Interventions for patients with dissociation??

[wish_me_luck, BSN, RN]

Hi,

What would you do for a patient who is experiencing dissociation/feeling of dreaming rather than reality? Other than the priority of keeping them safe. Do you only re-orient them to reality and help them figure out ways to cope with stress? Is it only caused from stress or is there some sort of pathophysiology behind it?

I am just curious what you do for them. This isn't a real situation or anything, just trying to figure out what you do.

[marshmallowstar, BSN, RN]

The dissociative mind is really amazing, it's exactly what the trauma survivor needed at the time. Unfortunately, it becomes an unhelpful and often counterproductive skill/instinct once the person is in a safer environment. I work on a dissociative disorders trauma unit.

An important thing to do can be ground or reoriented, this is the basis of most skills for symptom management and often involve using the 5 senses to be present in the moment. It can we as "simple" as naming 3 blue things you see. It seems simple but when a patient is having intrusive images or is slipping into a flashback looking around the room can be a very scary and difficult thing to do. We have a 54321 skill we use; What are 5 things you see? 4 things you feel? 3 things you hear? 2 things you smell? and 1 positive thing about you (or today or that you can do now) This requires them to be engaged with their current environment.

There are tons of skills to use then to manage the emotion/situation/trigger that caused to the dissociation.

A book I recommend is

Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists by Suzette Boon, Kathy Steele and Onno van der Hart

http://www.amazon.com/Coping-Trauma-Related-Dissociation-Training-

Therapists/dp/039370646X/ref=la_B001JXOMMY_1_1?ie=UTF8&qid=1347513063&sr=1-1

[wish_me_luck, BSN, RN]

Thank you, marsh! I appreciate your reply. I try and obtain any knowledge that I can from nurses and people who know more than I do. I will keep that in mind for any dissociation pts I receive. Dissociation was always one of those things that I wasn't exactly sure what to do because supposedly it comes and goes due to stress.

[Bluebell71]

Hello!

This is a really interesting discussion, I have picked up some tips also.

In the past I had a couple patients with dissociation and reoriented them to their evironment, but I have never thought of having a structure such as the one suggested above - it is really easy to use and I will treasure it for the future.

Thanks a lot!