An inpatient psychiatric nurse approaches a client diagnosed with schizophrenia. The client is pacing rapidly in the dayroom, staring intently at an empty corner, and looking terrified. The client points to the corner and shouts, "The demons are telling me that the food here is poisoned! Tell them to be quiet! You can hear them, right?" Which of the following is the most therapeutic response by the nurse?
- I do not hear any voices, but I can see that you are feeling very frightened by what you are experiencing.Answer
- BWhy do you believe that demons are trying to poison the food in the hospital?
- CThere is nothing in the corner; you are just having a hallucination because of your illness.
- DYou are completely safe here, and I promise that nobody is going to harm you or poison your food.
Answer
The most therapeutic response presents reality by stating that the nurse does not hear the voices, while simultaneously validating and addressing the client's intense feelings of fear.
The correct response utilizes the therapeutic techniques of 'presenting reality' (stating that the nurse does not hear the voices) and 'validating feelings' (acknowledging the client's fear). For a client experiencing active hallucinations, the nurse should never pretend to see or hear the hallucination, nor should they argue aggressively that it does not exist. Acknowledging the client's emotional distress while gently grounding them in reality is the safest and most effective way to de-escalate anxiety and build trust.
Step-by-Step Solution
Key Concept
Therapeutic Communication in Acute Psychosis