Martha D Buffum

Comprehensive Evidence-Based Program Teaching Self-Management of Auditory Hallucinations on Inpatient Psychiatric Units

Patients hearing command hallucinations to harm whose only self-management strategies are to obey these commands, can represent serious safety concerns on inpatient psychiatric units. A comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units is described that includes five components: suggestions for staff education; patient self-assessment tools; an interview guide and safety protocol; a course to teach strategies for managing distressing voices and commands to harm; suggestions to improve staff communication; and a plan to extend the program from inpatient care settings into the community by sharing materials with community case managers and caregivers when patients are discharged.

Responding to command hallucinations to harm: the unpleasant voices scale and harm command safety protocol.

Command hallucinations are relatively common in voice hearers and are taken seriously because of the potential threat to self and others. Many variables mediate the relationship between hearing commands and acting on them. This article describes the implementation of the Harm Command Safety Protocol and the Unpleasant Voices Scale to respond to command hallucinations to harm in the context of the dissemination of a multisite, evidence-based behavioral management course for patients with auditory hallucinations.

Self-Management of Unpleasant Auditory Hallucinations: A Tested Practice Model

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The models utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearers Experience, (b) Nursing Interventions, and (c) Voice Hearers Expected Positive Outcomes. These three parts of the model describe nursing assessments conducted with an interview guide and two self-report tools, nursing interventions that teach strategies to manage unpleasant AH in a 10-session course or individually, and evaluation of voice hearer outcomes with two self-report tools.

Behavioral Problems in Older Adults in Acute Care Settings: Challenges for Staff

Abstract The combination of mental and physical changes with age will impact agencies focusing on both acute and chronic problems. One of the biggest challenges for staff new to such patients is contending with agitated and aggressive behaviors. Conducting a needs assessment with staff is one method of mapping the nature and extent of problem behaviors for a specific setting. In the current study, a total of 71 staff members from different disciplines, across three acute care units and two VA health care facilities, completed a survey assessing the type and frequency of reported behavior problems, the extent to which staff members could identify and document relevant patient risk factors and to identify gaps in their training. Staff reported a large range of problem behaviors. They felt highly confident in their ability to respond effectively to the most frequently observed behaviors, such as patients appearing anxious or having difficulty concentrating and trouble sleeping. However, they felt less prepared for less frequent behaviors, such as physical aggression. This information will be used to design follow-up training for the staff in targeted areas, including the management of various behaviors and the recognition of risk factors for problematic behaviors.

Auditory hallucinations interview guide: promoting recovery with an interactive assessment tool.

The Auditory Hallucinations Interview Guide (AHIG) is a 32-item tool that helps psychiatric-mental health (PMH) nurses assess past and current experiences of voice hearers so they can provide more individualized care. The AHIG was developed as a research tool but has also been found to be clinically useful in both inpatient and outpatient settings to help voice hearers and nurses develop a shared terminology of auditory hallucinations (AH). Using the AHIG, voice hearers are able to tell their stories in a structured and safe environment, thus encouraging recovery. Through respect and active listening, PMH nurses can communicate unconditional acceptance, caring, and hope for recovery, which helps develop rapport and promote trust in the nurse-patient relationship. Once trust is developed, voice hearers and PMH nurses can work together to find effective strategies for managing AH, including commands to harm self and others.