NURS 310 Study Guide - Winter 2018, Comprehensive Midterm Notes - Anxiety, Major Depressive Disorder, Trust Law
12 Oct 2018
School
Department
Course
Professor
NURS 310
MIDTERM EXAM
STUDY GUIDE
Fall 2018
•Management of Hallucinations and Delusions
•Hallucinations
•Linda Brzustowicz talks about NOS1AP
•Hallucinations
•Voice Hearers – Paradigm Shift
•Eleanor Longden
•https:// www.youtube.com/watch?v=AgZHOSxN5cE
•http://www.intervoiceonline.org/support-recovery/a-practical-guide
•Voice Hearers - An
Alternative view
•Assessment – Overcome Obstacles
•Approaches
•Empathize and use observations
•Minimize questioning
•Seek information conversationally
•Directly but supportively seek information
•Prioritize what information is required
•Seek other sources for information (Varcarolis, p. 296)
•Assessment
•Assess patient
•Assess what is the person hearing or seeing
–“Are you hearing voices” and “What are you hearing”
•Safety Issue- Ask if voices are directing the person to harm self or others (command
hallucination?)
–Do they recognize the voice
–Do they believe they are real
–Do they plan to follow the command
•Assess yourself – Countertransference
•Interventions (cont.)
•Approach
•Watch for nonverbal cues
•Do not react to the hallucination as if they are real
•Do not address the voices
•Do not negate the person’s experience but offer your perceptions
• Distract to here and now
•Provide education – i.e., voices are part of the illness and allow to determine meaning of
these through exploration
•Interventions (cont.)
•Approach
•Concise statements
•If repeating – use the same sentence
•If telling to harm self or others notify police, physician and/or administration
•Document what client says
•Decrease environmental stimuli
find more resources at oneclass.com
find more resources at oneclass.com
•Explain to patient that while voices are real to them you do not hear them
•Refer to voices as “your voices or voices you hear”
•Interventions (cont.)
•Stay with the patient when they are starting to hear voices
•Direct them to tell the voices to go away
•Help focus on one topic at a time
•Explore how they are experience
•Identify needs underlying the hallucinations (grandiose – self-esteem
•Identify when most frightening and distressing
•Find activities for distraction
•Interventions (cont.)
•Engage in simple physical activities (writing, drawing, sports, treadmill, walking or
exercise bike)
•Observe for signs of increasing fear, agitation, or anxiety
•Medication or seclusions PRN
•CBT - Voice Hearers
•Explanation – Voices are like intrusive thoughts and are internally generated…
•But are mis-attributed to external forces
•Therapy helps the voice hearer to question the attribution
•For example, teach this by viewing a video where an individual is both experiencing
auditory hallucinations and is having a brain scan –shows activation of the speech area
thus proving this is inner speech
•CBT - Voice Hearers
•Experimental study - for group CBT therapy for voice hearers
•Compared to a control group
•Consisted of 8 sessions
•Measures at the end demonstrated statistically significant results in the frequency,
distress, perceptions of power in favour of CBT (McLeod, Morris, Birciiwood & Dovey,
2006).
•Using Narrative
•Characteristics of the voices are discussed, their age, gender, and the tone and manner
that they speak to the person
•Voices can be distressing and degree of distress connected to the extent the person
believes them to be powerful (Place, Foxcroft & Shaw, 2011).
•Using Narrative
•May begin by describing the first time a person heard a voice and often is fearful
•For example
“First heard a voice on 18 September 2009. I was feeling suicidal, stood watching traffic when
out of the blue I heard a man’s voice shouting at me. The voice was like something out of a
horror film. I turned around to look, and realized that no one was there. It was absolutely
petrifying, and I burst out crying” (Place, Foxcroft & Shaw, 2011).
•Delusions
Firmly held false beliefs that reasoning cannot correct and for which there is no support in
reality
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Fall 2018: management of hallucinations and delusions, hallucinations. Linda brzustowicz talks about nos1ap: hallucinations www. youtube. com/watch?v=agzhosxn5ce. Alternative view: assessment overcome obstacles, approaches. Seek information conversationally: directly but supportively seek information. Seek other sources for information (varcarolis, p. 296: assessment, assess patient, assess what is the person hearing or seeing. Are you hearing voices and what are you hearing . Safety issue- ask if voices are directing the person to harm self or others (command hallucination?) Do they plan to follow the command: assess yourself countertransference. Interventions (cont. : approach, watch for nonverbal cues, do not react to the hallucination as if they are real, do not address the voices, do not negate the person"s experience but offer your perceptions. Provide education i. e. , voices are part of the illness and allow to determine meaning of these through exploration. If telling to harm self or others notify police, physician and/or administration: document what client says, decrease environmental stimuli.
