What should a nurse do when a client with schizophrenia expresses harming thoughts?

When a client with schizophrenia expresses thoughts of harming themselves or others, it's crucial for the nurse to assess the situation thoroughly and ensure the patient's safety. Asking the client if they are hearing voices is important because it helps to evaluate the presence and nature of hallucinations, which are common in schizophrenia. Understanding whether the client is experiencing auditory hallucinations can provide insight into their mental state and the context of their harmful thoughts.

This approach is constructive for several reasons. It allows the nurse to gauge the severity and immediacy of the risk associated with the harming thoughts. This assessment can guide further intervention, whether that involves increased monitoring, safety precautions, or therapeutic interventions addressing the client's experience. By focusing on the client's perceptions and reality, the nurse can establish a rapport that may facilitate deeper conversations about the client's feelings and thoughts, leading to appropriate interventions.

In contrast, encouraging the client to communicate with the voices or inquiring what the voices are instructing could potentially reinforce delusional thinking and may cause the client to feel responsible for actions taken under the influence of these hallucinations. Focusing on reality-based topics, while helpful in some contexts, may not directly address the critical issue of harm and could lead to a lack of understanding about the client's mental health status