Impact of Internal and External Stimuli

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.