ABSTRACT
PURPOSE: To explore and synthesize literature related to the nursing process addressing the focus "Delusion". DESIGN AND METHODS: This literature review is integrated with a scoping study framework. From the total 252 papers found, 39 were selected. FINDINGS: Relevant data and diagnostic activities, hypothetic nursing diagnoses, and interventions addressing the focus "Delusion" were identified. PRACTICE IMPLICATIONS: This literature review allowed the development of a clinical data model addressing the focus "Delusion", based on the steps of the nursing process identified. This clinical data model may contribute towards improving nursing clinical decision-making and nursing care quality in relation to a client suffering from delusion as well as producing more reliable nursing-sensitive indicators.
Subject(s)
Delusions/diagnosis , Delusions/nursing , Delusions/therapy , Nursing Process , Clinical Decision-Making , Humans , Primary Care NursingABSTRACT
In their daily practice, psychiatric caregivers seek an encounter with the patient. This involves trying to understand the patient's suffering, to give meaning and to make the clinical connection. This equates to constructing together. Some care organisations are working to create spaces within units which are suited to receiving patients with an atmosphere favouring the encounter. The story of Baptiste illustrates this approach. Testimony.
Subject(s)
Mental Disorders/nursing , Mental Disorders/psychology , Nurse-Patient Relations , Risk-Taking , Delusions/nursing , Delusions/psychology , France , Humans , Male , Patient Admission , Psychiatric Department, Hospital , Psychotherapeutic Processes , Psychotherapy/methods , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Social EnvironmentABSTRACT
Patients with psychosis speak of an uneasy relationship with their body. Between feelings of too little and too much, for them it is a matter of trying to suture an image which is not always unified, a body which they are not always sure they have. The attentive clinician will attempt to support the solutions of each psychotic patient to maintain their body, beyond the death drive which pushes them to tear it apart.
Subject(s)
Body Image , Mind-Body Relations, Metaphysical , Nonverbal Communication , Nurse-Patient Relations , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Self Mutilation/nursing , Self Mutilation/psychology , Delusions/nursing , Delusions/psychology , Humans , Object Attachment , Psychiatric Nursing , ShameABSTRACT
The acceleration of the standardisation of care and the dominance of the quality approach, since the 1990s, have brought significant changes to nursing practices, the different therapeutic approaches and the 'place' of caregivers with regard to the patient. In this context of modern psychiatry which must comply with all kinds of recommendations, what is the situation of the patient suffering from psychosis, who would previously have been supported over the long term in a psychopathological process? The encounter, envisaged as an opening, is placed at the heart of the therapeutic relationship.
Subject(s)
Nurse-Patient Relations , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Quality Assurance, Health Care , Adult , Aged , Delusions/nursing , Delusions/psychology , Ethics, Nursing , Follow-Up Studies , France , Guideline Adherence/ethics , Humans , Male , Middle Aged , Nurse-Patient Relations/ethics , Patient Readmission , Psychotherapeutic Processes , Quality Assurance, Health Care/ethics , Schizophrenia/diagnosis , Schizophrenia/nursing , Schizophrenic PsychologyABSTRACT
Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient.
Subject(s)
Mental Disorders/nursing , Mental Disorders/rehabilitation , Patient Advocacy/legislation & jurisprudence , Patient Isolation/legislation & jurisprudence , Patient Isolation/psychology , Quality Indicators, Health Care/legislation & jurisprudence , Restraint, Physical/legislation & jurisprudence , Restraint, Physical/psychology , Aged, 80 and over , Commitment of Mentally Ill/legislation & jurisprudence , Delusions/nursing , Delusions/psychology , Ethics, Nursing , Fatal Outcome , Female , France , Hospitals, Psychiatric/ethics , Hospitals, Psychiatric/legislation & jurisprudence , Humans , Mental Competency/legislation & jurisprudence , Mental Competency/psychology , Patient Advocacy/ethics , Patient Isolation/ethics , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Quality Indicators, Health Care/ethics , Restraint, Physical/ethics , Therapeutic Community , Treatment Refusal/ethics , Treatment Refusal/legislation & jurisprudence , Treatment Refusal/psychologySubject(s)
Borderline Personality Disorder/nursing , Borderline Personality Disorder/psychology , Defense Mechanisms , Psychiatric Nursing , Psychotherapy , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Chronic Disease , Delusions/nursing , Delusions/psychology , Hallucinations/nursing , Hallucinations/psychology , Humans , Prognosis , Schizophrenia/nursing , Schizophrenic PsychologyABSTRACT
WHAT IS KNOWN ON THE SUBJECT?: Delusions are common experiences in psychosis and this is reflected in the number of studies focused on improving our understanding of their development, impact, and treatments. Many service users with psychosis are in informal caregiving relationships and carers can play an instrumental role in the recovery process. There remains a lack of knowledge and understanding about carer experiences and how they cope when their relative's delusions involve them or close others. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Data drawn from five individual carer interviews, which were subject to interpretative phenomenological analysis, identified the importance of six key themes. In addition to a carer's exposure to their relative's illness symptoms and a reported lack of understanding about their relative's delusions, was a fear of delusion-driven behaviours, and the carer's attempt to conceal the true extent of their caregiving challenges to others. Carers' relationships were fractured and their coping was best described as an ongoing process, mainly developed through trial and error. It extends our understanding of important issues faced by a subgroup of carers and facilitates discussion beyond their levels of stress and burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study, with its limitations, indicates some carers may live in fear of harm from their relatives but also be reluctant to disclose to others the full story of what they are coping with. Health professionals must routinely assess for risks that informal carers may be exposed to as part of their role, and offer tailored support and interventions. ABSTRACT: Background In recent years, there has been a gradual shift towards the study of individual symptom presentations in psychosis, this is particularly found in studies of delusional beliefs. However, the literature remains sparse on informal caregiver experiences of individual symptoms. Aim The study sought to investigate carer experiences of supporting a relative with delusional beliefs, which involve family members. Methods Semi-structured interviews were undertaken with five caregivers and subject to interpretative phenomenological analysis. Results Interviews yielded six superordinate themes highlighting issues concerning a carer's exposure to symptoms of illness; lack of understanding about their relatives' delusional beliefs; concerns over coming to harm from their relative: efforts made by the carer to conceal their relative's delusional beliefs and their consequences; fractured relationships, and a long process of learning how to best cope. Conclusion Caring for a relative with psychosis who experiences delusional beliefs about the carer and family members can be challenging. The results underscore the importance of providing a programme of support to meet the varied needs of informal carers with an explicit aim of assisting carers in their day-to-day problem solving. It should also help to address issues carers may have about causality, including beliefs about self-blame, and identifying effective coping strategies.
Subject(s)
Caregivers/psychology , Delusions/nursing , Family/psychology , Health Knowledge, Attitudes, Practice , Aged , Female , Humans , Middle Aged , Qualitative ResearchABSTRACT
How should madness and in particular delusional manifestations be considered? The caregiver's perception of delirium has an impact on how they view the function of the caregiver in psychiatry. Should delirium be suppressed? Delirium is an individual phenomenon but the themes are linked to social issues. Must we not take into account everyone's "thresholds" with regard to the place of delirium, in order to make it part of "living together". Two patients of a psychiatric care system discuss these issues.
Subject(s)
Attitude of Health Personnel , Communication , Delusions/nursing , Delusions/psychology , Hallucinations/nursing , Hallucinations/psychology , Nurse-Patient Relations , Psychiatric Nursing/methods , France , Humans , Morals , Physician-Patient Relations , Psychotherapy , Self Care/psychology , Smoking Cessation/psychology , Social Adjustment , Social Stigma , Violence/psychologyABSTRACT
Delusions of having been wronged, of persecution, of having a mission or order to execute, are frequently the causes of dangerous psychotic acting out. The regular clinical assessment of these patients and their treatment is essential for preventing this acting out, which can have dramatic consequences on the potential victims. If there is a treatment indication but refusal on the part of the patient to cooperate, it is necessary to resort to treatment without the patient's consent.
Subject(s)
Acting Out , Dangerous Behavior , Psychotic Disorders/nursing , Psychotic Disorders/prevention & control , Adult , Cognitive Behavioral Therapy/methods , Commitment of Mentally Ill , Delusions/nursing , Delusions/psychology , Emigrants and Immigrants/psychology , Family Conflict/psychology , France , Hallucinations/nursing , Hallucinations/prevention & control , Hallucinations/psychology , Homicide/prevention & control , Homicide/psychology , Humans , Male , Nurse-Patient Relations , Patient Compliance/psychology , Personality Assessment , Psychotic Disorders/psychology , Risk Factors , Schizophrenia, Paranoid/nursing , Schizophrenia, Paranoid/prevention & control , Schizophrenia, Paranoid/psychology , Social Isolation , Vietnam/ethnology , Young AdultABSTRACT
Sexual violence is significantly higher among those with mental illness than the rest of the population. The risk of sexual violence posed to patients during inpatient admissions is now also beginning to be recognized, but remains a challenging area of practice. This paper introduces a trauma-informed care approach for responding to disclosures of sexual violence by people with serious mental illness, taking into account the complexities of caring for individuals who might be unable to provide coherent accounts of assaults and/or who might be experiencing varying degrees of psychosis. A framework for understanding and responding to disclosures of sexual violence that occur in mental health facilities is described, recognizing that such disclosures take many forms, including plausible and implausible accounts of recent sexual violence, as well as disclosures of past abuse triggered by current traumatic experiences. Illustrated by case studies, the practice implications for each type of disclosure described in the framework are explored in relation to investigation, care planning, and prevention.
Subject(s)
Delusions/nursing , Hospitals, Psychiatric , Mental Disorders/nursing , Mental Disorders/psychology , Rape/psychology , Self Disclosure , Adult , Aged , Aged, 80 and over , Crime Victims/psychology , Crisis Intervention/methods , Delusions/psychology , Factitious Disorders/nursing , Factitious Disorders/psychology , Female , Humans , Male , Middle Aged , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Repression, Psychology , Stress Disorders, Post-Traumatic/nursing , Stress Disorders, Post-Traumatic/psychology , Truth DisclosureSubject(s)
Dangerous Behavior , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Schizophrenia/nursing , Schizophrenic Psychology , Violence/psychology , Crime Victims , Delusions/nursing , Delusions/psychology , Hallucinations/nursing , Hallucinations/psychology , Humans , Prejudice , Risk , Social StigmaABSTRACT
One of the most visible symptoms of Diogenes syndrome is the excessive hoarding of disparate objects in the home of the patient. This article describes an attempt to treat an "encumbered" woman.
Subject(s)
Delusions/nursing , Delusions/psychology , Hoarding/nursing , Hoarding/psychology , Anxiety Disorders/diagnosis , Anxiety Disorders/nursing , Anxiety Disorders/psychology , Female , Hoarding/diagnosis , Hospitalization , House Calls , Humans , Middle Aged , Object Attachment , Phobic Disorders/diagnosis , Phobic Disorders/nursing , Phobic Disorders/psychology , Suicide, Attempted/prevention & control , Suicide, Attempted/psychology , SyndromeSubject(s)
Delusions/nursing , Delusions/rehabilitation , Ecology , Ecosystem , Hospitalization , Nurse-Patient Relations , Psychotic Disorders/nursing , Psychotic Disorders/rehabilitation , Antipsychotic Agents/administration & dosage , Delusions/psychology , Humans , Male , Medication Adherence/psychologySubject(s)
Crisis Intervention , Delusions/nursing , Delusions/psychology , Emigrants and Immigrants/psychology , Nurse-Patient Relations , Psychiatric Nursing , Adaptation, Psychological , Adolescent , Aggression/psychology , Combined Modality Therapy , Defense Mechanisms , Female , Humans , Violence/psychologyABSTRACT
Delusions are one of the most severe psychiatric symptoms of individuals with Alzheimer's disease (AD), which often increase the stress experienced by caregivers. The purpose of this study was to understand the influences of earlier life experiences and the current environment on delusions, as well as the underlying needs of older adults with AD who experience delusions. Using an exploratory research design with a qualitative approach and purposive sampling, 20 family caregivers were interviewed. Two psychosocial types of attributes of delusion were categorized: Type A, the influence of earlier life experiences; and Type B, current environmental influences. The underlying needs of those with delusions include physical comfort, a desire to be secure, and a sense of belonging. The contents of delusions are easily influenced by patients' earlier negative experiences and responsibilities, whereas the current environment exerts a crucial influence on the occurrence, frequency, and severity of specific delusions. These results can facilitate planning for patient-centered care by enhancing health care providers' understanding of the psychosocial and environmental attributes and needs behind delusions.
Subject(s)
Alzheimer Disease/nursing , Delusions/nursing , Geriatric Nursing/methods , Life Change Events , Social Environment , Adult , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Delusions/psychology , Female , Humans , Male , Middle Aged , Qualitative ResearchSubject(s)
Delusions/nursing , Hallucinations/nursing , Psychotic Disorders/nursing , Acute Disease , Delusions/diagnosis , Delusions/psychology , France , Hallucinations/diagnosis , Hallucinations/psychology , Humans , Nurse-Patient Relations , Psychotic Disorders/diagnosis , Psychotic Disorders/psychologyABSTRACT
Acute and transient psychotic disorder remains an important element of the clinical field. It was first observed by Philippe Pinel in the 19th century. Other figures, such as Philippe Chaslin and Valentin Magnan, have contributed to the identification of the disorders and a psychopathological classification. While the central clinical element of acute and transient psychotic disorder is delusion and hallucinations, its resolution can be quick or it may be a sign of the gradual onset of a psychiatric pathology.
Subject(s)
Delusions/nursing , Delusions/psychology , Hallucinations/nursing , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Acute Disease , Adolescent , Delusions/classification , Delusions/diagnosis , Diagnosis, Differential , Female , Hallucinations/classification , Hallucinations/diagnosis , Hallucinations/psychology , Humans , International Classification of Diseases , Male , Psychopathology , Psychotic Disorders/classification , Psychotic Disorders/diagnosis , Schizophrenia/classification , Schizophrenia/diagnosis , Schizophrenia/nursing , Schizophrenic Psychology , Syndrome , Young AdultABSTRACT
Around the clinical situation of a patient presenting an acute and transient psychotic disorder, the importance of team work becomes evident. Nursing care is present in all phases of the patient's care, from admission to discharge, including in the isolation room and the electroconvulsive therapy sessions. Presence, support, reassurance as well as the bond with the family are cornerstones of the nursing care.
Subject(s)
Delusions/nursing , Hallucinations/nursing , Psychotic Disorders/nursing , Acute Disease , Adolescent , Antipsychotic Agents/therapeutic use , Combined Modality Therapy , Cooperative Behavior , Delusions/diagnosis , Delusions/psychology , Dissociative Disorders/diagnosis , Dissociative Disorders/nursing , Dissociative Disorders/psychology , Electroconvulsive Therapy/nursing , Female , Hallucinations/diagnosis , Hallucinations/psychology , Humans , Nurse-Patient Relations , Nursing, Team , Patient Admission , Patient Discharge , Patient Isolation , Professional-Family Relations , Psychotic Disorders/diagnosis , Psychotic Disorders/psychologyABSTRACT
On the care stage, all the actors are active. One comes to lay down their suffering, the other has a dutyto consider their pain. The caregiver must play a role in stage managing the patient from the moment he or she remains anchored in reality and in the present moment. Beyond listening to the delusional speech, beyond containment and the effort of establishing communication, the nursing care of delusional patients falls within the sphere of negotiation.
