P15 · Hearing or seeing things others do not
Actual Emotions and mind
Definition
The person perceives voices or images that are not there.- Mental illness
- withdrawal
- fever
- brain disease
- drugs
- Talks to someone unseen
- frightened
- says he hears voices
- distracted
📋 Scenario
A patient covers his ears and says voices tell him to run.
Subjective (S): "The voices are telling me to leave."
Objective (O): Covers ears; talks to an unseen person; frightened; paces.
Assessment tools for this scenario: CP-MIND Mood & Mind Screen
Validated scales to consider: PHQ-9, GAD-7, C-SSRS
**CarePath diagnosis:** Hearing or seeing things others do not related to mental illness, as evidenced by talks to someone unseen and frightened.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Do not argue. | Arguing about whether the voices are real can increase fear and mistrust, so accepting that they are real to him while not agreeing keeps trust. |
| Reassure. | Calm reassurance that he is safe and not alone eases the fear that often comes with hearing voices. |
| Ask about the voices and any commands. | Asking about what the voices say, especially commands to harm himself or others, shows how much risk there is and guides what safety steps are needed. |
| Ensure safety. | A safe, low-stimulation environment lowers the chance of harm if he acts on fear or commands, such as trying to run. |
| Report command voices. | Command voices can lead to dangerous actions, so the team needs to know quickly to assess risk and adjust observation and treatment. |
| Give medicine as ordered. | Antipsychotic or other ordered medicine can reduce the voices and distress, and giving it as prescribed keeps treatment safe and effective. |
**Expected outcomes**
- Feels safe.
- Commands not acted on.
- Voices less distressing within days.
- Takes medicine as ordered.
**Linking the data to the diagnosis**
The patient says, "The voices are telling me to leave." The nurse sees him cover his ears, talk to an unseen person, pace and appear frightened. He is experiencing perceptions that others do not, now, so this is an actual problem related to mental illness. The nurse asks about commands because they raise the risk of harm. The plan aims for him to feel safe, not act on commands, find the voices less distressing within days and take medicine as ordered.
CarePath diagnosis
Hearing or seeing things others do not related to mental illness, as evidenced by talks to someone unseen and frightened.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Do not argue. | Arguing about whether the voices are real can increase fear and mistrust, so accepting that they are real to him while not agreeing keeps trust. |
| 2. Reassure. | Calm reassurance that he is safe and not alone eases the fear that often comes with hearing voices. |
| 3. Ask about the voices and any commands. | Asking about what the voices say, especially commands to harm himself or others, shows how much risk there is and guides what safety steps are needed. |
| 4. Ensure safety. | A safe, low-stimulation environment lowers the chance of harm if he acts on fear or commands, such as trying to run. |
| 5. Report command voices. | Command voices can lead to dangerous actions, so the team needs to know quickly to assess risk and adjust observation and treatment. |
| 6. Give medicine as ordered. | Antipsychotic or other ordered medicine can reduce the voices and distress, and giving it as prescribed keeps treatment safe and effective. |
Expected outcomes
- Feels safe.
- Commands not acted on.
- Voices less distressing within days.
- Takes medicine as ordered.
Linking the data to the diagnosis
The patient says, "The voices are telling me to leave." The nurse sees him cover his ears, talk to an unseen person, pace and appear frightened. He is experiencing perceptions that others do not, now, so this is an actual problem related to mental illness. The nurse asks about commands because they raise the risk of harm. The plan aims for him to feel safe, not act on commands, find the voices less distressing within days and take medicine as ordered.