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Arellano University-Alderson Broaddus College

International Nursing Program

Nursing 368- Acute Psychosocial Nursing

Patient: I.C. Age: 30 Gender: F Date of Care: February 9-10, 2012

Diagnosis: Psychosis NOS r/o Delusional Disorder; Post Traumatic Stress Disorder

Date of Admission: May 2011

I. OVERVIEW:

In our 2nd and 3rd rotation in Estrellas, I was assigned to the same patient, I.C., a 30 year-

old female client with Psychosis NOS r/o Delusional D/O; Post Traumatic Stress D/O. On the

first day, I found her sitting on the corridor while doing her artworks. I approached her but she

seemed not in the mood to talk. She was just focused on her drawing and didnt even bother to

look at me. She was wearing a pink blouse and leggings. I noticed that she hasnt taken a bath

yet. When she said that shes not willing to talk, I asked the help of our C.I. I honestly dont

know what to do. So our C.I. talked to her and then she agreed to talk to me. As we talk, I

noticed that her approach to me has changed. She was more willing to talk about her feelings and

she shared some private things to me. Shes even said that shes comfortable with me.

During our conversation, shes calm and cooperates well. She responds to my questions

and eventually opens up herself even more compared to our first meeting weeks ago. I noticed

that she already has good eye contact, but still with mumbling episodes and verbalized that there

were times that shes anxious.


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II.EXCHANGES DAY 1 Feb. 9, 2012

INTERATION #1: During our first day, the client showed interest in the conversation. She

seemed glad to see me again. She shared more things about her life and experiences. At first she

was not in the mood to talk to me. Our C.I. talked to her and allowed me to spare sometime with

her to talk.

1) NURSE: Good morning, Irene! Natatandaan mo pa ako? Ako si Jeannine yung studentnurse galing sa Arellano university. Kamusta ka naman? Nandito ulit ako para makapag-

usap tayo.

Good morning, Irene! Do you still remember me? Im Jeannine, the student nurse from

Arellano University. How are you? Im here again so we could talk.

(Offering self: This is a way of expressing a desire to understand and collaborate with the

client. I also made boundaries during this phase of our conversation.)

(Giving Informationmakes available facts the patient needs. Supplies knowledge from

which decisions can be made or conclusions drawn. I used this technique to introduce

myself to my patient and for her to know my purpose of being there.)

CLIENT: Oo naman, ikaw pa! Okay lang ako. Sorry sa nangyari kanina kasi medyo

wala lang ako gana makipag-usap. Ikaw kamusta na? Bakit ang tagal niyo bumalik?

Of course! Im okay. Sorry about what happened a while ago. Im not just in the mood

to talk. How are you? What took you so long to come back?


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CLIENT:Sinabi mo siguro pero nawala sa isip ko. Madami din kasi ako iniisip mga

ilang araw na. Syempre nung hindi pa kayo bumabalik nalungkot ako. Tapos nung medyo

matagal na akong naghihintay , kala ko hindi ka na babalik. Sabi ko nalang sa sarili ko na

kailangan ko na magmove-on

You told me but I guess it slipped my mind. I was also thinking about many things these

past days. During the times that youre not here, I was sad. Then when I realized that I

was waiting for a long time already, I thought that youd never come back. I just told

myself that I have to move-on.

4) NURSE: Sabi mo madami kang iniisip na mga bagay netong mga nakaraang araw.Pwede mo ba sabihin sakin yung tungkol sa mga bagay na yun?

You said you were thinking about many things these past days. Could you tell me about

the things that you were thinking?

(Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual

understanding between nurse and patient)

CLIENT: Yung mga NBI kasi, lagi parin nila ako ginugulo. Tapos lagi pa nila ako

binabantayan. Tapos parang hindi sila napapagod

The NBI keeps on bothering me. They always look after me. And it seems like theyre

not getting tired of it.

5) NURSE:Ano mga ginagawa ng mga NBI sayo?What do they do to you?

(Exploring: Examines certain ideas, experiences, or relationships more fully.)


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CLIENT: Manipulating me and the people around me. They will do anything para

isipin ng mga tao na masama ako. Nagagalit na ako kasi hindi nila nirerespect yung

rights ko. Inaabuso na nila ako kasi alam nila na may sakit ako.

Theyre manipulating me and the people around me. They will do anything to make

other people think that Im bad. I-m mad because they dont respect my rights. They

were abusing me because they know that Im sick.

6) NURSE:Ahh. Manipulating you and otherpeople? Paano at ano mga ginagawa nila?Ahh. Manipulating you and other people? How and what do they do?


understanding between nurse and patient.)

CLIENT: Basta parang ganoon parin sa dati, gusto nila iprove sa mga tao na masama

ako. Lahat ng kilos ko alam nila. Gusto nila na nakikita akong malungkot.

Its just like before, they want to prove to everyone that Im bad. They know all my

actions. They want to see me sad.

7) NURSE: Silence.. Paano mo nalaman na ginagawa nila yung mga bagay na yan paramaging malungkot ka?

Silence.. How did you know that theyre doing those things just to see you sad?

(Silence: Gives the patient time to collect thoughts or think through a point.)


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CLIENT: Basta alam ko. Sinasabi din nila minsan. Pag malungkot ako hindi sila

nakikialam. Kaya kung anu-ano iniisip ng mga tao tungkol sakin

I just know. They sometimes tell me. When Im sad, they dont usually care. Thats why

people think of different things about me

8) NURSE: Ahh..Sino yung mga kung anu-ano ang iniisip sayo? Ano mga iniisip nila? Ahh..Who are those people who think of different things about you? What do they think

of?

(Accepting: Indicates that the person has been understood. The statement does not

necessarily indicate agreement but is non-judgemental.)

CLIENT: Basta. Yung mga tao, lahat sila! Iniisip nila kung ano yung iniisip nga mga

NBI, minanipulate nga kasi yung mga yun. Wag nalang natin sila pag-usapan

People, all of them! They think just like the NBI, because theyre manipulated by them.

Lets just not talk about them.

9) NURSE: Okay. Kung yun yung gusto mo, okay lang sakin. Okay ka lang?Okay, if thats what you want, thats fine with me. Are you okay?




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CLIENT: Smiles. Oo, okay lang ako. Sorry medyo nagagalit lang talaga ako. Thank

you.

Smiles. Im okay. Sorry Im just really mad. Thank you.

10)NURSE: Meron ka ba gusto gawin o pag-usapan?Do you want to do anything or anything you want to talk about?

(Giving broad openings - this clarifies that the lead is to be taken by the client. However,

the nurse discourages pleasantries and small talk)

CLIENT:Pwede mag-drawing nalang muna ako? Tapos dito ka nalang din muna?

Can I just draw first? Then just stay here.

III. ALTERNATIVES

1) In the nurse-client exchange # 1, I should have used Giving Broad Openingsso she could lead the conversation. I should have allowed her to lead the

conversation like asking her Where would you like to begin or what do you

want to talk about?.

2) In the nurse-client exchange # 2,even though its therapeutic, I should haveexplored her feelings even more. It might be difficult for her to accept that

were not going to see each other that much and that we have only few

meetings.

3) In the nurse-client exchange # 3, I should have used Exploring, this way thepatient could fully elaborate the details of her feelings and thoughts.


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4) In the nurse-client exchange # 3, I could also use Encouraging Comparison,so the patient can bring out recurring themes in her experiences. Maybe she

could compare this experience with her past student nurses.

5) In the nurse-client exchange # 4, I could have used Seeking OnsensualValidation, so I could clarify my understanding of what she said.

6) In the nurse-client exchange # 4, I could have also used Focusing, so shecould have concentrated on a single point.

7) In the nurse-client exchange # 5, I could have also used Exporing, so shecould further explain to me her ideas and thought most especially about the

actions of the NBI.

8) In the nurse-client exchange # 6, I could have also used EncouragingEvaluation, so I could have asked her about her feelings regarding the

incident.

9) In the nurse-client exchange # 7, I could have also used Exploring, so shecould further explain her ideas and experiences.


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10)In the nurse-client exchange # 9, I could have also used Encouraging ofPerceptions, so she could talk about her feelings and that could lessen the need

to act them out inappropriately.

EXCHANGES DAY 2 Feb. 10, 2012

INTERATION #2: During our second day, the client showed also interest in the conversation.

She seemed glad to see me again. She shared more things about her life and experiences. This

time I noticed that shes more sociable with other patients and nurses as well!

1) NURSE: Good morning, Irene! Kamusta ka naman? Nandito na ulit, diba sabi kokahapon babalik ako ngayon. Dito ulit ako para makapag-usap ulit tayo.

Good morning, Irene! How are you? Remember I told you yesterday that Ill be back today.

Im here again so we can talk again.

(Offering self: This is a way of expressing a desire to understand and collaborate with the

client. I also made boundaries during this phase of our conversation.)

(Giving Informationmakes available facts the patient needs. Supplies knowledge from

which decisions can be made or conclusions drawn. I used this technique to introduce

myself to my patient and for her to know my purpose of being there.)

CLIENT: Good morning! Buti nakabalik ka. Masaya ako kasi nandito ulit kayo. Okay

lang nmn ako. Medyo nahirapan lang makatulog kagabi.

Good morning! Im glad youre back. Im glad youre guys are here again. Im fine. I

just had difficulty falling asleep last night.?


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2) NURSE: Nahirapan ka makatulog? Ano sa palagay mo dahilan kung bakit hindi kamakatulog?

You had difficulty falling asleep? What do you think is the reason for that?

(Restating: Repeats the main idea expressed. Gives the client an idea of what have been

communicated. I used this so I could clarify my understanding.)

(Reflecting: Directs questions, feelings, and ideas back to the client. Encourages the

client to accept her own ideas and feelings.)

CLIENT: Madami pa rin ako iniisip. Tas ganun parin sa dati. Sinusundan parin ako

nung mga..

I was thinking of many things. Just like before... I was still followed by the..

3) NURSE: Nung mga?by the?

(Exploring: Examines certain ideas, experiences, or relationships more fully. I used this

so she would expound more about her thoughts)

CLIENT:Mga NBI.. Nanjan parin sila. Nanggugulo na naman.

the NBI.. theyre still there. Theyre bothering me again


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4) NURSE: ah. Ano mga ginagawa nila kagabi?Ah. What were they doing last night?




understanding between nurse and patient.)

CLIENT: Yung mga NBI kasi, lagi parin nila ako ginugulo. Tapos lagi pa nila ako

binabantayan. Tapos parang hindi sila napapagod

The NBI keeps on bothering me. They always look after me. And it seems like theyre

not getting tired of it.

5) NURSE:Ano mga ginagawa ng mga NBI sayo?What do they do to you?

(Exploring: Examines certain ideas, experiences, or relationships more fully.)

CLIENT: Kung anu-ano ginagawa. Gusto nila ako i-distruct! Kung anu-ano sinasabi

nila

Theyre doing random things. They want to distruct me! They keep on saying different

things


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6) NURSE:Ano sa tingin mo dahilan kung bakit ka nila gusting idistruct?What do you think is the reason to why they want to distruct you?


understanding between nurse and patient..)

CLIENT: Ayaw kasi nila malaman ng tao na mali na yung ginagawa nila sakin.

Inaabuso na nila yung karapatan ko. Hindi sila nakikinig!

They dont want others to know that theyre already doing the wrong thing. Theyre

abusing my rights. Theyre not listening!

7) NURSE: Silence..Nakikinig saan?Silence.. Listen to what?

(Silence: Gives the person time to collect thoughts or think through a point.)

CLIENT: Nakikinig sa akin. Ayaw nila maniwala na ako yung biktima dito. Parang ako

pa kasi yung masama sa mga tao.

They dont want to listen to me. They wont believe that Im the victim here. It seems

like other people think that Im bad

8) NURSE: ahh.Ano yung reason mo kung bakit mo nasabi na masama ang tingin sayo ngmga tao?

ahh.What made you think that other people think youre bad?


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CLIENT: Naririnig ko sila. Pinag-uusapan nila ako. Akala nila ako yung gumagawa ng

masama.

I heard them talking about me. They think that I was doing all those bad things.

9) NURSE: okay. Ano daw yung sinasabi nila na mga bagay daw na ginagawa mongmasama ?

okay. What were the bad things according to them that you did?



CLIENT: Basta. Nahihirapan ako sabihin at iexplain. Wag nalang natin pag-usapan.

Im having a hard timeexplaining that to you. Lets not just talk about it.

10)NURSE: Sige. Okay ka lang?Sige. Are you okay??




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CLIENT:Smiles. Oo.

Smiles. Yes.

III. ALTERNATIVES

1) In the nurse-client exchange # 1, I should have used Giving Broad Openingsso she could lead the conversation. I should have allowed her to lead the

conversation like asking her Where would you like to begin or what do you

want to talk about now?

2) In the nurse-client exchange # 2, I should have explored her feelings evenmore. Maybe I asked her to explain more her thoughts and the things that are

bothering her.

3) In the nurse-client exchange # 3, I should have used Exploring, this way thepatient could fully elaborate the details of her feelings and thoughts and

whats going on her mind that time.

4) In the nurse-client exchange # 3, I could also use Encouraging Comparison,so the patient can bring out recurring themes in her experiences. She might be

able to tell me if this happened already in the past or if this was the first time.

5) In the nurse-client exchange # 4, I could have used Seeking OnsensualValidation, so I could clarify my understanding of what she said.


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6) In the nurse-client exchange # 4, I could have also used Exploring. Ishouldve asked about the people behind those things. And she might tell me

more about the incident.

7) In the nurse-client exchange # 6, I could have also used Exporing, so shecould further explain to me her ideas and thought most especially the

distructions she was telling me. I should have asked what kind of distructions

these NBI were doing.

8) In the nurse-client exchange # 6, I could have also used EncouragingEvaluation, so I could have asked her about her feelings regarding the

incident.

9) In the nurse-client exchange # 7, I could have also used Exploring, so shecould further explain her ideas and experiences.

10)In the nurse-client exchange # 9, I could have also used Encouraging ofPerceptions, so she could talk about her feelings and that could lessen the need

to act them out inappropriately.


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III. THEORY

Patient, C.I. was still my patient. Just like the first time we met, she still manifests the

same thing. At first, when I approached her she seemed not in the mood to talk. She said that

shes not okay for us to talk and that I cant talk to her. But when our C.I. talked to her, she

agreed to talk to me. She was very cooperative and was calm and was totally different from the

first time I approached her. As we go along with our conversation, she said that she waited for

me for so long. She said that she was sad when were not visiting them. Then she again opened

up the topic about these NBI that according to her are sent by her enemy, she started to have

difficulty explaining or verbalizing her thoughts. This was not the first time she said it. During

our first meeting, she already told me stories about those NBIs. She would always say that shes

sorry that she couldnt everything well because she feels anxious and mad about it. When I asked

her about the NBI, she looked at her back and then looked at her surrounding and said that

theyre always there to make her feel as if its her fault that shes in that facility. She frequently

stops and pause for some time to think for the appropriate words to describe her feelings. She

said that those NBIs are secretly investigating her since 2004 and her enemy is the master

mind. Whenever I asked her about the enemy that shes saying, she would just avoid it and

will say that Basta, kakilala ko noon at kaaway ko na siya ngayon (I know him before hes

already my enemy now. She also told me how bad that guy was to her. At that point, she

repeatedly verbalized that she was anxious and feel uncomfortable with it so she would ask me to

change topic just like before and to talk about something that is happy. But even if were talking

about happy things like comedy movies that she likes, she would always talk about those NBIs

out of nowhere. She would always mention that the people around her would think negative

things about her even her family and would also emphasize the word malicious. The way she

emphasized it was so obvious to the point of raising the tone of her voice. In the middle of our


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conversation, she had mumbling episodes as if shes saying something, but I could hardly

understand it. I asked her to repeat it but she said she didnt say anything. I also no ticed that she

keeps on looking at her back and very sensitive about her surroundings and even told me that she

gets distracted easily especially when there are a lot of people around her. And we started to talk

about her family, she said they often visit her and she doesnt care because according to her even

though shes telling her parents all her problems, they wont believe her. She said that, maybe

her enemy is manipulating everybody even her family. During the entire time that were talking,

I can see that shes willing to share her stories but not everything. She refused to tell me the

cause of her scars on her forearm. She said shes not yet ready to share it with me and some other

time maybe. Shes trying to avoid sensitive issues and will always say that shes mad and

anxious and not yet time to talk about it. She also told me that her anger is still there and will

always be there for the rest of her life. She also shared to me the reason behind her scars at her

forearm. She refused to tell me about it during our first meeting. She said, she didnt know how

to express her emotions and all she could do is to hurt herself so she wont feeling anything. She

even told me of things to expect when you cut your forearm. She said, she has been doing that

for like a year before until she was admitted in the facility. She admitted that she has difficulty

coping with her problems because of her experiences. She refused to tell me about those

experiences but promised to share it some other time.

Irene has Post Traumatic Stress Disorder and considering Psychosis NOS r/o Delusional

Disorder. PTSD is a disorder whereinthe person has experienced, witnessed, or been confronted

with an event that involved actual or threatened death or serious injury, or a threat to the physical

integrity of oneself or others. The persons response involved intense fear, helplessness or horror.

The traumatic event is re-experienced in the mind, and there is an avoidance of stimuli associated

with the trauma and the numbing of general responsiveness. On the other hand, Delusional


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Disorder involves non-bizarre delusions of at least 1 months duration. The persons ability to

function is not markedly impaired nor is the persons behaviour obviously odd or bizarre.

Based on her chart, it was written there that she is physically and verbally assaultive,

easily gets irritable, (+) mumbling episodes, and insomnia for 4 days one week prior to her

admission. Her sister stated that, Mas grabe na yung mga ginagawa niya. Nagmumura tapos

naninira ng gamit tapos madalas na nagsasalita mag-isa. It is also written on her chart that

months prior to this duty, shes shouting spells to the other patients and was trying to stab the

nurse using a ballpen. She still has mumbling episodes and always stays in the corridor alone.

According to our lecture about psychiatric patients, they could decrease or prevent symptoms by

complying with the medications and with her since she has PTSS, she needs counselling and use

of therapeutic communication. They also need someone to talk to for them to vent their feelings

and for them to feel that theyre taken care of and suppo rted, participating regularly in any other

forms of treatment such as Milieu Therapy and other group activities, discussing the troubling

side effects of medications with the health care personnel, avoiding the use of alcohol and other

prohibited drugs, and maintaining physical health by following a healthy diet, regular exercise

and have adequate rest and sleep.

The clients current medications include: Epival 250mg BID - an anticonvulsant and

Thorazine 100mg after breakfast and 50mg after dinner - antipsychotic. She has not been taking

medications for weeks now because her family is not anymore giving her supply.

Based on Erik Eriksons Developmental Theory, Irene is under Intimacy vs Isolation

Stage. According to her she was being talked about by the people around her. Theyre saying

negative things about her that arent true according to her. Shes not married but she had a living

partner before for 10 years. Her partner was abusing her physically that resulted in her condition

now. According to Erikson, she was supposed to have her own family and establishing intimate


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bonds of love and friendship. But because of her situation, shes now in the isolation stage where

shes moving away from people. She thought that its the right thing to do since shes hearing a

lot of issues and negative things against her.

For Maslows Hierarchy of needs, the patient is currently under physiologic needs.

Proper hygiene is one of human basic needs. As I observed and also verbalized by the patient,

she has poor hygiene. She said shes not comfortable taking a bath and she doesnt want to fix

herself because theres no need for it.She also said that the NBI are also there and shes not

comfortable with it. And also, according to her, when people forced her to do things she doesnt

want, like eating or drinking, she would usually do the opposite. So interventions should still

focus on attending her physiologic needs.

My priority Nursing Diagnosis for this client is Ineffective Coping related to low self-

esteem, inadequate support system and inability to trust as evidenced by inability to meet basic

needs. The patient has problems with her self esteem after her traumatic experience with her

partner. She also has difficulty trusting people because she thinks that they will just judge and

misinterpret and hurt her. Her basic needs are also altered. She has difficulty coping with her

problems and has negative insights about life. She also thinks that her family is not there for her

because her enemy is manipulating them. These factors are the reasons why the patient is

having a hard time coping with her stressors.

IV.SELF-EVALUATION

During the start of the rotation, I was really scared. After seeing her reaction when I

approached her, I really dont know what to do or even say. Her aura threatened me. But when


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we started talking, it suddenly changed. When she explained to me the reason about her attitude,

I realized that I should be more understanding and patient with her. She doesnt want to be like

that its just that her condition played a big role with the way she reacts with stimuli and even

people. Her experiences also contributed a lot with her character now. I was able to explore her

feelings and thoughts and I think thats something that I have to be proud of. Patients like Irene

have difficulty trusting people and I was able to make her feel comfortable. I would say, I was

able to do my role as a nurse and I guess I was able to give her needs at that time. Therapeutic

communications also played a major role in dealing with patients like Irene. Since she thinks that

people will always judge her, I should be careful with the words Im saying. That may help her

or might further induce stress and guilt.

I was happy that at the end, she told me that shes thankful for me and that her anxiety

decreases and she feels better. Im so proud of myself that I was able to help her and that she

appreciates it and that means a lot to me!

A. PROSI was scared and nervous at the start of the duty but I didnt let those feelings affect

my way of thinking and of course my role. I was able to communicate with my

patient effectively. Though I was not comfortable at first, I was also able to use my

therapeutic techniques during the entire conversation. Because of that, she was able to

express her feelings and thoughts with me. She was also able to share her stories and

opened up some delicate issues about her life. When she opened up that shes sad that

I cant stay longer, I made my bounderies. I shouldnt be attached to her, and Im

there as a nurse so emotions shouldnt be affecting me. I also was able to recognize


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her strengths and weaknesses. I also accept and respect her for who she is and not

judge her emotions and actions.

B. CONSI wasnt able to explore more on some of her thoughts because she was hesitant and

not comfortable about it. She didnt want to share some informations to me because

she said shes not ready yet. I wasnt able to think of any appropriate words to use so

I could explore it. I really have a hard time to think of words to say so I wont be

offending or judging her.

V. FEELINGS AND PERSONAL INSIGHT

(MYERS-BRIGGS KIERSEY TYPE ANALYSIS)

Based on Myers Briggs Kiersey Type Analysis, I found out that I am an INFP. It means

that I am a perceiver and a judger and adapt to change well and I am able to adjust on a different

situation that would eventually come into my life.

As a judger, it was stated there that I live in such a way that everything is organized and

planned in an organized manner. As an introvert person, I tend to keep things hidden. I am more

comfortable of working alone than in groups. I also solve conflicts in my own way and I can also

be independent whenever I want to.

Since Im an introvert, I was able to relate to my patient. She preferred to keep some

important things to herself. But even though she wants to be independent, she has difficulty

solving her own problem.


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As an NF or intuitive feeler, they say that I need encouragement and recognition to do

things better. And I am also sympathetic and love to establish close relationships with people.

VI. STEDFAST

SELF ASSESS: Okay Ninay! Mindfully breathe... This is your 2nd rotation here.. so are

you ready?? Are you ready for all the things that youll be experiencing now?? How about your

emotions? Mindfully breathe.. Are you willing to open up your mind and even yourself with

your patient? She needs you now.. Are you equipped with therapeutic communication?

Mindfully breathe.. you can do this! Remember to always focus on your patients feelings, not

yours! Be yourself and try not to impose your beliefs and opinions. Okay? Mindfully breathe!

Good luck!..

THERAPEUTIC ROLE: Ninay, try to focus with your goals. You are here as a nurse

and you are trained to be one, right? Mindfully breathe..Your patient needs you now and you

might help her with her problems. You studied this on your class so youre equipped with

knowledge about dealing with these patients! Listen carefully to her and always talk to her using

therapeutic communication. Mindfully breathe.. Always understand her and accept her for who

she is. Her actions are part of her illness.. Mindfully breathe.. You can do it! Be the best nurse

you can be!

EMPATHY: That must be so hard for her.. I was also sad when she told about her

feelings and experiences in life.. and I think if Ill be in her position, I wont be able to make it, I


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swear! She must be in a very difficult situation right now. Mindfully breathe.. How could I be

firm with my role and not be affected by her actions and stories? Mindfully breathe!

DETACHED REFLECTION: Mindfully breathe, Ninay.. Yes, you feel for her but

thats it. You have your own thoughts and she has hers. Her feelings are hers and you have

yours.. Mindfully breathe.. You have to respect it and try to understand.. She needs you now and

you have to keep that in mind!.. She NEEDS YOU now!

FACILITATED DEBRIEFING: Mindfully breathe.. I think I need someone to talk to

about my feelings.. Its gonna be hard if Ill just keep it to myself.. Our C.I. said that we have to

accept our patients whoever they are. Mindfully breathe.. We have different ways of thinking

and thats what I have to understand and take in consideration! We are different beings and I

also have to accept that! Mindfully breathe..

ALERT EMPATHY:Waiitttt... I dont think its still okay.. Yes, I empathize her but

thats it! I am here to help them and be their nurse.. If Ill be sad like her, that wont help.. her

feelings are hers and I have mine. Shes sad and mad, and Im not! So dont let her feelings

affect you.. Mindfully breathe.. Focus on your goal! Remember your bounderies!

SELF-AWARE MINDFULNESS: Ive learned a lot today. Though I cant help myself

from being affected by my patients feeling, I still managed to be firm with my role and goal. I

was able to use therapeutic communication most of the time but sometimes, I couldnt help but

be non- therapeutic! Im sometimes running out of appropriate words to say! Mindfully breathe..


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Its just a matter of time and you have to learn from your experience and mistakes! Youll be

fine! Mindfully breathe....

THERAPEUTIC USE OF SELF: I offered myself to Irene today.. I am glad that shes

thankful for me and that I was able to decreased her anxiety level. Looking forward to our next

rotation so I could be able to help them again in the best way I can..


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NURSING CARE PLAN1

Nursing Diagnosis: Ineffective Coping related to low self-esteem, inadequate support systems

and inability to trust as evidenced by inability to meet basic needs

ASSESSMENT PLANNING INTERVENTION &

RATIONALE

EVALUATION

Subjective Data:

I dont take abath or fix myself

because theres no

need for that

I dont want totalk to otherpeople, they often

judge me

Objective Data:

(+) mumblingepisodes

labile affect reaction formation Poor eye contact

Decreasedproductivity

After the 8 hour

shift:

Client willdevelop trust instaffs even just

with their primary

caregiver Client will be able

to share and vent

her feelings and

thoughts

If possible, makesure that the

patient will be

having just 1

nurse or caregiver.To promote

trusting

relationship withthe caregiver.

Avoid laughing,giggling, andwhispering wherethe patient can see

but cant hear.

They may think

that youre talkingabout them

Be honest andavoid promiseswhen youre notsure if youll be

able to complywith it. To

develop trust with

the caregiver

Provide non-competitive

activities that

promote one-to-

one relationshipwith the nurse.

Competitive

activities are very

threatening to

suspicious clients.

After the 8 hour

shift:

Client developedtrust with herprimary caregiver.

She shared her

stories andthoughts during

the course of duty.

Client was able toshare and vent herfeelings and

thoughts


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Encourage clientto verbalize

feelings andthoughts.

Verbalization offeelings in a non-

threateningenvironment may

help the client

come to termswith long

unresolved issues.


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NURSING CARE PLAN2

Nursing Diagnosis: Anxiety related to situational crisis and stress as manifested by verbalization

of fear, poor eye contact, (+) mumbling episodes, diminished productivity, difficulty

concentrating, flight of ideas

ASSESSMENT PLANNING INTERVENTION &

RATIONALE

EVALUATION

Subjective Data:

Sorry medyoanxious na naman

ako.

Nawawala kasiako sa sinasabi

ko

Objective Data:

(+) mumblingepisodes

poor eye contact

diminishedproductivity

difficultyconcentrating

flight of ideas easy irritability forgetfulness impaired attention

After the 8 hour

shift:

Client will berelax and clam

during the shift Client will report

that her anxiety is

reduced

Client will be ableto share and vent

her feelings and

thoughts

Learn effectiveand healthy ways

deal with anxiety

If possible, makesure that the

patient will behaving just 1

nurse or caregiver.

To promotetrusting

relationship with

the caregiver.

Avoid laughing,giggling, and

whispering where

the patient can see

but cant hear.They may think

that youre talking

about them Provide non-

competitive

activities that

promote one-to-

one relationship

with the nurse.

Competitiveactivities are very

threatening to

suspicious clients.

Observe clientsbehaviour. This

may indicates

clients level of

anxiety

Take not ofdefense

mechanisms that

After the 8 hour

shift:

Client wasrelaxed and clam

during the entireshift

Client reportedthat her anxiety isreduced after the

duty Salamat,nakatulong ka

talaga. Medyo

konti nalang yungmga naiisip ko at

yung anxiety ko

din Client was able to

share and vent her

feelings andthoughts

Clientacknowledged and

verbalizedunderstanding

about the teaching

plan


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the patient is

using. This may

interfere with the

clients ability todeal with her

stress and problem

Establish atherapeutic

relationship all the

time. Thisprevents

misinterpretation

Listen attentivelyto the patient. This

assists patient tovent their feelings

Encourage clientto express herfeelings and

thoughts. This

may lessen theanxiety level ofthe patient

Provide feedbacksand checking

meaning with theclient. Clarify

clients meaning

of feelings andactions.

Be truthful andprovide physical

contact if possible.To soothe fears

and provides

assurance.

Accept the patientas it is. Thisprovide self worth

for the client andboosts her self-esteem

Allow the patientto vent her

feelings andemotions. Avoid

giving personal


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advices and

responses. This

prevents clientfrom escalating

Providenonthreatening

environment andminimize stimuli.

Lessen effects of

transmission offeelings

Teach client abouthealthy ways to

deal with her

anxiety(diversional

activities-drawing,

watching tv,reading)

Encourage patientto have anexercise program.This may help in

reducing anxiety

Encourage clientto verbalizefeelings and

thoughts.

Verbalization offeelings in a non-

threatening

environment mayhelp the client

come to terms

with long

unresolved issues.


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References:

Carson, V., Shoemaker, N., Varcarolis, E. (2006): The Clinical Interview and Communications

Skills, Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 5th Edition,

(pp. 171-194), Missouri: Saunders Elsevier.

Townsend, M.C., (2008):Nursing Diagnoses in Psychiatric Nursing 7th

ed., F.A.Davis

Company.

Stuart, G.W., Laraia, M.T., (2005): Principles and Practice of Psychiatric Nursing, 8th Edition,

(pp. 273), Missouri: Mosby Elsevier.

Nursing 386, Acute Psychosocial Nursing Syllabus.

estrellas 2

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