A patient admitted to the mental health unit is experiencing Disturbed Thought Processes. The patient believes that the food is being poisoned. Which communication technique the nurse plan to use to encourage the patient to eat?

1. A

   Using open ended questions and silence

2. B

   Offering opinion about the necessity of adequate nutrition

3. C

   Identifying the reason that the patient may not want to eat

4. D

   Focusing on self-disclosure regarding food preferences

Appeared in: Uttarakhand CHO - 2021

Explanation

• Using open-ended questions allows the patient to express their feelings and concerns without the nurse directly challenging or agreeing with the delusion.
• This technique focuses on the patient's underlying emotion (fear) rather than the illogical content of the thought (poison).
• Therapeutic silence provides a non-pressuring environment, giving the patient time to think and demonstrating the nurse's patience and acceptance.
• This combination is the most effective for building trust, which is the primary goal when caring for a patient with paranoia.

Why Other Options Were Wrong

• Option B: Offering an opinion or advice is a non-therapeutic technique. It can be perceived as confrontational and may increase the patient's defensiveness and resistance to eating.
• Option C: The reason the patient does not want to eat is the delusion itself. Trying to 'identify the reason' can lead to asking 'why' questions, which are non-therapeutic as they can make the patient feel interrogated and increase their paranoia.
• Option D: Self-disclosure is generally non-therapeutic. The nurse's food preferences are irrelevant to the patient's delusion and shift the focus away from the patient's needs and feelings.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Therapeutic communication with a patient experiencing paranoid delusions in acute care settings.
• The immediate priority in caring for a patient with persecutory delusions is not nutritional intake, but establishing a therapeutic alliance. Trust must be built before other interventions can be successful.
• Never argue with or try to reason a patient out of a fixed delusion. This will damage the therapeutic relationship and may strengthen the delusional belief.
• Patient safety is paramount. While encouraging nutrition is important, ensuring the patient feels safe with the nurse is the first step.

How to Approach the Question

• First, identify the core clinical problem in the stem: the patient has a 'Disturbed Thought Process' manifesting as a persecutory delusion (believes food is poisoned).
• Next, recall the principles of therapeutic communication for patients with psychosis. The primary goal is to build trust and reduce anxiety, not to challenge the delusion.
• Evaluate each option based on whether it is therapeutic or non-therapeutic in this specific context.
• Eliminate Option B (Offering opinion) and Option D (Self-disclosure) as they are classic non-therapeutic techniques that shift focus or create conflict.
• Consider Option C (Identifying the reason). While it sounds helpful, recognize that probing for the 'reason' behind a delusion can be perceived as questioning or challenging, which is counterproductive.
• Analyze Option A (Open-ended questions and silence). This aligns perfectly with therapeutic principles: it encourages the patient to express feelings, shows acceptance, and builds trust without confrontation. This makes it the best choice.

Concept Tested & Keywords

• Concept Tested: Therapeutic communication with a patient experiencing paranoid delusions.
• Stem keywords: Disturbed Thought Processes, food is being poisoned, communication technique, mental health
• Lead-in keywords: Which communication technique
• Clinical cues: The patient's belief that food is poisoned is a persecutory delusion, which guides the choice of communication.

Question ID

QUlNjL5Vr14Qth-GZKJ-TL

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 2 pp. 122-124, 123-125

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 48-50