A newly admitted patient with schizophrenia approaches the unit nurse and says, "The voices are bothering me. They are yelling and telling me stuff. They are really bad.". Which response by the nurse would be most appropriate?

Question

a. "Do you hear these voices very often?"
b. "Do you have a plan for getting away from the voices?"
c. "I'll stay with you. Tell me what you are hearing.".
d. "Try to ignore them and play cards with the others.".

Answer 1

C
Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, providing reality orientation, forestalling responses to the hallucinations that could result in injury, and general support to reduce anxiety. Asking for more information about the patient's experience allows for assessment of (and later intervention for) potential safety issues such as command hallucinations or paranoid themes. Asking about the frequency of the hallucinations is not particularly relevant at this point and does not address potential safety issues. Patients may have ways of coping with voices, but this patient's presentation suggests that his/her coping skills have been overwhelmed. Ignoring the voices and distracting oneself are not likely to be sufficient when the hallucinations are intrusive, disruptive, or frightening, as appears to be the case here.