CNA · Emotional and Mental Health Needs · 6 min read
Hallucinations, Agitation, Wandering and Repetitive Behaviors
- Distinguish between hallucinations and delusions, and describe how to respond calmly and safely without reinforcing or arguing with the resident's perceptions.
- Identify common triggers for agitation and explain proper de-escalation actions, including maintaining personal space and protecting safety.
- Describe safe nurse aide interventions for wandering, preventing elopement, and managing repetitive behaviors (perseveration) using redirection and comfort measures.
Understanding and Responding to Hallucinations and Delusions
A hallucination is a sensory perception of something that is not physically present. A resident experiencing a hallucination may see, hear, or feel things that do not exist in reality. For example, a resident may state that they see insects crawling on the bedsheets or hear voices speaking from an empty closet. In contrast, a delusion is a persistent, false belief held firmly by a resident despite clear evidence to the contrary, such as firmly believing that their meals are being poisoned.
When communicating with a resident who is having a hallucination or delusion, the nurse aide must never argue with or contradict them. Contradicting the resident can increase their distress and damage trust. At the same time, the nurse aide must not validate or reinforce a hallucination by pretending to see or hear what the resident perceives. Instead, focus on how the resident feels. Acknowledge and validate the resident's feelings of fear or distress rather than the hallucination itself. For example, you might say, 'I understand that you feel frightened right now, and I am here to help you.' Provide a calm, reassuring presence when a resident is frightened by a delusion.
Environmental factors can sometimes contribute to these experiences. Shadows, mirror reflections, or glare on a television screen may be misinterpreted by a resident as something threatening. The nurse aide should notice these factors, reduce them when it is safe to do so, and report any environmental concerns to the nurse. You can also gently redirect a resident experiencing a delusion toward a calm, pleasant, and familiar activity. Above all, a nurse aide must never tease, laugh at, or scold a resident experiencing delusions or hallucinations. Always report any new, sudden, or worsening hallucinations and delusions promptly to the nurse.
The following table highlights the key differences between these two conditions and outlines appropriate nurse aide actions for each.
| Feature | Hallucination | Delusion |
|---|---|---|
| Definition | Sensory perception of something not physically present (seeing, hearing, or feeling things that do not exist). | A persistent, false belief held firmly despite clear evidence to the contrary. |
| What NOT to do | Do not pretend to see or hear what the resident perceives; do not argue, contradict, tease, or scold. | Do not argue, contradict, try to disprove the belief, tease, or scold. |
| Appropriate NA Action | Acknowledge the resident's fear or distress; reduce shadows, glare, or reflections; redirect safely; report to the nurse. | Provide a calm, reassuring presence; validate feelings; gently redirect to a pleasant, familiar activity; report to the nurse. |
Common mistakes
- Arguing with a resident about their hallucinations or delusions, or conversely, pretending to see and hear what they perceive instead of validating their emotional distress.
- Applying physical restraints or using force to stop an agitated resident, rather than addressing unmet physical needs and giving personal space.
- Grabbing, cornering, or abruptly blocking a wandering resident, which can trigger severe anxiety and combativeness.
- Telling a resident who asks repetitive questions that they already asked, rather than answering with patience, offering reassurance, and using gentle redirection.
Key points
- A hallucination involves sensory perceptions of things not physically present, while a delusion is a persistent, false belief held despite evidence.
- Never argue with or validate a hallucination; acknowledge the resident's emotional distress, ensure a calm environment, and report changes to the nurse.
- Agitation is triggered by unmet physical needs (pain, hunger, full bladder) or environmental stressors; de-escalate by approaching calmly, keeping distance, and offering quiet activities.
- Restraints and physical force are never used to manage agitation; if a resident becomes combative, step back out of reach and call for help immediately.
- Wandering should be managed by walking alongside the resident, using non-skid footwear, checking wander-management bracelets, and notifying staff immediately if elopement is attempted.
- Repetitive behaviors (perseveration) stem from memory loss or anxiety; respond with patience, brief and consistent answers, tactile activities, and reassurance.
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