Nursing care for patients with schizophrenia (by guest blogger Nicole Muscari)

Here is my personal review and key takeaways from an article about nurses empowering patients with schizophrenia and relating this information to my current practice with the oncology population.

Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery

Some questions to consider when completing an assessment for a patient with schizophrenia diagnosed with cancer:

1. Who is your Psychiatrist?
2. Who is your Therapist?
3. What are you most concerned about related to your overall health?
4. What can I do to support you throughout your care here?
5. What lifestyle or personal goals do you have?
6. What barriers exist in reaching your goals?
7. Do you have any concerns or worry about your cancer treatment plan?
8. Do you have any concerns about your mental or emotional health?

A cancer patient with a mental illness, like schizophrenia, requires a personalized approach in delivering their care.   This patient population typically needs antipsychotic medication and psychosocial therapy to maintain symptom control. We know that this is already a difficult chronic illness and when symptoms are not well controlled then we may find ourselves with various challenges in cancer treatment and compliance, ultimately leading to poor outcomes. The first steps in caring for this specialized population is by:

1. Establishing shared decision-making
2. Empower the patient to be an active participant in care – provide them with education and information about their cancer and their treatment
3. Open and transparent therapeutic communication – being respectful, kind and supportive
4. Creating personalized goals together (goals that are reasonable and attainable)

Naturally we think about surgery, chemotherapy, radiation and other supportive treatments for one’s physical well-being. With this population, it is important to begin with psychosocial needs, by creating interventions that will support the patient emotionally and holistically. Types of interventions that you may consider for the patient with cancer and schizophrenia:

1. Social Work referral
2. Psychosocial Oncology referral
3. Supportive Therapies such as: Integrative Medicine, Chaplain
4. Exercise and Sleep interventions – consider Physical Therapy
5. Cognitive Supportive therapies – consider Occupational Therapy

Important information to keep in mind when caring for this population:

1. Medication compliance in patients with schizophrenia is about 40% during the first 3 months of initial treatment.
2. On average, it is reported that these patients take 51% to 70% of their prescribed medication.
3. In terms of treating cancer in a patient with schizophrenia, we know that follow through with scheduled visits, tests, chemotherapy and/or other supportive therapies are imperative to achieving remission.

With that being said, I would like to leave you with a few important questions to ask yourself when caring for a patient with both cancer and schizophrenia:

1. What can I do as a healthcare provider to support this patient and allow them the best chance for survival?
2. What does the patient need in terms of psychosocial support?
3. Am I taking a holistic approach and focusing on the patient’s mental, physical, spiritual, and emotional well-being?
4. Do I take into consideration the patient’s schizophrenia diagnosis when addressing cancer care needs?

Reference

Mahone, I., Maphis, C., & Snow, D. (2016). Effective strategies for nurses empowering clients with schizophrenia: medication use as a tool in recovery. Mental Health Nursing, 37, (372–379).

Background of Guest Blogger: Nicole Muscari is a Graduate Student at The Ohio State University studying Psychiatric Mental Health Advanced Practice Nursing and plans to graduate in May 2017. She has been a registered nurse for 15 years and has worked for The James Cancer Hospital for 13 years. She received her undergraduate BSN degree from The Ohio State University College of Nursing.