Calming a SCHIZOPHRENIC Patient 

 The admissions department of the hospital walks a schizophrenic patient named Jim , onto the psychiatric unit. He is psychotic after being off his medication for three weeks. His speech is pressured, speaking faster than normal. He states, “ I am the ‘king of England’ .I own this place .” He fluctuates between pacing the floor and standing still, staring into space while muttering under his breath.” As a charge nurse, it’s your responsibility to keep the patients safe on the unit and to develop a discharge plan before he leaves.

Calming a schizophrenic patient requires de-escalating skills. A schizophrenic patient has a mental disorder that can cause delusions or false beliefs, such as, “I am the’ king of England’ and I own this place.” Another symptom is hallucinations, which are seeing things or hearing voices not observed by others. Experiencing these symptoms can cause a person to lose touch with reality. Also, psychotic is a term describing an overall  loss of touch with reality.  https://www.mayo.clinic.org

Listed are some suggestions to assist in calming and de-escalating a psychotic schizophrenic patient. Before attempting to calm a patient, first do a self-check. Make sure you are calm by taking some slow deep breaths. Now, ask staff to remove the other patients from the area to decrease stimuli. Next , lower the lights, turn off the television and music. Lights and music can stimulate him. Give him space at least 1.5 feet from you, respecting his boundaries. Keep your voice, neutral, loud enough to hear, but don’t yell. If he yells, do not raise your voice, keep your volume low. The louder he gets, the lower your volume goes if he continues to yell, you quit speaking. You remain calm. If he calls you a name, ignore him. Some other calming techniques which can be used: maintaining eye contact, listening in a nonjudgmental way, avoiding confrontation. It is important to :avoid criticizing ,blaming, joking, or using sarcasm.

If things continue to escalate, it is important to have a plan for safety .If there is a risk of him harming himself or others. Be aware of the hospital’s policy about putting hands on a patient ; if they are in imminent danger of harming themselves or others.

 Also, maintain constant communication among staff. It is important to attempt to gain rapport with Jim . If he appears to find it easier to talk to a particular staff member, then that staff member should direct the interaction. As this interaction continued, it was apparent that Jim was starting to calm down and his speech was less pressured. His walking pace slowed down. He was interacting with a male employee. He had an injection ordered , he was agreeable to taking the medication. He was escorted to his room; the prescribed injection was given.

Throughout the patient’s hospital stay, the charge nurse and other team members developed a discharge plan. Members of the treatment team were involved in developing this plan. Members of this team were : the psychiatrist, therapist, social worker, charge nurse, and the patient. This plan was discussed weekly in a treatment team meeting .