1 │ Introduction

When the symptoms of schizophrenia interfere, the patient is easily immersed in the self-world because the patient’s thinking and perception are affected by the disease, and the daily life functions such as personal hygiene, sleep quality, health cognition and interpersonal interaction will also be affected [1]. Human being is a single individual. No matter what kind of situation they are in, the internal human field and the external environmental field are constantly exchanged. Whether they are harmonious or not depends on whether the two can develop in a balanced way. In the process of life, the patient’s human field and the environmental field appear inharmonious and irreversible. In this situation, I established a therapeutic interpersonal relationship with the patient, and used the principles of integrality, helicy and resonancy in Rogers’ nursing theory, to assess the patient's physical and emotional needs, alter the energy field of the patient disturbed by mental symptoms, and help to reorganize the interaction pattern between the patient, the family and the environmental field, so that the energy interaction pattern can reach a satisfactory harmony, thereby improving the health problems between the patient and the family [2].

Since there is currently no literature on the application of Rogers’ nursing theory in the care of schizophrenia in Taiwan, this prompted the authors to try to apply it to clinical nursing practice for the first time. I look forward to more discussions and experience sharing on Rogers’ nursing theory and the care of patients with schizophrenia.

2 │ Literature Review

2.1 │ Schizophrenia

Schizophrenia is a common functional mental illness, and its symptoms include positive symptoms such as delusions, hallucinations, thought disorders, etc., and negative symptoms such as apathy, social withdrawal, and poverty of thought, which affect cognitive content [3]. Some studies have shown that the memory, cognition and social function of people with onset in early adolescence are significantly lower than the level before the onset [4], that is, the earlier the onset time is, the easier it is to affect the patient's mood, thinking and cognitive ability, communication ability, interpersonal relationship, work and study, and the longer the attack, the more chronic the course of the disease. Among them, delusions and auditory hallucinations most often plague the patients [5].

Schizophrenia is usually treated with medicine. After drug treatments, the positive symptoms of the patient can be relieved. However, for the negative symptoms and cognitive function, these symptoms are difficult to be completely improved with antipsychotic drugs alone. Clinically, schizophrenia often affects the patient's self-care ability, sleep pattern, social interpersonal relationship, ability to adapt to the environment, ability to solve problems and other life functions, and also affects the family and society to increase a caregiver burden [6]. Therefore, non-invasive treatments can be used to slow the functional deterioration of the patient of limited improvement with drug therapy.

2.2 │ Rogers’ nursing theory

Martha Elizabeth Rogers defined in 1992 that "the environment as a force in itself lies outside the human domain, which is called the environmental field", and "man is integral; man and the environment is one and inseparable", that is to say, she emphasizes the interaction and holistic relationship between human and the environment. Based on these concepts, nursing science is viewed from a holistic point of view. Both human and environment are energy fields. Through open systems, two energies are continuously exchanged with each other in a dynamic pattern. Under the principle of integrality, helicy and resonancy, the energy field remains unchanged. When either the individual or the environmental field changes, the individual energy field will be incompatible. At this time, nursing measures can be used in a timely manner, so that the energy exchange process between the individual and the environmental field can be restored to coordination [7].

Rogers’ nursing theory mainly includes four major concepts, three major dynamic principles, and five assumptions. The four major concepts mainly explain characteristics between human and the environmental field: 1) The energy field is the fundamental unit of all life, including life and non-life, while human and the environment are regarded as integral and inseparable. The strength, density and range of the energy field are constantly changing interactively. 2) Openness means that the human and environmental domains are constantly exchanging energy, that is, there are no boundaries or barriers that can prevent the flow of energy between human and the environmental domains. 3) The pattern refers to the characteristics of the energy field, which exists in a single-wave irreversible way. This is an abstract concept. The characteristics of the pattern are continuity, innovation and relative changes. Each person's energy field pattern is unique and one with the environment, probably manifesting as sickness or happiness. 4) Universal space is a nonlinear domain with no spatial or temporal properties [8].

The three major dynamic principles explain the life process of human beings. At any space and time, there is an open and simultaneous interaction between the human and the environmental field. It describes the continuous growth and change of things, presenting the development of the life process. The process includes three principles: integrality, helicy and resonancy. 1) The principle of integrality: the human and the environment domain form an inseparable whole. In the process of mutual and continuous exchange of energy, the place that changes are called integrality. 2) The principle of helicy (evolution) means that the human life process is a natural one-way progress, which exists along the irreversible space-time continuity, and the human and environmental field patterns are continuous, innovative, unpredictable, and changes that constantly increase diversity. 3) The principle of resonancy (intensity change): refers to the energy of human and environmental fields, which is a rhythmic fluctuation pattern that continuously changes from low frequency to high frequency. Therefore, the change of energy exchange between human and the environment occurs through continuous and innovative resonant waves. When these fields merge with each other, they also become unique energy fields [9].

The five assumptions are to explain the view of the whole person: 1) Each person is a unique and single whole, not just the sum of the parts. In the process of exchanging with the environment, each person has the integrity of the individual, showing the characteristics different from the sum of the parts (energy field integrity). 2) There is a continuous exchange of matter and energy between human and the environment (openness). 3) The process of human life is one-way and exists along the irreversible space-time continuity, which cannot be reversed by time (helicy). 4) Patterns can be used to identify individuals and reflect the integrity (pattern and organization) of their innovations. 5) People express their characteristics (feeling, thinking) by the ability of imagination, thinking, language, perception and emotion. Therefore, Rogers’ theory believes that human and the environment are one and inseparable, and the two are constantly developing, changing and advancing together. After the change, the life process of human and the environment cannot return to the previous stage [10].

As per Rogers’ theory, the nursing evaluation period is to treat the patient as a whole, collecting the interaction pattern, the rhythm of the life process, the classification of diseases, and pathological data. between the life event energy fields (human and environment) of the patient. During the nursing intervention period, the nurse can assist the patient to achieve balance by coordinating the rhythm of the energy field in non-invasive ways such as music, meditation and guided imagery. The nursing evaluation period is to check whether the energy field has changed into a new pattern, so that it can coordinate with each other to ensure that the patient can move towards a better health pattern [10].

3 │ Case presentation

Patient was 28 years old and suffers from emotional agitation, auditory hallucinations, religious delusions, kneeling to worship, and disturbing behavior at home, so she has been hospitalized in the psychiatric ward of a medical center in southern Taiwan for the second time. The medical diagnosis of this patient was Schizophrenia. The patient has five elder brothers and elder sisters. Both the elder brother and the second eldest sister are mentally ill. The patient lives with her family. After graduating from senior high school, the patient chooses to work first instead of continuing to go to school. At the age of 24, she was admitted to university. Due to interpersonal problems with friends and classmates, she went to the psychiatric outpatient clinic for medical treatment. At that time, the patient was a freshman at the university. Because she was older than other students, she had difficulty in interacting, and persecutory delusion appeared. She felt that her classmates were going to be unfavorable to her and called her a bad classmate. It was the first time that she was hospitalized for treatment in a psychiatric ward. After being discharged from the hospital, her family members sent her to the hospital and she was hospitalized again for treatment due to irregular medication and a large degree of disturbance in her mental symptoms. Nursing assessment based on Rogers' system model of this patient is presented in Table 1. Also, nursing care plan based on Rogers’ system model for this patient is presented in Table 2.

Table 1. Nursing assessment based on Rogers’ system model of this patient.

4 │ Discussion

As discussed above, energy between the human field and environment field of the patient affects each other and forms an indivisible whole. The patient can reduce the disturbance of delusion by changing either human field or environment field. The said patient with delusions still believes she is deity; nevertheless, she shifted her attention by changing her physical environment to remodel her human field and environment field. The patient learns to live with her disease to improve interpersonal relationship, for instance, she quits to gesticulate behind other patients or suddenly says sorry to others during her hospitalization. Regarding the family, the appropriate interaction models are provided by her family members to cope with the syndromes and emotion of the patient to enhance the patient, her family and the environment to coordinate with each other. 

Table 2. Nursing care plan based on Rogers’ system model for this patient.

3 telephone communication and 1 follow-up visit after discharge reveals that the patient can follow doctor’s instruction to take medicine. Both her family life and campus internship are normal without any unusual situations, which will not affect her daily life. Currently she is referred to a community case health management worker for follow-up care.

Rogers' nursing theory is an abstract system concept that focuses on totality, experiences, existence. This theory has been gradually used in clinical practice internationally, such as therapeutic touch, music therapy, meditation, but in Taiwan, most of the literature is application of "Rogers' system model" in nursing care of patient with dementia [11], major depression [12], adolescent with mental Illness [13], and pre-school child with post-operative Abdominal [14]. This is little literature on its practical application in schizophrenic disorder care. In Taiwan, it is difficult to apply it clinically for the first time, authors often need to constantly read literature and books to understand their meaning, and then apply Rogers' nursing theory to the nursing process.

4.1 │ Clinical implications for nursing managers and policymakers

The authors hope that it will help nurses better understand Rogers’ nursing theory in order to better apply them in nursing practice.

4.2 │ Recommendations for future research

It is recommended to add "therapeutic touch" in the future, enable the patient's energy field to reach a state of reshaping.

5 │ Conclusions

Everyone is a unique person. The human field and the environmental field are constantly exchanging their energy in sickness and in health. There is incongruity single and irreversibility during life process of patients with Schizophrenia since their thinking and perception have been affected by disease. Rogers’ nursing theory mainly provides that in very limited circumstances, the interaction of the energy field between the patient and her family can be remodeled after using invasive nursing measures by nursing staff to help the family of the patient to achieve harmony and peace.

Acknowledgements

Not applicable.

Authors’ contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: XLY, MYY, XFY ; Drafting the work or revising it critically for important intellectual content: XLY, MYY, XFY; Final approval of the version to be published: XLY, MYY, XFY; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: XLY, MYY, XFY.

Funding

Self-funded.

Ethics approval and consent to participate

Not applicable.

Competing interests

We do not have potential conflicts of interest with respect to the research, authorship, and publication of this article.

Availability of data and materials

The datasets used during the current study are available from the corresponding author on request.

Using artificial intelligent chatbots

None.