Communicating for the First Time with Delusional Patients

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Abstract
BACKGROUND: Aggression and threats of violence are acknowledged elements of psychiatric settings. One of the most upsetting clinical experiences for nursing students is the psychiatric-mental health practicum in which students are expected to communicate therapeutically with hospitalized, delusional patients. OBJECTIVE: The purpose of this article is to describe the experiences of undergraduate baccalaureate nursing students as they communicate for the first time with delusional, hospitalized patients whom they perceived as frightening and to describe the meaning and essences of their experiences. It was assumed that students would find the delusional patients frightening. STUDY DESIGN: Colaizzi’s (1978) phenomenologic approach was used to investigate the student experience. Participants (N = 35) wrote about their experiences during week 12 of a senior year psychiatric-mental health nursing class. RESULTS: Students feared the unpredictable behavior of patients and wished to avoid interaction with them; the students also made the transition from fear of patients to empathy and concern for them. The findings indicated that students were reassured by staff proximity. CONCLUSIONS: Psychiatric nursing faculty should develop role-playing scenarios about caring for delusional patients and establish strong alliances with staff to increase the students’ sense of safety.