I'm a student nurse.. Currently, I am in a Psychiatric nursing rotation.. We just had our Christmas break, then we will resume again in January..
The essence of this message is that I would like to seek advice for my mentally-challenged client.. She's an old-adult with Paranoid Schizophrenia.. Will it be right for me to present her with reality or would it be a non-therapeutic approach because I would "challenge" her? I just thought that exploration or agreeing would just make her get indulged more with her delusions.. Another concern is that she told me that she did not like the previous student-nurses, she had nurse-patient interaction with, whom she said, "did not believe her (referring to her delusions).."
I'm just concerned with losing the established rapport with her.. We will still be meeting for 5 days for this coming January.. May I know what could be my possible approach or when will be the best time to start presenting her with reality?
The movie a Beautiful Mind inspired me that there's hope if the mentally-challenged client will be able to accept and realize the delusions on her own..
If it will be alright, encourage me to post her delusions if it will help with suggesting interventions.. If it would compromise privacy, I'll settle with "delusions.."
Specializes in psych, addictions, hospice, education.
As many have said, it's not productive to tell her that her beliefs are not real. To her they ARE real. You'll destroy rapport if you tell her she's wrong. Try going at it from the empathy side (as at least one person said)...if the beliefs are upsetting, say something like, "it seems that might make you upset, tell me more about it..." If you tell her she is wrong, she won't tell you more, but it you empathize with the feelings behind the beliefs, you could find out more related to her under-the-surface "stuff". It's not important for you to be "right." It's important to help her deal with what she is thinking and feeling, even if it's impossible to believe.
What defines "real" is just that the majority agree.
Imagine you saw a man walk into your bedroom and start talking to you. You are fully awake. You can hear his voice, you can see every detail. You tell your friend about him and your friend does not see him. Does it help to be told he is not real? What if he is distracting- dancing around in circles, shouting, talking over everyone else in the room. You can't make him leave, and neither can anyone else. Does the fact that he is not "real" matter? He is dancing around in your bedroom- as real as anything else you've ever experienced. On top of this, you've lost touch with reality on many other levels, and have realized that you don't know who to trust and who is real. Is your husband real? Or are you new children real, who insist you are their mother and tell you that you must be crazy to not believe in them. As you can imagine- this would be a very confusing and frustrating illness.
Unless you can cure her illness, I would be the one person she feels she can confide her reality in. Express to her that you nor anyone else will be able to see the children she claims to have, because that is her reality and not ours. If she is able to get better, then she will. But in the mean time, be her friend.
I feel that you still be reorient her to reality. If she is having visions that are fearful, if you acknowledge them, that will only reinforce to her that they are real.
As in the case of the professor in a beautiful mind, he was never able to rid himself of seeing the figures of his friend and a young boy...however, over time he came to realize that they were not real and learned to ignore them.
I wouldn't assume that because she is mentally challenged she cannot learn the difference, it depends the depth of her disability.
Because of her age there is a host of reasons why she is back in the hospital and as you know, she is probably taking quite a few medications in addition to the ones to help her with her schizophrenia.
Re: topic, uhm, she was a nurse and i'm kind of unsure yet on how i will approach the situation since she told me that she don't like those who do not believe in what she says.. she preceded before i can even start dealing with her delusions.. as they've suggested, i'll be a friend first.. although thank you for your suggestion..
My first suggestion is to speak with the nurses on the floor and to your clinical instructor. Second, your job is not to "orient her to reality" but assist in her general functioning on the unit. Rather than focusing on the delusions, you might want to ask her about her experiences since she's been ill, course she may not frame this as illness so you can ask about since things have "not gone well and you've found yourself in the hospital". Also, this is a good time to look for prodromal indicators for hospitalizations (also known as relapse warning signs). Look for people in her life that she trusts, if and when her illness starts to play tricks on her beliefs.....does she trust her MD, does she take her meds, does she have support people in her life, etc...
Discussions aimed at the validity of delusions are rarely helpful. Reframe and find out her current goals. Even if the goal is just to be released from the hospital it will give you common ground and a foundation to build upon. Good luck.
As in the case of the professor in a beautiful mind, he was never able to rid himself of seeing the figures of his friend and a young boy...however, over time he came to realize that they were not real and learned to ignore them.
RE: The movie. It was inaccurate. Highly inaccurate.
Specializes in psych, addictions, hospice, education.
a few more thoughts:
if a person sees, hears, feels, tastes things, even if another person doesn't, does that mean the first person is lying?
how about saying, "I don't see/hear/etc. that but I believe you do." ?
to the original poster of this thread: it seems you want to tell the patient that what is going on is unreal, despite most people here telling you to not focus on that....what's going on in YOU here? (said most gently, just wondering...)
From the suggestion a bit earlier, it came to me that I should instead dwell on what triggered.. As some of the other posters replied, I should be a friend..
..yes, i guess i was wrong during the start and i am thankful that experienced nurses gave me better interventions..
RE: The movie. It was inaccurate. Highly inaccurate.
I never stated that the movie was accurate...however, to this day he is STILL seeing the delusions and now knows they are not real. Some people with schizophrenia-related delusions...this is only as far as they can come.
That part of my post was indeed, factually correct.
Whispera, MSN, RN
3,458 Posts
As many have said, it's not productive to tell her that her beliefs are not real. To her they ARE real. You'll destroy rapport if you tell her she's wrong. Try going at it from the empathy side (as at least one person said)...if the beliefs are upsetting, say something like, "it seems that might make you upset, tell me more about it..." If you tell her she is wrong, she won't tell you more, but it you empathize with the feelings behind the beliefs, you could find out more related to her under-the-surface "stuff". It's not important for you to be "right." It's important to help her deal with what she is thinking and feeling, even if it's impossible to believe.