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.."
I know this is not your doing - so my comments are not at you - but something to consider.....
They just did not want to address the clients as patients..:)
..it's a privilege of the facility that those who recover, can and may work at the institution as staff..:)
"They... " - as in, the staff decided what they the patients would be called? There is a lot of argument for and against the use of the term "patient" in mental health. But I've never heard the term "trainee".
"..it's a privilege of the facility..." .. it's an arrogant presumption that anyone would want to.
Having a place of treatment that assigns it's residents the nomenclature of "trainee" suggests an inferiority of the patient who is required to undergo formal 'training' before they are 'good enough'.
What if someone does not get offered to work there?
Or what if someone never achieves the status of being 'employable'?
I do like the idea that patients may stay on and work there - and if they offer 'sheltered' employment conditions then this is also a good thing. I'm sure they are doing more good than bad... but ... the whole imagery of being a trainee .... do they have name tags and places to put all 5 stars??
well, we just followed the facility's rules.. i think it was the psychiatrists' or physicians' decision to use the tag trainee.. it's a private facility and let's leave their practice up to them..:) it may have been utilized because those with promising prognosis were disciplined, having reprimands or equivalent punishments to learn from their mistake(s)..
it may have been utilized because those with promising prognosis were disciplined, having reprimands or equivalent punishments to learn from their mistake(s)..
OK! now you have GOT to expand on that last point please....
..it was the facility's policy to give proper punishment for those who offend, reprimand, which was done by "facing the wall" - this is given when a client acts violently (verbally or physically) or in a harassing manner (physically or sexually) against another client with no injury meant.. if there was harm done, clients were restrained by tying their hands and was not allowed to join ward activities although can still be interviewed unless he/she was disturbed..
..for some of those who recovered, they worked in the facility as staff, usually as lecturers.. with those buffed guys, they worked as safety keepers.. these people are those of the higher societal classes and chose to volunteer their time in turn for their recovery..
Specializes in Psych, ER, Resp/Med, LTC, Education.
Trying to make sense of her dellusions will only make things worse.......As stated by the prior posts...in my experience ackowledging the fact that the person feels the way they do is important. To them those dellusions are as real as your standing in front of them. They can't see reality no matter what you say or do and as stated most will deny that they are even ill.......with time though you may see changes as the meds start to become therapeutic levels. Most CPS patients I see in the Psych ED have stopped taking their meds and have therefore decompensated......they should improve as the meds kick in. However it is important to remember that the majority of CPS patients will improve but will always have a baseline level of dellusional thinking and/or hallucinations. A small percent will be able to be free of all A/VH and dellusions....thus the Chronic part of the diagnosis. Lack of insight into thier own illness is minimal.
Acknowleding how the A/VH and dellusions effect her emotional is important........as a prior poster said. Responding with something like..."I understand that you are hearing these voices, how do they make you feel? Are they scary or maybe just annoying?" ...Wow that must be hard for you. I can't hear them but I know that you do. Is there something I can do to make them better? Would you like some medication to help with the voices?"
If you blatently disagree with the dellusions most patients will tend to get argumentative and agitated. A generic "Ah, thats very interesting Mrs. Smith" and Move on to another topic as suggested....."How has your appetite been? Did you enjoy your breakfast?"
You will find that this population may all cary the same diagnosis but I have fould that each patient seems to be just a little bit different. Therefore dealing with them is going to be a bit different.....the longer you are in psych the more comfortable you become and your ways of approaching each patient will come more naturally. Sometimes it really is just a matter of trial and error. But don't give up....it is a very different kind of nursing but very satisfying.
..i can't comment anymore now to the institution, since our rotation there is done.. and we were only affiliating..
I don't know what the standards of practice are where you live - but seriously - behaviour like this is tantamount to human rights violations; degrading and punitive.
Specializes in psych, addictions, hospice, education.
This isn't against you personally at all, but your facility is (expletive deleted)...
Trainees? Holy cow, that rubs me the wrong way--it's so condescending! I picture a prison with some of the inmates being "trustees" who have the keys and dole out the cigarettes. I hope someone gets rid of that word to refer to those in your CARE, as well as gets rid of the attitude that lets the word be used.
I wrote the words above before reading more that you wrote...I too am horrified by the treatment given at that facility!
sleepybunny005
29 Posts
They just did not want to address the clients as patients..:)
..it's a privilege of the facility that those who recover, can and may work at the institution as staff..:)