Best way to handle a delusional patient when they accuse you?

Specialties Psychiatric

Published

What is the best way to handle a delusional patient when they are accusing you of doing something (or saying something) that is not true?

Recently had one patient who was negative towards everyone but for some reason really focused on me and would accuse me of listening to her phone calls and talking about her.

What is the best way to handle this situation?

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Agree with them. Often times, they don't know what to make of that. If you keep yourself from getting defensive and arguing with a delusional person (a pointless activity, believe me!), usually you can reorient them in the right direction.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

I wouldn't agree with reinforcing delusional thinking. Other patients overhear and they'll think, "yeah, it's true," a follie et deux situation, and maybe a few other patients all filing complaints with MH Advocacy Commision.

I'd say something like..."no we don't _______ here.". Repeat it if needed. After that just reinforce " we already talked about that, and I'm not going to talk about it anymore"

If it can be used in the context of talking about other similar patterns, that's fine, but don't dwell on it

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Specializes in Psychiatry, Mental Health.

I also don't agree with reinforcing the delusion. Some alternatives are the calm refusal, described by MrChicagoRN above, reflecting the underlying feeling ("It must be awfully scary for you to feel like that."), and redirection. This should be discussed in the team and addressed in the care plan so that the patient gets similar responses from all staff and so that everyone knows you are on the patient's radar.

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I'm an MH counselor in a psych facility, and we deal with this a lot. You get accused of doing things you didn't and maybe even accused of being someone else. It happens, but I usually try to redirect. If that doesn't work, I will not buy into the delusion under any circumstance.

Sorry, I'm not a nurse but I deal with this all the time!

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Specializes in NICU.

Like others, I don't agree with feeding in to the delusion. I have a patient like that right now who is very paranoid and fixated on me. He told our doctor I was his neighbor and I go around telling all our neighbors about him, he won't take meds b/c he think we are poisoning him, said we are putting Ativan in everyone's food. States I follow him everywhere he goes and I'm out to get him. I work at a Men's Acute facility, and in a situation like that it's safety 1st, I just reassure him that what he is think is not true, and after a few times I tell him I'm not going to argue and end the conversation. If we have a patient fixated on us we try to take ourselves out of direct care if possible by switching with another nurse or something like that. For the past 4 days, every time he walked by he would make a comment and I got to the point I would just ignore it.

But do not feed in to it. It will make it worse. The object is to get the back on medication and help them, not feed into a delusion.

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My standard statement "I'm sorry you feel that way, but I do not listen in on you or any one else" - then turn & walk away. You are the nurse in control - do not let it become a "Yes you do" "No I don't" thing.

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don't argue. dont feed into their delusions. reinforce reality. walk away. document.

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