Nursing care for a patient with auditory hallucinations using crossword puzzle therapy: A case study at Bali Provincial Mental Hospital
Abstract
Background: Auditory hallucinations are a common and distressing symptom of schizophrenia that can disrupt patients’ behavior, cognitive functioning, and daily activities. Nursing management generally includes hallucination-control strategies and pharmacological treatment, while complementary cognitive interventions may provide additional support for symptom management.
Aims: This case study aimed to describe the implementation of comprehensive nursing care incorporating crossword puzzle therapy for a patient with auditory hallucinations at Bali Provincial Mental Hospital.
Methods: A descriptive case study was conducted involving a 36-year-old female patient diagnosed with paranoid schizophrenia and experiencing auditory hallucinations. Data were collected through interviews, physical examination, behavioral observation, and medical and nursing record review. Nursing care was implemented based on the Indonesian Nursing Intervention Standards (SIKI), including hallucination management and four patient implementation strategies (SP1-SP4). Crossword puzzle therapy was administered once daily for 15-20 minutes over five consecutive sessions. Patient responses and progress were documented throughout the intervention.
Results: At baseline, the patient reported auditory hallucinations occurring 1–2 times daily, lasting approximately five minutes, and was observed pacing, mumbling, and demonstrating a flat affect. During the intervention, the patient progressively required less assistance in completing the crossword puzzles. By the fourth and fifth sessions, she was able to complete the exercises independently and reported improved ability to control the hallucinations. At the final evaluation, the patient appeared calm and cooperative, no longer demonstrated pacing or self-talk, and reported a substantial reduction in hallucination frequency.
Conclusion: The integration of crossword puzzle therapy into comprehensive psychiatric nursing care was associated with improved cognitive engagement, greater independence in completing therapeutic activities, and reduced reported auditory hallucination symptoms in this case. Crossword puzzle therapy may represent a feasible complementary intervention within psychiatric nursing practice. Further studies involving larger samples and controlled designs are needed to determine its effectiveness.
Keywords:
auditory hallucination, case study, crossword puzzle therapy, nursing care, schizophreniaDownloads
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