Component Task: Management of a Patient with Inappropriate Perception (Hallucination and Illusion)

This is the process of helping a psychiatric patient with inappropriate perception to gain an awareness of the symptoms and be in touch with reality. It involves the use of a sequence of psychological steps that the nurse can assist the patient use to organize and interpret information from the environment.

Aims

·         Help increase awareness of the symptoms to interpret reality

·         Promote recovery

·         Prevent patient’s condition from worsening

·         Avoid the misinterpretation of a message

·         Prevent injury to self and others

Requirements

·         Table

·         Chair

·         Pen and paper

·         Patient’s folder (Electronic/Manual)

·         Serene environment

Steps

·         Approach patient in a calm manner and establish rapport (refer procedure)

·         Explain procedure to the patient

·         Assess content of command hallucination/illusion

·         Observe for verbal and nonverbal cues for hallucinations/illusions (e.g. inappropriate laughter)

·         Identify and verify the type of hallucinations/illusions patient is experiencing

·         Acknowledge and accept patient’s feelings and experiences

·         Identify precipitating factors

·         Interrupt the hallucination and engage the patient’s attention in another area

·         Direct the focus of the patient from the hallucinational/illusional expressions to the discussion of reality-centered situation

·         Set limits for discussing repetitive hallucinational/illusional expressions (e.g. you have already told me about this, let’s talk about something realistic)

·         Validate interpretation of what is being said (e.g. is this what you mean? who are they? etc.)

·         Teach voice dismissal when possible (e.g. singing out loud, listening to an audio player or reading out loud etc.)

·         Serve prescribed medications and monitor desired and adverse effects

·         Express appreciation to patient and direct him/her to the next activity

·         Document procedure and indicate patient’s level of co-operation in the nurses’ notes/patient’s folder