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with schizophrenia, but indicates no threat. You have just read according to Medical News
Today, that a paranoid schizophrenic stabbed his brother to death just hours after community
mental health workers left his house saying there was no sign of immediate danger (Medical
News Today 2012). In college you learned that schizophrenia is becoming more widely viewed
as a group of illnesses rather than a single condition. How does a nurse differentiate between all
of the facts given as it relates to nursing care for patients with schizophrenia? There was a five
time award-winning movie, "One Flew Over the Cuckoo's Nest", played by characters Randall
McMurphy (Jack Nicholson) and Chief Bromden (Will Sampson) that shares some real
cognitive deficits of this disorder. In short, the movie shares the perception that it is when we
speak and react to the patient as a person in whole we learn more about them, than to speak and
react to the patient as a schizophrenic. This paper will help new student nurses provide the best
therapeutic approach with an in-depth knowledge of their past, present and future. So, to make
sure we do not miss out on the most important question, let us begin with a simple but telling
Introduction
features of being out of touch with reality. Hallucinations, delusions and social isolation are the
major symptoms of this disorder. Patients with schizophrenia tend to exhibit very unusual
suspicions, fears and may also mention hearing voices. Although the condition may appear as an
acute, rapid onset or may even develop over time, the first few signs may be hard to identify
because people often develop this illness during the younger years of life. Most patients with this
disorder often integrate others around them into their delusion. Some patient's feel that the
nursing staff are deliberately trying to harm him or her in some way. Interestingly, one of the
characters who played a psychiatrist in the movie shared that it is not the same as a person with
multiple personalities. It's not split, but more like shattered untamed thoughts or a mismatched
Identity
There are psychiatric institutions in every city standing in place for insidious onsets of
schizophrenia. The movie setting used Oregon State Hospital as the ward specializing in the
treatment in serious psychiatric illnesses such a schizophrenia. McMurphy finds a way to get
transferred from jail to this Oregon facility to avoid the harsh labor of his sentencing by
pretending to be mentally ill. Chief Bromden, the Indian narrator and character in the movie has
been the longest resident on the ward for nearly a decade. Bromden's schizophrenic disorder
became evident that he suffered from hallucinations and paranoia. For example, when a person
with schizophrenia becomes angry or upset, they often revert to feeling powerful and strong like
the "Hulk". In their mind, there is enough increase in size and power to take down an army.
Alike, as they become mentally afraid, they tend to try and hide themselves to escape from the
real world. Chief Bromden experienced hallucinations that fog was enveloping him. He thinks,
"They start the fog machine again and its snowing down cold and white all over me like skim
milk, so thick I might even be able to hide in it if they didnt have a hold on me." (Kesey 1975).
What a great observation! This part of the identification assessment should let the nursing
student know the positive and negative symptoms of a patient that may be experiencing
schizophrenia.
Analysis
According to the Department of Health, there is no one single cause of schizophrenia, but
there are several predisposing factors that have been shown to have been associated with the
onset of it. A predisposition of schizophrenia can run in the family. If either parent has
schizophrenia, there is a 10-percent chance the child will have it too! Studies of identical twins
show that if one twin has schizophrenia, the other has about a 50-percent chance of developing it.
Other studies have examined that certain biochemical substances in the brain are believed to be
chemical imbalances and brain abnormalities such as fear and helplessness. (Williams & Hopper
pg 1369). Bromden, like his father is a big man who comes to feel small and helpless. When he
witnessed the death of his father as a young child, the officials acted as if he was not there. This
experience made him withdraw from himself as he ended up breaking down from all the
horrifying events he saw his father go through. Chief Bromden shares with McMurphy that most
of the patients take trips to the shock room to help minimize the carnival wheels of memories
and emotions. One patient explains that is a like a trip to the moon, only you pay with brain cells
rather than money. There was a scene in the movie when McMurphy faked to have been given
an electroshock treatment and joins the group therapy session with Chief Bromden. He walks
slowly towards him with his eyes rolling to the back of his head and then all of a sudden, he
Therapeutic Treatment
As a nurse, you should understand that one of the first and probably most confusing
experiences a patient diagnosed with schizophrenia will have is that of being bombarded with the
many various types of treatments options. A major component of the effectiveness of these
therapeutic modalities and medications is the compliance of the patient. If the patient refuses to
take the prescribed medications, social skills training, individual or group psychotherapy, they
may experience a relapse or worsen the condition. The nurse should establish a supportive
therapeutic alliance that will allow the patient to develop trust with the desire to cooperate with
treatment. Identify the patient's goals, aspirations, and barriers such as cognitive impairments.
Some patients are not willing to do something just because you or the doctor says so. Chief
Bromden shared his theory about how this works: "it's all a great big machine (called the
Combine) and everybody comes to the hospital to get the parts needed to be fixed by this
machine and the people who promote the Combine, like Nurse Rachett will give to prevent from
gaining power". He does not want to be part of it. He resists it and part of the resistance is
pretending to be deaf and dumb. However, psychotherapy techniques like individual and group
therapy sessions can help prime the patient experiencing schizophrenia to be more receptive to
the response to treatment (Mason 2013). There are also atypical antipsychotic medications help
to block dopamine actions in the brain such as clozapine (Clozaril) and risperidone (Risperdal).
Electroconvulsive therapy (ECT) is used in severe cases of schizophrenia, but this method is not
usually used until all other methods of therapy have been exhausted (Williams & Hopper
pg.1369). In the movie, McMurphy attempts to strangle the nurse because he felt she was partly
responsible for the death of another patient. Because of his violent actions, the nurse has him
opinion, is on the same lines as Electroconvulsive therapy. These types of therapy send shocks to
the frontal lobes of the brain to stabilize emotions without doing away with their intelligence.
However Chief Bromden shares a different perspective. The Lobotomy procedure left
McMurphy in a vegetable state. Upon McMurphy's return to the ward, Chief Brodem remarks
that "There's nothin' in the face. Just like one of those store dummies."
Therapeutic Communication
and how to communicate with schizophrenic patients. It is crucially important to not discuss
things with a patient experiencing schizophrenia while he or she is upset or angry. Use verbal
and non verbal methods of communication. Keep all verbal communications simple, brief and
specific. Non-verbal communication refers to how you say it- your tone of voice, posture, eye
contact, facial expressions and the physical distance between both parties. Although Chief
Bromden and McMurphy are two patients in the movie, McMurphy worked hard to save all the
patients from being labeled "schizophrenic", but Chief Bromden, a six-foot gigantic half indian
man, was the main target of his attention. McMurphy maintained a very calm manner which in
turn allowed Chief Bromden to open up about his thoughts and lower any anxiety he may have
been experiencing with haunting witnessing in the takedown of his father as chief of their tribe.
McMurphy encouraged Chief to do activities such as playing basketball being that he was tall
enough to touch the net without jumping. Sportsmanship showed Chief to realize his own value
and that he was not as weak and inferior as he thought. As a result, McMurphy won Chief
In conclusion, keep an open mind and do not under estimate the process of this serious
disorder. Chief Bromden shares an interesting brain teaser: "I have been silent so long now its
gonna roar out of me like floodwaters and you think the guy telling this is ranting and raving my
God; you think this is too horrible to have really happened, this is too awful to be the truth! But,
please. Its still hard for me to have a clear mind thinking on it. But its the truth even if it didnt
happen."
References
Shaun Hunt, Jerome Carson, (2017) "Remarkable lives: Shaun Hunt in conversation with
Jerome Carson", Mental Health and Social Inclusion, Vol. 21 Issue: 2, pp.80-85, doi:
10.1108/MHSI-01-2017-0003
Kesey, K. (2016). One flew over the cuckoo's nest. NY, NY: Penguin Books.
Mental Health and Social Inclusion. (n.d.). Retrieved April 13, 2017, from
http://www.emeraldinsight.com/doi/pdfplus/10.1108/MHSI-01-2017-0003
resource for consumers, families, and helping professionals. New York: Columbia
University Press.
News Archive from Medical News Today. (n.d.). Retrieved April 13, 2017, from
http://www.medicalnewstoday.com/categories
http://www.schizophrenia.com/