A schizophrenic client with delusions tells the nurse, “There is a man wearing a red coat who’s out to get me.” The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?
A. “This subject seems to be troubling you. Let’s walk to the activity room.”
B. “Describe the man who’s out to get you. What does he look like?”
C. “There is no reason to be afraid of that man. This hospital is very secure.”
D. “There is no need to be concerned with a man who isn’t even real.”
Correct Answer: A. “This subject seems to be troubling you. Let’s walk to the activity room.”
This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief. As a nursing diagnosis in the presence of delusions, the Nursing Interventions Classification (NIC) defines Delusion Control (6440), which is defined as the provision of a safe and therapeutic environment to the patient in acute state of confusion.2 Thus, in the presence of delusions, the nurses must demonstrate to patients that they accept that the patient has this belief, although they do not share the belief.
Option B: It is important not to discuss or deny belief so as not to risk compromising trust. Reasonable doubt must therefore be used as a therapeutic technique. For example, “I understand that you believe this to be true, but I do not think the same.”
Option C: One should also reinforce reality and talk about things and people that are real, avoiding ruminant thinking in false beliefs. The nurse should also be attentive during feeding and taking medication, since the delirium of poisoning may be present and the patient may believe that the food or medication is to poison him. Thus, it may be necessary to confirm whether the patient has taken the medication.
Option D: The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes. Establishing a therapeutic relationship is not easy, requiring special attention on the part of the nurse. Active listening and empathy are especially important and should focus on the patient’s experiences. Authenticity is necessary, allowing the person to distinguish between what is part of the disease and what is not part of it, i.e., what is real and what is not. It is crucial to help the patient find their personal resources and identify achievable goals in the medium and long term and the means to achieve them.