how do you manage a patient who has delusions

wonderbee, BSN, RN · Jun 1, 2008

During my first days as an psych RN, I thought it was my job to redirect patients to reality. I don't think that way anymore. I realize that the medication has to do its work before any reasoning can be effective. All that seems to happen is an argument and the patient is more agitated than before any intervention.

Now I just go with it if it's not harmful. For example, if someone thinks there's someone in their room, I check the room for them and tell them that I kicked the perpetrator out. I really find this tact the most helpful. Is it right? wrong? I don't know. I just know it works best most of the time.

SuesquatchRN, BSN, RN · Jun 1, 2008

If it's a scary one I acknowledge that they must be frightened and try to make them more secure. If it's more benign, like one of my LOL's thinking her mother is coming to pick her up from school, I'll generally redirect them with an offer of a snack (ice cream works well) and then ask if they would like me to wake them/get them/whatever when their mom comes so they can get on with their day.

If we could talk them out of it they wouldn't be there.

:)

ritaPHIL · Jun 1, 2008

wow cool.ive learned so much on what you said.youve given me an idea then.thanks a lot

ritaPHIL · Jun 1, 2008

as for me when i encounter with delusional patient.i assess if it is threatening to the patient but if it not then, i just let him/her talk about it and listen to it.i dont know it is right to do with that kind of patient but i would say it works the patient is not agitated or become restless.

SuesquatchRN, BSN, RN · Jun 2, 2008

as for me when i encounter with delusional patient.i assess if it is threatening to the patient but if it not then, i just let him/her talk about it and listen to it.i dont know it is right to do with that kind of patient but i would say it works the patient is not agitated or become restless.

If they calm down you're doing the right thing.

:)

MrChicagoRN, RN · Jun 3, 2008

just wondering and would like to ask how you talk to a patient who has delusions.it says that you will not say that the delusions is not true or else the patient becomes agitated or be more persistent with the delusions he has.what i usually do is silent type of therapeutic communication.can anyone here share some ideas?would appreciate it.tnx

You assess them for delusions.

You can do reality testing and reorient them to reality, but it shouldn't be challenging every delusion. If I think the FBI is monitoring me, the best you can do is empathize how it must feel to think the FBI is following me, and reassure me I am safe here. You can't prove that they aren't following me, can you?

But if the delusion is that there are people on the unit with guns ready to kill him, then the patient needs to be reassured that noone on the unit has guns and the staff actively works to keep everyone safe.

ritaPHIL · Jun 3, 2008

You assess them for delusions.
You can do reality testing and reorient them to reality, but it shouldn't be challenging every delusion. If I think the FBI is monitoring me, the best you can do is empathize how it must feel to think the FBI is following me, and reassure me I am safe here. You can't prove that they aren't following me, can you?
But if the delusion is that there are people on the unit with guns ready to kill him, then the patient needs to be reassured that noone on the unit has guns and the staff actively works to keep everyone safe.

got your point and i did appreciate coz it really helps.tnx a lot.and of course, i do emphasize to the patient that i can guarantee his/her safety in the institution. :nurse:

green12, BSN, RN · Jun 4, 2008

Also, sometimes delusions overlap with reality so be sure to listen carefully to what the patient is saying. I had a patient with religious delusions and on Easter sunday he asked me what Easter meant to me. I gave him a very brief non-religious answer (time of renewal, caring about others, blah, blah) while thinking oh-oh here we go. When I asked him his thoughts he said "Well since I'm god...etc." I must have had a look on my face (whoops, not good listening skills in this encounter) because he quickly said "I mean we are all god, god is within us, etc." So anyway I learned that within/aside from his delusions he also had a strong sense of spirituality and we were able to have a therapeutic conversation about it. :wink2:

kiwipsychnurse · Jun 5, 2008

For me delusions are all about risk management. If they seem quite harmless eg. I have a million dollars somewhere, then I just ignore it. If there is any element of danger/risk involved then he/she will have an urgent assessment.