Have you ever tried to chase a blue smurf? They are fast, sneaky and funny, and always in trouble.
Far, far away, in a little mushroom village, live a group of little blue pixies in short trousers and white bonnets called the Smurfs. Only as tall as three apples, they speak in "Smurf", a language that only they understand. The Smurfs are carefree, peaceful creatures that live in harmony with nature. But they have a nasty habit of wanting to act like man, which causes them 1,001 problems.
Some how Papa Smurf made it over to our hospital, and was running up and down the halls. The 6'2 young man who spotted him thought he was so funny and laughed a deep belly laugh most of the evening.
He came up to one of the nurses and said
"Do you see Papa Smurf? He is hiding behind you"
She replied, "No I don't see him"
Young man stated "Be careful don't move he is right behind you"
The nurse said, "Ok" and took a step backwards.
The young man had a shocked looked on his face "You stepped on him! You killed him!"
He dropped his head and walked down the hall.
Was there a smurf? We did not see him - this mentally ill young man did. It was very real to him and he wanted to share papa smurf with the staff.
How does a mental health nurse chase blue papa smurfs and present reality at the same time for good care to that client?
Does Nursing Theory Adequately Prepare Psychiatric Nurses to Work with Delusional Patients?
Anyone in mental health care knows you have to be careful how you find humor in a clients delusional sights - however there are times when you can folow along with them until you reach a point that you can redirect them that papa smurf is only a delusion. This young mans comment was "Yes I know."
It takes trust for a client to bring to the staffs attention about his own delusions and for them to describe to you what Papa Smurf has on and what he is saying and doing. Most people will deny they see or hear things. For the nurse or staff to get a client to trust you enough to share with you the things the voices are saying and what the delusions are doing is a break through in their care.
The nursing theory of mental health nurses is is present reality to these clients and redirect them to the here and now. As a new nurse or a new nurse in this field it is easy to go by the book and present reality. However, to someone who is standing and looking at the blue smurf behind your right leg laughing at them - that is their reality. A nurse/staff can talk with them about their delusion. Let them tell you about it - in details if they will. They open up to you and feel like they can actually talk about what is going on with them. Once they have been reminded that it is not real - they will still come back to you and tell you about their stories even though they know it is just not real.
A mental health nurse has to be able to play with the smurfs, the demons and stay in focus for the real life too.
The joking should be done with the intention of establishing rapport or being supportive or therapeutic in some way. It should never be mean-spirited. And, the patient should not be very upset or in an overly-serious mood. I believe it's easiest and most appropriate to joke with patients with whom we already have established some degree of therapeutic alliance.
The next time you see a blue smurf hiding behind the chair, be careful not to step on them - they are sticky on the bottom of your shoe. It is just a delusion but sometimes - you just have to smile and wave at Papa Smurf.
