The exception is with hallucinations that command patients to harm themselves or others or to do other destructive acts. In such a case, the nurse should contract with patients to avoid acting on the commands they hear and to tell the staff. Another exception is with patients with dementia or severe cognitive impairments. These patients are not likely to be able to process the content or themes of the hallucinations. For them, the strategy of “ignore and distract” is more useful.