A. Definition
Hallucinations are disturbances of perception (perception) adanyarangsangan post without external senses that can include all of the sensing system in which occurs when the individual's awareness of the full / good.
Hallucinations are the most common form of the disorder of perception. The form of hallucinations may be noises or buzzing noise, but the most frequent form of words arranged in sentences rather perfect. Usually the last sentence talks about how the patient distress or addressed to the patient. As a result, patients can fight or speak with the voice hallucinations. Can also be seen as being in the patient's hearing or speaking loudly as if he answered someone's question or lips moving. Sometimes patients think hallucinations come from any body or outside the body. Hallucinations are sometimes fun example is lying, and other threats.
According to Durant Thomas May (1991) hallucinations in general can be found in patients with psychiatric disorders such as: Skizoprenia, Depression, Delirium and conditions associated with alcohol and substance use environment. Based on the assessment in mental hospital patients found 85% of patients with cases of hallucinations. So the writer is interested to write case by giving nursing care ranging from assessment to evaluation.
B. Classification
Classification hallucinations as follows:
1. Hallucinations of hearing (acoustic, auditory), patients heard voices talking, taunting, ridicule, or threaten but no sound in the vicinity.
2. See hallucinations (visual), the patient's view of a person, animal or something that does not exist.
3. Hallucinations of smell / inhale (olfactory). Hallucinations are rare to get. Patients who have a say smell odors such as the smell of flowers, the smell of incense, the smell of dead bodies, that there is no source.
4. Hallucinations ketchup (gustatorik). It usually occurs in conjunction with hallucinations smell / inhale. The patient feels (to taste) a taste in his mouth.
5. Allusion hallucinations (tactile, kinaestatik). The individual in question was someone who touched or hit. When rabaab is sexual stimulation is called a hallucination hallucination heptik.
C. Etiology
According to Mary Durant Thomas (1991), Hallucinations may occur in clients with psychiatric disorders such as skizoprenia, depression or state of delirium, dementia and conditions relating to the use of alcohol and other substances. Adapat hallucinations also occur with epilepsy, a condition of systemic infection with metabolic disorders. Hallucinations can also be experienced as a side effect of various medications including anti-depressants, anti-cholinergic, anti-inflammatory and antibiotic, while the hallucinogenic drugs can make the hallucinogenic drug the same as above. Hallucinations may also occur when the normal individual circumstances ie individuals who experience isolation, sensory changes such as blindness, lack of hearing or any problems to the talks. Specific causes of auditory hallucinations is unknown but many factors that influence such as biological, psychological, social, cultural, and environmental stressors originators are stress, biological, trigger problems coping resources and coping mechanisms.
D.Psikopatologi
Psychopathology of hallucinations is not known. Many theories have proposed that emphasizes the importance of psychological factors, physiological and others. Some say that in the normal waking state of the brain are bombarded by a stream of stimulus that comes from within the body or outside the body. This input will menginhibisi perception over to the natural appearance of this input sadar.Bila attenuated or not present at all as we have encountered in normal or pathological conditions, the materials contained in or preconscious unconsicisus be released in the form of hallucinations.
But others argue that the hallucinations began with a repressed desire to unconsicious and then because it is the breakdown of the personality and power of judging the reality of the destruction of desire was projected to come out in the form of external stimulus.
E. Signs and Symptoms
Patients with hallucinations tend to withdraw, often get to sit with eyes glued on one particular direction, smiling or talking to himself, suddenly angry or attacking others, restless, moving like he was enjoying something. Also, information from the patient's own hallucinations in natural (what is seen, heard or felt).
F. Management
Management of patients with hallucinations ways:
1. Creating a therapeutic environment
To reduce the level of anxiety, panic and fear in patients affected by hallucinations, preferably at the beginning of the approach is done on an individual basis and try to have happen knntak eyes, if you can touch the patient or on hold. Patients in isolation should not either physically or emotionally. Each nurse came into the room or close to the patient, talk to the patient. So also when the patient should be told to leave. The patient was told that the action will take place.
In that room should be provided the means to stimulate interest and encourage patients to get in touch with reality, such as wall clocks, picture or wall hanging, magazines and games.
2. Implement treatment programs doctor
Often patients refuse medication that is given with respect to the stimulus hallucination on receipt. The approach should be persuasive but instructive. Nurses must observe that the drug that is given right at telannya and drug reactions given.
3. Explores the problems of patients and help resolve any problems
After the patient is more cooperative and communicative, nurses can explore issues that are causing the patient's hallucinations and help resolve any problems. Data collection can also be through the information the patient's family or others close to the patient.
4. Giving activity in patients
Patients were invited to enable themselves to perform physical movement, such as exercising, playing or doing activities. This activity can help steer patients to real life and cultivate relationships with other people. Patients were invited to schedule activities and choose appropriate activities.
5. Involve families and other officers in the care process
Patient's family and other officers should be notified about the patient data so that there is unity of opinion and continuity in the nursing process, misalny of the conversation with the patient in the know when it is alone, he often heard the mocking men. But if there are others nearby voices were not heard clearly. The nurse suggested that patients should not be alone and get busy in a game or activity that exists. This conversation should be in to tell the patient's family and petugaslain not to let the patient alone and advice that is given is not contradictory.
Nursing Care in Patients with Hallucinations
A. Assessment
At this stage the nurse explore the factors are presented below:
1. Predisposing factors.
Are risk factors that affect the type and amount of resources that can be generated by individuals to cope with stress. Obtained either from the patient or his family, the social development of cultural factors, biochemical, psychological and genetic risk factors that influence the type and amount of resources that can be generated by individuals to cope with stress.
o Development Factors
If job growth obstacles and disrupted interpersonal relationships an individual will experience stress and anxiety.
o sociocultural factors
Various factors could cause the community to feel excluded by a lonely environment where clients in exaggerated.
Factors Biochemistry
Have an influence on the occurrence of mental disorders. With the excessive stress experienced by someone then the body will produce a substance that can be hallucinogenic and neurochemistry as Buffofenon Dimetytranferase (DMP).
o Psychological Factors
Interpersonal relationships are not harmonious with the dual role of the conflicting and often accepted by the children will lead to high stress and anxiety disorders, and ended with reality orientation.
o Genetic factors
What genes influence in skizoprenia unknown, but studies suggest that family factors showing a highly influential in this disease.
2. Precipitation Factors
Stimulus that is perceived by the individual as the challenges, threats / demands that require extra energy for coping. The existence of environmental stimuli often as the client's participation in the group, too long encouraged communication, objects that exist in the environment is also a quiet atmosphere / isolation is often a trigger hallucinations because it can increase stress and anxiety that stimulates the body to secrete hallucinogenic substances.
3. Behavior
Client's response to hallucinations to be suspicious, fear, insecurity, anxiety and confusion, self-destructive behavior, lack of attention, not able to take decisions and can not distinguish between real and unreal circumstances. According to Rawlins and Heacock, 1993 trying to solve the problem of hallucinations based on the existence of an individual nature as a creature that is built on the basis of the elements of bio-psycho-socio-spiritual that hallucinations can be seen from the dimensions:
o Physical Dimension
Man built by the sensory system to respond to external stimuli provided by the environment. Hallucinations can be caused by a number of physical conditions such as fatigue, drug use, fever of delirium, alcohol intoxication and difficulty to sleep in a long time.
o Emotional Dimension
Excessive feelings of anxiety on the basis of problems that can not be overcome is the cause hallucinations occurred. The content of command hallucinations can be pushy and scary. Clients no longer able to defy the order to the client's condition to do something to fear.
o Dimensions of Intellectual
In this intellectual dimension explained that individuals with hallucinations would show a decrease in the function of the ego. At first hallucination is a business of his own ego to fight the impulse to press, but it is a matter that raises awareness that can take the whole attention of clients and often will control all client behavior.
o Social Dimension
The social dimension in individuals with hallucinations showed a tendency to be alone. Individuals preoccupied with hallucinations, as if it is a place to meet the need for social interaction, self-control and self-esteem were not found in the real world. Fill hallucinations control systems used by the individual, so that if the command hallucinations in the form of a threat, the individual himself or anyone else inclined to it. Therefore, an important aspect in implementing nursing interventions to clients seeking a process of interpersonal interactions that lead to a satisfying experience, and not aloof mengusakan client so that the client always interacts with its environment and hallucinations did not last.
o Spiritual Dimension
God created human beings as social creatures, so the interaction with other human beings is a fundamental requirement. In these individuals tend to be aloof to the above process does not occur, the individual is not aware of the existence and hallucination into the control system of the individual. When the hallucinations people control themselves lose control of life itself.
4. Coping Resources
An evaluation of a person's choice of coping strategies. Individuals can cope with stress and anxiety by using coping resource environment. Coping as a source of capital to solve problems, social support and cultural beliefs, can help one integrate stressful experience and adopt coping strategies that work.
5. Coping Mechanisms
Any attempt aimed at the implementation of stress, including efforts to resolve problems directly and defense mechanisms used to protect themselves.
B. Nursing Diagnosis Appears
1. The risk of violent behavior in yourself and others associated with hallucinations.
2. Changes in sensory perception: hallucinations associated with withdrawal
3. Social isolation: withdrawal associated with low self-esteem.
C. Intervention
Diagnoasa 1.:
The risk of violent behavior in yourself and others associated with hallucinations
Objective: Not happening violent behavior in yourself and others.
Criteria results:
1. Patients can express their feelings in its current state verbally.
2. Patients can mention the usual action as hallucinations, hallucinations and decide how to carry out an effective way for patients to use
3. Patients can use the patient's family to control hallucinations often by interacting with the family.
Intervention:
• Construct a trusting relationship
• Give the client the opportunity to express his feelings.
• Listen to the client's expression of empathy
• Hold a brief but frequent contacts gradually (time adjusted to the condition of the client).
• Observation of behavior: verbal and non-verbal hallucinations associated with.
• Explain to the client signs on to describe hallucinations hallucinatory behavior.
• Identify with the client situation that raises and not cause hallucinations, content, time, frequency.
• Give the client the opportunity to express his feelings experienced while hallucinating.
• Identify with the client acts committed when he was having hallucinations.
• Discuss ways to decide hallucinations
• Give the client a chance to express how to decide in accordance with the client's hallucinations.
• Encourage clients to participate in group activity therapy
• Encourage clients to notify family when experiencing hallucinations.
• Discuss with clients about the benefits of the drug to control hallucinations.
• Help clients use the drug correctly.
Diagnosis 2.:
Changes in sensory perception: hallucinations associated with withdrawal
Objective: The client is able to control his hallucinations
Criteria results:
1. Patients can and will shake hands.
2. Patients want to mention names, would call out the name of the nurse and want to sit together.
3. Patients can mention the cause of the client withdrew.
4. Patients want to connect with other people.
5. After the home visit clients in touch with the family gradually
Intervention:
• Construct a trusting relationship.
• Create a contract with the client.
• Make introductions.
• Call the favorite names.
• Encourage the patient to talk with friendly.
• Assess the client's knowledge about the behavior of withdrawal and signs
and give the client a chance to express feelings cause the patient does not want to hang out / pull away.
• Explain to the client withdrawn behavior, and signs that may be the cause.
• Give praise to the client's ability to express feelings.
• Discuss the benefits of touch.
• Slowly and with the patient in the room activity through defined stages.
• Give credit for the success that has been achieved.
• Instruct the patient to independently evaluate the benefits of touch.
• Discuss the daily schedule to do the patient to fill his time.
• Motivation of the patient in following the activity room.
• Give credit for participation in the activity room.
• Do kungjungan home, building a trusting relationship with the family.
• Discuss with your family about withdrawing behavior, cause and car a family facing.
• Encourage family members to communicate.
• Instruct patient's family members regularly visit patients at least once a week.
Diagnosis 3.:
Social isolation: withdrawal associated with low self-esteem
Objective: Patients can connect with other people gradually.
Criteria results:
1. Patients can mention coping that can be used
2. Patients can mention coping effectiveness used
3. Patients are able to begin to evaluate themselves
4. patients are able to make a realistic plan in accordance with existing capabilities in him
5. Patients are responsible for any action taken in accordance with rencanan
Intervention:
o Encourage the patient to mention the positive aspects in him physically.
o Discuss with patients about their expectations.
o Discuss with patients who stand out for their skills at home and in the hospital.
o Give praise.
o Identify the problems being faced by patients
o Discuss coping used by the patient.
o Discuss effective coping strategies for patients.
o Together with the patient identification stressor and how penialian patients to a stressor.
o Explain that the confidence of patients to a stressor affects the mind and behavior.
o Together with the patient identification illustrate the belief that the purpose is not realistic.
o Together with the identification of patients coping strengths and resources owned
o Indicate the concept of success and failure with the perception that match.
o Discuss adaptive and maladaptive coping.
o Discuss the disadvantages and consequences of maladaptive coping responses.
o Help patients to understand that the only patients who can transform themselves not others
o Encourage the patient to formulate a plan / goal itself (not a nurse).
o Discuss the consequences and realities of planning / goal.
o Help patients to menetpkan clearly expected changes.
o Encourage the patient to start a whole new experience to develop according to the potential
