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Nursing practice problem examples


Subject: Psychosocial

Subject area: Nursing
Education Level: Undergraduate
Length: 5 pages
Referencing style: APA
Preferred English: US English
Spacing Option: Double
Title: EBP on Schizophrenia
Instructions: Find (5) articles related to the clinical question. *picot format has to be use** 1. develop clinical question (“What are the social, mental and environmental causes that exacerbate hallucinations in a patient diagnosed with schizophrenia?”) 2. search for the best evidence 3. appraise or synthesize the evidence 4. implement the evidence in practice 5. evaluate whether the practice changes have improved outcomes 6. disseminate the results aslo I need a matrix chart (i included an example)
Important notes: On the instructions I wrote a guideline that the professor posted. However, I the rubric for the EBP, the picot format and the matrix.


Schizophrenia is a chronic disorder of the brain that affects the ability of an individual to interpret reality normally. An active schizophrenia reveals symptoms such as lack of motivation, hallucinations, delusions, difficulty with concentration and thinking. Although there is no cure for schizophrenia, various studies have been conducted to determine the causes of the disease and develop new and more effective therapies to the address the causes that exacerbate the symptoms. The causes of schizophrenia such as environmental, mental, genetic, and social factors vary significantly between individuals as well as the symptoms. These are risk factors that contribute to the onset and course of the disorder. Because of these multiple factors that contribute to the development of the disorder, it has made it difficult to identify specifically the exact cause of the disease in individual cases. The clinical question to be discussed in this paper includes, “What are the social, mental and environmental causes that exacerbate hallucinations in a patient diagnosed with schizophrenia?

Literature Review

According to the study conducted by McCarthy-Jones and Longden, 2015), the auditory verbal hallucination (AVH), which involves ‘hearing voices’ is a schizophrenia disorder linked with earlier exposure to emotionally or traumatic events that were overwhelming. The study suggests that these events may be recurring and if these memories form the basis of AVH, then changing an individual’s current perspectives and beliefs may alter memories that they create and causes their ability to contrast voices to arise from these events. Based on the study results, evidence suggests that there is a direct relation between trauma and hallucination. All these evidence indicate that a subsection of individuals with schizophrenia disorder have earlier experiences of trauma in their life and a subset of these traumas has associations with their hallucinations.

The implementation of this evidence in practice requires a trans-diagnostic strategy of treatment (Garwood, Dodgson, Bruce & McCarthy-Jones, 2015). Implementation of trauma-based interventions for AVH that are based on trauma is crucial to improving patient outcome. The trauma specialized interventions have proved to be appropriate for many patients. They change the negative content of voices thus have beneficial consequences and improved outcomes for many patients. Sariaslan et al. (2016) point out that various systematic reviews have shown that neighborhood contributes to the etiology of schizophrenia. Evidence indicates that based on interpretation of social causation, systematic reviews have revealed that early experiences of adverse neighborhood stressors over a period of time contribute to the development of schizophrenia. Neighborhoods that are socially disorganized are characterized by ethnic heterogeneity, marital instability, poverty, and residential mobility.

The study findings indicated that the risk for development of schizophrenia and neighborhood deprivation was statistically significant. Although the results were inconsistent and inconclusive, it is evident that social factors have an influence on the social drift of patients with schizophrenia based on the social selection interpretation. The implementation of clinical and policy interventions in the treatment of patients with schizophrenia associated with social causation will contribute significantly towards the identification of the possible causal factors between socioeconomic courses and cognitive functions thus leading to improved outcomes.

Wright, Peters, Ettinger, Kuipers, and Kumari, (2016) conducted a study to determine the impact of environmental factors such as noise on the cognitive function of patients diagnosed with schizophrenia. Cognitive impairment is a common symptom related to poor functional outcomes in schizophrenia, especially the executive and memory function areas. Schizophrenia patients have been observed to have the oversensitivity to sensory stimuli and it is possible that environmental factors such as noise could exacerbate cognitive impairment especially those residing in urban environments (Bristow et al., 2014).  The study suggests that environmental noise has an adverse impact on various cognitive areas in healthy adults as well as those with schizophrenia. The results of the study revealed that environmental noise contributes to further cognitive impairment.

The study assessed the comprehensive cognitive battery in healthy participants such as measuring verbal learning and memory, executive functioning, attention, and psychotic speed. These measures were conducted under three major environmental conditions including social noise, for instance, the footsteps and babble background noise from a crowded hall, urban noise including the noise in the construction site, and in both conditions. Both the healthy participants and those with schizophrenia displayed considerable interruption of functioning memory by the social noise and the verbal recognition and recall by both the social and urban noise as opposed to the silent condition. Therefore, it is evident that environmental noise has an adverse impact on the areas of working and verbal memory both in healthy participants and patients with schizophrenia but may be challenging in patients because it can cause further deterioration of the pre-existing cognitive problems such as hallucinations. The study intervention includes noise management like minimizing exposure to noise where practical such as noisy wards. The implementation of this intervention could contribute towards improved outcomes by improving the lives of individuals with psychotic disorders.

Marín, Rodríguez-Franco, and Chugani et al. (2018) conducted a study to investigate the widespread of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders. The ASD describes the behaviors and symptoms that have an adverse impact on how an individual comprehend and respond to the world around them. Chisholm, Lin, Abu-Akel, and Wood (2015) indicate that ASD affects the intelligence levels of a person. Their IQ scores are often below average and sometimes at mentally deficient intelligence levels. The results finding of the study revealed that there is a considerable percentage (6%) of the prevalence of SSD in the total ASD sample of 278 references. This suggests that the mentally deficient intelligence levels in ASD adults are a risk factor for the development of schizophrenia in these patients.

For many years, the SSD and ASD were being conceptualized as same disorders. However, since their separation into individual diagnostic, they have been identified as different disorders, that are mutually exclusive. The implementation of this aspect in practice could improve outcomes because it would contribute to the proper diagnosis of each disorder independently. The disorders share various risk factors and phenotypic similarities, which may co-occur at advanced levels hence they could lead to misdiagnosis. Moreover, having knowledge of how and why there is a high co-occurrence between these disorders has significant implications for establishing aetiological models, prognosis, treatment, and diagnosis of the disorders. Consequently, taking into consideration the predisposing factors of schizophrenia to the people with ASD will help to prevent and reduce its prevalence in members of ASD population.

According to Upthegrove, Marwahia, and Birchwood (2017), depression has been identified as a common syndrome in schizophrenia. It can be described as a mental causal for schizophrenia. It is related to increased duration of illness, poor quality of life, and frequent psychotic episodes. Despite existing of a clear indication of the need for effective strategies in the management of depression in schizophrenia there is no specific guidance outlined.This has resulted in challenges in treatment and management of depression in schizophrenia patients. The study results point out that depression in schizophrenia has been a problem to the Kraepelinian dichotomy that has affected the efforts to address the major difference such as refining and evoking diagnoses. The evidence revealed that identification of the presence of depression in schizophrenia would help to recognize and address the potential treatment and etiological pathways challenges (Dauwan, Begemann, Heringa, & Sommer, 2015). Additionally, an identification that depression is beyond comorbidity, as well as enhanced therapeutic interventions focusing majorly on mood symptoms would contribute significantly towards support prevention and improve outcomes for patients with schizophrenia.


From the discussed literature review above, it is evident that schizophrenia is caused by social, environmental, and mental factors. The identified environmental factors include urban noise from building sites and social noise from background footsteps of a crowd in the hall. The social factors include deprived neighborhoods, and mental factors include early exposure to traumatic events, depression, and mentally deficient intelligence levels in people with ASD. These factors exacerbate the pre-existing cognitive deficits in patients with schizophrenia leading to adverse effects such as hallucinations. Hallucination is a common symptom of schizophrenia that causes individuals to perceive the world around them abnormally. Therefore, appropriate interventions such as trauma-based interventions, noise management, and clinical and policy interventions related to the causal factor have significant implication in the prevention of exacerbation of hallucinations in schizophrenia patients thus resulting in improved outcomes.


  1. Sariaslan, A., Fazel, S., D’onofrio, B. M., Långström, N., Larsson, H., Bergen, S. E., and Lichtenstein, P. (2016). Schizophrenia and subsequent neighborhood deprivation: revisiting the social drift hypothesis using population, twin, and molecular genetic data. Translational Psychiatry, 6(5), e796. Retrieved from
  2. McCarthy-Jones, S., and Longden, E. (2015). Auditory verbal hallucinations in schizophrenia and post-traumatic stress disorder: Common phenomenology, common cause, common interventions? Frontiers in Psychology, 6, 1071. Retrieved from
  3. Marín, J. L., Rodríguez-Franco, M. A., Chugani, V. M., Maganto, M. M., Villoria, E. D., and Bedia, R. C. (2018). Prevalence of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders: A Meta-analysis. Journal of Autism and Developmental Disorders, 48(1), 239-250. Retrieved from
  4. Heinz A., Deserno. L., and Reininghaus, U. (2013). Urbanicity, social adversity, and psychosis. World Psychiatry, 12, 187–197. Retrieved from
  5. Garwood, L., Dodgson, G., Bruce, V., and McCarthy-Jones, S. (2015). A preliminary investigation into the existence of a hypervigilance subtype of auditory hallucination in people with psychosis. Behav. Cogn. Psychother., 43, 52–62. Doi: 10.1017/S1352465813000714. Retrieved from
  6. Dauwan, M., Begemann, M. J., Heringa, S. M., and Sommer, I. E. (2015). Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin, 42(3), 588-599. Retrieved from
  7. Chisholm, K., Lin, A., Abu-Akel, A., and Wood, S. J. (2015). The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neuroscience and Bio-behavioral Reviews, 55, 173–183. Retrieved from
  8. Bristow E., Tabraham P., Smedley N., Ward T., and Peters E. (2014). Jumping to perceptions and to conclusions: specificity to hallucinations and delusions. Schizophr. Res, 154, 68–72. Retrieved from
  9. Upthegrove, R., Marwaha, S., and Birchwood, M. (2017). Depression and schizophrenia: Cause, consequence, or trans-diagnostic issue?. Schizophrenia Bulletin, 43(2), 240-244. Retrieved from
  10. Wright, B., Peters, E., Ettinger, U., Kuipers, E., and Kumari, V. (2016). Effects of environmental noise on cognitive (dys) functions in schizophrenia: A pilot within-subjects experimental study. Schizophrenia Research, 173(1), 101-108. Retrieved from

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