A Behavioral Analysis on a
Patient with Schizophrenia
Vision
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Behavioral Analysis on a Patient with Schizophrenia
2
December 31, 2011
Mr. Jeffrey Lloyd R. Titong, BSN-RN
Clinical Instructor, Psychiatric rotation
College of Nursing, Silliman University
Dumaguete City
Dear Sir:
I, Cherie Mae Orobia – Romas, a 4th year students of the College of Nursing, Silliman University is currently on Psychiatric Rotation, assigned in Negros
Oriental Provincial Hospital Psychiatric Extention in Talay, Dumaguete City, would like to ask permission to present the behavioral analysis of my patient
with Schizophrenia. I am strictly obliged to maintain confidentiality with the data acquired from thorough assessment and the objective facts, which
all that will be discussed and studied will be for academic purposes.
The behavioral analysis presentation will serve as a partial fulfillment in the requirement for NCM 105, Psychiatric Rotation. The knowledge will be
broadened, skill will become more efficient and attitude will be enhanced as we present the case of our patient.
We hope that this will grant us your consideration to conduct the said presentation.
Sincerely yours,
Cherie Mae Orobia – Romas
Behavioral Analysis on a Patient with Schizophrenia
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TABLE of CONTENTS
I. Objectives
… page 5
II. Acknowledgment
… page 6
III. Introduction
… page 7
IV. Growth and Development
… page 8
V. Patient’s profile
… page 9
 Demographic data
… page 11
 Genogram
… page 12
VI. Medications
… page 13
VII. Overview of the Disease Condition
… page 15
VIII. Psychodynamics
… page 16
IX. Psychiatric checklist
… page 18
X. Review of the 5 Domains
… page 23
XI. Nursing care plans
… page 25
XII. Summary of nursing diagnoses
…. page 33
XIII. Synthesis
… page 34
XIV. Bibliography
… page 35
Behavioral Analysis on a Patient with Schizophrenia
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OBJECTIVES
Topic Description:
This behavioral analysis deals with a client with schizophrenia as a psychiatric disorder. This focuses on the
psychodynamics and manifestations of our patient with schizophrenia. It also talks about its physiologic changes undergone
by the patient, the nursing interventions to be given, with the medications and their significance to the patient.
Central Objectives:
At the end of the behavioral analysis, the students would be able to develop beginning skills and gain more knowledge
and manifest positive attitude towards the care of client with schizophrenia, behavioral change and other mentally ill
clients.
Specific Objectives:
At the end of the behavioral analysis, the learners shall be able to:
 Define what schizophrenia in their own understanding is.
 Discuss the developmental task and psychosocial tasks appropriate to his age.
 State at least 3 manifestations shown by our client who is experiencing schizophrenia
 Identify appropriately the nursing interventions applicable to our patient.
 Explain thoroughly the psychodynamics of Schizophrenia as a Disorder.
 Recognize all possible, actual, and risk problems seen in our patient
 Know the medications (effects, doses, and nursing implications) that our patient are receiving
 Evaluate the behavioral analysis objectively.
Behavioral Analysis on a Patient with Schizophrenia
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ACKNOWLEDGMENT
I am BLESSED to have all these people around us.
First of all, I would like to thank our Lord Almighty for giving us the opportunity to study in Silliman University
College of Nursing to render our services to the needy especially to all the patients belonging at Negros
Oriental Provincial Rehabilitation Center located in Talay, Dumaguete City. He has been providing me with
ample knowledge, wisdom, strength, patients, and inspiration to continue our care to my client.
Second, I would like to thank our ever supportive, loving, and supportive parents who never surrender in
providing me all the things we needed for our studies. I also thanked them for giving me the will and the
strength to continue doing my best in our studies and for giving me enough money allotted for this paper.
Third, to Silliman University College of Nursing for giving me the facility and resources to be able to achieve
triumph in everything I do to surpass the challenges I encounter in my studies.
To our beloved mentor, Mr. Jeffrey Lloyd R. Titong for facilitating me and guiding me in my way for the
achievement and a satisfactory journey in our psychiatric rotation. He has been very patient and
understanding all throughout in our duty days.
And lastly to Talay Rehabilitation Center for the warm welcome and for accommodating the entire section all
throughout our psychiatric rotation.
It has been a pleasure working with you!
Again THANK YOU VERY MUCH
Behavioral Analysis on a Patient with Schizophrenia
6
INTRODUCTION
Psych rotation was new to me for this area is far different form my other rotation experiences in the college. Feeling of anxiety and
excitement were felt for this will be the first time that I will be encountering mentally challenged individuals in the field of Talay Rehabilitation
Center. Upon the first contact to Mr. Sy (not his real name), I directly noticed his behavioral changes such as sudden withdrawal during
conversation, cannot focus on a certain position and topic, holds information, a little manifestations of hand tremors and didn’t participate in
any activity by himself. According to the books schizophrenia is a major mental disorder with psychotic symptoms marked by a profound
withdrawal from interpersonal relationships and cognitive and perceptual disturbances that makes dealing with reality difficult. Major
enduring split exist between the emotional and cognitive aspect of the personality; the person’s moods is not congruent with his thoughts. A
patient with this kind of attitude is experiencing unpredictable behavior and is manifesting commonly by hallucinations (auditory and visual),
delusions, and we observed to our patient for negative symptoms.
I was very delighted with my journey in the Rehabilitation Center because another type of patient that are mentally ill and needs my
attention at the most. What I intend to do was, to focus on the right care for them to attain their optimum health they need. Basically this kind
of patient needs proper attention and medications for them to be back on their normal function. During the course of our psychiatric rotation,
I have exhausted our knowledge in dealing with our patient, communicating them therapeutically, and the best that I can do for them to
share their emotions and past experiences they were into.
This behavioral analysis workbook focuses on the case of Mr. Sy who was diagnosed to have Schizophrenia. So as to specially and to
better understand the case of Mr. Sy, this paper consists of relevant and vital information concerning Mr. Sy which includes the Demographic
data, Medical, Family and Social history. The psychodynamics of Mr. Sy condition is also dealt with in order to fully grasp how and what to
address his problems. For the purpose of augmenting our skills and knowledge as student nurses, care plans are also included as part of this
workbook in order to encourage discussion among students inspiring for more and better knowledge and understanding.
Behavioral Analysis on a Patient with Schizophrenia
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GROWTH AND DEVELOPMENT
Young Adult (20-40 years old)
Psychosocial Stages of Development
Erik Erikson’s Stage: INTIMACY vs. ISOLATION
In this stage, the most important events are love relationships. No matter how successful you are with your work, said Erikson, you are
not developmentally complete until you are capable of intimacy. An individual who has not developed a sense of identity usually will fear
a committed relationship and may retreat into isolation.
 Young adults, having developed as sense of identity, deepen their capacity to love others and care for them through work.
The emotional health of the young adult is related to the individual’s ability to address and resolve personal and social tasks.
 The young adult is usually caught between wanting to prolong the irresponsibility of adolescence and wanting to assume adult
commitments.
 Between the ages of 23 and 28, the person redefines self-perception and ability for intimacy. From 29 to 34 the person directs
enormous energy toward achievement and mastery of the surrounding world. The years from 35 to 43 are a time of vigorous
examination of life goals and relationships.
 During adult years, people generally give more attention to occupational and social pursuits.
 During this period individuals attempt to improve their socio-economics status.
 Many young adults are facing the added stress of greater competition in the workplace for few positions.
 For many young adults, a dual-income family is also needed to achieve and maintain middle-class status.
Analysis on our client:
In the psychosocial developmental stage of Erik Erikson, my patient is 26 years of age which is under intimacy vs. isolation. During my
interview he mentioned that he doesn’t had any girlfriend. In the continuation of our conversation he mentioned about a Chinese girl
which he claimed that he will going to get married with. He also claimed that the girl was his first love. During this stage, my client always
talks about work and how he can improve his life. He also shared to me his past experiences during his work in her town.
He is fixated in industry vs. inferiority the non-achievement results in difficulty in interpersonal relationships because of feelings of
personal inadequacy. He may become either passive and meek or overly aggressive to cover up for feelings of inadequacy. The patient
manipulates or violates the rights of others to satisfy his or her own needs or desires; he is known to be “workaholic” with unrealistic
Behavioral Analysis on a Patient with Schizophrenia
8
expectations for personal achievement. This task remains unresolved when parents set unrealistic expectations for the child, when discipline
is harsh and tends to impair self-esteem, and when accomplishments are consistently met with negative feedback.
Psychoanalytic Theory
Sigmund Freud’s Personality Components
Freud conceptualized personality structure as having three components: id, ego, and superego. The id is the part of one’s nature that reflects
basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. The id seeks instant gratification; causes impulsive,
unthinking behavior; and has no regard for rules or social convention. The superego is the part of a person’s nature that reflects moral ethical concepts,
values, and parental and social expectations; therefore, it is in direct opposition to the id. The third component, the ego, is the balancing or mediating
force between the id and the superego. The ego represents mature and adaptive behavior that allows a person to function successfully in the
world.Freud believed that anxiety resulted from the ego’s attempts to balance the impulsive instincts of the id with the stringent rules of the superego.
(Videbeck, 2008)

Id:The id is the locus of instinctual drives—the “pleasure principle.” Present at birth, it endows the infant with instinctual drives that seek to
satisfy needs and achieve immediate gratification. Id-driven behaviors are impulsive and may be irrational

Ego:The ego, also called the rational self or the “reality principle,” begins to develop between the ages of 4 and 6 months. The ego
experiences the reality of the external world, adapts to it, and responds to it. As the ego develops and gains strength, it seeks to bring the
influences of the external world to bear upon the id, to substitute the reality principle for the pleasure principle (Marmer, 2003). A primary
function of the ego is one of mediator, that is, to maintain harmony among the external world, the id, and the superego.

Superego:If the id is identified as the pleasure principle, and the ego the reality principle, the superego might be referred to as the
“perfection principle.” The superego, which develops between ages 3 and 6 years, internalizes the values and morals set forth by primary
caregivers. Derived from a system of rewards and punishments, the superego is composed of two major components: the ego-ideal and
the conscience. When a child is consistently rewarded for “good” behavior, his or her self-esteem is enhanced, and the behavior becomes
part of the egoideal; that is, it is internalized as part of his or her value system. The conscience is formed when the child is consistently
punished for “bad” behavior. The child learns what is considered morally right or wrong from feedback received from parental figures and
from society or culture. When moral and ethical principles or even internalized ideals and values are disregarded, the conscience
generates a feeling of guilt within the individual. The superego is important in the socialization of the individual because it assists the ego
in the control of id impulses. When the superego becomes rigid and punitive, problems with low self-confidence and low self-esteem arise.
(Townsend, 2008)
Behavioral Analysis on a Patient with Schizophrenia
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The major task in the anal stage is gaining independence and control, with particular focus on the excretory function. Freud believed that the
manner in which the parents and other primary caregivers approach the task of toilet training may have far-reaching effects on the child in terms of
values and personality characteristics. When toilet training is strict and rigid, the child may choose to retain the feces, becoming constipated. Adult
retentive personality traits influencedby this type of training include stubbornness, stinginess, and miserliness. An alternate reaction to strict toilet training
is for the child to expel feces in an unacceptable manner or at inappropriate times.
Behavioral Analysis on a Patient with Schizophrenia
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Analysis on our client:
My patient is fixated on his anal stage. The Far-reaching effects of not achieving the satisfaction results to this behavior pattern include
malevolence, cruelty to others, destructiveness, disorganization, and untidiness. My patient is untidy and does not regularly take a bath and that he
thoughts are disorganized in a way that he has flight if ideas and grandiosity of thoughts and ideas.
Abraham Maslow’s Hierarchy of Needs
Maslow formulated the hierarchy of needs in which he used a pyramid to arrange and illustrate the basic drives or needs that
motivate people. The most basic needs—the physiologic needs of food, water, sleep, shelter, sexual expression, and freedom from pain—
must be met first. The second level involves safety and security needs, which include protection, security, and freedom from harm or
threatened deprivation. The third level is love and belonging needs, which include enduring intimacy, friendship, and acceptance. The
fourth level involves esteem needs, which include the need for self-respect and esteem from others. The highest level is self-actualization,
the need for beauty, truth, and justice.
Maslow hypothesized that the basic needs at the bottom of the pyramid would dominate the person’s behavior until those needs
were met, at which time the next level of needs would become dominant. For example, if needs for food and shelter are not met, they
become the overriding concern in life: the hungry person risks danger and social ostracism to find food. Maslow used the term selfactualization to describe a person who has achieved all the needs of the hierarchy and has developed his or her fullest potential in life.
Few people ever become fully self-actualized.
Maslow’s theory explains individual differences in terms of a person’s motivation, which is not necessarily stable throughout life.
Traumatic life circumstances or compromised health can cause a person to regress to a lower level of motivation. For example, if a 35year-old woman who is functioning at the “love and belonging” level discovers she has cancer; she may regress to the “safety” level to
undergo treatment for the cancer and preserve her own health. This theory helps nurses understand how clients’ motivations and behaviors
change during life crises. (Townsend, 2008)
Analysis on our client:
The physiologic need of my patient is not totally met due to lack of resources and without a support from the family, he needs to work
hard in order to support himself and provide food and all the necessities. He hasn’t felt any endearment and love from his parents because
Behavioral Analysis on a Patient with Schizophrenia
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during our conversation he usually hides his identity when it comes to family issues. I failed to confirm the detail because there was no
significant others present. There has been no self-actualization.
PATIENT’S PROFILE
Demographic Data
Name: Mr. Sy_
Civil status: Single
Home Address: Nabago, Zamboanguita, Negros Oriental
Religion: Roman Catholic
Room and Bed No: B3
Nationality: Filipino
1985
Date of Admission: September 2, 2011 @ 2:45 PM
Sex: Male
Age: 26 years old
Birth date: March 11,
Chief Complaints:
One day prior to admission, patient manifested mild behavior at home. With lapses of incoherent. With
auditory hallucination noted.
HISTORY of Present Illness:
Onset of the problem was when he was admitted to NOPH due to an accident. He fell down from a coconut
tree and his head was the one landed first.
Family History:
As we have looked at his family, no history of mental illness.
Behavioral Analysis on a Patient with Schizophrenia
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General Impression of Client:
He was inside his room as I come and approached my client. He was standing near the bars of his cell, as he
was staring blankly on the sky. He was appropriately dressed with his shirt and shorts, but his clothing appeared
untidy. His hair was not neatly combed. As soon as I arrived in front of my patient and I greeted him, he smiled
to me. I have noticed that his teeth have discoloration. His posture was slouched and stooping shoulders.
Behavioral Analysis on a Patient with Schizophrenia
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GENOGRAM
MR. C
67 Y.O.
MR. D
35 y.o
MR. E
33 y.o
LEGEND:
MALE
MENTALLY ILL
FEMALE
MS. B
65 Y.O.
MS. F
29 y.o
MR. Sy
26 y.o
MR. H
23 y.o
Our patient is
manifesting behavioral
changes as observed.
He was admitted on
September 2, 2011 at
2:45 PM. From
Nabago, Zamboanguita
Negros, Oriental.
Behavioral Analysis on a Patient with Schizophrenia
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MEDICATIONS
Chlorpromazine (Thorazine)
Mechanism of action
- Alter the dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking activity. Therapeutic effects:
diminished signs and symptoms of psychosis. Relief of nausea and vomiting or intractable hiccups. Decreased symptoms
of porphyria.
Indications
- Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Unlabelled uses:bipolar
disorder.
Contraindications
- Hypersensitivity, hypersensitivity to sulfites or benzyl alcohol; cross sensitivity with other phenothiazines may occur; angleclosure glaucoma; bone marrow depression; severe liver or cardiovascular disease and current pimozied used.
Dosage
- Psychoses – 10 to 25 mg 2-4 times daily; may increase every 3-4 days or 30-300 mg 1-3 times daily as extended-release
capsules.
Side effects and Adverse effects
- Neuroleptic malignant syndrome, sedation, extrapyramidal reaction, tardive dyskinesia blurred vision, dry eyes,
photosensitivity, constipation and dry mouth.
Nursing Responsibilities
- Monitor vital signs
- Assess mental status (orientation, mood, behavior) prior to and periodically during therapy
- Assess weight and BMI initially and throughout therapy
- Monitor for the development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions,
diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, and loss of bladder control). Report
symptoms immediately.
Behavioral Analysis on a Patient with Schizophrenia
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Behavioral Analysis on a Patient with Schizophrenia
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FluphenazineHydrochloiride (Prolixindecanoate)
Mechanism of action
- Alter the effect of dopamine in the CNS. Has anticholinergic and alpha-adrenergic blocking activity. Therapeutic effect:
diminished signs and symptoms of psychoses.
Indications
- Acute and chronic psychoses.
Contraindications
- Hypersensitivity, cross-sensitivity to with other phenothiazines may exist; subcortical brain damage; severe CNS depression;
some of alcohol or tartrazine and should be avoided in patients with known intolerance.
Dosage
- 0.5 to 10 mg/day in divided dose every 6-8 hours (maximum dose = 40 mg/day)
Side effects and Adverse effects
- Neuroleptic malignant syndrome, sedation, extrapyramidal reaction, tardive dyskinesia blurred vision, dry eyes,
photosensitivity, constipation and dry mouth.
Nursing Responsibilities
- Monitor vital signs
- Assess mental status (orientation, mood, behaviour) prior to and periodically during therapy
- Monitor patient for onset of akathisia and tardive dyskinesia
- Monitor for the development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions,
diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, and loss of bladder control). Report
symptoms immediately.
Behavioral Analysis on a Patient with Schizophrenia
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Overview of the Disease Condition
Schizophrenia facts
Schizophrenia, also sometimes colloquially called split personality disorder, is a chronic, severe, debilitating mental illness that affects about 1% of the
population, more than 2 million people in the United States alone. With the sudden onset of severe psychotic symptoms, the individual is said to be
experiencing acute schizophrenia. Psychotic means out of touch with reality or unable to separate real from unreal experiences.
There is no known single cause of schizophrenia. As discussed later, it appears that genetic factors produce a vulnerability to schizophrenia, with
environmental factors contributing to different degrees in different individuals.
There are a number of various treatments for schizophrenia. Given the complexity of schizophrenia, the major questions about this disorder (its cause or
causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of)
schizophrenia.
Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. Symptoms of
schizophrenia may include delusions, hallucinations, catatonia, negative symptoms, and disorganized speech or behavior.
There are five types of schizophrenia based on the kind of symptoms the person has at the time of assessment: paranoid, disorganized, catatonic,
undifferentiated, and residual.
Children as young as 6 years of age can be found to have all the symptoms of schizophrenia as their adult counterparts and to continue to have those
symptoms into adulthood. Although the term schizophrenia has only been in used since 1911, its symptoms have been described throughout written history.
Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental factors.
Health-care practitioners diagnose schizophrenia by gathering comprehensive medical, family, mental-health, and social/cultural information.
The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical examination
will usually include lab tests.
In addition to providing treatment that is appropriate to the diagnosis, professionals attempt to determine the presence of mental illnesses that may cooccur.
People with schizophrenia are at increased risk of having a number of other mental-health conditions, committing suicide, and otherwise dying earlier
than people without this disorder.
Medications that have been found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics.
Behavioral Analysis on a Patient with Schizophrenia
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Psychosocial interventions for schizophrenia include education of family members, assertive community treatment, substance-abuse treatment, socialskills training, supported employment, cognitive behavioral therapy, and weight management.
Cognitive remediation, peer-to-peer treatment, and weight-management interventions remain the focus topics for research.
Behavioral Analysis on a Patient with Schizophrenia
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PSYCHODYNAMICS
Behavioral Analysis on a Patient with Schizophrenia
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+PSYCHIATRIC CHECKLIST
Check the manifestations/ Responses Observed in
your patient and write the other specific significant
data on the column for comments
I.
Remarks/Comments
Appearance and Physical Condition
1. Facial Expression
- Fatigue
- Fear
- Tension
- Happiness
- Indifference
- Sadness
- Others
 Shyness
2. Posture
- Stands erect
- Slouch
- Dropping shoulders
3. Physical Cleanliness
- Hair combed
- Face washed
- Full bath
- Body odor
- Clothes changed
Throughout my interaction with the patient, he usually displays sadness and
shyness on his face. Often when I’m talking to him, he listens attentively and is
frequently bowing down his head from time to time and seldom makes eye to
eye contact. He seldom laughs nor smiles.




Normal gait is observed while walking. In a side view vision, my patient is
observed to be slouching. Shoulders are observed to be drooping.
During our interaction, I have observed that he doesn’t take a bath everyday. I
can see that his clothing used today is the same as for the other day. I can smell
a little bad odor in a far. Though I can meet him while he is inside his cell, I can
still able to smell his body odor. His teeth are also not clean. Though he has his
toothbrush and toothpaste located inside his cell, he seldom use it.

Behavioral Analysis on a Patient with Schizophrenia
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-
Teeth brushed
4. Movements
- Inappropriate gestures or
mannerisms
- Slow
- Rapid
- Restless (Move back and forth)
- Easily tears

o
The patient walks slow, talks slow, and do things slow. He never does things in a
rush. During the whole rotation with him, I never saw him walk fast even inside
his cell. He sometimes kept on moving back and forth while staring on the floor.


5. Skin
-
Clean
Clear
Flushed
Perspiring
Scratched
Blistered
Dry
Warm
6. Legs and ankles
- Swollen
- Atrophied
- Others
 Dry
 Scaly
7. Complaints of pain
- Specify

My patients’ skin appears clean and dry. Sometimes I can observe that his skin
is scaling especially in his lower extremities. It is warm to touch and has minimal
perspiration. His skin is clean with no scratches and blisters. He also appears pale
or flushed sometimes.



His legs have dry skin; sometimes his skin in the lower extremities is observed to
be scaly. There is absence of swelling and edema on legs and ankles.

Behavioral Analysis on a Patient with Schizophrenia
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 Sometimes complained of
on and off muscle pain on
his shoulder.
8. Habits (note if normal or with
disturbance)
- Sleeping
- Drinking
- Elimination




9. Food
-
II.
Eats well and enjoys food
Voracious
Picks on food
Does not eat at all
Emotive Assessment
1. Characteristics of affect
- Spontaneous
- Appropriate
- Flat
- Ambivalent
- Mood swings
2. Predominant Affective reactions
- Euphoric
- Resigned
- Anxious
When I had our working phase, I asked him if he had any complaints of pain
and he said that his shoulders are aching and that he frequently feels it without
any trigger. According to the patient, it is due to fall from a coconut tree.
Drinking and elimination are normal. He seldom drinks soft drinks and verbalized
that he urinates frequently in a day but forgot the exact frequency. He
defecates once a day. According to him, he can’t sleep very well due to
environmental factors and he has nightmares as well (which he refuses to
mention). He usually sleeps 7 in the evening and wakes up 6 in the morning. He
seldom wakes up in the middle of the night. During the day, he usually sleeps
Eats well and enjoys eating his food. Verbalized that he consumes his food or
meal and does not leave anything, since it is a grace from God. He does not
choose on what food to eat. He has a healthy appetite. He likes to eat
vegetables. In addition, his favorite food is Beef soup.



There are times when he just stares at you with no facial reaction or blank facial
expression. But often times, he has appropriate affect and seldom maintains
eye contact when talking.
He rarely shows his expression, most of the time he looks depressed and sad. He
seldom smiles. I also observed that he doesn’t interact with other patient in the
hospital, I asked him and he verbalized that he does not initiate doing a
conversation with other person. He is always alone (although he is always locked
Behavioral Analysis on a Patient with Schizophrenia
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-
Over active
Depressed
Withdrawn
Resentful
Irritable
3. Appropriateness of affect to
- Speech
- Behavior
- Immediate situation
4. Reaction to
- Being in hospital
- Treatments
- Medications
- Interviews
- Visitors
III.
Cognitive Assessment
1. Thought content
- Flight of ideas
- Associated looseness
- Preoccupations
- Concerns
- Coherence











inside the cell) and often sleeps more inside his cell. I have observed that he is
withdrawn. He usually stares on the floor.
Speech and behavior is appropriate since his facial expression is coherent with
his speech and behavior. He only smiles and sometimes laughs when there is
something to laugh about or a need to do so.
The patient usually verbalized that being in Talay is fine with him, but he
sometimes feel alone and depressed whenever he remembers his family. He
feels powerless to change his current situation, but he really likes it very much to
have a work and gain money for living.
He has no complaints regarding his treatment and with his medical regimen.
He is very cooperative to student nurses. He answers the questions of student
nurses without hesitance. He finds relief, whenever he talks to us because it is
only his way to express his feelings and problems.
His visitors are his mother, student nurses and sometimes his siblings.
He is observed to be preoccupied with family problems. But he said that he
really doesn’t think about it seriously due to his situation right now. He is coherent
in answering our questions. Although he sometimes is not consistent with his
answers. Flight of ideas, associated looseness, and concerns are not identified
to our patient.
Behavioral Analysis on a Patient with Schizophrenia
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2. Thought disturbance
- Delusions
- Hallucinations
- Obsessions
- Phobias
- Compulsions
- Suicidal thought/ideas
- Ideas of reference
- Loose associations
- Logical ways of thinking
3. Sensorium
- Degree of consciousness
- Confused
- Past and present memory
- Orientation to time, place and
person
4. Judgment and insight
- Can make appropriate
decision
- Decision making
- Aware of psychiatric problem
- Understands own motives or
behaviors
IV.








On his chart, he has auditory hallucination noted during the admission. But
within our 4 days interaction, it was not noted.
Sometimes my patient loses association. He has disorganized thinking that jumps
from one idea to another with little or no evident relation between the thoughts.
Oriented as to person, place, and time. He clearly remembers the things that
happened to him in the past. He also remembers the year and month he got in
to the institution. In addition, he even verbalized that he can clearly picture her
siblings’ and father’s face. He can also remember his past years with his 2 cousins
whom he considered his best friends back in his hometown. He can also
remember from the start of the scene when he falls down from a coconut tree
up to when he was brought to the hospital last 2007.
He is capable of making simple decisions, but has not made any major life
decisions. He has plans for the future, but does not know where to start. He
knows the reason why he is in Talay, He always verbalized that he already wants
to go home to be with his family and be able to play with his friends in the
neighborhood.
Behavior assessment
Behavioral Analysis on a Patient with Schizophrenia
25
1. General Attitude
- Confident
- Fearful
- Friendly
- Evasive
- Demanding

He is unsure of himself but he is very friendly and nice. He is also shy and always
quiet at one side. He talks to people, when other people talk to him, he does
not initiate to start a conversation since he is shy. He doesn’t mingle with other
patients at all except when he is mingled first by other patients. He is also
approachable and is willing to take part in interaction with us as well as with
other therapies or activities while inside his cell.
Review of the 5 Domains
A. PHYSICAL DOMAIN
This refers to the concrete, physical reality of the self-system. The components are body systems, gross motor skills, sensory skills, physiologic
parameters, genetics, organ development, fine motor skills, vital signs, height, weight and organ functioning. Physical influences how a person
response to psychosocial stress or illness. The healthier a person is, the better he or she can cope with stress or illness. Poor nutritional status, lack of
sleep, or a chronic physical illness may impair a person’s ability to cope. Unlike genetic factors, how a person lives and takes care of himself or
herself can alter many of these factors. Personal health practices, such as exercise, can influence the client’s response to illness. Motor activities
for schizophrenic clients may be within the normal range or may be either of the two extremes: too little or too much. Those with too little motor
activity, catatonic clients unable to respond to commands and shows a marked withdrawal. They may move themselves into unusual, seemingly
uncomfortable positions and remain there for hours. An increase in motor activity is usually demonstrated by agitation, inability to sleep, weight
loss and loss of appetite. Increased motor activity may be accompanied by emotional liability, impulsiveness, and flight of ideas. When the
individual is unable to exert the usual, socially expected control, impulsive behavior may result. This behavior appears to be sudden, unpredictable,
unmotivated and illogical. The client may become verbally abusive, aggressive or even violent.
Client’s Manifestations:
As what I have observed in my client, he stands erected, with inappropriate mannerisms like staring blankly sometimes during our interaction.
He doesn’t brush his teeth once a day and dentals carries were very evident His skin is dry. He is not abusive, aggressive and hostile during the
whole duration of the interaction.
B. EMOTIONAL DOMAIN
Emotions are described in terms of mood and affect. Mood is defined as an extensive and sustained feelings tone that can be experienced
for a few hours or for years and can noticeably affect the person’s worldview. Affect refers to behaviors such as hand and body movements,
facial expression, and pitch of voice that can be observed when a person is expressing and experiencing feelings and emotions.
Behavioral Analysis on a Patient with Schizophrenia
26
Client’s Manifestations:
As what I have observed in my client, he smiles when he will able to see me. He has flat affect then shifts to being euphoric. He often has blank
stares on the floor during the interaction. When I asked him what he was thinking, he would look at me straight and blankly. He also verbalized
that he was a bit sad because his family is not already visiting him except his mother. He stands erect but sometimes he slouches and drops his
shoulders.
Behavioral Analysis on a Patient with Schizophrenia
27
C. SOCIAL DOMAIN
Socialization is the ability to form cooperative and interdependent relationships with others. This was placed last among the five major brain
functions because problems with others must be understood to appreciate the relational consequences of maladaptive neurobiological
responses. Social problems are often the major source of concern to families and health care providers because these tangible effects of illness
are often more prominent than the symptoms related to cognition and perception.
Client’s Manifestations:
As what I have observed in my client, he usually welcomes the presence of student nurses. He claims that he has less friends especially in his
hometown he doesn’t really mingle to other people he doesn’t know. He just likes to be with his 2 close friends who are also his cousins. He also
told me that whenever he goes to his hometown, he stays at his friend’s house. He actually doesn’t have a friend inside the rehabilitation center.
D. SPIRITUAL DOMAIN
Life force, soul, consciousness of existence, one’s transcendental relationship. Components include commitment, verve/resiliency, ethics,
survival instincts, faith, ability to love and be loved, purpose/drive in life, allocentrism, integrity, meaning of life, hope, will. Spirituality is at the core
of the individual’s existence, integrating and transcending the physical, emotional, intellectual and social dimensions. Spirituality involves the
essence of a person’s being and his or her beliefs about the meaning of life and the purpose for living. It may include belief in God or a higher
power, the practice of religion, cultural behaviors and practices, and a relationship with the environment.
Client’s Manifestations:
As what I have seen in the chart of my client, he is a Roman Catholic. He claimed that only God understands him. He also believes that
everything is planned for him. He also verbalized that he would offer his life for God and that he has great faith in him. He believes that God can
only be the one who can help him to solve his problem.
E. COGNITIVE DOMAIN
It is the act or process of knowing. It involves awareness and judgment that enable the brain to process information in a way that ensures
accuracy, storage and retrieval. Information processing involves the organization of sensory input by brain processes into behavioral responses.
Sensory input from both internal and external senses is screened according to the focus of the person’s attention and ability to remember, learn,
discriminate, interpret and organize information. The result is evident in the person’s thinking, perceiving, feeling, behavior and relatedness to
others.
Client’s Manifestations:
I have seen in his chart that his educational attainment is first year high school. He also claimed that he stopped studying because he has
to travel to Manila to find a work for his family. He actually knew why he was admitted in the institution. He remembered the first time he was
Behavioral Analysis on a Patient with Schizophrenia
28
admitted in the institution and how many months he was there. He was able to remember how many times he was admitted in the hospital and
what’s the cause of his mental problem is.
Behavioral Analysis on a Patient with Schizophrenia
29
Nursing Care Plans
Behavioral Analysis on a Patient with Schizophrenia
30
First Priority Nursing Care Plan
Cues and
evidences
Subjective data:
- “Daghan ra ang
problema sa
among pamilya,
nag-pasamot pa
ko.”
- “Naguol ko kay
wala nako
nakatabang sa
akong pamilya.”
- “Dili ra ko mu
drawing kay dili
ko kabalo.”
- “Scientist lang
ang kabalo
mudrawing. Dili
nako na kaya.”
Objective data:
- Inability to ask
for help.
- Inability to
problem-solve.
- Inability to
manage own
Nursing
diagnosis
1. Ineffective
individual
coping related
to inadequate
level of
confidence in
ability to cope
Objectives
Within our 4 days
interaction, our
client will
improve coping
strategies as
evidenced by:
Implementation
Independent:
1. Assess/ observe for
destructive behavior
towards self and others.
a. Ability to
demonstrate
an absence of 2. Assess and recognize
destructive
early signs of
behavior.
manipulative behavior.
b. Cease use of
manipulation
to obtain
needs and
control others.
c. Ability to solve
a problem.
d. Respond to
external
controls
(medication,
seclusion,
nursing
interventions)
when
potential or
3. Assess presence of
positive coping skills/
inner strengths such as
use of relaxation
techniques, willingness to
express feelings or use of
support system.
4. Maintain a firm, calm
and neutral approach at
all times.
5. Avoid arguing with the
client.
Rationale
1. Hostile verbal behaviors, poor
impulse control, provocative
behavior, and violent acting out
against others or property are
some of the symptoms of this
disease and are seen in extreme
and/ or acute intervention can
prevent in the environment.
2. Setting limits is an important step
in the intervention of bipolar
clients, especially when
intervening in manipulative
behavior.
3. When the individual has coping
skills that have been successful in
the past, they may be used in the
current situation to relieve tension
and preserve the individual’s
sense of control.
4. Behavior by mental staff can
escalate environmental
stimulation and consequently,
manic activity. Adaptation Theory
by Sister Callista Roy: Helping and
assisting the patient to develop
coping abilities.
Evaluation
At the end of our 4
days interaction,
our client was able
to meet the
objectives as
evidenced by:
a. Met. There was
no destructive
behavior happened
within our care.
b. Met. No
manipulation done
by the patient as
observed.
c. Slightly met. Was
not able to solve a
problem. Only that
he was able to
accept and learn
that he was inside
the rehabilitation
center in order to
recover from his
illness.
d. Met. He was
place in an isolated
area specifically at
Behavioral Analysis on a Patient with Schizophrenia
31
ADLs such as
taking a bath
and brushing
the teeth.
- Destructive
behavior
towards self or
others.
- Change in usual
communication
patterns.
- Presence of
auditory
hallucination.
- Diagnosed to
have
unpredictable
behavior.
actual loss of
control occur.
e. Respond to
limit-setting
techniques
with aid of
medication
when
unpredictable
behavior is
observed.
f. Absence of
auditory
hallucination
g. Ability to
manage his
own ADLs
6. Establish therapeutic
nurse-patient
relationship.
7. Note expressions of
indecision, dependence
on others, and inability to
manage own ADLs.
8. Discuss feeling of selfblame/projection of
blame on others.
9. Encourage patient to
talk about what is
happening at this time
and what has occurred
to precipitate feelings of
helplessness and anxiety.
5. Once the client is out of control,
seclusion might be required,
which can be traumatic to the
individual as well as the staff.
Environmental Theory by Florence
Nightingale: Provision of optimal
conditions to enhance the
person’s reparative processes and
prevent the reparative processes
from being interrupted.
6. Patient may feel freer in the
context of this relationship to
verbalize feelings of
helplessness/powerlessness and to
discuss changes that may be
necessary in patient’s life.
7. May indicate need to lean on
others for a time. Early recognition
and intervention can help patient
regain equilibrium.
8. Although these mechanisms may
be protective at the moment of
crisis, they eventually are
counterproductive and intensify
feelings of helplessness and
hopelessness.
Isol B and was
transferred to Isol C
and was locked
inside to prevent
any harm if
destructive
(unpredictable)
behavior occurs.
e. Not met. No
unpredictable
behavior observed
within our care.
f. Met. Auditory
hallucination not
noted within our
care.
g. Not met. Patient
still was not able to
take a bath every
interaction and
dental carries also
observed. Hair is still
not combed.
9. Provides clues to assist patient to
develop coping and regain
equilibrium.
a.
10. Evaluate ability to
understand events.
Behavioral Analysis on a Patient with Schizophrenia
32
Correct misperception,
provide factual
information.
11. Provide quiet,
nonstimulating
environment. Determine
what patient needs,
and provide if possible.
Give example, factual
information about what
patient can expect and
repeat as necessary.
10. Assists in identification and
correction of perception of
reality and enables problem
solving to begin.
11. Decreases anxiety and provides
control for patient during crisis
situation.
12. Allow patient to be
dependent in the
beginning, with gradual
resumption of
12. Promotes feelings of security. As
independence in ADLs,
control is regained, patient has
self-care, and other
the opportunity to develop
activities. Make
adaptive coping/problemopportunities for patient
solving skills.
to make simple
decisions about
care/other activities
when possible,
accepting choice not to
do so.
Collaborative:
13. Administer an
antipsychotic
medication as ordered
and evaluate for
13. Schizophrenia is caused by
biochemical neurologic
imbalances in the brain.
Behavioral Analysis on a Patient with Schizophrenia
33
efficacy, and side and
toxic effects.
14. Refer to other resources
as necessary such as
psychiatric clinical nurse
specialist /psychiatrist,
family/marital therapist,
addiction support
group.
Appropriate antipsychotic
medications allow psychosocial
and nursing interventions to be
effective.
14. Additional assistance may be
needed to help patient resolve
problems/make decisions.
Second Priority Nursing Care Plan
Cues and
evidences
Nursing diagnosis
Objectives
Implementation
Rationale
Evaluation
Behavioral Analysis on a Patient with Schizophrenia
34
Subjective data:
- “Dili ra ko musulti
sa akong gibati kay
maulaw ko.”
- “Naguol ko kay
wala nako
nakatabang sa
akong pamilya.”
- “Nitabang ko sa
akong ginikanan sa
paghakot kay mao
ra man among
pangabuhian.”
- “Wala rako ni apil
therapy kay
maulaw ko unya dili
pud ko kabalo.”
Objective data:
- Inability to ask for
help
- Inability to meet
basic needs
- Feeling of
uselessness and/or
helplessness
2. Situational low
self-esteem related
to role performance
as evidenced by
verbalization of
negative feelings
about the self
Within our 4 days
interaction, our
client will improve
self-esteem as
evidenced by:
a. Ability to ask for
help from the
student nurses or
nurses in the
institution
b. Ability to meet
basic needs
c. Ability to solve
problem
d. Ability to control
his behavior
towards self or
others
e. Improvement in
usual
communication
patterns
f. Absence of
auditory
hallucination
Independent:
1. Ask what the
1. Shows courtesy/respect and
patient would like to
acknowledges person.
be called.
2. Identify SO from
whom the patient
derives comfort and
who should be
notified in case of
emergency.
2. Allows provision to be made
for specific person(s) to visit
or remain close, and
provides needed support for
patient.
3. Determine patient
perception of threat 3. Patient’s perception is more
to self.
important than what is really
happening and needs to be
dealt with before reality can
be addressed.
4. Active-Listen patient
concerns and fears. 4. Conveys sense of caring and
can be helpful in identifying
patient’s needs, problems,
and coping strategies and
how effective they are.
Provides opportunity to
duplicate and begin a
5. Encourage
problem-solving process.
verbalization of
feelings, accepting 5. Helps patient/SO begin to
what is said.
adapt the change, and
reduces anxiety about
altered function/lifestyle.
Adaptation Theory by Sister
Callista Roy: Helping and
At the end of our 4
days interaction, our
client was able to
meet the objectives
as evidenced by:
a. Met. Was able to
ask help from the
student nurses on
how to cope
with his problem
such as being
one of the
money gainer of
his family.
b. Met. He can eat
well, has a bed
with pillow and
blanket for him to
sleep, has
container for
drinking water
and a plastic
glass, and is freely
able to gasp air.
c. Slightly met. Was
not able to solve
a problem. Only
that he was able
to accept and
learn that he was
inside the
Behavioral Analysis on a Patient with Schizophrenia
35
- Inability to
problem-solve
- Destructive
behavior towards
self or others
- Change in usual
communication
patterns
- Presence of
auditory
hallucination
- Diagnosed to
have
unpredictable
behavior.
- Poor self-esteem.
6. Provide
nonthreatening
environment, listen
and accept patient
as presented.
assisting the patient to
develop coping abilities.
6. Promotes feelings of safety,
encouraging verbalization.
7. Observe nonverbal
communication
such as body
posture and
movement, eye
contact, gestures,
use of touch.
7. Nonverbal language is a
large portion of
communication and
therefore is extremely
important. How the person
uses touch provides
information about how it is
8. Observe and
accepted and how
describe behavior in
comfortable the individual is
objective terms.
with being touched.
9. Identify age and
developmental
level.
8. All behavior has meaning,
some of which is obvious
and some of which needs to
be indentified.
9. Age is an indicator of the
stage of life patient is
experiencing. However,
developmental level may be
more important than
chronologic age in
anticipating and identifying
some of patient’s needs.
Some degree of regression
occurs during illness,
rehabilitation
center in order to
recover from his
illness.
d. Met. He was able
to control his
behavior in the
sense that he was
calm and he
doesn’t make
any plans of
hurting his own
self or even
others.
e. Slightly met. Still
he has the ability
to jump from one
topic to another.
But he can
answer fluently
some of our
questions. He
communicates
well to student
nurses.
f. Met. Auditory
hallucination not
noted within our
care.
Behavioral Analysis on a Patient with Schizophrenia
36
10. Discuss the patient’s
view of body image
and how
illness/condition
might affect it.
depending on many factors
such as normal coping skills
of the individual, the severity
of the illness, and
family/cultural expectations.
11. Acknowledge
10. Patient’s perception of a
efforts at problem
change in body image may
solving, resolution of
occur suddenly or over time
current situation,
or be a continuous subtle
and future planning.
process.
12. Ascertain how
patient sees own
11. Provides encouragement
role within the family
and reinforces continuation
system such as
of desired behaviors.
breadwinner,
homemaker,
brother, son.
12. Illness may create a
13. Determine patient
temporary or permanent
awareness of own
problem in role expectations.
responsibility for
How patient views self in
dealing with
relation to the current illness
situation, personal
also plays important parts in
growth.
recovery.
Collaborative:
14. Provide information
and referral to
hospital and
community
resources
13. Conveys confidence in
patient’s ability to cope.
When patient acknowledges
own part in planning and
carrying out treatment plan,
he or she has more
investment in following
Behavioral Analysis on a Patient with Schizophrenia
37
through on decisions that
have been made.
15. Refer to psychiatric
support/ therapy
group, social
services, as
indicated.
16. Support
participation in
group/community
activities.
14. Enables patient/SO to be in
contact with interested
groups with access to
assistive and supportive
devices, services, and
counseling.
15. May be needed to assist
patient/SO to achieve
optimal recovery.
16. Promotes skills of coping and
sense of self-worth.
Third Priority Nursing Care Plan
Cues and evidences
Subjective data:
Objective data:
- Frequent Yawning.
- Eye bag noted.
- Appears sleepy
during interaction.
Nursing diagnosis
3. Disturbed sleep
pattern related to
frequent nightmares
Objectives
Within our 4 weeks
interaction, our client
will have an improve
sleep pattern as
evidenced by:
a. Client will sleep 6-8
hours per night.
b. Absence of
yawning.
Implementation
Rationale
1. Assess patient’s
sleeping pattern.
1. Serves as the baseline data,
problems in sleeping.
2. Encourage
frequent rest
periods during the
day.
2. Lack of sleep can lead to
exhaustion and death.
3. Keep client in areas
of low stimulation.
3. Promotes relaxation and minimizes
unnecessary behavior.
Environmental Theory by Florence
Nightingale: Provision of optimal
Evaluation
At the end of our 4
weeks nursing care,
our client was able to
improve his coping
strategies as
evidenced by:
a. Met. Client was
able to sleep for 6
hours per night.
Behavioral Analysis on a Patient with Schizophrenia
38
- Droopy eyes during
interaction.
conditions to enhance the
person’s reparative processes and
prevent the reparative processes
from being interrupted.
c. Absence of eye
bags.
- Sagging eyes.
- Restless.
d. Client will
participate during
the interaction.
4. Avoid giving client
caffeine.
4. Promotes relaxation: rest and
sleep.
5. Encourage client to
avoid using
5. Promote good sleeping pattern:
cigarette.
nicotine has a chemical contents
that affects the patients sleeping
pattern.
b. Met. Absence of
yawning.
c. Met. Absence of
eye bags.
d. Met. The client
participated
during our
interaction and to
our activities/
therapies but he
only stays inside his
cell.
Behavioral Analysis on a Patient with Schizophrenia
39
Summary of Nursing Diagnoses
Ineffective individual coping related to ineffective problem solving
strategies.
Situational low self-esteem related to role performance as
evidenced by verbalization of negative feelings about the self
Disturbed sleep pattern related to frequent nightmares.
Disturbed thought processes related to overwhelming stressful life
events
Risk for self-directed violence related to antisocial character.
Behavioral Analysis on a Patient with Schizophrenia
40
Behavioral Analysis on a Patient with Schizophrenia
41
SYNTHESIS
Sometimes, we, as student nurses work so hard to deliver the best interventions for our patients, but above all the
different intricate interventions, we sometimes do not realize that the best intervention in the psychiatric rotation is our
unselfishness. By letting them feel the unconditional concern for them, they are being cared for. That would be the
best intervention, though unselfishness would be a tough value, it will eventually grow after a number of sincere student
nurse-patient interactions. In my case, I can say that I have already established a good therapeutic relationship.
Service is the overflow which pours from a life full of love and devotion (James Reimann 1998). The services we
render to our patient are those that come after we had felt concern from others. In our profession, altruistic service is
essential that is because without it, there will never be an improvement in the patient’s condition. After I had our
Working Phase, I got to see how life really works, how delicate my patient in the Psychiatric Ward is, and most of all
how he underwent appalling experiences that were causes of the mental challenges he is facing.
Behavioral Analysis on a Patient with Schizophrenia
42
REFERENCES
 Antai-Otong, D. (2008). Psychiatric Nursing: biological and Behavioural
Concepts. W.B. Saunders Company.
 Bostrom, C.E., Keltner, N.L. and Schwecke, L.H. (2003). Psychiatric Nursing. 4th
ed. St. Louis, Missouri: Mosby Inc.
 Laraia, G.W. and Stuart, M.T. (2001). Principles and Practice of Psychiatric
Nursing. 7th ed. St. Louis, Missouri: Mosby Inc.
 Mohr, W. (1998). Johnson’s psychiatric mental health nursing. 5th ed.
Lippincott.
 Nobles, S. (2002). Delmar’s Drug Reference for Health Care Professionals.
Austalia: Delmar Thomson Learning.
 Rawlins, R.S. et al. (1993). Mental health psychiatric nursing. 3rd ed. St. Louis,
Missouri: Mosby Inc.
 Videbeck, S. (2006). Psychiatric mental health nursing. 6th ed. W.B. Saunders
Company.
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43