During my mental health clinical I encountered many patients each with different diagnoses and backgrounds. One patient in particular that stood out to me was a patient who was around my age and their main diagnosis was schizophrenia. Throughout the four weeks I had clinical I saw this patient each week and got to get to know them a little better each week. I would play cards with the patient and go on walks around the unit with them. During our interactions, the patient was always pleasant and appeared to be in a good mood however the stories I had heard from other times did not seem all that pleasant. I noticed during the interactions on the unit with the client that they appeared to be fighting within themselves with what their brain was telling them to do and what they were doing physically.
The patient would start talking about cards while we played but then would off onto random unrelated topics and had a flight of ideas. The patient would be present in the moment and play cards but would be talking about the government bugging their room and chipping people’s brains. The client appeared disheveled most of the time which was similar to their thoughts. The patient at moments also appeared as though they wanted to sit and play cards but that it was hard for them to sit still so they would shake their leg or fidget their hands around. The client appeared to have insight into these connections. They would mention how they know what they are saying sounds crazy to other people and that their family tells them they are crazy, but they can’t help it. I feel as though those comments from others don’t help the patient, but other statements could by validating how they feel but also bringing reality into the conversation.
The patient is homeless and does not have a source of income or occupation currently. The patient is married but we were not sure where the wife is because it appears as though she is no longer in the picture. The patient’s family also doesn’t live close by or in state which doesn’t provide much support for the patient and their current living situation. The patient’s social status affects their mental health and illness because they do not have the support or resources that are needed to help them. For example, the patient does not have transportation or money to pay for medication that can help them with their mental illness. The patient’s hygiene and living situation were addressed and their hygiene improved while at the hospital however it may decrease again once they go back to living on the streets. The patient also mentioned reaching out to family because they called family while at the hospital and may be able to get support from them.
The patient’s wife was not fully addressed while patient was at the hospital and the patient’s current living and hygiene could have been addressed further. The patient mentioned being homeless and not having much but did not mention staying at a shelter or having any items such as hygiene items. The client’s teeth were assessed and needed cleaning and everyday brushing but due to their living situation that was not happening. In my opinion, the patient’s social domain overall needs more assessment and possibly provide them with resources and support because most of what is causing the severity of their mental illness is the lack of social support and resources. If the patient had support such as a shelter or somewhere to stay their hygiene and physical health would most likely improve and this could help aid in improving their mental illness. Also, if the patient had a way to pay for and retrieve their medications to improve their mental illness that would also help aid in improvement. I think the deficiency in a social support system and in many aspects of the patient’s social domain is playing a significant role in the patient’s frequent admission to the hospital.
Regarding the patient’s biologic domain, the main problem would be a self-care deficit and medication adherence. Due to the client’s current living situation and lack of support medication and self-care needs are not being met. The main problems regarding the patient’s social and psychologic domain would be disturbed thought process and interrupted family process. The patient does not appear to have any family support and due to living with schizophrenia their thought process is disrupted. For example, the patient thinks that the owner of Yoplait is being caught in scandals by the government and thinks that the government is out to get him and everyone around him. The patient also mentioned to other students and I that eating a beet is like eating a male’s reproductive organs and eating grapes is like eating a woman’s reproductive organs. The patient also seemed to have no filter when they spoke and would make inappropriate and derogatory comments to students and staff and had to be told that saying those things was not appropriate.
The priority nursing interventions are to create a safe environment for the patient and the other patients on the unit. Another intervention would be to try and understand the significance of the patient’s beliefs because this can help identify and fears or issues that the client may be experiencing. Explaining what you’re doing and why you are doing it prior to physically doing it can help relieve any paranoia or anxiety the patient may be feeling about it. It is also important not to argue the client’s beliefs or convince them that they are not real or are false. This could cause the patient to go into a defensive position and they could feel even more misunderstood and isolate themself. In this case, I think it would be important to provide this patient with resources such as housing, food, and possibly a way to get medication due to their current living situation and financial status.
Overall, meeting patients in clinical and getting to observe their interactions with others and their behaviors when they were alone was helpful in pairing mental health disorders with characteristics that are commonly seen related to them. This patient stood out most to me due to their lack of resources, their age, and their diagnosis. I felt for this patient because they are so young and when they are getting the help, they need they are positive, and they mentioned that they know they need the help and that when they are in the hospital it helps them a lot. In my opinion, the lack of resources the client has is playing a key role in their mental illness and if we could provide them with some resources, it could help them improve for longer than just their hospital stay.
