Paranoid Schizophrenia

[sleepybunny005]

Good day!

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.."

Thank you! :)

[Atheos]

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.

Point in fact. He can't tell what is real or not. He has to confirm with people (that he already confirmed) that they are real.

He does have a coping medicine and he does refuse the meds.

That however is a rarity. Most people with mental illness are not equipped to deal with it without strong interventions. The fact that she is hospitalized already speaks to that fact.

[SuesquatchRN, BSN, RN]

none of us know what the guy in "a beautiful mind" does or doesn't know.

[Whispera, MSN, RN]

I've had patients tell me they know their hallucinations aren't real but "they're still there!"

[Atheos]

none of us know what the guy in "a beautiful mind" does or doesn't know.

he gave an interview. i just quoted him. so, i knwo what he said...

[sleepybunny005]

Our first NPI for this year transpired today.. I tried to be her friend and listened to her delusions.. It was surprising that we (I and my CI) discovered that there was a new reason behind her paranoid delusions..

..Should I continue to explore more with her delusion or will it make the condition worse? It seems that there's no clear history (if to be traced by psychodynamics) yet of her condition..

[Whispera, MSN, RN]

wow, those abbreviations have me confused...

but, yes, ask her about what she believes is going on...get her to tell her "story" it won't make it worse; it will help her feel you care and will help her open up to exploring it.

by the way, people can have delusions without any icky stuff in their history--schizophrenia is thought to be a malfunction in neurochemicals and brain structure as well as environmental challenges...

[sleepybunny005]

ow sorry about the abbreviations..x] didn't think if we had the same for them..

..i see, my problem is, if ever i'll trace down the problem using psychodyanamics, she wouldn't have a problem..

..though as our nurse-patient interaction began to end, a new information was given by her, it seemed that she referred to someone "she seemed to know" responsible.. the delusion seemed to have rooted from a mistrust with somebody.. although i am hesitant because it would come from her and that i will not be able to get any validations since we are not allowed to talk to relatives of the client..

..limitations as a student aren't helpful sometimes

[Whispera, MSN, RN]

your mission is not to find the root and fix it, but to help her find her own problem-source, through exploring thoughts, feelings, etc...that's what we do. It's interesting to find the cause, but often you can't! and, it's possible there is no cause...it just happens that she is schizophrenic and there's no basis for her feelings at all!

[sleepybunny005]

i see, thank you.. i'll give it a try again tomorrow.. then i'll give another feedback on what will transpire..

[diane227, LPN, RN]

As a general rule I do not try to redirect these patients into reality because it does not work and it results in a great deal of conflict and mistrust. To the people that are having hallucinations and delusions, those thought are reality and you cannot change anyone's reality. I try to help them feel safe and try to develop a rapport with them so that they trust coming to me when they need something. For example, I had a man on my unit one day who was having delusions that people were trying to kill him. He was very scared and threatening to the staff. When this occurs I feel that it is most effective to have one staff member try to communicate with the pt. In any case I took all the other staff out of the picture. It was just him and me in the hall. I kept myself at a good distance and reassured him that I would not harm him and would not allow anyone else harm him. After several minutes he agreed to sit with me on the sofa. He agreed to take some medication, all the while having only me talking and caring for him. If he had multiple people coming at him, even though they were trying to help, he would have viewed this as threatening. After his medication he was calm and was able to talk about how he was feeling. It was a positive end to what could have been a violent situation if we had taken another course of action. It is incidents like these that always made me feel good about being in psychiatry.

[sleepybunny005]

I apologize if I was inactive for too long.. The case study for the rotation really ate my time.. This would be the first time I would be able to sleep properly after a week..

..Now here's my feedback..:) I did not challenge her.. However, I tried to know more of her delusion, hoping that her schizophrenia was triggered by extrinsic factor/s.. The facility did not provide the old charts, which tempted me to dwell with her delusions, though i did not agree, instead, I tried to explore.. But when delusions are getting deeper, I diverted the discussion to topics with their daily activities and her personal experiences..

..our rotation for psychiatric ward was over last January, 14, 2009.. I'll miss the experience.. We prepared an activity for them, it was called grand socialization.. The trainees (term for clients in the facility) enjoyed..:) It was a fulfilling experience.. Before returning to their respective rooms, my client thanked me and even bid me goodluck..:)

..I would like to thank all those who supported me through this thread.. Unfortunately, we'll be moving to medical-surgical pediatric clients this coming rotation.. see you again next next next semester when we will return to psychiatric nursing rotation..:)

[Mr Ian]

by the way, people can have delusions without any icky stuff in their history--schizophrenia is thought to be a malfunction in neurochemicals and brain structure as well as environmental challenges...

Rubbish!

It's termites.

The trainees (term for clients in the facility)....

Nothing to do with sleepybunny - but ... "trainees"?

Otherwise, that was rather a cute little thread.