MANUSCRIPT
CASE REPORT
THE MANAGEMENT OF SENSORY PERCEPTION
DISORDER: AUDITORY HALLUCINATION
IN MR. A AT MENTAL HOSPITAL PROF. DR. SOEROJO
MAGELANG
By:
SITI ATIQOH
0121668
NGUDI WALUYO NURSING ACADEMY
UNGARAN
2015
THE MANAGEMENT OF SENSORY PERCEPTION DISORDER:
AUDITORY HALLUCINATION
IN MR. A AT MENTAL HOSPITAL PROF. DR. SOEROJO MAGELANG
Siti Atiqoh (*), Abdul Wakhid (**), Wulansari (***)
Nursing Academy Ngudi Waluyo
Sitiatiqoh15@yahoo.com
ABSTRACT
Welfare soul becomes a determinant of health status of a person. In Indonesia there are
1.728 people who have disturbed soul welfare and have been diagnosed with a severe mental
disorder. Of the mentioned amount, more than 90% of the clients experience hallucinations. The
purpose of this writing is to examine the management of the disorder of sensory perception:
auditory hallucination in Mr. A at Mental Hospital Prof. Dr. Soerojo Magelang.
The technique used in data collecting was by interviewing, doing physical examination,
and observating the patient's behavior. The method used to provide management for 2 days in Mr.
A as an action to help the client to identify his hallucination, to help patient to control
hallucinations by rebuking and taking medication. The results of the management from the
implementation and evaluation of the patient obtained that the patient was able to control his
hallucination with Sp 1 (rebuking) optimally and Sp 2 (taking medication) still with the guidance
of a nurse.
A suggestions for the hospital is to provide some examples about the description of the
management of patients with mental disorders and they are provided in each room to provide
deeper insight to the writen in the in the management of patients with impaired sensory perception:
auditory hallucination.
Keywords
: auditory hallucinations, rebuke, taking medication
INTRODUCTION
Welfare soul becomes a
determinant of health status of a
person. In Indonesia there are 1,728
people who have disturbed soul
welfare and have been diagnosed
with a severe mental disorder. From
the mentioned amount, more than
90% of clients have hallucination
(Data Basic Health Research
(RISKESDAS) (2013)). According
to Joseph & Sutini (2009), in a
mental
hospitals
Indonesia,
approximately 70% of hallucination
experienced by patients with mental
disorders are auditory hallucinations,
visual hallucinations 20% and 10%
are hallucinations of smell, taste, and
touch.
The amount of the incidence
of severe mental disorder, is still
relatively high where the auditory
hallucination
dominates.
Hallucination can be very worrying
because it has negative impact on the
client itself, do the others and the
environment. Therefore, the writen in
interested in performing management
and more discussion about the
process of managing disorders of
sensory
perception:
auditory
hallucinations.
MANAGEMENT METHOD
The method used was provide
management for 2 days in Mr. A in
the form of action to help the client
to identify hallucinations, to help the
patient to control hallucinations by
rebuking and taking medication. The
techniques used in data collecting
were
interview,
physical
examination, and observation of the
patient's behavior.
RESULTS MANAGEMENT
From the results of the
management of the implementation
and evaluation, the patient was
already able to control his
hallucinations with Sp 1 (rebuking)
optimally and Sp 2 (taking
medication) still with the guidance of
a nurse.
DISCUSSION
From the results of the
assessment in Mr. A, the patient
heard a male voice telling him to
walk and prohibit to sleep. Basically
the voice heard by the patient voice
was only the sound or false
perception because it was only
experienced by patients, in which
healthy people could not hear it.
Patients who experience a
false perception are those with
impaired
sensory
perception.
According to Maramis (2009) in
Hindra, people who have impaired
sensory perception are that they are
experiencing an error in perception
involving the five senses tools
although they are not tied to stimulus
from the outside but look so real for
patients with schizophrenia.
A false perception can occur
because the patient can not
distinguish between internal and
external stimuli. Patients can not
distinguish between a real stimuli
and unreal stimuli. According to
Moyet (2006), take sound or false
perceptions can emerge due to
secondary misinterpretation because
of changes in sensory organs,
neurological changes, metabolic
changes, impaired oxygen transport.
Besides
secondary
mobility
limitations, due to paraplegia or
quadriplegia,
secondary
misinterpretation (drugs, surgery),
secondary misinterpretation due to
pain or stress, social environmental
restrictions,
excessive
noise,
excessive activity, frequent demands,
monotonous environment and loss of
socialization can also affect the
occurrence of false voices heard by
patients.
According
to
Ngadiran
(2010) in Fa'izah (2013) false
perceptions can emerge after a
hostile relationship, stress, isolation,
useless, hopeless, and helpless
feeling. Mr. A experienced hostile
relations with his neighbors because
of the exhaust of motor, felt not able
to support his family, and his
relationship with his girlfriend was
not approved by his mother, so that
these conditions are triggered the
patient to experience a disorder in
determining the sensory perception.
The patient heard the false
sound when the patient was alone
and before going to bed. According
to Twistiandayani and Widati (2013),
this perception can arise due to lack
of stimulus environment around the
patient. Patients often feel lonely so
that the patient is not able to create a
positive stimulus to the environment.
After the assessment, the data
will be analyzed to determine the
nursing diagnoses. For the case of
Mr. A, the writer raised the diagnosis
of a disorder of sensory perception:
auditory hallucinations. According to
Kusumawati (2010) in Rahmawati
(2014), hallucination is the loss of
the human ability to distinguish
internal stimuli and external stimuli.
Hallucinations experienced
by
a
patient
characteristics.
According
Twistiandayani
and
Widati (2013) the forms of
hallucinations that occur can be
noises or buzzing that may affect the
client's behavior, such as talking to
himself, fighting and other harmful
responses-responses, as well as the
responses shown by the patient are
pacing and irritability.
The writen raised the
diagnosis of sensory perception:
auditory hallucinations because the
data obtained both subjectively and
objectively showed that Mr. A
showed the characteristics of
experiencing
hallucinations.
According to Moyet (2006), the
problem of sensory perception
disorders can be enforced if there are
major characteristics of sensory
perception disorders: hallucination is
inaccurate
interpretation
of
environmental stimuli and / or
negative changes in the number or
pattern of coming stimuli, then the
defining characteristics are minor
disorientation of time , people, and
places, changes in behavior or
communication
patterns,
hallucinations to hear or see, changes
in the ability to solve problems,
anxiety, sensitive to stimuli, poor
concentration.
The next step was the
preparation of interventions which
refer to the general purpose (TUM)
and Special Purpose (TUK). In
general,
the
preparation
of
intervention aimed to protect the
patient from possible risk of injuring
himself and others. According to
Rasmun (2009) in Fa'izah (2013) the
rational of building mutual trust is as
the basic therapeutic interaction
between nurses and clients.
Next intervention was to help
the client to recognize his
hallucinations. The ways to do that:
were are observation of behavior
associated
with
the
client’s
hallucinations,
identification
of
contents,
the
triggered
circumstances, time and frequency of
hallucinations experienced by the
client. When the nurse and the client
have already know the experienced
hallucinations, this will facilitate
nurses in determining interventions
that should be developed. According
to Rasmun (2009) in Fa'izah (2013)
the rationale of the action was that
the active participation of the client
determined the effectiveness of
nursing actions performed.
Further intervention, was by
explaining and training the client to
control
hallucinations,
namely:
rebuking, by taking medicine,
chatting and doing activities. The
aim was that the client was able to
control hallucinations and the
rational was a common action of the
client as an attempt to overcome
hallucinations (Rasmun (2009) in
Fa'izah (2013)).
And for the last intervention
was the collaboration with the family
in supporting the client’s healing
client, to encourage families to
always provide support to control his
hallucinations when the client had
gone home. Rasmun (2009) in
Fa'izah (2013) stated this important
intervention aims to provide clients
with the support of the family in
controlling
hallucinations,
the
rational family is able to care for
clients with hallucinations while in
the house.
Once the intervention is
determined, the next step is by
implementing interventions that are
suitable and followed by evaluation.
The implementation was carried out
in Mr. A was by doing Sp 1 (trained
to
control
hallucinations
by
rebuking). The rebuke was done by
expelling the coming noises.
According to Anggraini (2013)
rebuke is one attempt to control
hallucinations by rejecting appeared
hallucinations.
Rebuke can be taught by
nurses in the management of patients
with impaired sensory perception:
auditory hallucinations. According to
Anggraini (2013) rebuke can be done
in 2 ways by covering ears and
without covering ears. Both methods
have proven capable to derease the
level of hearing hallucinations
experienced by patients.
Rebuke can be done by
rejecting
the
coming
noise.
According to Twistiandayani and
Widati (2013) rebuked technique is
called as thought stopping as one
example of cognitive behavior in
psychotherapy technique that can be
used to help the client to change
thought processes it is. Done by
saying stop and expelling the
hallucinations. The basis of this
technique is to consciously ask
himself
to,
"stop!",
While
experiencing negative over and over,
is not important, and distorted
thoughts . Then replace the negative
thoughts with other thoughts which
are more positive and realistic.
At the first meeting the
patient, was taught Sp 1, because the
hallucinations of the patient still
often appeared and the patient could
not perform the way to rebuke. After
Sp 1, the evaluation process was
obtained in which the patient was
able to rebuke optimally and
independently.
Currently the second meeting,
the nurse did Sp 2 (train control
hallucinations by taking medication).
Sp 2 was done because the patient
was able to perform Sp 1 optimally ,
thus continued by Sp 2. The rational
of this ability to take medicine to
reduce the patient’s anxiety and to
reduce the risk of the emergence of
hallucinations. According to the
standard of nursing care at Mental
Hospital of Prof. Dr. Soeroyo
Magelang, to take this medication Sp
was implemented by discussing the
benefits, disaduarages of not taking
medication, name, color, dose,
method, therapeutic effects and side
effects of using drugs.
Medication
onedience
supports the recovery of a patient, a
nurse must monitor and discuss
properly to the patient. According to
Keliat in Kaunang, Kanine and Kallo
(2015) a client with mental disorders
(schizophrenia) is usually difficult to
follow the rules of taking drugs
because of the reality and the
inability to take decisions.
The evaluation process was obtained
from the second meeting that the
patient had not been able to control
hallucinations to take medication in
an optimal way. Guidance as well as
assistance in taking medication still
need to be done.
CONCLUSION
After assessment in auto and
allo anamnesis, the data obtained that
the Patient often heard a male voice
telling him to pace and forbid to
sleep when bedtime and alone. The
male voice came over 15 minutes,
missing, then appearing again. The
client folt disturbed and sometimes
the client responded the voice
grumpyly. Where the sound can not
be heard by healthy people.
From the results of the
assessment, the data obtained from
the patient can be used as supporting
data in diagnosing disorders of
sensory
perception:
auditory
hallucinations. And the data used in
this
diagnosis
are
correct
theoretically. Major and minor
characteristics mentioned in theory
are partly suitable with the
assessment of the patient in the
outcome data.
The writer gave nursing
action plans (interventions) in order
for the patient to control his
hallucinations by teaching Sp 1
(rebuke) and Sp 2 (taking
medication).
Implementation was done for
2 days and based on the interventions
that had been drawn up by teaching
the patient Sp 1 (rebuke) and Sp 2
(taking medication). The result was
that the patient was able to control
hallucinations using Sp 1 optimally
and Sp 2 still with the help of nurses,
so that the outline of the process of
managing Mr. A’s results was
suitable conformity with
the
objectives and met the criteria of the
desired results of the writer.
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