Persistent Mentally Ill

Clients

Schizophrenia
Bipolar Disorder
Substance Abuse Disorder
Cognitive Impairment Disorder
 Scope of Persistent
Mental illness
3.5 million severe mental illness ( 2.2 million
have schizophrenia and 1.3 million have bipolar
disorders)

estimated 40% of these individuals, or 1.4

million people, do not receive treatment on any
given day
factors related to the current
problems of the persistently
mentally ill
 poverty
 poor health care
compounds
 deinstitutionalizatio
n
 homelessness

 Incarceration
NURSING PROCESS
Assessment
 current symptomatic behavior – for example,
the presence of hallucination or, delusions,
associative looseness, change in affect,
evidence of loss reality contact, impaired
judgments or excessive anxiety or agitation.

 self-care abilities

 living situation

 available support system

 compliance of medication

 presence of substance abuse

 physical health status

Nursing Diagnosis

Many diagnosis can apply to the client with

persistent mental illness. The nurse
establishes priorities among the possible
nursing diagnoses base on the potential for
harm to self or others, current symptomatic
behaviors, self care abilities, available
supports, and physical status.
 interrupted family process related to
presence of persistent mental illness in a
member

 ineffective health maintenance related to

inability to access services for health care

 imbalance nutrition: more than body

requirements related to high-fat, high-
carbohydrates diet

 ineffective role performance related to

presence of persistent mental illness

 disturbed thought process related to

presence of delusion and/or associative
looseness
 chronic low self-esteem related to multiple
psychiatric hospitalization and failure to
establish independent lifestyle

 hopelessness related to lack of resources

necessary to establish and maintain a home

 impaired social interaction related to lack f or

inability to use social and communication skills

 ineffective coping related to inability to handle

problems of daily living

 noncompliance (failure to take prescribed

psychotropic medications or participate in long
term psychiatric treatment) related to
uncomfortable side effects of medication
and/or denial o mental illness
 risk for violence: self directed or other
directed related to presence of
command hallucinations, impaired in
reality contact, or increase agitation

 disturbed sensory perception (visual

and/or auditory) related to presence of
hallucinations

 social isolation related to failure to

establish and maintain interactions wit
others
Outcome
Identification
Outcome criteria focus on maintaining client
safety, establishing and maintaining client self
care, establishing client trust and facilitating
interaction with stuff peers, and decreasing
delusional thinking and hallucinatory
experiences.
 the family will verbalized knowledge of
coping measures useful when dealing with
a persistently mentally ill family members

 the client will utilize referrals for services

necessary to maintain health

 the client will maintain healthy diet

consisting of low fat, adequate protein, and
carbohydrate intake

 the client will accept necessary assistance

to function in expected goals
 the clients thoughts will remain reality
based without presence of delusional
thinking

 the client will identify positive aspects

of self-functioning in several area of
life .

 the client will use resources necessary

to establish and maintain a home

 the client will use social and

communication skills in establishing
 the client will take prescribed psychotropic
medications and participate in long term
psychiatric treatment

 the client will maintain safety of self and

others

 the client will verbalized decrease r absence

of hallucinatory experiences

 the client will identify and interact with

people who are supportive and helpful
Implementation

Combining narcoleptic medications with

cognitive behavioral and psychosocial
rehabilitation approach is helpful in treating
clients with persistent mental illness.
 Providing Safe Environment
-on the inpatient unit, the nurse establish and maintains
an environment that promotes and protects client safety.
Suicide precaution, safety rounds, and consistent rules
and expectations for the client behavior on the unit are
important in the promotion of safety.

 Orienting to reality
-realty orientation techniques include the use of a
calendar and large poster boards that include the date,
whether, and name of stuff and schedule of activities of
the unit.

 Promoting self care

-the nurse encourages the client to maintain personal
hygiene and uses techniques such as positive
reinforcement for the client to improved

 Providing support
-the nurse provide support t the client by listening with
empathy to the clients story.
 Enhancing self-esteem
the client with persistent mental illness often has a great
difficulty feeling positive about herself or himself due to
repeated failures in multiple area of living. Encouraging the
client to identify positive self-statements and provide
examples of positive functioning promotes self-esteem. Other
nursing intervention include the following:
helping the client us problem solving for identified problems
teaching assertiveness skills
encouraging participation in support groups in which others
are experiencing similar problems

 Promoting physical health

the nurse uses a wellness education approach improve the
health status of the client. She or he teaches and encourages
the client to stop smoking, improved nutrition, and increase
physical activity, and exercise. Regular routine screenings
such as pap smears, mammograms, and prostate screening
are also encouraged
 Assisting family members
-the nurse provides assistance to the families

coping with a member having a persistent mental

illness by using psyhcoeducation approach. After
assessing the family’s area of concern the nurse
teaches about the illness, symptom management,
use of medications, and measures to enhance
medication compliance. The nurse also encourages
the family members to use support groups.

 Planning continued treatment

 Providing assistance for homeless clients

 Providing care for imprisoned clients

Evaluation

The nurse evaluates the outcomes of the

client care and the degree to which
established goals have been met.