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 Med-Surg, Geriatric, Behavioral Health.
Many valid points raised here folks against referring to patients as "trainees" and referring to the milieu as a training ground for employment. In my opinion, demeaning, intentionally misleading, and sub-therapeutic at best.
I'll refer it to the clinical instructor who handled us.. Can you help me out on how to support the stand not to use the tag trainees anymore.. Thank you..:)
Hi sleepybunny - and thanks for considering the responses you've had here.
I'm not sure whether this has given you any difficulty but I certainly would appreciate you, as a nursing colleague, just raising your observations with your clinical instructor and asking them if they think it's something that needs to be taken further.
I'd be disappointed if it wasn't taken further from what little you've mentioned here - but I would only expect you to report it to supervisors whilst you're a student.
As for changing the world - or just the word "trainees" - I think once you've passed the story over to your tutor then it is in someone else's hands and you should concentrate on continuing on with your studies.
If you wanted support on how to present it to your instructor, then I'm sure it can be done. I might request one of the forum staff support you to do that - esp as I'm in Australia.
Sorry if this has put you 'on the spot' and sometimes it's acceptable to tolerate 'differences' in other people's ways, but - to me - this 'treatment' goes beyond acceptable.
Patient, client, resident are all acceptable and interchangeable terms. It's often debated - perhaps I'll start a thread on it? :)
But going back to the Paranoid Schizophrenia - I was watching this thread from a bit late in the game so didn't want to jump in and confound things - the delusions this woman was having about the children and partner - did you ever find a reason for this?
I ask this because it's my experience that even the most deluded of ideas can be traced back to a rational thought, feeling or belief. My advice would have been to sit and discuss her delusions with her in a matter-of-fact way and see what 'reality' there is to it.
eg: Aliens are up my nose stealing oxygen from my brain - this is a real delusion as told to me by a patient.
When he got better (as he often did when he wasn't playing with amphetamines ) he could recall having the thought and couldn't really understand what it was about. So we talked about it and tried to come up with a rational explanation.
Through the course of discussion he noted that when he got ill his head was confused, throbbing and 'not right'.
Because of the drugs his rationality was compromised and he couldn't put it simply down to that he'd been overdoing the drugs - because that would also mean challenging a 'belief' that taking the amphetamines wasn't a bad thing (denial). So in order not to compromise his denial of the effects of amphetamines - he created an alternative answer - aliens up his nose stealing oxygen from his brain.
So if someone tells me something that is too far to believe - I try to work it out.
Another patient who presented in a hypomanic state claimed he had 'connections' with the Turkish Embassy but after a course of antipsychotics his hypomania cleared up pretty well.
Turned out his Dad did work at an Embassy tho! Be careful what you discount as a delusion!
I had another patient who thought he had female genitalia in his forehead..... that was a lot more complex.
If your female patient were to have a 'rational' basis to what has now become a delusion of having kids and a husband - what do you think it might have been to begin with?
I was not able to ask her about it because she told me that she did not want those who did not believe in her.. But she was aware that it was written in her chart that she was single.. (she was a retired nurse)
..to begin with, her main delusion was that she had a chip implanted in her brain so that these JFK followers (of bad CIA agents) can get information about her.. that was what the staff of the institution new, as well as my clinical instructor (since she did not personally interview clients, it was up to the students, she just knows the diagnoses).. Further nurse-patient interactions brought me to a continuation of the delusion that there was a neurosurgeon in the hospital she last worked at, whom she suspected to be the one who implanted the chip.. Then she told me that this person was the one being protected by the JFK followers and that this neurosurgeon stole money from her bank account..
..i tried to explore more by asking, "How much was taken?", "Were there money left?" She told me that only $5,000 dollars were taken.. I asked, "Can you recall an instance that you may have bought something?", and "Can you recall if you have lent your family members that money?" She continued to tell me that it was stolen.. Then, she refused to tell more because she said that it was a long story and that i should focus on the nursing care..
..succeeding nurse-patient interactions were more about her daily activities and childhood development..
Specializes in Psych, ER, Resp/Med, LTC, Education.
Well generally in a hospital or acute care setting we use "patient", a long term care facility--where the person actually resides/lives a "resident" (LTC/SNF, residential treatment facility where the person lives there) and in the outpatient setting "client". Then there is a weird one.. I once worked in a medical model adult day health care and the guidelines for this setting that we had to follow actually state what that you are to refer to them as "registrants"...that one took a while for me to get used to. But I do believe the prior 3 do infer as to acute tx vs. residential tx vs outpatient tx.
Specializes in psych, addictions, hospice, education.
I just have to add a few more tags...how about calling them by name or calling them men and women?
I wish I could have seen you in action with the lady you wrote about. I think you were quite caring and very good at what you were doing. If only all students (and people who care for men and women in psych settings) put so much thought and energy into doing the right thing!
Thank you ma'am Whispera for that lovely comment.. I just thought of rendering her the care that I should have given to my late grandmother..
..Yes, we call them by names.. We practice it in the clinical settings.. I just use the term client when I make my case study, in place of the client's initials to avoid monotony..:)
..in addition, not all clients are ill, that's why I prefer to use client instead of patient (stereotype for ill individuals) since they came to avail the health care services, may it be for wellness or treatment..:)
) he could recall having the thought and couldn't really understand what it was about. So we talked about it and tried to come up with a rational explanation.
Thunderwolf, MSN, RN
3 Articles; 6,621 Posts
Many valid points raised here folks against referring to patients as "trainees" and referring to the milieu as a training ground for employment. In my opinion, demeaning, intentionally misleading, and sub-therapeutic at best.
Great discussion.
Carry on.