Disturbed Thought Processes -Disruption in cognitive operations and activitiesAssessment Data Non-reality-based thinking, Disorientation, Labile affect, Short

attention span, Impaired judgment, DistractibilityExpected 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 delusionalthoughts N U R S I N G I N T E R V E N T I O N S R A T I O N A L E Be sincere and honest when communicating with theclient. Avoid vague or evasive remarks.Delusional clients are extremely sensitive about others andcan recognize insincerity. Evasive comments or hesitationreinforces mistrust or delusions.Be consistent in setting expectations, enforcing rules,and so forth.Clear, consistent limits provide a secure structure for the client.D o n o t m a k e promises that you cannot keep.Broken p r o m i s e s r e i n f o r c e t h e c l i e n t s m i s t r u s t o f o t h e r s . Encour age the client to talk with you, but do not pry for information.Probing increases the clients suspicion and interferes withthe therapeutic relationship.E x p l a i n p r o c e d u r e s , a n d t r y t o b e s u r e t h e c l i e n t understands the procedures before carrying them out.When the client has full knowledge of procedures, he or sheis less likely to feel tricked by the staff.Give positive feedback for the clients successes. Positive feedback for genuine success enhances the clientssense of well-being and helps make non-delusional reality amore positive situation for the client.R e c o g n i z e t h e c l i e n t s d e l u s i o n s a s t h e c l i e n t s perception of the environment.R e c o g n i z i n g t h e c l i e n t s p e r c e p t i o n s c a n h e l p y o u und erstand the feelings he or she is experiencing.Initially, do not argue with the client or try to convince theclient that the delusions are false or unreal.Logical argument does not dispel delusional ideas and caninterfere with the development of trust.Interact with the client on the basis of real things; do notdwell on the delusional material.Interacting about reality is healthy for the client.Engage the client in one-to-one activities at first, thena c t i v i t i e s i n s m a l l g r o u p s , a n d g r a d u a l l y a c t i v i t i e s i n larger groupsA distrustful client can best deal with one person initially. Gradual introduction of others when the client can toleratesis less threatening.Recognize and support the clients accomplishments( p r o j e c t s c o m p l e t e d , r e s p o n s i b i l i t i e s f u l f i l l e d , o r interactions

initiated).R e c o g n i z i n g t h e c l i e n t s a c c o m p l i s h m e n t s c a n l e s s e n a n x i e t y a n d t h e n e e d f o r d e l u s i o n s a s a s o u r c e o f s e l f - esteem.Show empathy regarding the clients feelings; reassurethe client of your presence and acceptance.The clients delusions can be distressing. Empathy conveysyour caring, interest and acceptance of the client.Never convey to the client that you accept the delusionsas reality.Indicating belief in the delusion reinforces the delusion (andthe client illness).A s k t h e c l i e n t i f h e o r s h e c a n s e e t h a t t h e d e l u s i o n s interfere with or cause problems in his or her life.Discussion of the problems caused by the delusions is afocus 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 takinganti-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 troubleseeking these out on their own. Community mental health programs where people with illnesses like schizophrenia can goduring the day are an excellent resource. People with mental illness can be with others and participate in work or leisureactivities. 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 theNational Alliance for the Mentally Ill offer valuable sources of social and emotional support, information and other resources tomentally ill persons and their families.FAULK, 2008DISTURBED SLEEP Sleep is as important as food and air. Quantity and quality are very important. Most adults need between 7.5 to 8.5hours of uninterrupted sleep. If you press the snooze button on the alarm in the morning you are not getting enoughsleep. 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 thesame time is most important. Getting bright light, like the sun, when you get up will also help. Try to go to bed onlywhen you are sleepy. Bright light in the morning at a regular time should help you feel sleepy at the same time everynight. Stay away from stimulants like caffeine. This will help you get deep sleep which is most refreshing. If you take anycaffeine, take it in the morning. Avoid all stimulants in the evening, including chocolate, caffeinated sodas, andcaffeinated 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 problemif the material is very stimulation and you read with a bright light. If it helps to read before sleep make sure you use avery 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 bedcan 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 sleepeventually.

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 tomake 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 upthroughout the night. You may not notice it. (It is worse if you have sleep apnea because the alcohol makes theapnea worse.) Sometimes people snore only if they have had some alcohol or may snore worse if they alreadysnore.) 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 therapeuticcommunication is not utilized as much as it should be in the clinical setting. The chief complaint from staff nurses is time. Agreat 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 areoften numerous directions they are being pulled in and unfortunately patients wants and even needs often fall through thecracks. 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. Patientsare often viewed simply as a body in the bed. I feel it is crucial that we dont 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 littlesympathy 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 arecommunicated to others not always by words, but by gestures and facial expressions. A nurse must always be aware of theseexpressions in clients, for these expressions may be the only way that the nurse can tell if there is something else going onthat needs their attention. The term given to this type of nonverbal communication is called, meta-communication. In meta-communication, the client may look at their amputated stump and say that it doesnt really look that bad, while at the sametime tears are rolling down from their eyes. Kimmel N. (2007, June 05)Step2Examples 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.Step3Therapeutic communication techniques.1. Active listening -Listening intentively with ones 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 persons reality, to accurately perceive feelingand 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 nurses deal effectively with difficult situations and patients and creates a sense of cohesivenessbetween the two.6. Sharing Feelings Acknowledging the patients feels communicates that the nurse listened to and understood the emotionalaspects of their illness situation.7. Using Touch8. 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 patientwas trying to communicate to you.12. Self Disclosing Revealing personal experiences, thoughts, ideas, values, or feelings in context of the relationship with theintent 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)Step4Effectively utilizing therapeutic communication techniques.Patient satisfaction weighs heavily on therapeutic communication. Patients in the hospital have to undergo many psychologicalchanges in order to cope. The nurse plays a vital role in orchestrating how successful the person will be at coping. All patientshave some degree of apprehension and need to be able trust their care givers and even rely on them for comfort andsympathy. When those components are not accessible to the patient the end result is always a negative experience.