Presentation

Nursing management for patients with

delusions

Sandra Haro
INDEX 01 -Related factors
02 - Evidenced by
03 -Goals
04 -Nursing Intervention
 01 - RELATED FACTORS

- Impaired ability to process and synthesize internal and external

stimuli.
-Biologic factors (neurophysiologic, genetic)
- Psychosocial/environmental stressors.
- Weak ego boundaries
- Lack of trust
- High level of anxiety.
 02- EVIDENCED BY

- Autistic thinking.
- Delusional thinking
- Believes that his or her thoughts are responsible for world events or
disasters (magical thinking).
 03 - GOALS

- Demonstrate reality-based thinking in verbal

and non-verbal behavior.
- Demonstrate absence of psychosis
(delusions, magical thinking, …etc)
04 - NURSING
INTERVENTIONS:
ESTABLISH A TRUSTING
RELATIONSHIP
- Avoid challenging the client’s delusional system or arguing with the client,
since delusion cannot be changed through logic, and challenging the belief,
may force the client to adhere to it and defend it

- Be honest, genuine, reliable, and consistent all the time.

- Keep your promise and do not promise clients about unattainable things.
- Use clear, direct, and simple statements while communicating with clients
with delusions.

- Maintain facial expressions and behaviors that are in harmony with verbal
statements to avoid misinterpretation or confusion.
- Interpret the client’s misconceptions and misperceived environmental events
in a calm, matter-of-fact manner, empathic, and supportive manner.
04 - NURSING
INTERVENTIONS:
ESTABLISH A TRUSTING
RELATIONSHIP
- Assure the clients that it is a safe environment, and no harm will
come if needed.
- Center on the client as a person, rather than on the need to control
the symptoms.

- Refrain from touching a client who is experiencing persecutory

delusion to avoid misinterpretation.
 ASSESS DELUSIONAL
EXPERIENCE

- Assess the content and the type of delusion.

Ask the patient to describe his beliefs. Example: “tell me more
about someone trying to hurt you”, “what makes others against
you?”
- Identify the emotional needs and feelings behind the delusion.
- Assess duration, frequency, and intensity of delusional
experiences.
- Identify what triggered the delusion. For example, you can ask
the client “tell me what is happening before thinking that way”
 ASSESS DELUSIONAL
EXPERIENCE

- Assess whether the client acts based on his/her delusion. Protect

self and others if needed.
- Assess the degree of conviction. How much the client is certain
about the delusion belief including the existence of evidence to
support the belief?
- Investigate the concrete ways that the delusion interferes with
daily-level activities.
 Once the dynamics of
delusion are understood the
nurse should:
- Avoid seeking the details of the client’s delusion so as not to
reinforce the false belief and further distance the client from reality.
- Focus on the client’s meaning, and feelings rather than the
delusional content. Listen carefully to the client’s feelings and
reflected them to the client. For example, “It must be frightening for
you to think that people are against you”.
- Meet the emotional needs the delusions fulfill. For example, if the
delusion fulfills a need for security, attempt to meet this need in
everyday life.
 Once the dynamics of
delusion are understood the
nurse should:
- Distract the client from the delusion by engaging him in a less
threatening or more comforting real topic and activities that need
attention and cognitive skills to stimulate the cognitive process, and
structure the environment so that it is difficult for the client to
spend time in delusions.
- If the client asks you directly if you believe the delusion, respect
that this is the patient’s experience. For example, you can say “I
believe you are telling me this as you see it” or that is your
thought”. If the client persists in asking if you believe the delusion,
simply present the reality that you do not share the delusional
beliefs.
 Once the dynamics of
delusion are understood the
nurse should:
- Observe events that trigger delusions. If possible, help the client
find ways to avoid such triggers or reduce the associated anxiety.
- Teach clients stress management techniques.
- Teach the client to approach the staff when frightening thoughts
occur.
- Offer praise as soon as the client begins to differentiate between
reality-based and non-reality-based thinking
Presentation

Thanks

Sandra Haro