Best practice ideas for handling delusions...?

[WannaBeNrse]

Hi,

I am still fairly new to psych nursing (a little over a year now), and I really LOVE what I do. But, every time I am taking care of a highly delusional patient, I find myself wondering how to respond. For example, we have a patient who is experiencing auditory hallucinations, and believes that she communicates with people in this way. She is on a court hold now, but stands by the locked doors all day because she hears the voices of the judge and the voices of her psychiatrist and nurses telling her she can leave. When I explain to her that I only talk to her when she sees me face-to-face, and the judge only talks to her in the court room, she looks at me like I am either crazy or lying to her. So - what is the best way to handle a patient who is so entrenched in their delusions? I have tried scripted lines like "I believe that you are hearing that" etc but I really feel like I am losing rapport with her because what she hears me tell her in her head contradicts what I am actually telling her. Any advise?

Thanks! :)

[macfar28]

The approach I have tried is to gently say "do you think it's possible the chemicals in your brain aren't working right?" Or something to that effect. But that's only if I feel like there is some part of the patient that can grasp that insight. It seems to me that until her meds stabilize there's not much you can say to address the delusion.

[Davey Do]

Your Endeavor to want to communicate with a Psychotic Patient is Admirable, WannaBeNrse.

I started a Thread a Little While Back on Dealing with Patients' Perception of Reality. Perhaps you can get some ideas from some of the Posts.

https://allnurses.com/psychiatric-nursing/reinforcing-perception-reality-843349.html

The Best to you.

[greenbeanio]

I found this article by Richard Lakeman at work and I think it's very helpful:

View a PDF

Here's an excerpt from the introduction to his article:

"One of the most perplexing interpersonal situations a mental health professional will encounter is how to respond to another’s expression of bizarre or frankly delusional ideas.

The adage “Don’t argue but don’t reinforce” fixed false beliefs leaves one decidedly short on

solutions. Using tricks such as diversion, switching topics or worst of all, ignoring the

expression runs the risk of invalidating the person’s experience and leaving them feeling

misunderstood or unheard. Whilst, these tricks may not reinforce the delusion they may

reinforce a sense of alienation. This brief paper provides some principles on how to respond

in a therapeutic manner to someone who expresses bizarre or delusional ideas. "

[TerpGal02, ASN]

Find something for her to do when the auditory hallucinations are at their worst, even if its just coloring a picture. You can say, "I know the things you're hearing are bothering you. Could you just sit here and be with me for a little bit while we color this picture".