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Running head: SCHIZOPHRENIA DISORDER 1

Caring For Patients With Schizophrenia Disorder

Tonya M Woodward

South Piedmont Community College

Nursing 103AB
SCHIZOPHRENIA DISORDER 2

Contents
Abstract................................................................................................................................2

Identity.................................................................................................................................4

Analysis...............................................................................................................................4

Therapeutic Treatment.........................................................................................................5

Therapeutic Communication...............................................................................................7

References............................................................................................................................8

Abstract

During morning report, the previous shift nurse discussed a patient diagnosed with

schizophrenia, but indicated he is not a threat and he stayed quietly in his room all night. You

have just read according to Medical News Today, that a paranoid schizophrenic stabbed his

brother to death just hours after community mental health workers left his house saying there

was no sign of immediate danger (Medical News Today 2012). In college you learned that

schizophrenia is becoming more widely viewed as a group of illnesses rather than a single

condition. How does a nurse differentiate between all of the facts given as it relates to nursing
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care for patients with schizophrenia? There was a five time award-winning movie, "One Flew

Over the Cuckoo's Nest", played by characters Randall McMurphy (Jack Nicholson) and Chief

Bromden (Will Sampson) that shares some real cognitive deficits of this disorder. In short, the

movie shares the perception that it is when we speak and react to the patient as a person in whole

we learn more about them, than to speak and react to the patient as a schizophrenic. This paper

will help new student nurses provide the best therapeutic approach with an in-depth knowledge

of their past, present and future. So, to make sure we do not miss out on the most important

question, let us begin with a simple but telling conversation opener, "What happened to you"

(Hunt, 2017).

Caring For Patients With Schizophrenia Disorder

Schizophrenia is a serious disorder of muddled thoughts and association with defining

features of being out of touch with reality. Hallucinations, delusions and social isolation are the

major symptoms of this disorder. Patients with schizophrenia tend to exhibit very unusual

suspicions, fears and may also mention hearing voices. Although the condition may appear as an

acute, rapid onset or may even develop over time, the first few signs may be hard to identify

because people often develop this illness during the younger years of life. Most patients with this

disorder often integrate others around them into their delusion. Some patient's feel that the

nursing staff are deliberately trying to harm him or her in some way. Interestingly, one of the

characters who played a psychiatrist in the movie shared that it is not the same as a person with

multiple personalities. It's not split, but more like shattered untamed thoughts or a mismatched

jig saw puzzle in a distorted thinking kind of way (Kesey, 1975).


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Identity

There are psychiatric institutions in every city standing in place for insidious onsets of

schizophrenia. The movie setting used Oregon State Hospital as the ward specializing in the

treatment in serious psychiatric illnesses such a schizophrenia. McMurphy finds a way to get

transferred from jail to this Oregon facility to avoid the harsh labor of his sentencing by

pretending to be mentally ill. Chief Bromden, the Indian narrator and character in the movie has

been the longest resident on the ward for nearly a decade. Bromden's schizophrenic disorder

became evident that he suffered from hallucinations and paranoia. For example, when a person

with schizophrenia becomes angry or upset, they often revert to feeling powerful and strong like

the "Hulk". In their mind, there is enough increase in size and power to take down an army.

Alike, as they become mentally afraid, they tend to try and hide themselves to escape from the

real world. Chief Bromden experienced hallucinations that the fog was enveloping him. He

thinks, "They start the fog machine again and its snowing down cold and white all over me like

skim milk, so thick I might even be able to hide in it if they didnt have a hold on me" (Kesey,

1975). What a great observation! This part of the identification assessment should let the nursing

student know the positive and negative symptoms of a patient that may be experiencing

schizophrenia.

Analysis

According to the Department of Health, there is no one single cause of schizophrenia,

but there are several predisposing factors that have been shown to have been associated with the

onset of it. A predisposition of schizophrenia can run in the family. If either parent has
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schizophrenia, there is a 10-percent chance the child will have it too! Studies of identical twins

show that if one twin has schizophrenia, the other has about a 50-percent chance of developing it.

Other studies have examined that certain biochemical substances in the brain are believed to be

involved in schizophrenia, especially a neurotransmitter known as dopamine, thus causing

chemical imbalances and brain abnormalities such as fear and helplessness. (Williams &

Hopper , 2015 pg. 1369). Bromden, like his father is a big man who comes to feel small and

helpless. When he witnessed the death of his father as a young child, the officials acted as if he

was not there. This experience made him withdraw from himself as he ended up breaking down

from all the horrifying events he saw his father go through. Chief Bromden shares with

McMurphy that most of the patients take trips to the shock room to help minimize the carnival

wheels of memories and emotions. One patient explains that is a like a trip to the moon, only you

pay with brain cells rather than money. There was a scene in the movie when McMurphy faked

to have been given an electroshock treatment and joins the group therapy session with Chief

Bromden. He walks slowly towards him with his eyes rolling to the back of his head and then all

of a sudden, he winks. Lobotomy anyone?

Therapeutic Treatment

As a nurse, you should understand that one of the first and probably most confusing

experiences a patient diagnosed with schizophrenia will have is that of being bombarded with the

many various types of treatments options. A major component of the effectiveness of these

therapeutic modalities and medications is the compliance of the patient. If the patient refuses to

take the prescribed medications, social skills training, individual or group psychotherapy, they

may experience a relapse or worsen the condition. The nurse should establish a supportive

therapeutic alliance that will allow the patient to develop trust with the desire to cooperate with
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treatment. Identify the patient's goals, aspirations, and barriers such as cognitive impairments.

Some patients are not willing to do something just because you or the doctor says so. Chief

Bromden shared his theory about how this works: "it's all a great big machine called the

Combine and everybody comes to the hospital to get the parts needed to be fixed by this

machine and the people who promote the Combine like Nurse Rachett, will give to prevent from

gaining power". He does not want to be part of it. He resists it and part of the resistance is

pretending to be deaf and dumb. However, psychotherapy techniques like individual and group

therapy sessions can help prime the patient experiencing schizophrenia to be more receptive to

the response to treatment (Mason, 2013). There are also atypical antipsychotic medications help

to block dopamine actions in the brain such as clozapine (Clozaril) and risperidone (Risperdal).

Electroconvulsive therapy (ECT) is used in severe cases of schizophrenia, but this method is not

usually used until all other methods of therapy have been exhausted (Williams & Hopper, 2015

pg. 1369). In the movie, McMurphy attempts to strangle the nurse because he felt she was partly

responsible for the death of another patient. Because of his violent actions, the nurse had him

committed to a special ward deemed "disturbed" and undergoes a Lobotomy which in my

opinion, is on the same lines as Electroconvulsive therapy. These types of therapies send shocks

to the frontal lobes of the brain to stabilize emotions without doing away with their intelligence.

However Chief Bromden shares a different perspective. The Lobotomy procedure left

McMurphy in a vegetable state. Upon McMurphy's return to the ward, Chief Bromden remarks

that "There's nothin' in the face. Just like one of those store dummies."
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Therapeutic Communication

According to Schizophrenia.com, Good communication involves knowing when, what

and how to communicate with schizophrenic patients. It is crucially important to not discuss

things with a patient experiencing schizophrenia while he or she is upset or angry. Use verbal

and non verbal methods of communication. Keep all verbal communications simple, brief and

specific. Non-verbal communication refers to how you say it- your tone of voice, posture, eye

contact, facial expressions and the physical distance between both parties. Although Chief

Bromden and McMurphy are two patients in the movie, McMurphy worked hard to save all the

patients from being labeled "schizophrenic", but Chief Bromden, a six-foot gigantic half Indian

man, was the main target of his attention. McMurphy maintained a very calm manner which in

turn allowed Chief Bromden to open up about his thoughts and lower any anxiety he may have

been experiencing with haunting witnessing in the takedown of his father as chief of their tribe.

McMurphy encouraged Chief to do activities such as playing basketball being that he was tall

enough to touch the net without jumping. Sportsmanship showed Chief to realize his own value

and that he was not as weak and inferior as he thought. As a result, McMurphy won Chief

Bromden's respect and trust, the key to any therapeutic relationship.

In conclusion, keep an open mind and do not under estimate the process of this serious

disorder. Chief Bromden shares an interesting brain teaser: "I have been silent so long now its

gonna roar out of me like floodwaters and you think the guy telling this is ranting and raving my

God; you think this is too horrible to have really happened, this is too awful to be the truth! But,

please. Its still hard for me to have a clear mind thinking on it. But its the truth even if it didnt

happen."
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References

Kesey, K. (2016). One flew over the cuckoo's nest. NY, NY: Penguin Books.

Mental Health and Social Inclusion. (n.d.). Retrieved April 10, 2017, from

http://www.emeraldinsight.com/doi/pdfplus/10.1108/MHSI-01-2017-0003

Miller, R., & Mason, S. E. (2011). Diagnosis: schizophrenia: a comprehensive resource for

consumers, families, and helping professionals. New York: Columbia University Press.

News Archive from Medical News Today. (n.d.). Retrieved April 13, 2017, from

http://www.medicalnewstoday.com/categories

Schizophrenia.com. (n.d.). Retrieved April 13, 2017, from http://www.schizophrenia.com/

What treatment is available? (n.d.). Retrieved April 07, 2017, from

http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-w-whatschiz-

toc~mental-pubs-w-whatschiz-treat

Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical nursing. Philadelphia:

F.A. Davis Company.