Case study 20.1

Reflect on what might be causing Jim to think there was a dog in the room.

This happened in the evening when daylight was fading and light levels were going down. Jim has an ageing eye and has cataracts, both cause changes in the ability to manage low light. The room may well have had shadows moving across the room. Jim was feeling confused as a result of his infection and possibly was also receiving medication that could have made this worse. He was feeling anxious about being away from home. He was in a busy area at the entrance of the ward and this could have been noisy. All of this could have made him misperceive the environment and he may have ‘seen’ the dog because the light moving may have looked that shape, he worked with animals and having a dog with him may have brought comfort.

Identify some interventions that could improve Jim’s situation.

The first action should be to increase the level of light in the room so Jim could see more clearly. Spend some time with him and talking about his concerns is important. Provide him the opportunity to speak with his wife or family to reassure him all was well. Check he is not in pain or distress and has had his physical needs for food, fluids and elimination. Check any adverse effects from any medication he is receiving.