Disturbed Thought Processes

-Disruption in cognitive operations and activities

Assessment Data

 Non-reality-based thinking, Disorientation, Labile affect, Short attention span, Impaired judgment, Distractibility

Expected Outcomes

 Be free from injury

 Demonstrate decreased anxiety level

 Respond to reality-based interactions initiated by others

 Verbalize recognition of delusional thoughts if they persist

 Be free from delusions or demonstrate the ability to function without responding to persistent delusional
thoughts

NURSING INTERVENTIONS RATIONALE

Be sincere and honest when communicating with the
client. Avoid vague or evasive remarks.
Be consistent in setting expectations, enforcing rules,
and so forth.
Do not make promises that you cannot keep.
Encourage the client to talk with you, but do not pry for
information.
Explain procedures, and try to be sure the client
understands the procedures before carrying them out.
Give positive feedback for the client’s successes.
Recognize the client’s delusions as the client’s
perception of the environment.
Initially, do not argue with the client or try to convince the
client that the delusions are false or unreal.
Interact with the client on the basis of real things; do not
dwell on the delusional material.
Engage the client in one-to-one activities at first, then
activities in small groups, and gradually activities in
larger groups
Recognize and support the client’s accomplishments
(projects completed, responsibilities fulfilled, or
interactions initiated).
Show empathy regarding the client’s feelings; reassure
the client of your presence and acceptance.
Never convey to the client that you accept the delusions
as reality.
Ask the client if he or she can see that the delusions
interfere with or cause problems in his or her life.
Delusional clients are extremely sensitive about others and
can recognize insincerity. Evasive comments or hesitation
reinforces mistrust or delusions.
Clear, consistent limits provide a secure structure for the
client.
Broken promises reinforce the client’s mistrust of others.
Probing increases the client’s suspicion and interferes with
the therapeutic relationship.
When the client has full knowledge of procedures, he or she
is less likely to feel tricked by the staff.
Positive feedback for genuine success enhances the client’s
sense of well-being and helps make non-delusional reality a
more positive situation for the client.
Recognizing the client’s perceptions can help you
understand the feelings he or she is experiencing.
Logical argument does not dispel delusional ideas and can
interfere with the development of trust.
Interacting about reality is healthy for the client.
A distrustful client can best deal with one person initially.
Gradual introduction of others when the client can tolerates
is less threatening.
Recognizing the client’s accomplishments can lessen
anxiety and the need for delusions as a source of self-
esteem.
The client’s delusions can be distressing. Empathy conveys
your caring, interest and acceptance of the client.
Indicating belief in the delusion reinforces the delusion (and
the client’ illness).
Discussion of the problems caused by the delusions is a
focus on the present and is reality based.

IDEAL TREATMENT

3. Drug Treatments Available

Treatment for paranoid schizophrenia is medication. Psychiatrists prescribe drugs that can help control delusional thinking,
hallucinations, depression and anxiety. Certain symptoms like apathy and lack of motivation do not respond very well to

1
medication. For some people with schizophrenia these symptoms remain present for most of the time. When people are taking
anti-psychotic medications, the drugs that treat delusions and hallucinations, they need to see a doctor regularly. Some of
these medications have potentially dangerous side effects, so it is important to closely monitor usage.

4. Stay Active and Focused

Both social support and meaningful activity are very important for people with schizophrenia, but they may have trouble
seeking these out on their own. Community mental health programs where people with illnesses like schizophrenia can go
during the day are an excellent resource. People with mental illness can be with others and participate in work or leisure
activities. Family support is also important. Although a person with schizophrenia can often manage his own personal affairs,
family members can help him stay organized, make sound decisions and keep track of appointments and medications.

5. Help for Family Members

Families caring for or helping a person with schizophrenia will need support. Family support groups and organizations like the
National Alliance for the Mentally Ill offer valuable sources of social and emotional support, information and other resources to
mentally ill persons and their families.

FAULK, 2008

DISTURBED SLEEP

• Sleep is as important as food and air. Quantity and quality are very important. Most adults need between 7.5 to 8.5
hours of uninterrupted sleep. If you press the snooze button on the alarm in the morning you are not getting enough
sleep. This could be due to not enough time in bed, external disturbances, or a sleep disorder.
• Keep regular hours. Try to go to bed at the same time and get up at the same time every day. Getting up at the
same time is most important. Getting bright light, like the sun, when you get up will also help. Try to go to bed only
when you are sleepy. Bright light in the morning at a regular time should help you feel sleepy at the same time every
night.
• Stay away from stimulants like caffeine. This will help you get deep sleep which is most refreshing. If you take any
caffeine, take it in the morning. Avoid all stimulants in the evening, including chocolate, caffeinated sodas, and
caffeinated teas. They will delay sleep and increase arousals during the night.
• Use the bed for sleeping. Avoid watching TV or using laptop computers. Know that reading in bed can be a problem
if the material is very stimulation and you read with a bright light. If it helps to read before sleep make sure you use a
very small wattage bulb to read. A 15 watt bulb should be enough. Bright light from these activities may inhibit sleep.
• Avoid bright light around the house before bed. Using dimmer switches in living rooms and bathrooms before bed
can be helpful. (Dimmer switches can be set to maximum brightness for morning routines.)
• Don't stress if you feel you are not getting enough sleep. It will just make matters worse. Know you will sleep
eventually.
• Avoid exercise near bedtime. No exercise at least 3 hours before bed.
• Don't go to bed hungry. Have a light snack, avoid a heavy meal before bed.
• Bedtime routines are helpful for good sleep. Keep routines on your normal schedule. A cup of herbal tea an hour
before bed can begin a routine.
• Avoid looking at the clock if you wake up in the middle of the night. It can cause anxiety. This is very difficult for
most of us, so turn the clock away from your eyes so you would have to turn it to see the time. You may decide not to
make the effort and go right back to sleep.
• If you can't get to sleep for over 30 minutes, get out of bed and do something boring in dim light till you are sleepy.
• Keep your bedroom at comfortable temperature. Not too warm and not too cold. Cooler is better than warmer.
• If you have problems with noise in your environment you can use a white noise generator. A old fan will work or
you can buy noise machies from many sources.
• Know that the "night cap" has a price. Alcohol may help you to get to sleep but it will cause you to wake up
throughout the night. You may not notice it. (It is worse if you have sleep apnea because the alcohol makes the
apnea worse.) Sometimes people snore only if they have had some alcohol or may snore worse if they already
snore.)
• If you have a sleeping partner, ask them if they notice any snoring, leg movements and/or pauses in breathing .
Take this information and try the sleep test. You may have a sleep disorder or you may just need to increase your
awareness about your own sleep need. If you have any concerns see your doctor.

2
Establish what therapeutic communication is.

Therapeutic communication is a vital part of patient care that is often over looked. There are many reasons why therapeutic
communication is not utilized as much as it should be in the clinical setting. The chief complaint from staff nurses is time. A
great deal of staff feel pulled in so many directions that the thought of sparing a few minutes to really listen to what their
patients are saying is over whelming. Nurses and other health care providers have to be very skilled at multitasking. There are
often numerous directions they are being pulled in and unfortunately patients’ wants and even needs often fall through the
cracks. I have actually heard patients say that the harried and rushed appearance of the nurse made them afraid to ask for
something they wanted or even needed unfortunately. The focus has been lost in a lot of cases on what is important. Patients
are often viewed simply as a body in the bed. I feel it is crucial that we don’t just nurse bodies, but minds and spirits as well.
Many patients will sum up their entire experience in a hospital based on nothing more than how they were treated, if the staff
was friendly and took an interest in their well being as a person. Patients are looking for a kind word and perhaps even a little
sympathy from their nurses and other hospital staff.
Everyone has seen the individual that looks like they are either angry, stressed, feeling ill or maybe sad. These emotions are
communicated to others not always by words, but by gestures and facial expressions. A nurse must always be aware of these
expressions in clients, for these expressions may be the only way that the nurse can tell if there is something else going on
that needs their attention. The term given to this type of non-verbal communication is called, meta-communication. In meta-
communication, the client may look at their amputated stump and say that it doesn’t really look that bad, while at the same
time tears are rolling down from their eyes. Kimmel N. (2007, June 05)
Step2
Examples of therapeutic communication.

There are a number of ways to utilize therapeutic communication. A very important approach is to ask open ended questions.
Open ended questions require the patient to give more than a yes or no response. Example: Does your leg hurt? Open ended:
Where does your leg hurt? Open ended questions allow the nurse to get as much information from the patient as possible.
Step3
Therapeutic communication techniques.

1. Active listening -Listening intentively with one’s whole being (mind, body and soul).
2. Sharing Observations – Stating observations helps the patient communicate without the need for extensive questioning,
focusing or clarification.
3. Sharing Empathy – Builds trust. The ability to understand and accept another person’s reality, to accurately perceive feeling
and to communicate this understanding to the patient.
4. Sharing Hope – Is essential for healing. Communicate a sense of possibility to others.
5. Sharing Humor – Helps nurse’s deal effectively with difficult situations and patients and creates a sense of cohesiveness
between the two.
6. Sharing Feelings – Acknowledging the patients feels communicates that the nurse listened to and understood the emotional
aspects of their illness situation.
7. Using Touch
8. Using Silence – Allows the patient time to think and the nurse time to observe.
9. Ask Relevant Questions – Allows the health care provider to seek information needed for decision making.
10. Provide Information – Tell the patient what they need or want to know so they can make educated decisions.
11. Paraphrasing, Clarifying, Focusing, and Summarizing – All help to ensure you are correctly interpreting what the patient
was trying to communicate to you.
12. Self Disclosing – Revealing personal experiences, thoughts, ideas, values, or feelings in context of the relationship with the
intent of helping the other person.
13. Confronting – Helping the patient become more aware of inconsistencies in their feelings, attitudes, beliefs and behaviors.
Potter, Perry (2001)
Step4
Effectively utilizing therapeutic communication techniques.

Patient satisfaction weighs heavily on therapeutic communication. Patients in the hospital have to undergo many psychological
changes in order to cope. The nurse plays a vital role in orchestrating how successful the person will be at coping. All patients
have some degree of apprehension and need to be able trust their care givers and even rely on them for comfort and
sympathy. When those components are not accessible to the patient the end result is always a negative experience.