TOKEN ECONOMY THERAPY AS AN INNOVATIVE APPROACH TO IMPROVE BATHING SELF-CARE KNOWLEDGE IN PATIENTS WITH SCHIZOPHRENIA: A CASE REPORT

Abstract

Background: Self-care deficits are common among patients with schizophrenia due to disturbances in thought processes, which impair their ability to perform daily self-care activities independently. Poor personal hygiene may negatively affect physical health, self-esteem, and social interactions. Token Economy therapy is a behavioral intervention that can be used to improve patient motivation and self-care behavior. This case report highlights the effectiveness of Token Economy therapy in improving bathing self-care ability in a patient with schizophrenia. Case Summary: A patient diagnosed with schizophrenia presented with poor personal hygiene and self-care deficits. Clinical manifestations included untidy appearance, body odor, dirty clothing, unclean hair and skin, long and dirty fingernails, and poor oral hygiene accompanied by halitosis. The patient also showed decreased motivation, lack of initiative, social withdrawal, feelings of helplessness, and low self-esteem. Investigation and Diagnosis: Assessment was conducted through psychiatric nursing observation and mental status examination focusing on self-care ability. The patient demonstrated an inability to perform bathing and personal hygiene independently. Based on the clinical findings, the patient was diagnosed with self-care deficit: bathing/hygiene associated with schizophrenia. Differential diagnoses included negative symptoms of schizophrenia and social isolation. Management: The patient received behavioral therapy using the Token Economy method for five consecutive days. The intervention consisted of one 30-minute session per day, during which the patient was positively reinforced with tokens for completing self-care activities, particularly bathing and maintaining personal hygiene. Nursing care also included education, motivation, and supervision during self-care practice. Outcome: Following the intervention, the patient demonstrated improved motivation and the ability to perform bathing self-care independently. The patient’s appearance became cleaner and neater, with improvements in personal hygiene and grooming. Conclusion: Token Economy therapy was effective in improving bathing self-care ability in a patient with schizophrenia. This case demonstrates that behavioral reinforcement can enhance patient motivation and independence in performing self-care activities, making it a useful intervention in psychiatric nursing practice.