Callo, Dimple C. (Case Scenario 2)

Callo, Dimple C.
BSN III-A
Case Scenario 2
A. WHAT NEEDS TO BE DONE AND WHO SHOULD BE INVOLVED IN

DEVELOPING A CARE PLAN FOR THE PATIENT?
Nursing Assessment
 Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia

(e.g., speech abnormalities, thought distortions, poor social interactions).
 Establish trust and rapport. Don’t tease or joke with patients. Expect that patient is
going to put you through rigorous testing periods. Introduce yourself and explain your
purpose.
 Maximize level of functioning. Assess patient’s ability to carry out activities of daily
living (ADLs).
 Assess positive symptoms. Assess for command hallucinations; explore answers.
Assess if the client has fragmented, poorly organized, well-organized, systematized,
or extensive system of beliefs that are not supported by reality. Assess for pervasive
suspiciousness about everyone and their actions (e.g., vigilant, blames others for
consequences of own behavior, argumentative, threatening).
 Assess negative symptoms. Assess for the negative symptoms of schizophrenia (as
mentioned above).
 Assess medical history. Assess if the client is on medications, what these are, and
adherence to therapy.
 Assess support system. Determine whether the family is well informed about the
disease. Does the family understand the need for medication adherence?
 Ensure safety. Maintain a safe environment with minimal stimulation.
 Ensure adequate nutrition. Monitor patient’s nutritional status and if
the patient thinks his food is poisoned, let him fix his own food if possible
or offer him foods in closed containers that he can open. Institute suicide
and/or homicide precautions as appropriate.
 Deal with hallucinations by presenting reality. Explore the content of
hallucinations. Avoid arguing about the hallucinations. Tell them you do
not see, hear, smell, or feel it but explain that you know that these
hallucinations are real to him.
 Promote compliance and monitor drug therapy. Administer prescribed
drugs and encourage the patient to comply. Ensure that patient is really
taking the drug. Observe for manifestations that warrant hypersensitivity
reactions and toxicity.
 Encourage family involvement. Involve family in patient treatment and
teach members to recognize impending relapse (e.g. nervousness,
insomnia, decreased ability to concentrate). Suggest ways how families
can manage symptoms.
B. AS A MEMBER OF THE INTERDISCIPLINARY TEAM, DESCRIBE YOUR ROLE

AND WHAT YOU CAN BRING TO THE TEAM?
 Psychiatric nurses admit or discharge patients, monitor patients being detained for psychiatric
hospitalization for safety, perform high-risk assessments, manage medications, and groom and
bathe patients.
 Psychiatric nurses facilitate social and emotional needs, provide crisis intervention and treatment,
and administer cognitive-behavioral therapy.
 Psychiatric nurses assess patient’s mental and physical health, develop treatment plans, consult
with psychiatrists and other health professionals, and manage medications.
 Psychiatric nurses work double duty in this clinical nursing specialty to provide physical and
mental health care. Psychiatric nurses work in a community capacity to deliver mental health
services, others help individuals one-on-one to accomplish daily tasks and improve their lives.
Nurses engaged in this profession help develop a treatment plan and use their therapeutic skills to
offer a range of options to patients and their families.
C. WHAT CHALLENGES AND OPPORTUNITIES DO YOU THINK MAY EXIST

FOR YOU IN THE TEAM?
Interdisciplinary teams face many unique challenges which they must address in order
to be successful. For example, since communication between disciplines can be difficult, an
interdisciplinary team must set aside time to learn how to speak to one another without
confusion. They also must ensure that they are able to meet in person, and must set aside time
in order to do so. This becomes more difficult the further apart the collaborating team is from
one another.
Also, an interdisciplinary team must give experts from every discipline an equal
amount of respect. Unfortunately, many people have assumptions about other disciplines,
which can damage interdisciplinary collaborations. The power balance in an interdisciplinary
team will reflect the power structure of the outside world, unless the team intentionally
identifies these imbalances and structures the team so that every discipline has equal status.
This is important to ensure that each member’s knowledge, experience and understanding is
being represented in the team’s work. Sometimes those are complementary, but sometimes
they are conflicting. The team must learn to value diversity, remain cohesive when viewpoints
conflict, and negotiate agreement to which all team members are committed.
In the best situations, disagreement leads to a more complete interprofessional

discussion of the patient's care, resulting in a new consensus about the best course of action.
The new consensus may require compromises from each individual. When members of a team
cannot arrive at a consensus of what should be done, it may be helpful to consult other
professionals who are not directly involved in the patient's care team for objective input. If the
disagreement still cannot be resolved, another resource may be the hospital's ethics
committee, which can listen to disagreements and help suggest solutions.
D. WHAT CONSIDERATIONS NEED TO BE MADE TO ENSURE THE SUCCESS OF

THE TEAM IN PROVIDING BEST PRACTICE?
1. Positive leadership and management attributes - Having a clear leader of the team, with
clear direction and management; democratic; shared power; support/supervision; personal
development aligned with line management; leader who acts and listens.
2. Communication strategies and structures - Individuals with communication skills;
ensuring that there are appropriate systems to promote communication within the team.
3. Personal rewards, training and development - Learning; training and development;
training and career development opportunities; incorporates individual rewards and
opportunity, morale and motivation.
4. Appropriate resources and procedures - Structures (for example, team meetings,
organizational factors, team members working from the same location). Ensuring that
appropriate procedures are in place to uphold the vision of the service (for example,
communication systems, appropriate referral criteria and so on).
5. Appropriate skill mix - Sufficient/appropriate skills, competencies, practitioner mix,
balance of personalities; ability to make the most of other team members' backgrounds;
having a full complement of staff, timely replacement/cover for empty or absent posts.
6. Supportive team climate - Team culture of trust, valuing contributions, nurturing
consensus; need to create an interprofessional atmosphere.
7. Individual characteristics that support interdisciplinary team work - Knowledge,
experience, initiative, knowing strengths and weaknesses, listening skills, reflexive practice;
desire to work on the same goals.
8. Clarity of vision - Having a clear set of values that drive the direction of the service and the
care provided. Portraying a uniform and consistent external image.
9. Quality and outcomes of care - Patient-centered focus, outcomes and satisfaction,
encouraging feedback, capturing and recording evidence of the effectiveness of care and
using that as part of a feedback cycle to improve care.
10. Respecting and understanding roles - Sharing power, joint working, autonomy.

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Callo, Dimple C.

A. WHAT NEEDS TO BE DONE AND WHO SHOULD BE INVOLVED IN

 Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia

B. AS A MEMBER OF THE INTERDISCIPLINARY TEAM, DESCRIBE YOUR ROLE

C. WHAT CHALLENGES AND OPPORTUNITIES DO YOU THINK MAY EXIST

In the best situations, disagreement leads to a more complete interprofessional

D. WHAT CONSIDERATIONS NEED TO BE MADE TO ENSURE THE SUCCESS OF

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