Dealing with delusional patients

[hearts895, RN BSN]

Hi everyone, :)

First a disclaimer: I'm just a volunteer (& nursing student) - not yet a nurse. And I don't mean "delusional" in a rude way - just in a clincal way.

As a volunteer in the ED, I dealt with a pt who was delusional (I was later told that was the nurses impression). When I first went to help her, I didn't know this (thought she just had a typical injury & was in normal frame of mind). I quickly found that something was not "quite right." I made the mistake of acting overly friendly and caring and then by the time I figured out what was up I just decided to stick with that attitude/approach. I noticed that the nurses had a very matter of fact, no-nonsense approach to dealing with the pt. After a while the pt started to get very angry & upset w/ me (glaring at me w/ scary look in her eye, swearing & muttering hateful things etc.) but left the nurses alone. This really worried me cause I have a thin skin for this sort of thing lol - as I have never dealt with psych. patients yet and am only a volunteer (yes I'm serious newbie lol). I'm thinking I left my self open to this by acting overly cheery, helpful, & friendly (since I'm super enthusiastic to have a chance to interact with patients). I was just wondering if anyone has any advice for developing a thicker skin to this sort of thing and any tips for dealing with patients like this. As a (hopefully) future ED nurse I know I need to get better at handling these situations. Thanks all :)

[pinkiepie_RN]

i tend to agree with you.

however, i did get kicked off the locked-unit on my psych rotation (in school) because i enabled the pts too much.

an allegedly "dangerous and violent" schizophrenic (a pt i begged for) looked at me and said "you're one of the good guys" and i said, "yes, i am".

my instructor hauled me away, telling me i should've told him "my name is leslie and i am a sn".

another end-stage aids pt (w/aids dementia) was literally crying, insisting "they" were trying to take his baby.

i 'pretended' to hold it, assuring him i would keep the baby safe.

again, hauled off and after asking to shake the hand of a manic pt (he told me he was president of the us), i was permanently removed from the unit.

yet ea interaction i had, seemed to placate the pt.

i just don't know what is truly therapeutic.

leslie

I think it's important to validate the patient's feelings and agree with your behavior. I think as long as it doesn't increase agitation or put the patients or nursing staff at safety risk, it's worth trying.

[leslie :-D]

Has this been a while ago, Leslie? Unfortunately what is considered therapeutic seems to vary depending on what theory is in favor at that time. I believe there is room for both reality orientation as well as being supportive of some delusions in the interest of soothing an agitated patient. Depends on the situation and the patient, imo.

yes jules, this happened in the mid 90's.

everything was taught to be reality-based...

which i (still) believe, can result in scaring/agitating some of the psych population.

and definitely agree that it always depends on the situation and pt.

i don't want anyone getting the impression i do this with all psych pts.

I think it's important to validate the patient's feelings and agree with your behavior. I think as long as it doesn't increase agitation or put the patients or nursing staff at safety risk, it's worth trying.

let's face it:

there are pts who are truly beyond healing.

and 'their' world is much safer than the real one.

sometimes i try to reinforce that.

leslie

[hearts895, RN BSN]

Thank you for your advice everyone. I really appreciate hearing from nurses who have more experience with these sorts of things. In the future I think I will approach patients at first with a polite, yet low key attitude and then depending on what they seem like, take it from there. If they seem like someone who could use a cheery presence to brighten their day, then I'll be that person, but if they seem like someone with 'issues' I'll keep a friendly, yet no nonsense demeanor. And thanks for the advice about not taking it personal - I have to admit I felt a bit unnerved for the rest of the day. I know I better get my "sea legs" if I want to be an ER nurse lol :)