Reality Orientation for hallucinations/delusions?

[babaloo, BSN]

I know that you cannot talk patients out of delusions because they are fixed false beliefs, so do you not provide reality orientation for a pt experiencing a delusion? Instead do you just respond to the feeling tone vs. the illogical nature of the pt's delusion?

Also, for a pt experiencing hallucinations, for example a pt says there's a cat underneath her bed, do you provide reality orientation to that person and tell the pt there is no cat under the bed?

What are the steps to providing reality orientation anyways and when do you use it?

[elkpark]

You tell the person that you don't see a cat under the bed (after actually looking, of course), and gently suggest that this may be a little trick her mind is playing on her.

[lasair]

never say it is not there, because for them it is very real, but gently allow them to know that you cannot see it and explain why.

[SickSister]

There are already couple of good answers. I just want to add that, the patients shouldnt be encouraged to talk about their delusions -unless in a therapeutic setting- on ward usually say to the patients you believe them, but you cant see what they are seeing.Then try to distract and talk about topics that has nothing to do with their hallu/delusions. If they insists talking about it, ask what would help them, also you could offer them medication, if the things they seeing/hearing scares them.

Hope this helps :)

[Retired APRN, MSN, RN, APRN]

I just want to emphasize what elkpark said about actually looking. Sometimes people see something real that is anomalous and then misinterpret it in accordance with their disordered thoughts.

I learned this early in my career when a patient was going on about seeing a huge rat on the roof. I soothed and redirected her. A short time later I went out into the patients' courtyard and saw an opossum on the roof.

[elkpark]

I just want to emphasize what elkpark said about actually looking. Sometimes people see something real that is anomalous and then misinterpret it in accordance with their disordered thoughts.

I learned this early in my career when a patient was going on about seeing a huge rat on the roof. I soothed and redirected her. A short time later I went out into the patients' courtyard and saw an opossum on the roof.

I've had similar experiences. I started out my psych nursing career on a unit in a small, community hospital in a rural area. It was an old building and the rooms shared connecting baths. One night, on night shift, one of our older ladies (who was known to have some dementia) wandered out to the nurses' station and indignantly asked us to come "get that lady out of my bed." The tech assumed she was confused and, without getting up from her seat, told her no one was in her bed and to go back to bed. I got up and walked down the hall with her to her room and, sure enough, another elderly lady from the next room, even more demented, had gotten up to the BR, gone back to the wrong (adjoining) room, and climbed into the first lady's bed with her. You can't just assume people are hallucinating or confused ...

[tareija]

It depends on how much insight they have. Some of my patients, especially if they've been ill previously and then improved., kind of get that their hallucinations or delusions may not be real. They are kind of testing whether or not they're real, or looking to staff for reassurance. For instance, someone hearing voices, they know the voices are a symptom, but are getting worn down by having to listen to them. For those patients I might be a little more direct that these experiences are symptom of their illness. I affirm their feelings (e.g. I can see that this is frightening for you), and then provide feedback that they are safe and it will be okay, then discuss coping strategies (e.g. meds, distraction, what have you).

For patients who are more ill and don't have insight, reality feedback of this type can be counterproductive. I may provide reality feedback of a more general nature. E.g. someone who is paranoid and scared that people are going to come hurt them. I might not argue with them that no one is after them. But I may say something like, you are in the hospital, this is a safe environment. We have staff and security here 24/7 to make sure no one comes on the ward unless they're allowed to be here. Sometimes people can find this kind of reality feedback helpful even if they are still delusional.