Case study methodology problem classification for adult with schizophrenia
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Case Study Methodology: Problem Classification for Adult with Schizophrenia. Elaine H Darst, PhD, RN Nicole Gapp , BSN, RN Karen Monsen, ,PhD, RN, FAAN. Case Study Complex Factors and Interactions. Mental Health. Problem: schizophrenia Knowledge - 2

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Case Study Methodology: Problem Classification for Adult with Schizophrenia

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Case study methodology problem classification for adult with schizophrenia

Case Study Methodology:Problem Classification for Adultwith Schizophrenia

Elaine H Darst, PhD, RN

Nicole Gapp, BSN, RN

Karen Monsen, ,PhD, RN, FAAN


Case study complex factors and interactions

Case StudyComplex Factors and Interactions


Mental health

Mental Health

  • Problem: schizophrenia

  • Knowledge - 2

    • does not identify self as having a mental illness, but is discussing schizophrenia with a support person

  • Behavior - 4

    • takes medications as prescribed because “I have to take them to live here” (supervised setting)

  • Status - 2

    • Paranoia ongoing

    • Psychotic symptoms at a stable level

    • Executive functioning (initiative, planning) impaired


Cognition

Cognition

  • K – 2 Needs external reminders/management regarding personal and room hygiene

  • B – 3 Reminders by support system (HHA) to shower/change clothes

  • S – 3 Cognitive deficits in executive functioning (memory, initiative; follow-through, but normal intelligence)


Income

Income

  • K – 3, B – 2, S - 5

  • K – 3 (Basic), client requires use of payee

  • B – 2 Behavior is rarely appropriate regarding overall financial management, but he tries to use his allowance carefully

  • S – 5 In contrast, status is rated 5. No issues are present, so the structure is working.


Abuse

Abuse

  • K – 2, B – 3, S - 5

  • Minimal knowledge about self & other protection

  • Basic ability for self-protection

  • Status - no problems at this time. Has been assaultive in past when paranoid


Interpersonal relationship

Interpersonal Relationship

  • K – 3, B – 3, S – 4

  • K - basic knowledge about relationship maintenance

  • B - sometimes inappropriate suspiciousness and interpersonal withdrawal

  • S - minimal symptoms – the environment provides daily social opportunities and support, as well as help with interpersonal conflict


Environmental support provides

Environmental Support provides

  • Mental Health management – medication compliance

  • Stability in Interpersonal Support & contact with others

  • Structure to support executive functioning

  • Protection from abuse due to accessible support

  • Prevention of aggression through mental health management


Case conclusion

Case Conclusion

  • This patient

    • Takes medications as prescribed although not able to recognize illness

    • Keeps appointments although not able to plan and execute plans

    • Works on managing self-care

  • Conclusion:

  • The environment/setting provides supports that accommodates deficits, so the client is functional.


Complex data is distilled for decision making

Complex Data is Distilled for Decision Making

  • The Omaha system was used to distill complex information into meaningful problem categories and KBS ratings.

  • Contrasting KBS ratings clarified the contribution of the environment to the client’s abilities.

  • Significant decisions, such as the optimal living situation or discharge planning from acute care, can be more effectively implemented.


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