The Effects on Clients

Running head: EXPERIENCING A HEALTH CHALLENGE: THE EFFECTS ON CLIENTS

Nursing 360 Scholarly Assignment

Experience of a Health Challenge: The Effects on Clients
Mathota Samaraweera
823 069 448
Humber College
Practical Nursing Theory 3, 7884.201470-NUR-209-0ND
Prof. Janet Jeffery
November 19, 2014

The Effects on Clients

A Beautiful Mind - The Story of John Nash and his Struggles with Schizophrenia
The movie is about the life of the Nobel laureate John Nash who suffers from the serious
mental illness, schizophrenia. The movie begins with John being accepted to Princeton
Universitys Graduate Mathematic Program. The disease affects Johns studies at the university.
He is portrayed to being an outstanding mathematician who is able to find a solution for any
mathematical problem. Delusions and hallucinations seriously affect his everyday life at the
university.
He gets married to Alicia who is one of his students, and they face many problems
because of his illness. He is admitted to the mental hospital and treated by psychiatrist Dr. Rosan
who explains his condition as paranoid schizophrenia to his wife. After the course of insulin
shock therapy and explaining of his condition by his wife, he realizes his situation. John refuses
taking antipsychotic medications due to side effects, and thereby, his symptoms relapse and
auditory and visual hallucinations appear again. As a result of his condition, the whole family
suffers a great deal, and Dr. Rosan suggests that he has to take his medications. However, he
refuses and decides to control his disease by himself.
Finally, he understands his hallucinations as unreal and begins to ignore them. According
to wifes advice, he starts to involve in social events more and as a result, he grants permission to
work at The Princeton University again. After several years, in 1994, he is honoured by Nobel
Memorize Prize in Economics for his revolutionary achievements on Game Theory (A Beautiful
Mind, December 13, 2001).
Three main physical effects of health challenge that influence Johns life are
disorganized speech, impaired body movements, and sexual disability. Disorganized speech is

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evidenced by the movie, when John talks with Charles who imaginary roommate at the library he
shouts at him is saying that he has respect for beer. At another instance, when he is in the mental
hospital, he tries to break the restraints and tells Dr. Rosan that he is right here as showing
Charles Herman (visual hallucination). This is explained by Wood (2011) as, The speech of
schizophrenics is often very difficult, if not impossible, to understand. The content of the
message may be extremely vague, or the person may invent words or use them inappropriately
(The World of Psychology, 2011, p.420).
The second physical effect is impaired body movements. In the movie, when John restarts
to attend Princeton University and after talks with Martin Hansen who is his friend and head of
The Mathematic Department now, outside of the building he argues with imaginary supervisor
William Parcher and states that he is not real, and tries to fight with him by moving his body
around. It is included in Woods The World of Psychology as grossly disorganized behaviour. It
also states, There may also be unpredictable agitation, including shouting, and swearing, and
unusual or inappropriate motor behaviour, including strange gestures, facial expression, or
postures (The World of Psychology, 2011, p.420).
Another physical effect that is visible in this movie is sexual disability. John has
difficulties to response to his wifes sexual stimulations, and it probably occurs after starting
medication as a result of side effects. In the movie, when John doesnt care about his wifes
encourage, she asks whether it is due to the medications and he nods his head. After that, his wife
gets mad and breaks the washroom mirror. This incident clearly shows that he suffers from
sexual disability. It is inserted in A review, Sexuality and Schizophrenia by Deanna L. Kelly
and Robert R. Conley, as, Although the extent of sexual dysfunction among people with

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schizophrenia remains largely unknown, approximately 50 percent of patients have reported

sexual dysfunction during treatment with conventional antipsychotics"(Gladirian et al.1982;
Sullivan and Lukoff 1990).
Significant psychosocial effects of the health challenge on him are social isolation,
anxiety and impaired home maintenance. Behaviours of social isolation is withdrawal, sad, dull
affect, need-fear dilemma; preoccupation with own thoughts; expression of feelings of rejection
or of aloneness imposed by others; uncommunicative; seeks to be alone (Essential of
Psychiatric Mental health Nursing-Mary C. Townsend, DSN, PHMCNS-BC). It is evident in the
movie when John talks and drinks beer with Charles, he says that he doesnt like people much
and people dont much like him either. It reveals his social withdrawal, sadness and dull effects
toward the society.
Anxiety is another psychosocial effect which affects John that is demonstrated in this
movie. Throughout the movie, he experiences unusual fear about his classified assignment that is
given by imaginary supervisor, William Parcher. He always worried about how to complete it on
time. For instance, when he is in mental hospital, he tells Alicia (wife) that he has been doing to
secret work for the government, and there's a threat that exists. Relationship between anxiety and
schizophrenia clearly describes in an article by Sam G. Siris and Raphael J. Braga as, "Anxiety is
frequently observe among patients with schizophrenia. Its presence can be conceptualized as a
component of the presentation of schizophrenia it self-particularly during an acute psychotic
episode" (Anxiety in Schizophrenia, 2014).
The next psychosocial effect is impaired home maintenance. This is viewed in the movie
when john put his baby in a bathtub unsafely and he talks with imaginary roommate, Charles

The Effects on Clients

Herman. As a result, he argues with is his wife and accidentally hits her and the baby. She
becomes full of fear and tries to leave home. In the text by Mary C. Townsend defines the
meaning of impaired home maintenance as, "unsafe, unclean, disorderly home environment,
household members express difficulty in maintaining their home in a safe and comfortable
condition"(Essential of Psychiatric Mental Health Nursing, 2011, p.330).
Considering his symptoms of schizophrenia, I have realized that the main priority area as
hallucinations. Throughout the movie, I have noticed hallucinations, mostly auditory
hallucinations. It is described in the peer reviewed journal by Guillermo Horga, "Auditory verbal
hallucinations (AVH), a core positive symptom of schizophrenia often manifest in the form of
emotionally distressing voices"(Brain Metabolism during Hallucinations, 2014). During the
movie, John sees, talks, and hears of Marcie, Charles, and Parcher who are hallucinations. All
over the movie, he is affected by these three people and in the last part, when John is attending to
the Nobel Prize and leaving the auditorium with his wife he sees them again.
As a nursing student, I consider main nursing interventions to provide him such as by
assessments, therapeutic communication, and medication administration. I closely observe
client's signs of hallucinations and pay my special attention to his behaviour such as responses,
level of consciousness, activities of daily living, communication, and safety. It helps me to
identify problems and needs of the client and plan to provide appropriate intervention.
In addition, I establish a good therapeutic communication with the client in order to
make him understand that hallucinations are not real. I explain the client that the perception of
visual and auditory hallucinations are only felt by him and no one else can feel them. Also, I
describe him that he gets hallucinations as a result of schizophrenia and help him to focus on the

The Effects on Clients

realities to control the disease. Moreover, I describe him the importance of taking prescribed
medications in order to control the disease properly. Also, I provide adequate information about
his condition to the family members, especially to his wife and explain the importance of giving
medication as doctor's orders and evaluate the progress. More than that, I describe them the
importance of follow up visits and close monitoring of the patient at home.
I pay my attention on administering antipsychotic medication to manage the disease
because he refuses to take his medication. In addition, I encourage the client to take his
medication on time and explain their undesirable side effects. As well, I verify whether he
swallows the tablets by checking his mouth after each medication administration.
Other than above, I can collaborate with other professionals to give better care for this
patient. I realize that psychiatrist or psychologist can provide tremendous help by diagnosing the
disease, prescribing antipsychotic medications, arranging appropriate therapies such as Electro
Convulsive Therapy (ECT), and explaining the reality of hallucinations to the client. Also,
pharmacist can help patient by explaining the importance of taking medication and their side
effects. Besides, he can support him to reduce symptoms of hallucinations by providing
antipsychotic medication. In addition, social worker can support him financially to purchase his
medications which need to control his hallucinations.
Community resources such as Centre for Addiction and Mental Health (CAMH) provides
great support to schizophrenia patients like John. This institution helps patients to change their
attitudes toward hallucinations and delusions by breaking down barriers to eliminate the stigma
of mental health illnesses (www.camh.ca). In addition, Canadian Mental Health Association
(CMHA) provides a wide range of mental fitness programs which play an important role in

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reducing anxiety, depression, loneliness, and hallucinations. They have mental fitness tips such
as exercise, hobbies, and volunteering programs which help patients to mitigate their worries and
negative concerns. John can earn benefits of feeling rejuvenated, more confident and become
free of hallucinations from this resource (www.cmha.ca).
In conclusion, John Nash is an excellent mathematician who is honoured by Nobel
Memorial Prize in Economics for his progressive dedication on game theory. Throughout his life,
he suffers from paranoid schizophrenia and struggles to reach his expectation toward
mathematics. He gets married to a generous woman who gives tremendous support to him in
order to manage his disease and win his life. He experiences physically with disorganized
speech, impaired body movements, and sexual disability which are positive symptoms of
schizophrenia. Also, this disease affects him psychosocially such as social isolation, anxiety, and
impaired home maintenance.
I have realized nursing interventions as assessment, maintaining better therapeutic
communication and medication administration to control his main problem of hallucinations. In
addition, he can get enough support from psychiatrist, pharmacist, and social worker to get rid of
hallucinations. As well, John can gain assistance from community resources such as Center for
Addiction and Mental Health (CAMH) and Canadian Mental Health Association (CMHA) to
deal positively with his disease and reduce side effects. I surprise of how he wins his life
struggling with serious mental disease of schizophrenia.

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References
Canadian Mental Health Association. (n.d.). About CMHA. Retrieved November 18, 2014, from
CMHA: http://www.cmha.ca/about-cmha
Centre for Addiction and Mental Health. (n.d.). About Centre for Addiction and Mental Health.
Retrieved November 18, 2014, from About CAMH:
http://www.camh.ca/en/hospital/about_camh/Pages/about_camh.aspx
CIHNAL. (2014, 18). Brain Metabolism during Hallucination-Like Auditory Stimulation in
Schizophrenia. Retrieved November 18, 2014, from PLOS ONE:
http://www.plosone.org/article/metrics/info%3Adoi
%2F10.1371%2Fjournal.pone.0084987
Goldsman, A. (Writer), & Howard, R. (Director). (2001). A Beautiful Mind [Motion Picture].
United States: Universal Pictures.
Kelly, D. L., & Conley, R. R. (2004). Sexuality and Schizophrenia: A Review. Schizophrenia
Bulletin , 30 (4), 767-768.
Siris, S. G., & Braga, R. J. (2013, 09 24). Anxiety in Schizophrenia. Retrieved November 18,
2014, from http://www.uptodate.com/contents/anxiety-in-schizophrenia
Townsend, M. (2011). Essentials of Psychiatric Mental Health Nursing. Philadelphia: F.A Davis
Company.
Wood, S. E., Wood, E. G., Boyd, D., Wood, E., & Desmarais, S. (2011). The World of
Psychology (6th Edition). Toronto: Pearson Canada.