Impact of Internal and External Stimuli

by Brenda Marshall, EdD, MSN, RN

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    00:02 Now let's think about something a little bit different.

    00:07 Let's think about internal and external stimuli.

    00:12 And what do we mean by internal and external stimuli? Internal stimuli means it's a thought that I have.

    00:22 It's something that's coming from inside of me.

    00:27 It might be a thought.

    00:30 It might be a delusion, which is a thought.

    00:34 It might be a hallucination, which could be visual, auditory, tactile, olfactory.

    00:45 That's internal, coming from inside.

    00:48 My brain is creating it or another part of my body is creating some sort of stimulus.

    00:58 External is when I'm in a room, and I'm having a lot of stimuli coming towards me.

    01:05 It could be something as simple as the wallpaper might be overstimulating.

    01:12 It could be the amount of noise in the room, the amount of movement.

    01:17 So let's start with internal stimuli.

    01:21 Let's start with the idea of intrusive thoughts.

    01:25 What do we think are intrusive thoughts? Intrusive thoughts are when you have a thought that will not stop.

    01:37 Perhaps the person comes into the unit and says, the world's going to end tomorrow.

    01:44 I didn't want to come into the hospital because the world's going to end tomorrow.

    01:50 You say what makes you think that? I don't know.

    01:53 I just have this feeling, it's in my head.

    01:55 I can't get it out.

    01:57 That is an intrusive thought.

    02:00 No matter how hard the person tries to not think about it, it keeps coming back.

    02:07 Another internal stimuli is delusionary thoughts.

    02:11 Thoughts that even when you offer facts to demonstrate that that thought is not correct, the person cannot believe you.

    02:22 A delusion might be, "I am the Queen of England." And you say, "No Brenda, you are not the Queen of England.

    02:30 You happen to be a psychiatric nurse.? And I say, "That's what you think.

    02:36 You don't know the truth.

    02:38 The truth is, I am the Queen of England." That is a delusion.

    02:42 That is a false fact that I have adopted in my mind, and I believe it, I believe it to the core of me.

    02:51 And no matter what you tell me, you cannot make me think otherwise.

    02:58 Another one would be illusions.

    03:01 We see this sometimes post operatively.

    03:05 As someone has an IV, and they look up and they see the tubing to the IV and they say is that a worm? Well, there's actually a tubing there, they actually see something there.

    03:19 But they are missrepresenting, they see it as something that it is not and that is an illusion.

    03:27 Hallucinations, on the other hand.

    03:30 Hallucinations are something that do not exist in reality, in our environment or on our skin.

    03:40 And we either see them or hear them, feel them, touch them or taste them.

    03:50 So, those are all the ones that emanate from inside us external stimuli.

    03:59 And it's it's difficult with internal stimuli for us to be able to control them until we actually know what's going on.

    04:07 And usually with internal stimuli, we are able to find medications that help to reduce that level of internal stimuli.

    04:18 External stimuli, on the other hand, is the noise, the noise that surrounds you.

    04:26 There might be some disruption in the environment that is going on.

    04:32 There might be an influx of new people.

    04:35 Suddenly, you have four new admissions.

    04:38 And now you have patients getting somewhat agitated.

    04:41 Because these people don't know the rules, they don't know the regulations, they're doing things outside of them.

    04:48 Overcrowding.

    04:49 And this is something that we've noticed especially during the COVID period, where people were supposed to be a certain amount of distance from each other.

    05:03 And then you had too many people in one area, and people would get agitated.

    05:09 Because even though the room was large enough, there shouldn't be six people in this room.

    05:15 And so the agitation increases.

    05:20 Or it could be a number multiple stimuli all happening at once.

    05:24 It might be a fire engine passing by and people talking.

    05:31 Anything that affects our five senses can be causing external stimuli.

    05:38 And it can happen one at a time.

    05:41 It could happen multiple things happening at the same time.

    05:45 So we have to think about the impact of internal and external stimuli, and how it affects us emotionally.

    05:57 If it is causing agitation, if it's external stimuli, we really want to be able to reduce that external stimuli.

    06:07 When I am speaking to students who are going to go onto a psychiatric floor, I will tell them, "Don't wear bright colors." It might be stimulating for someone.

    06:18 Don't talk to the patient the way you may be talking to your friends when you go on the phone.

    06:25 Don't say, "Hey, my name is Brenda and I really am here to talk to you today.

    06:28 I hope that you really are going having a nice time.

    06:31 I mean, I don't know very much about your hospital.

    06:33 I'm not that I don't know about your hospital.

    06:35 I mean I've never been in a psychiatric hospital.

    06:37 Oh, I hope that doesn't, you know, hurt your feelings." That is stimuli.

    06:43 That kind of agitated chatter brings that kind of stimuli into an environment and can cause a person to start getting agitated.

    About the Lecture

    The lecture Impact of Internal and External Stimuli by Brenda Marshall, EdD, MSN, RN is from the course Accessing Acute Psychiatric Care (Nursing).

    Included Quiz Questions

    1. Intrusive thoughts
    2. Delusions
    3. Illusions
    4. Movement
    5. Noise
    1. Intrusive thought
    2. Delusionary thought
    3. Illusion
    4. Auditory hallucination
    1. The client who previously appeared to be enjoying the group but began rocking back and forth with hands over the ears when the group leader started playing loud music
    2. The client who walked up to another client who was sitting quietly and started accusing them of calling them names and taunting them
    3. The client who runs to the nursing station crying, stating that the police have been sending them messages and are after them
    4. The client who has been pacing the unit all day and states to the nurse, "I know that something bad will happen tomorrow"

    Author of lecture Impact of Internal and External Stimuli

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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