This is a 49-year-old man born in an Asturias village whose family lives in the countryside and livestock.
Her parents, without studies, died due to tumor pathology, and she due to heart disease and diabetes.
He's the last of five brothers.
Schooled up to 15 years old, then starts working as a peon and later in the mining.
He is recognized as a happy person, friend of parties, worker, active and collaborator.
Two of his sisters emit Europe for labour reasons.
One of them, the elderly, commits suicide at 48 years of age.
Shortly before he was diagnosed with paranoid schizophrenia in 1982, he married, although his wife requested separation within a few months.
He received outpatient care, irregularly complying with the pharmacological treatment and avoided medication adherence. In 1984, he abandoned treatment.
Four years later, he was arrested and accused of a double attempt at murder against marriage, with which he always maintained an excellent relationship.
According to him, these people "used crimes" to make things bad.
He is imprisoned, admitted to a PHU (a psychiatric hospitalization unit) and later transferred to a prison psychiatric hospital.
In 1996 he returned to Asturias, located in different closed units of Mental Health Services until May 2000 and was admitted to La Casita.
It is characterized by a lack of awareness of psychiatric or somatic disease, as it suffers from non-insulin-dependent diabetes mellitus, and manifests a clear rejection to treatment even if it is taken as a condition to stay in the protected home.
It has a high level of conservation for activities of daily living (ADLs) and has good capacity for verbal communication.
She has lost contact with her environment due to the almost 15 years she has been institutionalized and although she has no economic problems, family support is not enough to stay at home.
Upon admission, the nursing assessment was performed using the mental health protocol, identifying altered patterns according to Gordon5, and using NANDA diagnoses 2001-20026.
Two scales and a questionnaire whose results are shown in Table 1 are also applied and subsequently evaluated by objectives.
1.
Regarding health patterns, there are four clearly dysfunctional.
Table 2 shows these patterns and the diagnoses selected for each of them.
After examining the patterns and selecting the diagnoses, different target groups were established from which activities were designed to achieve them.
1.
Infective management of the therapeutic regimen.
Regarding the first diagnosis, three groups of objectives were established: initial objectives; objectives at six months and two years.
The initial objectives are those that must be fulfilled from the first moment.
They have to do with basic issues of the functioning of the device that the subject must assume in order to stay in the protected home.
These are the following: 1) taking your medication from the first day; 2) attending appointments at the primary care center (PCC); 3) undergoing relevant analytical controls, and 4) accepting the anti-glycemic diet.
The second group of objectives, i.e. those to be achieved at six months, are: 1) the patient has a basic notion of "smoking" not knowing what drugs are; and 3) the patient will be able to recognize serious diseases "smoking" and "smoking" medication without medication; 2)
The objectives to be achieved at two years are the third group of those corresponding to the first diagnosis and include: 1) the patient will self-administer his/her medication to prescribe medication himself/herself and without crushing the prescription 2) will use the medication
Then, we proceed to the programming of activities aimed at the achievement of each of the three groups of objectives.
For the initial objectives, we worked at the level of interview patient-tutor at the time of admission.
The patient is informed of the rules to follow, the importance of the medication and controls that he/she must assume, showing the advantages and places where it will be performed.
It is accompanied by the PAC and presents the professionals who will assist it.
The express consent and voluntary acceptance of the operating regulations of La Casita were requested.
Among the activities performed to achieve the objectives at six months and two years, the inclusion of the patient in an individual self-medication program is highlighted, which is developed in the form of a workshop with medications and which also integrates self-medication.
Their collaboration and acceptance of the treatment are continuously reinforced and encouraged to prepare the medication.
In the weekly interview, problems related to the tutor are dealt with.
The patient is accompanied by the pharmacy, inspection and PAC to ensure that the process is implemented.
Smoking abstinence is reinforced; its use is restricted to certain spaces of the house and signs of violence are placed.
There are also sessions to discuss the smoking habit.
In the evaluation, to say that both the immediate objectives and those that go to six months have been achieved.
The same does not occur with those programmed at two years, since objectives 1, 4 and 5 relating to self-administration of drugs, the anti-glycemic diet and tobacco were not achieved.
The patient continues to smoke >40 cigarettes/day, and if not under supervision, he does not take his medication or respect the diet.
Disorders of thought processes and Disorders of auditory sensory perception.
Continuing with the two following diagnoses, two groups of objectives were presented: one permanent and the other at two years.
The permanent ones were: 1) to know the psychopathological symptoms presented by the patient regarding alterations of thought and cognitive-perceptive, and 2) to avoid episodes of heteroaggressiveness and crisis.
The objective at two years indicates that the subject will have eliminated aggressive verbal expressions with content of death to others.
Associated with the process, agreed activities are carried out, which include first the recording of data collected on the delusional idea and patient behavior.
It seeks to generate and maintain a common space for coexistence and tolerance, promoting respect for people.
In the interviews held by the patient with the tutor, the author analyzes unwanted behaviors, presenting alternatives that, when reproduced, are reinforced by praise.
The presence of the clinician is also requested, apart from the consultations, for the interviews when the tutor values them.
The three objectives that we have just set out, two permanent and one at two years, were achieved in terms of the foreseen objectives.
Deterioration of social interaction.
To address the problem presented by the fourth diagnosis, four objectives are established at six months and two at two years.
The first four are: 1) visiting and informing the forces of their people; 2) interviewing the people in order; 3) scheduled visits to their home being accompanied by nurses; and 4) publicly available.
The following two objectives, to be achieved after two years, are: 1) the patient will develop normal activity during visits, relating to relatives or relatives in the social alarm mediated as possible, and 2) his presence in the area will be
In order to achieve these objectives, a number of interviews with people and relatives were conducted over the months, with the person agresses (the other deceased), and with the cure threatened by our patient.
In these meetings, the characteristics of the visiting program were informed and the idea that these visits would not alter the public order at all or pose any risk to anyone was reinforced.
It was also perfectly clear that the patient would always be accompanied by health personnel.
Citizenship was also briefly informed.
These activities led to satisfactory achievement in time and form of all proposed objectives.
Compromised family coping.
The fifth and final diagnosis requires a new approach of three target groups.
A first permanent objective, the second group composed of three objectives to be met at six months and two more that should be achieved at two years.
The permanent objective is that the family receives information from the rehabilitation project and the evolution of the patient with form, through contact and interviews with the tutor.
The objectives at six months include: 1) greater protagonism of this family in the therapeutic process; 2) scheduled weekly visits to the patient to take him to eat out, and 3) take care of the washing agreement.
At two years of age, the objectives are established, on the one hand: 1) that his brother is able to verbalize compliments to the patient for his progress and his presence and on the other hand: 2) that the patient respects
The design of activities for these objectives included, at first, a series of scheduled interviews with family members, patients and tutors in order to clarify all aspects related to the patient's therapeutic project, functioning standards, activities within and outside the family.
Over time, they were informed about the evolution of the patient, the autonomy they achieved and all the advances and obstacles.
The interviews are encouraged to verbalize what one thinks of others with correction and respect, the patient is taught to respect the opinions and intervention shifts of the other agreements, and the family is collected daily.
The evaluation shows that both the permanent goal and those referred to six months were correctly implemented, but not the objectives proposed at two years.
The patient's brother was uneasy if he was able to praise the patient's evident progress, nor was he able to eliminate certain expressions and frequencies diminished towards his family, especially his brother, although in his opinion
