There was a Discussion here back some time ago on Feeding into a Patient's Delusion in order to decrease anxiety or de-esculate a Behavior. Although not Texbook, many Nurses have utilized this Technique successfully.
Take, for example, a Geriatric Patient who wakes in the Night, is Anxious, and wants to know "Where's my Mother?!" The Patient is informed that her Mother is "taken care of". This Perceptual Statement of Fact decreases the Patient's anxiety and allows her to go back to sleep.
Reality Orientation, for example, by telling the Patient that her Mother passed away long ago, would only serve to increase her Confusion and Anxiety. And, it would not be an Untruth to inform the Patient that her Mother is taken care of, for wherever her Mother may be, she is being taken care of.
At a Mandatory Inservice recently, a Co-Worker and I were in a Group together from our Gero-Psych Unit. All the Groups where asked to list Alternative Methods to Mechanical Restraints. Among other Techniques, I named "Feed into the Patient's Delusion". My Co-Worker asked me to Rephrase the Concept, so I said, "Reinforce the Patient's Perception of Reality". The Concept was Generally Accepted by those present.
Recently, on a MN Shift, I experienced yet another Situation to implement this Concept. A Patient would wake up, get out of her bed, stand at her door, and loudly Sling Insults. "You are Stupid!" she would shout. "I could be smarter", I replied. "You don't know your *** from a hole in the ground!" she said. "I have to admit, I don't", I said. You are a liar!" she accused. "I do tend to embellish and have been told I have a Gift for Fiction", I admitted. You are dirt!" she said. "I am less than dirt", I replied.
This approach gave the Patient no Defensive Comebacks, so the most she could do was to insult me until she ran out of Fuel. And run out of fuel she did. Her Behavior occurred at least Three Times that night and never esculated.
Ever have any Similar Experiences?
Thank you all for the Support and Creative Examples in dealing with Delusional or Demented Patients.
I agree that LTC's Xeroxed Checks and Hygiene Queen's Xeroxed Money really "Fit the Bill" (Pun intended.)
Often times, as in CBOS' example, a Therapeutic Response to some Demented Remarks are difficult to come up with. Luckily, since I work straight MN's, I can always reinforce their desire to be responsible, however, also advise them to take care of Business during Regular Business Hours. I often tell them that their Rest is the Most Important Thing, and they'll need their Rest in order to Adequately take Care of Business. This Approach has a High Success Rate.
I wanted to Address TerpGal's Excellent Example:
Quote from TerpGal02
the pt states, "The CIA is coming to kill you" I would say, "It must be very scary to have those thoughts".
TerpGal not only lets the Patient know that she/he is being heard, but also Addresses the Meat of the Matter, which is the Patient's Feelings.
In fact, TerpGal doess not Acknowledge whether the Patient's Belief is Real or Not, but instead Focuses on that which is Objectively Real. Good Job!
Originally, with my Example Patient, I attempted to Address her Delusion by focusing on her Viewpoint. In Essence, when the Patient said something like, "You're Stupid!" I would reply with something like, ""Well, you are entitled to Your Opinion". To which the Patient would reply, "You're G.D. Right I'm entitled to My Opinion!" and on she would go. I found out that if I Ageed
with the Patient, that gave her No Obstacles or would not Fuel Her Fire. The Therapeutic Goal of De-esculation was attained.
I also want to mention that these Outbursts were Sporadic, i.e. the patient was labile. This Patient could be Sweet as Potato Pie or Mean as a Venomous Snake.
As always, we usually need to Adjust Our Approach to the Specific Patient and/or Situation.
Thanks again for your Posts!
Last edit by Davey Do on Jul 11, '13