

Plan short, frequent periods with a client throughout
periodic meetings give a client a chance to
the day.
develop familiarity and safety.

Use clear or simple words, and keep directions Client might have difficulty processing
simple as well. even simple sentences.

Minimizes misunderstanding and/or

Use simple, concrete, and literal explanations. incorporating those misunderstandings
into delusional systems.

Focus on and direct client’s attention to concrete Helps draw focus away from delusions
things in the environment. and focus on reality-based things.

Look for themes in what is said, even though spoken

Often client’s choice of words is symbolic
words appear incoherent (e.g., fearful, sadness,
of feelings.
guilt).

Pretending to understand limits your

When you do not understand a client, let him/her
credibility in the eyes of your client and
know you are having difficulty understanding.
lessens the potential for trust.

When client is ready, introduce strategies that can

Helping the client to use tactics to lower
minimize anxiety and lower voices and “worrying”
anxiety can help enhance functional
thoughts, teach client to do the following:
speech.
  Focus on meaningful activities.
 Learn to replace negative thoughts with
constructive thoughts.
 Learn to replace irrational thoughts with
rational statements.
 Perform deep breathing exercise.
 Read aloud to self.
 Seek support from a staff, family, or other
supportive people.
 Use a calming visualization or listen to
music.

Use therapeutic techniques (clarifying feelings when

Even if the words are hard to understand,
speech and thoughts are disorganized) to try to
try getting to the feelings behind them.
understand client’s concerns.

2. Impaired Social Interaction

Patients with a progressive form of the disease are increasingly socially isolated.

Nursing Diagnosis

Impaired Social Interaction: The state in which an individual participates in an

insufficient or excessive quantity or ineffective quality of social exchange.

Related Factors

Here are the common related factors for impaired social interaction that can be as your
“related to” in your schizophrenia nursing diagnosis statement:
 ADVERTISEMENT

 Difficulty with communication

 Difficulty with concentration
 Exaggerated response to alerting stimuli
 Feeling threatened in social situations
 Impaired thought processes (delusions or hallucinations)
 Inadequate emotional responses
 Self concept disturbance (verbalization of negative feelings about self)

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:

 Appears upset, agitated, or anxious when others come too close in contact or try
to engage him/her in an activity
 Dysfunctional interaction with others/peers
 Inappropriate emotional response
 Observed use of unsuccessful social interactions behaviors
 Spends time alone by self
 Unable to make eye contact, or initiate or respond to social advances of others
 Verbalized or observed discomfort in social situations

Desired Outcomes

Expected outcomes or patient goals for impaired social interaction nursing diagnosis:

 Patient will attend one structured group activity within 5-7 days.
 Patient will seek out supportive social contacts.
 Patient will improve social interaction with family, friends, and neighbors.
 Patient will use appropriate social skills in interactions.
  Patient will engage in one activity with a nurse by the end of the day.
 Patient will maintain an interaction with another client while doing an activity
(e.g., simple board game, drawing).
 Patient will demonstrate interest to start coping skills training when ready for
learning.
 Patient will engage in one or two activities with minimal encouragement from
nurse or family members.
 Patient will state that he or she is comfortable in at least three structured
activities that are goal directed.
 Patient will use appropriate skills to initiate and maintain an interaction.

Nursing Interventions and Rationale

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

Nursing Interventions Rationale

Many of the positive symptoms of

schizophrenia (hallucinations,
Assess if the medication has reached therapeutic
delusions, racing thoughts) will subside
levels.
with medications, which will facilitate
interactions.

Increased anxiety can intensify

Identify with client symptoms he experiences when he
agitation, aggressiveness, and
or she begins to feel anxious around others.
suspiciousness.

Client might respond to noises and

Keep client in an environment as free of stimuli (loud crowding with agitation, anxiety, and
noises, crowding) as possible. increased inability to concentrate on
outside events.
 Touch by an unknown person can be
misinterpreted as a sexual or threatening
Avoid touching the client.
gesture. This particularly true for a
paranoid client.

Avoids pressure on the client and sense

Ensure that the goals set are realistic; whether in the of failure on part of nurse/family. This
hospital or community. sense of failure can lead to mutual
withdrawal

Client can lose interest in activities that

Structure activities that work at the client’s pace and
are too ambitious, which can increase a
activity.
sense of failure.

Structure times each day to include planned times for

Helps client to develop a sense of safety
brief interactions and activities with the client on one-
in a non-threatening environment.
on-one basis

If client is unable to respond verbally or in a coherent An interested presence can provide a

manner, spend frequent, short period with clients. sense of being worthwhile.

Client is free to choose his level of

If client is found to be very paranoid, solitary or one-
interaction; however, the concentration
on-one activities that require concentration are
can help minimize distressing paranoid
appropriate.
thoughts or voice.

If client is delusional/hallucinating or is having trouble

Even simple activities help draw client
concentrating at this time, provide very simple
away from delusional thinking into
concrete activities with client (e.g., looking at a picture
reality in the environment.
or do a painting).

Learn to feel safe with one person, then

If client is very withdrawn, one-on-one activities with
gradually might participate in a
a “safe” person initially should be planned.
structured group activity.

Try to incorporate the strengths and interests the client Increase likelihood of client’s
had when not as impaired into the activities planned. participation and enjoyment.
Teach client to remove himself briefly when feeling
Teach client skills in dealing with
agitated and work on some anxiety relief exercise
anxiety and increasing a sense of
(e.g., meditations,rhytmic exercise, deep breathing
control.
exercise).

These are fundamental skills for dealing

Useful coping skills that client will need include
with the world, which everyone uses
conversational and assertiveness skills.
daily with more or less skill.

Remember to give acknowledgment and recognition Recognition and appreciation go a long

for positive steps client takes in increasing social skills way to sustaining and increasing a
and appropriate interactions with others. specific behavior.

Provide opportunities for the client to learn adaptive

social skills in a non-threatening environment. Initial Social skills training helps the client
social skills training could include basic social adapt and function at a higher level in
behaviors (e.g., appropriate distance, maintain good society, and increases the client’s
eye contact, calm manner/behavior, moderate voice quality of life.
tone).

As the client progresses, provide the client with graded

Gradually the client learns to feel safe
activities according to the level of tolerance e.g., (1)
and competent with increased social
simple games with one “safe” person; (2) slowly add a
demands.
third person into “safe”.

As the client progresses, Coping Skills Training

should be available to him/her (nurse, staff or others).
Basically the process:
Increases client’s ability to derive social
 Define the skill to be learned. support and decrease loneliness. Clients
 Model the skill. will not give up the substance
of abuse unless they have alternative
 Rehearse skills in a safe environment, then means to facilitate socialization they
in the community. belong.
 Give corrective feedback on the
implementation of skills.
 Eventually engage other clients and significant others
Client continues to feel safe and
in social interactions and activities with the client
competent in a graduated hierarchy of
(card games, ping pong, sing-a-songs, group sharing
interactions.
activities) at the client’s level.

3. Disturbed Sensory Perception: Auditory/Visual

This nursing diagnosis is chosen related to altered sensory perception experienced by the
patient. Auditory and visual hallucinations are the most common in schizophrenia.

Nursing Diagnosis

Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli

accompanied by a diminished, exaggerated, distorted or impaired response to such
stimuli.

Related Factors

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

 Altered sensory perception.

 Altered sensory reception; transmission or integration.
 Biochemical factors such as manifested by inability to concentrate.
 Chemical alterations (e.g., medications, electrolyte imbalances).
 Neurologic/biochemical changes.
 Psychologic stress.

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:

 Altered communication pattern.

 Auditory distortions.
 Change in a problem-solving pattern.
 Disorientation to person/place/time.
 Frequent blinking of the eyes and grimacing.
 Hallucinations.
 Inappropriate responses.
 Mumbling to self, talking or laughing to self.
 Reported or measured change in sensory acuity.
 Tilting the head as if listening to someone.

Desired Outcomes

Expected outcomes or patient goals for disturbed sensory perception nursing diagnosis:

 Patient will learn ways to refrain from responding to hallucinations.

 Patient will state three symptoms they recognize when their stress levels are
high.
 Patient will state that the voices are no longer threatening, nor do they interfere
with his or her life.
 Patient will state, using a scale from 1 to 10, that “the voices” are less frequent
and threatening when aided by medication and nursing intervention.
 Patient will maintain role performance.
 Patient will maintain social relationships.
 Patient will monitor intensity of anxiety.
 Patient will identify two stressful events that trigger hallucinations..
  Patient will identify to personal interventions that decrease or lower the
intensity or frequency of hallucinations (e.g, listening to music, wearing
headphones, reading out loud, jogging, socializing).
 Patient will demonstrate one stress reduction technique.
 Patient will demonstrate techniques that help distract him or her from the
voices.

Nursing Interventions and Rationale

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

Nursing Interventions Rationale

Accept the fact that the voices are real to the

Validating that your reality does not include
client, but explain that you do not hear the voices.
voices can help client cast “doubt” on the
Refer to the voices as “your voices” or “voices
validity of his or her voices.
that you hear”.

Might herald hallucinatory activity, which

Be alert for signs of increasing fear, anxiety or can be very frightening to client, and client
agitation. might act upon command hallucinations
(harm self or others).

Exploring the hallucinations and sharing the

Explore how the hallucinations are experienced by experience can help give the person a sense
the client. of power that he or she might be able to
manage the hallucinatory voices.

Help the client to identify the needs that might

Hallucinations might reflect needs for anger,
underlie the hallucination. What other ways can
power, self-esteem, and sexuality.
these needs be met?
 Helps both nurse and client identify
Help client to identify times that the hallucinations situations and times that might be most
are most prevalent and frightening. anxiety-producing and threatening to the
client.

If voices are telling the client to harm self or

others, take necessary environmental precautions.

 Notify others and police, physician, and

administration according to unit
protocol.
 If in the hospital, use unit protocols for
suicidal or threats of violence if client People often obey hallucinatory commands
plans to act on commands. to kill self or others. Early assessment and
intervention might save lives.
 If in the community, evaluate the need
for hospitalization.

Clearly, document what the client says and if

he/she is a threat to others, document who was
contacted and notified (use agency protocol as a
guide).

Stay with clients when they are starting to The client can sometimes learn to push
hallucinate, and direct them to tell the “voices voices aside when given repeated
they hear” to go away. Repeat often in a matter- instructions. especially within the
of-fact manner. framework of a trusting relationship.

Decrease environmental stimuli when possible Decrease the potential for anxiety that might
(low noise, minimal activity). trigger hallucinations. Helps calm client.

Intervene before anxiety begins to escalate.

Intervene with one-on-one, seclusion, or PRN If the client is already out of control, use
medication (As ordered) when appropriate. chemical or physical restraints following
unit protocols.
 Client’ thinking might be confused and
Keep to simple, basic, reality-based topics of
disorganized; this intervention helps the
conversation. Help the client focus on one idea at
client focus and comprehend reality-based
a time.
issues.

If clients’ stress triggers hallucinatory

Work with the client to find which activities help
activity, they might be more motivated to
reduce anxiety and distract the client from
find ways to remove themselves from a
a hallucinatory material. Practice new skills with
stressful environment or try distraction
the client.
techniques.

Redirecting the client’s energies to

Engage client in reality-based activities such as
acceptable activities can decrease the
card playing, writing, drawing, doing simple arts
possibility of acting on hallucinations and
and crafts or listening to music.
help distract from voices.