CASE BASED LEARNING REPORT:

NURSING CARE FOR CLIENTS WITH SCHIZOPHRENIA

Arranged to fulfill the task of Mental Health of Nursing II course
Lecturer Ns. Reza Fajar Amalia, M.Kep., Sp.Kep.J

By:
Group 4/International Class (C)/Semester V/Batch 2020

Fuzna Dahlia Mudzakiroh (I1J020010)

Haeqal Wildanta Assofa (I1J019002)
Nur Aljananti (I1J020004)
Nurul Izzah Islamy (I1B020028)
Resty Desyani Fitri (I1B020058)

NURSING UNDERGRADUATE STUDY PROGRAM

FACULTY OF HEALTH SCIENCES
JENDERAL SOEDIRMAN UNIVERSITY
PURWOKERTO
2022
 CHAPTER 1: INTRODUCTION

A. Background
Currently mental health has become one of the issues that must be addressed, it's just
that the Indonesian people still often ignore the importance of mental health. One of the
most common mental disorders is schizophrenia. Schizophrenia is a group of psychotic
disorders, with a basic personality disorder, characteristic distortions of mental processes
think. Sometimes he has a feeling that he is being controlled by outside forces. This
disorder is generally characterized by disturbances in thoughts and perceptions that are
wrong and distinctive, and blunt effect.

Schizophrenia is a mental disorder characterized by disturbances in thought patterns,

perceptual processes, affection and social behavior (Kopelowicz, Liberman, Wallace,
2003). Patients diagnosed with schizophrenia usually also show positive symptoms, such as
hallucinations and delusions and negative symptoms, such as social withdrawal, self-
neglect, loss of motivation and initiative and blunted emotions (Picchioni & Murray, 2007).
Traditionally, schizophrenia may involve positive symptoms, such as hallucinations,
delusions, formal thought disorders, and negative symptoms, such as paucity of speech,
anhedonia, and lack of motivation. This activity outlines the evaluation of schizophrenia
and explains the role of the interprofessional team in improving care for patients with this
condition.

Patients with schizophrenia in Indonesia itself are increasing every year. There was
an increase in the prevalence of schizophrenia from 1.7% in 2013 to 7% in 2016. The
prevalence of schizophrenia in Indonesian society in 2016 reached around 400,000 people/
1.7 per 1,000 population (Riskesdas, 2013). Symptoms of schizophrenia generally develop
in late adolescence or early adulthood, starting from the age of 20 years (Harrop & Trower,
2001).
 Not only the number of people with schizophrenia is quite large, the number of
sufferers who experience relapse is also quite large. Relapse is the reappearance of the
symptoms of the disorder after the patient is hospitalized. Patients who relapse have the
potential to endanger themselves and those around them so they must return to
hospitalization (Amelia & Anwar, 2013).

B. Purpose
• General Purpose :
Understanding the nursing management of patients with Schizophrenia
• Specific Purpose :
1. Can understand about the definition, etiology, signs and symptoms and
management of schizophrenia.
2. Can identify the results of the assessment of cases of clients with schizophrenia.
3. Can determine nursing diagnosis in cases of clients with schizophrenia.
4. Can determine appropriate nursing outcomes in cases of patients with
schizophrenia.
5. Can determine the appropriate nursing intervention in the case of clients with
schizophrenia.
 CHAPTER 2: CASE DISCUSSION

A. Case Overview
Sam is a 19-year-old single engineering student, from a middle socioeconomic
background. Over the previous year and a half, He believed that others were able to
identify his physiological state by the appearance of his groin and therefore were
laughing at him and making derogatory comments. He had made attempts to mask
these perceived bodily changes by changing the way he dressed. Secondary to these
beliefs he had also become socially withdrawn, was frequently absent from class and
had had significant academic decline. The patient had even shifted colleges because
of the perceived ridicule by others. He also avoided situations, which required him to
stand upright, such as crowded buses, elevators, and shops. He had attempted self-
harm a year earlier by slashing his wrist. The patient experienced auditory
hallucinations. He complained of hearing voices and engaged in third person
conversations involving both a man and a woman. The patient also complained that
he heard people talking about him and insulting him, some of whom he knew. He was
therefore suspicious and felt uneasy with others. As a result, the patient said that he
had been spending the night with a friend and refused to return to his parents’ house
because he was not safe there. He believed that he had been targeted. His thought
content revealed paranoid delusions and delusions of reference. (The patient’s sister
said he often complained that people wanted to harm him and as such felt unsafe. She
also added that he often complained of receiving death threats through phone calls
from an unfamiliar telephone number.) The patient also had poor insight.

B. Discussion
1. Basic Concept
a) Definition
Schizophrenia is a group of psychotic disorders, with a basic personality
disorder, characteristic distortions of mental processes think. Sometimes he has a
feeling that he is being controlled by outside forces. This disorder is generally
characterized by disturbances in thoughts and perceptions that are wrong and
distinctive, and blunt effect. Schizophrenia is a mental disorder characterized by
disturbances in thought patterns, perceptual processes, affection and social behavior
(Kopelowicz, Liberman, Wallace, 2003). Patients diagnosed with schizophrenia
usually also show positive symptoms, such as hallucinations and delusions and
negative symptoms, such as social withdrawal, self-neglect, loss of motivation and
initiative and blunted emotions (Picchioni & Murray, 2007). Traditionally,
schizophrenia may involve positive symptoms, such as hallucinations, delusions,
formal thought disorders, and negative symptoms, such as paucity of speech,
anhedonia, and lack of motivation. This activity outlines the evaluation of
schizophrenia and explains the role of the interprofessional team in improving care
for patients with this condition.
Bleuler (in Nevid, 2012) adds that schizophrenia can be recognized based on
the main symptoms/4A: (1) Association, namely the relationship between thoughts
being disturbed or commonly referred to as thought disorders and loose associations;
(2) Affect, ie emotional response to be flat or inappropriate; (3) Ambivalence, ie
individuals have ambivalent feelings towards others such as hate and love for their
partner; (4) Autism, namely withdrawal into a private fantasy world that is not bound
by the principles of logic.
Schizophrenia is a mental disorder with a collection of psychotic symptoms that
is influenced by various individual factors, including areas of thinking and
communication, accepting and interpreting reality, feeling and showing emotions and
behavior according to social norms. Schizophrenia can also be called a disease that
affects parts of the brain and causes disturbed thoughts, emotions, movements, and
behavior.
The definition of schizophrenia is as a neurological disease that affects the
client's perception, way of thinking, language, emotions, and social behavior
(Neurological disease that affects a person's perception, thinking, language, emotion,
and social behavior).
 Schizophrenia disorders are divided into 3 types, namely disorganized,
catatonic and paranoid schizophrenia (APA, 2000). This type of disorganization is
often described as chaotic behavior, incoherent speech and disorganized delusions
with sexual/religious themes. The hebephrenic type often appears in the form of
slowing of activity that progresses to stupor and even agitation. The paranoid type is
seen with frequent auditory hallucinations and delusions that cause anxiety or fear
(Nevid, 2005).

b) Etiology
Until now, the cause of schizophrenia is not known with certainty. Various
factors such as genetic factors, mental resilience, personality and environmental
factors are thought to play a role in aggravating the number of people with
schizophrenia in the world. Genetic factors such as the role of the overactive
neurotransmitter dopamine, which disrupts the work of the brain, have led to the
emergence of major antipsychotic/sedative drugs as a treatment method
schizophrenia. There are also studies regarding the brain volume of schizophrenic
patients 5% smaller than normal people, with the largest reduction in the cerebral
cortex (Cowan & Kandel, 2001).
The causes of schizophrenia can be due to biological causes or psychological
causes. Biological causes are genetic, neurobiological, neurotransmitter imbalance
(increased dopamine), brain development and viral theory. Psychological causes,
namely failure to fulfill the task of psychosocial development and family disharmony
increase the risk of schizophrenia. Sociocultural stressors, stress that accumulates can
contribute to the onset of schizophrenia and other psychotic disorders. There are also
factors that cause schizophrenia, namely predisposing factors in the form of genetic
factors, brain damage, increased dopamine neurotransmitters, immunology, triggering
stressors, psychosocial, health, environment, attitudes or behavior. In addition,
environmental factors also affect, including: malnutrition during pregnancy, problems
in the birth process, stress in environmental conditions and stigma.
The factors that cause schizophrenia according to (Yosep, 2010) are:
❖ Heredity: proven by research on families who suffering from mental disorders
in a child who has twins but one egg, and a child with one suffering parent
schizophrenia.
❖ Endocrine explains that schizophrenia occurs at puberty.
❖ Metabolism, in this theory seen from the client who looks pale, decreased
appetite and weight loss.
❖ Central nervous system: causes directed at structural abnormalities central
nervous.
❖ Adolf Meyer's theory: can be caused by bodily disease which until now has not
found any abnormalities either pathological, anatomical and physiological.
❖ Sigmund Freud's theory: the weakness of the ego caused by psychogenic or
somatic.

c) Sign and Symptoms

In Mary C.T and Karyn I.M. (2017), schizophrenia symptoms are generally
described as positive or negative. Positive symptoms are symptoms present in a
person with schizophrenia that would not be present in someone without the disease,
sometimes described as "added" features. In contrast, negative symptoms are those
that reflect a decline in normal function (functions that have been "eliminated" by the
disease). Most but not all clients exhibit a mixture of both types of symptoms.
Positive symptoms were associated with normal brain structures on
computerized tomography scans and responded relatively well to treatment. Sadock
and colleagues (2015) identified that positive symptoms tend to become less severe
over time, whereas negative symptoms or "deficits" are socially debilitating and may
increase in severity.
❖ Positive Symptoms
➢ Delusions
- Delusion of persecution: Individuals feel threatened and believe that other
people intend to harm or persecute themselves.
- Delusion of grandeur: Individuals have exaggerated feelings about power,
knowledge, or identity (e.g. think of themselves as God).
- Delusion of reference: a false belief that persists and is adhered to despite
evidence to the contrary.
- Delusion of control or influence: Individuals believe that a particular object
or person has control over their behavior.
- Somatic delusions: Individuals have a false idea of bodily functions.
- Nihilistic delusion: The individual has the false idea that the self, part of the
self, other people or the world do not exist or have been destroyed
➢ Hallucination
- Auditory hallucinations: the most common type in schizophrenia. Auditory
hallucinations are false perceptions of sound. Potentially dangerous when
hallucinations are commands to violence against self or others.
- Visual hallucinations: false visual perceptions that may consist of formed
images such as people, or amorphous images, such as flashes of light.
- Tactile hallucinations: false sense of touch, often of something on or under
the skin.
- Gustatory hallucinations: false perception of taste.
- Olfactory/olfactory hallucinations: incorrect perception of the sense of smell.
➢ Disorganized thinking
- Loose association: Thinking is characterized by speech in which ideas shift
from one unrelated subject to another. Usually, individuals with this loose
association do not realize that the topic is unrelated.
- Tangentiality: refers to veering away from the topic of discussion and
showing difficulty in maintaining focus and attention.
- Circumstantiality: the individual experiences delays in reaching the point of
communication due to unnecessary and tedious details.
- Neoligism: the individual utters newly discovered words that are
meaningless to others but have a symbolic meaning to himself.
- Clang association: word choice is governed by sound, often rhyming, such as
 “it is very cold. I am cold and bold. The gold has been sold”
- Echolalia: repetition of words or sentences spoken by others.
➢ Very disorganized or abnormal motor behavior: hyperactivity,
hypervigilance, hostility, agitation, childlike silliness, catatonia, catatonic
excitement, stereotypes, unusual behavior or posture
❖ Negative Symptoms
➢ Lack of emotional expression: blunted affect, lack of movement of the head
and hands, lack of intonation in speech.
➢ Lack of motivation to complete purposeful activities: neglecting activities
of daily living.
➢ Decreased verbal communication (alogia).
➢ Decreased interest in social interactions and relationships: withdrawal, poor
relationships.
➢ Reduced ability to think abstractly.

d) Management
Prevention of relapse in schizophrenic patients can be accomplished with
adequate preparation for discharge and mobilization of existing health care facilities
in the community. This is particularly the participation and support of the family.
Families with high emotional expression will cause a relapse in family members with
schizophrenia. Kassim (1998) suggests that emotional behavior is believed to affect
the future of schizophrenic patients.
Management of schizophrenia or schizophrenia aims to relieve and control
symptoms, because there is no drug that can cure this disease. For this reason,
management must be carried out for life, including the provision of medication and
psychosocial therapy. In some cases, patients may require hospitalization, if there is a
potential danger to themselves or others.
❖ Pharmacology Administration
Drugs that can be used for patients with schizophrenia are from the
antipsychotic group. This class of drugs is thought to control symptoms by
 affecting the neurotransmitter dopamine in the brain. The goal of treatment with
antipsychotics is to control the signs and symptoms of schizophrenia
effectively, at the lowest possible dose.
❖ Electroconvulsive therapy (ECT).
❖ Surgery of the brain or Hospital treatment.
❖ Psychosocial approach the psychosocial approach aims to provide emotional
support to clients so that clients are able to improve their social and work
functions to the maximum.
❖ Psychotherapy
- Psychoanalytic therapy in this therapy, a person is aware of his problems and
makes defense mechanisms with the aim of controlling his anxiety.
- Behavior Therapy There are two forms of psychosocial programs to improve
the function of independence, including: 1) Social Learning Program:
schizophrenic clients to learn appropriate behavior 2) Social Skills Training:
train sufferers about their skills or expertise.
- Humanistic therapy Group and family therapy.
- Supportive psychotherapy, is a form of therapy that aims to provide
encouragement and motivation so that people with schizophrenia do not feel
hopeless and have a fighting spirit in facing life (Prabowo, 2014). In
schizophrenic clients, there is a need for encouragement to struggle to
recover and be able to prevent a relapse.
- Re-educative psychotherapy This form of therapy is intended to provide re-
education to change old education patterns with new ones so that people
with schizophrenia are more adaptive to the outside world (Prabowo, 2014).
- Reconstructive psychotherapy aims to restore the personality that has
changed due to stressors that the client is unable to deal with (Ikwati, 2011).
- Cognitive psychotherapy is a therapy to restore cognitive function so that
people with schizophrenia are able to distinguish ethical social values.
According to Ikwati (2011) the treatment and recovery of schizophrenia
consists of several stages of treatment and recovery, namely:
 - Acute phase therapy in this acute phase, the client shows clear psychotic
symptoms marked by positive and negative symptoms. Treatment in this
phase aims to control the psychotic symptoms that appear in people with
schizophrenia. Administration of drugs in the acute phase is given within six
weeks.
- Stabilization phase therapy in the stabilization phase the client experiences
psychotic symptoms with mild intensity. In this phase, the client has a high
probability of relapse so that routine treatment is needed towards the
recovery stage.
- Maintenance phase therapy in the maintenance phase is given in the long
term with the aim of being able to maintain the client's recovery, control
symptoms, reduce the risk of recurrence, reduce the duration of
hospitalization, and teach skills to live independently. Therapy in this phase
can be in the form of giving antipsychotic drugs, family counseling, and
rehabilitation.

2. Data Analysis

Objective Data Subjective Data Etiology Diagnosis

• Low visibility. • The client feels insecure about his Related to Self-concept
• His thought body shape. body image disorder:
content revealed • He had made attempts to mask disturbance Chronic low
paranoid these perceived bodily changes by self-esteem
delusions and changing the way he dressed.
delusions of • The patient had even shifted
reference. colleges because of the perceived
ridicule by others.
• The patient also had poor insight.
• Patient • The client feels auditory Related to Sensory
Hallucinating hallucinations withdrawal, perception
• The client complains of hearing social disorder:
voices and engaging in third- isolation and auditory
person conversations involving Chronic low hallucinations
men and women. self-esteem.
• The patient also complained that
he heard people talking about him
and insulting him, some of whom
he knew.
• The client also complains that he
hears people talking about him
and insulting him.

• His thought • The client avoids situations that Related to Social

content revealed require him to stand up straight, chronic low Isolation:
paranoid such as crowded buses, elevators, self esteem Withdrawing
delusions and and shops.
delusions of • Clients are always Socially
reference Attractive.
• Clients are often absent from
class.
• The client experienced a
significant academic decline.

• He had tried to • The client feels auditory Related to Suicide risk

injure himself the hallucinations auditory
year before by • The client complains of hearing hallucinations
slashing his wrist voices and engaging in third- and delusions
person conversations involving
 men and women.
• The patient also complained that
he heard people talking about him
and insulting him, some of whom
he knew.
• The client also complains that he
hears people talking about him
and insulting him.
• Over the previous year and a half,
He believed that others were able
to identify his physiological state
by the appearance of his groin
and therefore were laughing at
him and making derogatory
comments.
• The patient’s sister said he often
complained that people wanted to
harm him and as such felt unsafe.
She also added that he often
complained of receiving death
threats through phone calls from
an unfamiliar telephone number.
• the patient said that he had been
spending the night with a friend
and refused to return to his
parents’ house because he was not
safe there.
• He believed that he had been
targeted.
 • The patient also had poor insight.

• Low self- • He was therefore suspicious and Related to Delusion

awareness (he felt uneasy with others. withdrawal,
does not realize • Over the previous year and a half, social
that he is sick) He believed that others were able isolation and
• His thought to identify his physiological state Chronic low
content revealed by the appearance of his groin self-esteem.
paranoid and therefore were laughing at
delusions and him and making derogatory
delusions of comments.
reference. • The patient had even shifted
colleges because of the perceived
ridicule by others.
• The patient’s sister said he often
complained that people wanted to
harm him and as such felt unsafe.
She also added that he often
complained of receiving death
threats through phone calls from
an unfamiliar telephone number.
• the patient said that he had been
spending the night with a friend
and refused to return to his
parents’ house because he was
not safe there.
• He believed that he had been
targeted.
• The patient also had poor insight.
3. Priority Diagnosis

Data Etiology Diagnosis

Subjective Data (SD): Related to Delusion

• He was therefore suspicious and felt uneasy with withdrawal,
others. social
• Over the previous year and a half, He believed that isolation and
others were able to identify his physiological state by Chronic low
the appearance of his groin and therefore were self-esteem.
laughing at him and making derogatory comments.
• The patient had even shifted colleges because of the
perceived ridicule by others.
• The patient’s sister said he often complained that
people wanted to harm him and as such felt unsafe.
She also added that he often complained of receiving
death threats through phone calls from an unfamiliar
telephone number.
• the patient said that he had been spending the night
with a friend and refused to return to his parents’
house because he was not safe there.
• He believed that he had been targeted.
• The patient also had poor insight.

Objective Data (OD):

• Low self-awareness (he does not realize that he is
sick)
• His thought content revealed paranoid delusions and
delusions of reference.
4. Problem Tree

Suicide Risk

Sensory perception disorder:

Auditory hallucinations Delusion

Social Isolation

Self-concept disorder:
Chronic low self-esteem

5. Nursing Intervention

Diagnosis Outcome Intervention

Delusion After nursing action for 3x24 • Cognitive Behavioral Therapy

hours, the client will get the for Psychosis (CBTp)
related to
following criteria:
withdrawal, • Self-control against thought Reality Orientation (NIC: 4820)
distortion (NOC: 1403) • Use a calm and unhurried
social isolation
Indicators Before After approach
and Chronic • Avoid frustrating clients with
demands that require more
low self- Recognizing 2 4
the delusions capacity
esteem. that are going • Present reality with an attitude
on that maintains the client's self-
esteem
Refrain from 2 4 • Involve clients in concrete
following activities that focus on
delusions something outside of themselves
that is concrete and reality-
 oriented
• Give initial hints and show the
Monitor 2 4 moves needed to complete the
delusional task
frequency • Adjust human and environmental
sensory stimuli based on client's
needs
Explain the 2 4 • Use environmental cues to
contents of the stimulate memory, reorient, and
delusion promote appropriate behavior
• Give access to current news
Report a 2 5 precisely
delusional drop • Involve clients in reality-oriented
groups when needed and when
Sharing 2 5
available
emotional
• Monitor changes in orientation,
responses
cognitive function, and behavior
Shows logical 2 4 and the client's quality of life
thinking patterns
Note:
1 = Never show
2 = Rarely shows
3 = Sometimes shows
4 = Often shows
5 = Consistently shows

• Cognitive orientation (NOC:

0901)
Indicators Before After

Identify 2 4
themself

Identify 2 5
significant
people

Identify the 2 5
current place

Correctly 2 5
identify day,
month, year,
 season

Significant 2 4
current events
Notes:
1 = Very disturbed
2 = Much disturbed
3 = Moderately disturbed
4 = Slightly disturbed
5 = Not bothered

Sensory After nursing action for 3x24 • Music Stimulation Therapy

perception hours, the client will get the Hallucination Management (NIC:
disorders: following criteria: 6510)
hallucinations • Note the client's behavior that
related to • Sensory function: hearing shows hallucinations
withdrawal, (NOC: 2405) • Use concrete statements rather
social isolation than abstract statements when
Indicators Before After
and Chronic talking to patients
low self- Right and left 3 5 • Give the client a chance to
esteem. hearing acuity discuss his hallucinations
• Monitor the presence of
Different 2 5
hallucinations regarding the
hearing of
content (of hallucinations that
different sounds
are) violent or self-harming
Responds to 2 4 • Encourage the client to develop
auditory stimuli control and responsibility for his
Notes: or her own behavior, if the
1 = Very disturbed client's abilities allow
2 = Much disturbed • Encourage client to validate
3 = Moderately disturbed hallucinations with trusted
4 = Slightly disturbed people
5 = Not bothered • Focus on the discussion on the
• Cognitive orientation (NOC: underlying feelings rather than
0901) on the content of the
hallucination
Indicators Before After
• Give antipsychotic and anti-
Identify 2 4 anxiety drugs regularly and as
themself needed stop or reduce drugs that
can cause hallucinations
Identify 2 5
• Involve client in reality-based
significant
activities that may distract from
people
hallucinations
Identify the 2 5
current place

Correctly 2 5
identify day,
month, year,
season

Significant 2 4
current events

Notes:
1 = Very disturbed
2 = Much disturbed
3 = Moderately disturbed
4 = Slightly disturbed
5 = Not bothered

• Neurological status (NOC:

 0909)

Indicators Before After

Awareness 2 4

Cognitive 2 4
orientation

Cognitive 2 4
status

Notes:
1 = Very disturbed
2 = Much disturbed
3 = Moderately disturbed
4 = Slightly disturbed
5 = Not bothered

Social After nursing action for 3x24 • Sosial Skill Training

Isolation: hours, the client will get the Improved Socialization (NIC:
Withdrawing following criteria: 5100)
related to • Encourage increased
chronic low • Social engagement (NOC: involvement in established
self-esteem. 1503) relationships
• Encourage patience in
Indicators Before After
relationship development
Every day in 2 5 • Improve relationships with
touch with people who share the same
other people interests and goals
• Promote social and community
Interact with 2 5
activities
 • Encourage honesty in presenting
close friends,
yourself to others
neighbors,
• Increase engagement in
family
completely new interests
members
Promote respect for the rights of
Establish 2 4 others
important • Encourage participation in
relationships groups
Note: • Refer the patient to the
1 = Never show interpersonal skills group
2 = Rarely shows • Provide feedback on
3 = Sometimes shows improvements in personal
4 = Often shows appearance care or other
5 = Consistently shows activities
• Do role play in order to practice
• Body image (NOC:1200) improving communication skills
and techniques
Indicators Before After

Self-image 2 4 Activity Therapy (NIC: 4310)

• Consider the client's ability to
Satisfaction 2 4
participate through specific
with body
activities
appearance and
• Help client to explore personal
function
goals from usual activities
Attitudes 2 4 • Help clients to choose activities
towards the use and achieve goals through
of strategies to activities that are consistent with
improve the physical, physiological, and
appearance of social abilities
 • Help the client to identify and
the body
obtain the necessary resources
Notes:
for the desired activities
1 = Never positive
• Identify strategies to increase
2 = Rarely positive
participation related to desired
3 = Sometimes positive
activities
4 = Often positive
• Help clients to increase self-
5 = Consistently positive
motivation and reinforcement

• Social support (NOC: 1504)

Indicators Before After

Ability to 2 4
contact others
for help

Emotional 2 4
support
provided by
others

Best friend 2 4
relationship

People who can 2 4

help as needed

Social support 2 4
connection

Notes:
1 = Inadequate
 2 = Slightly adequate
3 = Adequate enough
4 = Mostly adequate
5 = Completely adequate

Suicide risk After nursing action for 3x24 • Dialectical Behavior Therapy
related to hours, the client will get the Behavior Management: Self-Harm
auditory following criteria: (NIC: 4354)
hallucinations • Self-control against • Identify previous history of self-
and delusions. depression (NOC: 1409) mutilating behavior
• Develop expectations of
Indicators Before After
appropriate behavior and
Monitor the 2 4 consequences, based on level of
intensity of cognitive function and capacity
depression for self-control
• Communicate the behavior
Monitor 2 4
expected of the patient and the
behavior due to
consequences for the patient
depression
• Monitor for patient self-harm
Monitor 2 4 impulses that may develop
physical suicidal thoughts or behavior
condition due to • Help the patient to identify and
depression feelings that may trigger self-
harm
Follow the 2 4
• Help the patient to identify more
treatment
appropriate coping strategies and
regimen
their consequences
Set realistic 2 5 • Contract with patient not to hurt
goals yourself
• Formulate a treatment plan with
 the patient that includes goals to
Report changes 2 5
prevent unwanted self-harming
in symptoms
behavior
Note:
• Involve patients in individual
1 = Never show
and group therapy, as
2 = Rarely shows
appropriate
3 = Sometimes shows
• Give medication to reduce
4 = Often shows
anxiety, stabilize mood / mood
5 = Consistently shows
and reduce self-stimulation in an
appropriate way
• Hope (NOC: 1201)

Indicators Before After Suicide Prevention (NIC: 6340)

• Determine the existing suicide
Expressing 2 4
risk and the level of suicide risk
positive future
• Determine if the patient has the
hope
tools to carry out his or her
Expressing 2 4 suicide plan
desire to live • Treat and manage psychiatric
illnesses or symptoms that may
Expressing the 2 4
put the patient at risk for suicide
meaning and
• Provide advocate to control
purpose of life
quality of life and pain issues
Express inner 2 4 • Instruct the patient to perform
peace appropriate coping strategies
• Implement the necessary actions
Shows the spirit 2 4
to reduce the individual's distress
of life
when negotiating not to put
Note: oneself in danger
1 = Never show • Use a direct, non-judgmental
 2 = Rarely shows approach in discussing suicidal
3 = Sometimes shows behavior
4 = Often shows • Support the patient to seek
5 = Consistently shows treatment, provide an
opportunity to speak up when
• Depression level (NOC: self-harm
1206) • Observe, record, and report
changes in mood or behavior that
Indicators Before After
may significantly increase the
Feelings of 2 4 risk of suicide and are
depression documented regularly
• Facilitate support for patients
Feeling 2 4
from family and friends
worthless
• Increase access to mental health
Sadness 3 4 services

Despair 2 4

Low self- 2 4
esteem

Note:
1 = Weight
2 = Quite heavy
3 = Medium
4 = Light
5 = None

Self-concept After nursing action for 3x24 • Family Psychoeducation and

disorder: hours, the client will get the Cognitive Therapy Exercises
Chronic low following criteria: Coping Enhancement (NIC: 5230)
self-esteem • Self-esteem (NOC: 1205)
related to body • Assist patients in identifying
Indicators Before After
image appropriate short-term and long-
disturbance. Verbalization 2 4 term goals
of self- • Assist patient in checking
acceptance available resources to meet goals
• Help patients in solving
Acceptance of 2 4
problems in a constructive way
one's
• Assess the patient's adaptability
limitations
to changes in body image
Self-image 2 4 • Assist the patient in developing a
more objective assessment of the
Confidence 2 4
incident
level
• Help the patient to identify the
Notes:
most desired information
1 = Never positive • Evaluate the patient in making
2 = Rarely positive
decisions
3 = Sometimes positive • find ways to understand the
4 = Often positive
patient's perspective on stressful
5 = Consistently positive
situations
• Self-awareness (NOC: 1215)
• Support the ability to cope with
Indicators Before After the situation gradually.

Differentiate 2 4
yourself from
others

Acknowledge 2 4
personal
physical,
mental and
 emotional
abilities

Recognizing 2 4
personal values

Accept your 2 4
own feelings

Note:
1 = Never show
2 = Rarely shows
3 = Sometimes shows
4 = Often shows
5 = Consistently shows
 CHAPTER III. CONCLUSION

A. Conclusion
Schizophrenia is a very severe mental disorder and this disorder is characterized by
typical symptoms such as disorganized speech, delusions, hallucinations, cognitive
disturbances, and disorders that cause low self-esteem. After we made observations on the
theory and carried out direct mental nursing care by identifying cases with hallucinations,
we can draw the following conclusions:
The assessment is carried out on the client based on the main complaint, the client
shows signs and symptoms of auditory hallucinations, the client often says he often hears
whispers that seem to threaten him. Clients are always suspicious of others and have low
visibility. The diagnosis that appears in the client in this case is sensory perception
disorder: delusions, auditory hallucinations, low self-esteem, social isolation and the risk of
suicide. Priority diagnoses are delusional. The nursing care plan carried out on the client
uses a standard approach to nursing care according to the diagnosis to assist the client in
controlling and pharmacological therapy.

B. Suggestions
In the case of a schizophrenic client, the nurse provides not only clinical or medical
support but also in other ways. For example, facilitating clients in spiritual matters. Then
provide therapeutic therapy and positive support that can increase the client's self-
awareness. Can also teach clients to learn to introduce themselves in order to start getting
along with people.
The motivation for the client to take medicine frequently and what will happen if the
client does not take medicine, this also needs to be known by the family. Also on actions
that have not been resolved so that nurses can continue and take the recommended actions
with home visits.
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