Author Question: A patient diagnosed with paranoid schizophrenia is describing religiously-based delusions that other ... (Read 23 times)

Mr.Thesaxman · **on:** Jul 19, 2018

A patient diagnosed with paranoid schizophrenia is describing religiously-based delusions that other patients find offensive. Which nursing intervention will the nurse implement to provide a therapeutic milieu?

a. Engaging the delusional patient in prayer in order to redirect the problematic be-havior
b. Explaining to the delusional patient that such talk is offensive to some of the mi-lieu and will not be allowed
c. Asking for the pastoral counselor to visit the unit and talk with both the delusion-al patient as well as the rest of the milieu
d. Removing the delusional patient from the milieu when staff is unable to success-fully refocus the conversation to a non-religious topic

Question 2

A patient confides to the nurse that she feels guilty about the poor relationship she had with her mother-in-law, who is now deceased.

The patient tells the nurse that she is sure God will punish her for this and that she needs to confess her sins to someone. Which of the following is the best response by the nurse?
a. Would you like to speak to the chaplain when he comes later today? In the meantime, we could talk about your relationship with your mother-in-law.
b. It sounds as if you need to talk about this. Let's sit down in a private area. I'd like to know more about your relationship with your mother-in-law.
c. We all have trouble with our in-laws occasionally. God doesn't punish us for that.
d. What's done is done. We need to focus on your positive qualities.

dreamfighter72 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: C
Occasionally, individuals with serious mental disorders experience delusions that are spiritual or religious in nature. Certified pastoral counselors are skilled with regard to counseling pa-tients and consulting with staff about these problems, and they assist the health care team in ways that address the particular concerns of individual patients. Challenging or debating the truth of a person's delusions is not therapeutic, and spiritual delusions are no exception. En-gaging in spiritual or religious practice with individuals on a psychiatric unit is also inappro-priate. Removing the patient from the milieu is seldom therapeutic and done only to maxim-ize milieu safety.

Answer to Question 2

ANS: A
The patient has identified a specific spiritual problem that a chaplain would be equipped to handle, so a referral is appropriate. The nurse, in the meantime, is equipped to discuss rela-tionship issues. Offering to talk about the relationship without addressing the patient's ex-pressed spiritual needs is not therapeutic. Suggesting that the patient's relationship issues are not uncommon minimizes the patient's feelings. Attempting to refocus the patient dismisses the patient's needs.