Schizophrenia Q 13
A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?
A. “I get upset once in a while, too.”
B. “I know just how you feel. I’d feel the same way in your situation.”
C. “I worry, too, when I think people are talking about me.”
D. “At times, it’s normal not to trust anyone.”
Correct Answer: A. “I get upset once in a while, too.”
Sharing a benign, non-threatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can’t know how the client feels. Identify with the client symptoms he experiences when he or she begins to feel anxious around others. Increased anxiety can intensify agitation, aggressiveness, and suspiciousness. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices.
Option B: Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client’s seemingly illogical fantasies. Initially do not argue with the client’s beliefs or try to convince the client that the delusions are false and unreal.
Option C: This is incorrect because it focuses on the nurse’s feelings, not the client’s. Recognize the client’s delusions as the client’s perception of the environment. Recognizing the client’s perception can help you understand the feelings he or she is experiencing.
Option D: This wouldn’t help establish rapport or encourage the client to confide in the nurse. Show empathy regarding the client’s feelings; reassure the client of your presence and acceptance. The client’s delusion can be distressing. Empathy conveys your caring, interest, and acceptance of the client. Interact with clients on the basis of things in the environment. Try to distract the client from their delusions by engaging in reality-based activities (e.g., card games, simple arts and crafts projects etc).