Behavioral Analysis Final

COLLEGE OF NURSING
SILLIMAN UNIVERSITY
Dumaguete City
NCM 105
Psychiatric Nursing Rotation

Talay Mental Rehabilitation Center
BEHAVIORAL ANALYSIS
Submitted to:
MRS. NOYME LOUR ABEGIL L. LAVISTE

Clinical Instructor
Submitted by:
DEANS, Charles Ian E.

OIRA, Fate Lee E.
Section B2
March 12, 2013
Table of Contents
Vision Mission
Application Letter
Topic Description & Objectives
3-4
Demographic Data
Genogram
Psychiatric-Mental Health Observation Checklist
7-12
Growth & Development
13-18
Psychodynamics
19-25
Psychopharmacology
26-27
Assessment of the 5 Domains
28-32
Nursing Care Plans
33-42
Summary of Nursing Diagnoses

Related Readings
Bibliography
Appendix
43
44-52
53
54-182
Silliman University
Dumaguete City
VISION:
A leading Christian Institution committed to total human development for the well-being of society and
environment.
MISSION:
Infuse into the academic learning the Christian faith anchored on the gospel of Jesus Christ; provide an
environment where Christian fellowship and relationship can be nurtured and promoted.
Provide opportunities for growth and excellence in every dimension of the University life in order to
strengthen character, competence and faith.
Instills in all members of the university community an enlightened social consciousness and a deep sense of
justice and compassion.
Promote unity among peoples and contribute to national development.
March 12, 2014

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MRS. NOYME LOUR ABEGIL L. LAVISTE, RN, MN

Clinical Instructor, Psychiatric-Mental Health Nursing Rotation
Silliman University College of Nursing
Dumaguete City
Dear Mrs. Laviste:
Pleasant greetings!
We, Charles Ian E. Deans and Fate Lee E. Oira, Junior students of Silliman University College of Nursing, currently in Psychiatric-Mental Health Nursing
Rotation at Talay Mental Rehabilitation Center, would like to apply for a behavioral analysis regarding our client under our nursing care last December 2013
to February 2014 of our Related-Learning Experience (RLE) in partial fulfillment for the requirements of the mentioned rotation.
Our patient is Mr. Ferdinand Mayang who has been admitted last October of 2013.
We are privileged to conduct this case study since this would enhance our knowledge, skills and attitudes toward the delivery of our psychiatric nursing
care. With this, we would like also to present information and impart our learning to our fellow learners through a case presentation after the study.
Thank you and we hope for your approval.
Respectfully yours,
CHARLES IAN E. DEANS
FATE LEE E. OIRA
BSN III (Section B2)
Approved by:
MS NOYME LOUR ABEGIL L. LAVISTE, RN, MN
Clinical Instructor
Topic Description:
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This case presentation deals with Mr. F. Magellan, a 45-year old male, admitted due to restlessness, auditory and visual hallucinations, eating
and sleep pattern disturbances realized by significant other, bizarre behavior verbalized by significant other, behavior aggression realized by
significant other, self-talk noted, blank stares and not able to groom self as verbalized by the significant other. Client also has history of drug
abuse and smoking. It covers her family history as traced in the genogram, demographic profile, overview of the disorder, manifestations,
domains of a person, medications, and nursing care plan. This presentation will facilitate learning and skills to both the researchers and the
listeners regarding schizophrenia. In addition, this presentation will assist the researchers in their journey to fully understand and recognize
the diverse nursing interventions of schizophrenia.
Central Objective:
At the end of our case presentation, the learners shall acquire deeper knowledge, enhance beginning skills, and manifest desirable
attitudes towards rendering holistic and quality nursing care to a patient with history of drug abuse.
Specific Objectives:
In the process of gathering relevant data related to the case, the researchers shall be able to:
Discuss the demographic profile and the history of the client in detail.
Define clearly the various terminologies related to the discussion.
Analyze factors that led to the maladaptive behaviors of the patient.
Critically examine the patients growth and development.
Identify behavioral problems presented by our patient.
Discuss and apply appropriately the theories learned.
Identify factors that precipitated the development of the mental illness of our patient.
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Recognize the prescribed medications for the patient, their mechanism of action, side effects and adverse reactions,
contraindications, and the appropriate nursing responsibilities in the administration of the medications.
Identify behavioral problems presented by our patient.
Successfully trace the psychodynamics of the patient.
Utilize psychiatric nursing concepts and principles as they relate with the discussion.
Formulate an effective nursing care plan relative and applicable to the client based on the conditions that the client is
subjected to.
Demonstrate enhanced therapeutic techniques in dealing with clients having similar disorder.
Evaluate the nursing care given to the patient.
Evaluate the behavioral analysis as a whole.
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Demographic Data
Name: F. Magellan
Religion: Roman Catholic
Address: Kabangkalan, Negros Occidental
Educational attainment: AB- Bachelors of Arts
Doctor-in-charge: Dr. Angelo Jesus V. Arias, M. D.
Date & time of admission: October 9, 2013 at 3:50 pm
Age: 45 years old

Nationality: Filipino
Work: Retired seaman
Gender: Male
Status: Single
Room & bed no.: Isolation C, Room 8
History of Present Illness: Claims to have smoked during teen years; used marijuana during college due to curiosity.
Chief Complaint: Admitted for first time with the following manifestations: restlessness, auditory and visual hallucinations, eating and sleep
pattern disturbances realized by SO, bizarre behavior verbalized by SO, behavior aggression realized by SO, self-talk noted, blank stares and
not able to groom self as verbalized by the SO. On suicide and escape precaution, placed inside isolation room C room 8 with watcher Esther/
Mary Ann.
General Impression: Client calm, alert and oriented to time and place. Moderate build, short stature. Ambulates independently.
Communicates coherently in low monotone voice.
Medications:
- Chlorpromazine hydrochloride (CPZ) 100mg 1 tab by mouth, twice a day
- Fluphenazine decanoate (FD) ICC intramuscularly
- Biperiden hydrochloride by mouth as necessary
GENOGRAM
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Patient cannot recall the ages and cause of death of grandparents.

grandparents.
Patient cannot recall the ages

and cause of deaths.
Died d/t
Malnourishment
Diabetes
Patient cannot recall the ages and cause of death of
Heart failure
Patient cannot recall her age,

residence, and any diseases or cause of death.
LEGEND
Female
Male
Deceased female
Deceased male
Female with disease condition
Male with disease condition
Client
Behavioral Checklist
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MANIFESTATION
1
Facial Expression Shows

- Fatigue
- Fear
- Tension
- Happiness
- Indifference
- Sadness
- Others (Blank)
COMMENTS
Stands up when we are nearing him and would greet

us while shaking with our hands; however, smiling is
absent during visitations.
Blank stares noted during interactions.
Posture
- Stands erect
- Slouch
- Dropping shoulder
Physical cleanliness
- Hair combed
- Facial washed
- Full bath
- Body odor
- Clothes changed
- Teeth brushed
Movements
Inappropriate
gestures or
mannerisms
Slow
Rapid
Restless (moves back
& forth)
Easily tears
Rigid
Skin
Clean
Sits down with a slight hunch.
X
X
Appears to be physically well-kempt.

Absent for odor, looks clean.
Changes clothes when client has taken a bath, as

claimed.
Body exhibits minimal movement; blinks eyes

consistently during thought processing and fixes his
hand grabbing onto hem of shorts. Looks toward the
interviewers intermittently, but directs his attention
back to between the student nurses.
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DEVELOPMENTAL STAGE AND ANALYSIS

Erik Ericksons Stages of Development
Erik Erickson developed the 8 stages of development. In each stage the person must complete a life task that is essential to his or her
well-being and mental health. These tasks allow the person to achieve lifes virtues: hope, will, purpose, competence, fidelity, love, care, and
wisdom. Erickson believes psychological growth occurs in sequential phases, and each stage is dependent on completion of the previous
stage and life task.
STAGE
Trust vs. mistrust (infant)
VIRTUE
Hope
Autonomy vs. shame/doubt (toddler)

Initiative vs. guilt (preschool)
Will
Purpose
Industry vs. inferiority (school age)

Identity vs. role confusion (adolescence)
Intimacy vs. isolation (young adult)
Generativity vs. stagnation
(adulthood 25-65)
Ego integrity vs. despair (maturity)
Competence
Fidelity
Love
Care
Wisdom
TASK
Viewing the world as safe and reliable; relationships as
nurturing, stable, and dependable
Achieving a sense of control and free will
Beginning development of a conscience; learning to manage
conflict and anxiety
Emerging confidence in own abilities; taking pleasure in
accomplishments
Formulating a sense of self and belonging
Forming adult, loving relationships and meaningful attachments
to others
Being creative and productive; establishing the next
generation
Accepting responsibility for ones self and life
We have identified our client to be in the life stage of Generativity vs. Stagnation. Generativity is defined as the concern
for establishing and guiding the next generation (Kozier, p. 399), in other words, the concern about providing for the welfare
of humankind is equal to the concern of providing for self. Generative middle-aged persons are able to feel a sense of comfort
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in their lifestyle and receive gratification from charitable endeavors. People unable to expand their interests at this time and
who do not assume the responsibilities of middle age suffer a sense of boredom and impoverishment, that is, stagnation.
Through the NPI, we have come to discover that our client has a deep sense of caring towards his mother, who is
currently located in Kabangkalan of Negros Occidental. He expresses anxiety and sadness to know that he is far away from
her, and states he needs to come back to his home in order to continue caring for her. Through the NPI we have staged our
client to be in the Generativity vs. Stagnation. Since our client has been unable to feel a sense of comfort in his lifestyle,
unable to expand his interests at this time, and do not assume the responsibilities of middle age suffer a sense of boredom
and impoverishment, we consider him to be in the stagnation category. He seems preoccupied and withdrawn from the rest of
the patients in the center of Talay as he always thinks about going back home to see his family again.
Freuds Personality Components

Freud conceptualized personality structure as having three components: id, ego, and superego. The id is the part of ones nature that
reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. The id seeks instant gratification; causes
impulsive, unthinking behavior; and has no regard for rules or social convention. The superego is the part of a persons nature that reflects
moral ethical concepts, values, and parental and social expectations; therefore, it is in direct opposition to the id. The third component, the
ego, is the balancing or mediating force between the id and the superego. The ego represents mature and adaptive behavior that allows a
person to function successfully in the world. Freud believed that anxiety resulted from the egos attempts to balance the impulsive instincts of
the id with the stringent rules of the superego.
Id: The id is the locus of instinctual drivesthe pleasure principle. Present at birth, it endows the infant with instinctual drives
that seek to satisfy needs and achieve immediate gratification. Id-driven behaviors are impulsive and may be irrational
Ego: The ego, also called the rational self or the reality principle, begins to develop between the ages of 4 and 6 months. The
ego experiences the reality of the external world, adapts to it, and responds to it. As the ego develops and gains strength, it seeks
to bring the influences of the external world to bear upon the id, to substitute the reality principle for the pleasure principle
(Marmer, 2003). A primary function of the ego is one of mediator, that is, to maintain harmony among the external world, the id,
and the superego
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Superego: If the id is identified as the pleasure principle, and the ego the reality principle, the superego might be referred to as the
perfection principle. The superego, which develops between ages 3 and 6 years, internalizes the values and morals set forth by
primary caregivers. Derived from a system of rewards and punishments, the superego is composed of two major components: the
ego-ideal and the conscience. When a child is consistently rewarded for good behavior, his or her self-esteem is enhanced, and
the behavior becomes part of the egoideal; that is, it is internalized as part of his or her value system. The conscience is formed
when the child is consistently punished for bad behavior. The child learns what is considered morally right or wrong from
feedback received from parental figures and from society or culture. When moral and ethical principles or even internalized ideals
and values are disregarded, the conscience generates a feeling of guilt within the individual. The superego is important in the
socialization of the individual because it assists the ego in the control of id impulses. When the superego becomes rigid and
punitive, problems with low self-confidence and low self-esteem arise
Freud believed the self or ego used ego defense mechanisms, which are methods of attempting to protect the self and cope with basic
drives or emotionally painful thoughts, feelings, or events. Most defense mechanisms operate at the unconscious level of awareness, so
people are not aware of what they are doing and often need help to see the reality.
In relation to our client, when our client had his break down that led to his admission into Talay, it was clear that his id
desired to become irate and throw a chair, after he witnessed something in particular that he believed was wrong. Her superego knows that due to his actions, he is now placed in the center. Even though he was sent to Talay by his family under
enforcement of the police, his family had placed him there in order for him to get treated for his nervous breakdown which led
to his hostile behavior. He knew at the time his id was not able to get what it desired, which was and currently still is to return
back home. Since the id was not able to get its way, it reacted recently during his admission and caused the patient to
irrationally run away to the Dumaguete market. Once our client eventually returned back to the center and continued the
scheduled medication, he realized it was a mistake to have done so, coming to his senses with the help of his ego. Ego
defense mechanisms were used and are still used to this day to help him cope with the emotionally saddened thoughts and
feelings he has towards his unwanted stay and towards his condition. Some of the ego coping mechanisms used by the
patient are: denial, rationalization, and suppression.
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Sullivans Interpersonal Relationships
Sullivan (1953) believed that individual behavior and personality development are the direct result of interpersonal relationships.
Sullivans major concepts include the following: Anxiety is a feeling of emotional discomfort, toward the relief or prevention of which all
behavior is aimed. Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the
development of serious difficulties in living. It arises out of ones inability to satisfy needs or achieve interpersonal security. Satisfaction of
needs is the fulfillment of all requirements associated with an individuals physiochemical environment. Sullivan identified examples of these
requirements as oxygen, food, water, warmth, tenderness, rest, activity, sexual expressionvirtually anything that, when absent, produces
discomfort in the individual. Interpersonal security is the feeling associated with relief from anxiety. When all needs have been met, one
experiences a sense of total well-being, which Sullivan termed interpersonal security. He believed individuals have an innate need for
interpersonal security. Self-system is a collection of experiences, or security measures, adopted by the individual to protect against anxiety.
Sullivan identified three components of the self system, which are based on interpersonal experiences early in life:
The good me is the part of the personality that develops in response to positive feedback from the primary caregiver. Feelings of
pleasure, contentment, and gratification are experienced. The child learns which behaviors elicit this positive response as it becomes
incorporated into the self-system.
The bad me is the part of the personality that develops in response to negative feedback from the primary caregiver. Anxiety is
experienced, eliciting feelings of discomfort, displeasure, and distress. The child learns to avoid these negative feelings by altering
certain behaviors.
The not me is the part of the personality that develops in response to situations that produce intense anxiety in the child. Feelings of
horror, awe, dread, and loathing are experienced in response to these situations, leading the child to deny these feelings in an effort to
relieve anxiety. These feelings, having then been denied, become not me, but someone else. This withdrawal from emotions has
serious implications for mental disorders in adult life.
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AGE
STAGE
Birth to onset of language
Infancy
Language to 5 years
Childhood
5 to 8 years
Juvenile
8 to 12 years
Preadolescence
FOCUS
Primary need for bodily contact and tenderness

Prototaxic mode dominates (no relation between experiences)
Primary zones are oral and anal.
If needs are met, infant has sense of well-being; unmet needs
lead
to dread and anxiety.
Parents viewed as source of praise and acceptance
Shift to parataxic mode (experiences are connected in sequence
to
each other)
Primary zone is anal.
Gratification leads to positive self-esteem.
Moderate anxiety leads to uncertainty and insecurity; severe
anxiety results in self-defeating patterns of behavior.
Shift to the sytaxic mode begins (thinking about self and others
based on analysis of experiences in a variety of situations).
Opportunities for approval and acceptance of others
Learn to negotiate own needs
Severe anxiety may result in a need to control or restrictive,
prejudicial attitudes.
Move to genuine intimacy with friend of the same sex
Move away from family as source of satisfaction in relationships
Major shift to syntaxic mode
Capacity for attachment, love, and collaboration emerges or fails
to develop.
Lust is added to interpersonal equation.
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Puberty to adulthood
Adolescence
Need for special sharing relationship shifts to the

opposite sex.
New opportunities for social experimentation lead to the
consolidation of self-esteem or self-ridicule.
If the self-system is intact, areas of concern expand to
include
values, ideals, career decisions, and social concerns.
Our 45-year-old client, F.M., is already in his adulthood. However, his relationship towards the opposite sex is merely the
relationship he has with his mother. He states that being away from his home in Kabangkalan has made him anxious, sad, and
depressed, and his main goal is to return home in order to take care of his mother. There are no visitors for F.M. besides the
occasional visits from Mary Ann, Esther and the staff. Even with the bantays and the staff in his environment, he does not
share his feelings or thoughts with anyone. He is currently not married and not in a relationship, furthermore having no plans
at the moment for any type of relationships leading up to marriage and children. His current predicament of being at the Talay
Rehabilitation Center causes him to make returning home his main priority. He also states having attained a Bachelors
Degree in Communication in Manila and he hopes to put that into use with a job sometime in the future.
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PSYCHODYNAMICS
The etiology of schizophrenia remains unclear. No single theory or hypothesis has been
postulated that substantiates a clear-cut explanation for the disease. Indeed, it seems the
more research that is conducted, the more evidence is compiled to support the concept of
multiple causation in the development of schizophrenia (Townsend, 2008). Explanations can be
broadly categorized into biological or psychological (psychodynamic) causes. These two
categories parallel the nature vs. nurture debate and the organic vs. functional dichotomy
(Keltner, 2000).
It is for this reason that we present this paradigm through the Vulnerability-Stress
Model, an eclectic approach that seems to capture the major forces at work in the genesis of
schizophrenia. This model appreciates the variety of forces that have an impact on persons
causing schizophrenia and recognizes that both biological and psychodynamic predispositions
to schizophrenia, when coupled with stressful life events, can precipitate a schizophrenic
process (Keltner, 2000). Having said this, we furthermore incorporated other stress-inclined
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theories particularly
Selyes Stress-Adaptation Model and Lazarus Interactional Model in the
BIOLOGIC
development
ofofthe
process.
There
is unquestionable evidence
geneticschizophrenic
contribution to some, and perhaps
all,
of the diseases classified as schizophrenic. It has long been observed that
schizophrenia and schizophrenia-like symptoms occur at an increased rate in
relatives with schizophrenia. (Varcarolis, 2002)
We were not able to fully trace the patients family history of mental illness since
there was no immediate family member around to validate any queries, that still
make the possibilities of having schizophrenia or other mental illness in the family
relevant to the patients case.
Utilizing VULNERABILITY-STRESS MODEL OF SCHIZOPHRENIA
Whereas the lifetime risk for developing schizophrenia is about 1 percent in most
population studies, the siblings or offspring of an identified client have a 5 to 10
percent risk of developing schizophrenia. (Townsend, 2008)
Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely
does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age
for men and 25 to 35 years of age for women. The incidence is also higher in
males than in females. (Videbeck, 2008)
Sadock and Sadock (2003) report that epidemiological data indicate a high
incidence of schizophrenia after prenatal exposure to influenza. Cytokines are
chemical messengers between immune cells, mediating inflammatory and
immune responses. Specific cytokines also play a role in signaling the brain to
produce behavioral and neurochemical changes needed in the face of physical or
psychological stress to maintain homeostasis. It is believed that cytokines may
have a role in the development of major psychiatric disorders such as
schizophrenia (Townsend, 2008)
Other biological and neurological views also take the position that schizophrenia is
caused by anatomical, physiological, or biochemical abnormalities. The three
specific neurostructural changes mentioned most often are increased ventricular
brain ratios (enlarged ventricles), brain atrophy, and decreased cerebral blood
flow. The prevailing biochemical explanation is referred to as the dopamine
hypothesis (ex. excessive dopaminergic activity in mesolimbic areas causes acute
positive symptoms of schizophrenia). (Keltner, 2007)
Various other biochemicals have been implicated in the predisposition to
schizophrenia. Abnormalities in the neurotransmitters norepinephrine, serotonin,
acetylcholine, and gamma-aminobutyric acid and in the neuroregulators, such as
prostaglandins and endorphins, have been suggested (Townsend, 2008).
The patient had not undergone laboratory tests that would validate any
anatomical, physiological and biochemical abnormalities. There are also no
evidences that will invalidate that having these abnormalities are not present.
SOCIOCULTURAL
Family Theories of Schizophrenia
Family theories of schizophrenia are naturally
linked to developmental theories. If early-life
experiences are crucial in development, the
argument is made, then the family the
environment in which most people grow up is
significant in the development of mental health.
Lack of a loving, nurturing primary care giver,
inconsistent family behaviors, and faulty
communication
patterns
are
thought
responsible for mental problems in later life.
Our client seems to have a loving and caring
relationship with his mother. He is the third son
out of the five boys, along with three older
sisters and one younger sister. Being a middle
child, you are less noticed in the family, but he
can still have the familys attention.
There might be a time wherein a certain
developmental stage of the patient was
compromised. Having an elder sister might lead
us to the possibility that the family was used to
taking care of a female child. Developing a
personality will take place as early as birth.
Such instances of not fully gratifying a childs
need will predispose a child of having a mental
disorder.
PREDISPOSING
FACTORS
PSYCHOLOGIC
Personality Organization
Theory/Developmental Theory
This theory focuses on the major psychosocial
variable of low self-esteem. The patients selfconcept is an underlying issue, whether expressed
as dejection and depression or as
overcompensation with supreme competence.
Threats to self-esteem arise from poor role
performance, perceived low-level everyday
functioning, and the absence of a clear self-identity.
Freudian concepts such as poor ego boundaries,
fragile ego, ego disintegration, inadequate ego
development, superego dominance, regressed or id
behavior, love-hate (ambivalent) relationship, and
arrested psychosexual developments are still used
meaningfully in discussions of schizophrenia.
(Keltner, 2000)
We observed, though not verbally validated by the
patient, that he is a very private person and he
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ag
does not want just anybody to get involved
hise
personal issues. He even verbalized that he does
not share any concerns or feelings to the bantay
Mary Ann and Esther.
PSYCHOLOGIC
PSYCHOSOCIAL
Developmental Psychiatry
Meyer and Freud believed that the seeds of mental health and illness
are sown in previous experiences and that to understand the presentday functioning of a person, it is important to understand his
upbringing and development. An extension of their arguments is that
events in early life can cause problems as severe as schizophrenia.
(Keltner, 2000)
In Eriksons eight stages of development, he emphasized that defects
in development carried from one stage to the next progressively
interfere with functioning that can significantly precipitate emotional
crisis. (Fortinash, 2003)
Environment
Hostile or critical environment, unsatisfactory
housing, loss of independent living, changes
in life events or daily patterns of activity,
interpersonal difficulties or disruptions in
interpersonal relationships, social isolation,
lack of social support, job pressures or poor
occupational skills, stigmatization, poverty,
lack of resources, inability to get or keep job;
all of these pose also considerable influence
in mental health and illness.
Stressful Life Events

Studies have been conducted in an effort to determine whether
psychotic episodes may be precipitated by stressful life events. There
is no scientific evidence to indicate that stress causes schizophrenia.
However, it is very probable that stress may contribute to the severity
and course of the illness. It is known that extreme stress can
precipitate psychotic episodes. Stress may indeed precipitate
symptoms in an individual who possesses a genetic vulnerability to
schizophrenia. Stressful life events may be associated with
exacerbation of schizophrenic symptoms and increased rates of
relapse. (Townsend, 2008).
The patient is currently unemployed. He is

still single, but were not able to assess when
the patient had his last opposite-sex
relationship.
We were not able to assess the childhood history of the patient, but
the patient did recall having experienced stressful events during this
developmental stage. He states having been in an argument with the
chief cook on a ship which led to his termination.
Selyes Stress-Adaptation Model

Stage 1 Alarm Reaction/Fight-orFlight Response
PRECIPITATING
STRESSORS
BIOLOGIC
Neurobiology
Cocaine and other stimulants block the reuptake of
various neurotransmitters; including dopamine,
serotonin, and norepinephrine, with the effect of
prolonging the action of these brain chemicals on
target cells. Ingestion of mood-altering substances
stimulates the dopamine pathways in the limbic
system which produces pleasant feelings or a
high. Distribution of substances throughout the
brain alters the balance of neurotransmitters that
modulate pleasure, pain, and reward responses.
Low serotonin levels may lead to increased
aggressive behavior.
The patient stated having experimented with
marijuana in his high school years; however, he
denies having taken any form of stimulants such as
cocaine or methamphetamines.
Lazarus Interactional Model

Primary Appraisal
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Ineffective immediate defense

mechanism
Experiences and develops

a crisis

Stage 2 Stage of Resistance
Attempts to cope up with habitual

problem-solving skills/ego defense and
coping mechanisms
COGNITIVE AND AFFECTIVE

According to Aaron Beck, schemata
(persons beliefs, values, and assumptions)
shape personality. Schemata influences
people to interpret certain life situations,
explain their own behavior, understand a
sentence, do arithmetic, solve intellectual
problems, reason, form opinions, and
remember events. These mental
processes determine emotional,
behavioral, and physiological responses.
The patient is from a well-off family. He
states having attained a college degree
that serves him well in relating life events
and perhaps understanding of his
condition, hence, some possible insight.
PHYSIOLOGICAL
Available coping
resources
According to Abraham Maslow, a basic

need is inactive or functionally absent in
the healthy person. If basic needs are
not met, illness is likely to occur and
when basic needs are met, health is a
result. Needs are hierarchal, with the
lower level needs being critical to
survival. These physiologic needs are
the biological need for food, shelter,
water, sleep, oxygen, and sexual
expression.
The patient belongs to a middle-class
family, as evidenced by staying in the
private cell and being admitted by his
siblings. Provision of basic needs such as
food, water and shelter is not a major
problem.

Secondary Appraisal
SOCIAL
BEHAVIORAL
Coping mechanisms are defined as the

skills used to reduce stress and they tend
to be learned from parents, individual
experiences, and social interaction.
The patient enjoys being able to interact
with us and being able to leave his room.
However, he is restricted from leaving his
room since his last escape. He lies down
on his bed and talks with us to lessen
boredom and relieve anxiety. He also does
not smoke or use alcohol, but used
marijuana in the past, a significant
ineffective learned behavior influenced by
peers.
Family resources such as parental and

sibling understanding of the illness,
finances, availability of time and energy,
and ability to provide ongoing support
influence the course of illness.
Patients family does not visit him and he
has not seen them since they admitted
him to Talay. In terms of financial
support, the patient has no problems. He
has bantays Mary Ann and Esther who
visit him sometimes.
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Ego defense/coping mechanisms

used by client
SUPPRESSION/DENIAL
RATIONALIZATION/PROJECTION
ISOLATION/DISSOCIATION
Voluntary exclusion from awareness, anxietyproducing feelings, ideas, and situations/

Unconscious refusal to admit an unacceptable
idea or behavior.
Attempting to make excuses or formulate logical reasons

to justify unacceptable feelings or behaviours/ Blaming
someone else for ones difficulties or placing ones
unethical desires on someone else.
Separating a thought or memory from the feeling

tone or emotion associated with it. The unconscious
separation of painful feelings and emotions from an
unacceptable idea, situation or object
When asked about or to further explain his

problem, he answers superficially. When asked
about if he is aware of his stereotyped behaviour
such as self talking of slight restlessness, he
denies them.
Verbalized that he was brought to TMRC because he

threw a chair out of anger from what his brother had
done; he cannot elaborate further about his present
condition. Admission notes state that he bizarre and
aggressive behavior. He does admit to having a condition
and that he is taking medication for it.
After the aggressive event of throwing chairs and

being admitted, patient has a desire to return home
to tend to his mother. During his stay in the facility,
he barely mingles with other patients or talk with
them.
Ineffective individual
coping
Violent behavior
Ineffective coping
mechanisms
Withdrawn behavior
18 | P a g e
Prolonged use of coping

mechanisms

Stage 3 Stage of Exhaustion
Maladaptive response and ego

breakdown

Ineffective/Negative Reappraisal
Psychotic
Manifestations
Excessive dopaminergic activity in the
Diminished dopaminergic activity in the

NEGATIVE
POSITIVE
Spend time with client, listening with

regard and providing support for
memory
emotions
changes client is making.
Provide a safe environment by not
*Auditory
*Aggression/
arguingand
with or ridiculing
the client
violent
visual
Orient to reality by communicating
hallucinations
behaviors
effectively and clarifying
time, place,
and visual
person.
Ineffective
Disturbed
Be
honest
in expressing
fears,
individual
and auditory
especially if potential
for violence is
perception
coping
perceived.
Provide external controls, such as a
Medications:
calm and
quiet environment.
Fluphenazine
Be alert for
impending
decanoate
violent/aggressive
behavior.
Chlorpromazi
Scheduledne
anti-psychotic
medication: Chlorpromazine (CPZ) 1
tab daily.
Determine individual stressors.

Assist client to
identify present
arousal
memory
Social
coping patterns and the
behavior
Sleeplessness
Tangentially
consequences/effectiveness
of
andbehaviors.
and
Blunted
Teach problem-solving techniques. affect
Encourage to think through
Medications:
problems and identify goals for
Biperidine
own care.
Encourage to assume control over

own reactions to stressful event,
even though the circumstances

cannot always be controlled.
Cognition
Planning/
Spend problemtime with client by offering
self.
solving/motiva
Poverty of
Develop Loss
a therapeutic
nurse-client
of
speech
relationship
through
frequent,
motivation
brief contacts and an accepting
attitude.
Risk for social
Showisolation
unconditional positive
regard.
After client feels comfortable in a
one-to-one relationship,
encourage attendance in group
activities.
Accept clients decision to remove
self from group situation if anxiety
becomes too great.
Schizophrenia
(Residual)
Cognition
Inability to
experience
pleasure or
joy
19 | P a g e
PSYCHOPHARMACOLOGY
20 | P a g e
A. Chlorpormazine
Generic Name: Chlorpromazine
Brand Name: Thorazine
Classification: Antipsychotic
Indication: Acute and chronic psychoses; particularly when accompanied by increased psychomotor activity
Action: Alters the effects of dopamine in the CNS; possesses significant anticholinergic and alpha-adrenergic blocking activity; diminished
signs and symptoms of psychoses
Contraindication: Hypersensitivity (in sulfites), povidone or benzyl alcohol; cross-sensitivity with other phenothiazines may occur; narrow
angle glaucoma
Side Effects: Sedation, tardive dyskinesia, dry eyes, blurred vision, tachycardia, urinary retention, rashes
Adverse Effects: Neuroleptic Malignant Syndrome, photosensitivity
Nursing Implications:
1. Assess patients mental status (orientation, mood, behavior) prior to and periodically during therapy
2. Monitor blood pressure (sitting, standing, lying) ECG, pulse and respiratory rate prior to and frequently during the period of dosage
adjustment. May cause Q-wave and T-wave changes in the ECG.
3. Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded
4. Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize the constipation
5. Monitor patient for onset of extrapyramidal side effects
B. Biperidine
Generic Name: Biperine
Brand Name: Akineton
Classification: Antiparkinson agent
Indication: Adjunctive treatment of all forms of Parkinsons disease, including drug-induced extrapyramidal effects and acute dystonic
reactions
Action: Blocks cholinergic activity in the CNS, which is partially responsible for the symptoms of Parkinsons disease; restores the natural
balance of neurotransmitters in the CNS; reduction of rigidity and tremors
Contraindication: Hypersensitivity, narrow angle glaucoma, tardive dyskinesia, bowel obstruction, megacolon
Side Effects: Confusion, weakness, headache, sedation, dizziness, dry mouth, nausea
Adverse Effects: Hallucination, depression
21 | P a g e
1. Assess Parkinson and extrapyramidal symptoms, prior to and throughout course of therapy
2. Assess bowel function daily. Monitor for constipation, abdominal pain, distention, or the absence of bowel sounds
3. Monitor intake and output ratios and assess the patient for urinary retention C. Lithium Carbonate
C. Fluphenazine decanoate
Generic Name: Fluphenazine decanoate
Brand Name: Prolixin
Classification: Antipsychotic
Indication: Treatment of acute and chronic psychoses
Action: Alters the effects of dopamine in the CNS; possesses anticholinergic and alpha-adrenergic blocking activity; diminished signs and
symptoms of psychoses
Contraindication: Hypersensitivity, cross-sensitivity with other phenothiazines may exist, narrow-angle glaucoma, bone marrow depression,
severe liver or cardiovascular disease, hypersensitivity to sesame oil
Side Effects: sedation, tardive dyskinesia, dry eyes, blurred vision, lens opacities, hypotension, tachycardia
Adverse Effects: Extrapyramidal reactions, photosensitivity
1. Assess patients mental status (orientation, mood, behavior,) prior to and periodically throughout therapy
2. Monitor blood pressure (sitting, standing, lying) and pulse prior to and frequently during the period of dosage adjustment.
3. Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded
4. Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize the constipating effects of this medication.
5. Observe patient carefully for extrapyramidal symptoms (pill-rolling motions, drooling, tremors, rigidity, shuffling gait), tardive
dyskinesia, nad neuroleptic malignant syndrome. Notify physician immediately at the onset of these symptoms.
Assessment of the 5 Domains

22 | P a g e
Physical Domain
This refers to the concrete, physical reality of the self-system. The components are body systems, gross motor skills, sensory skills,
physiologic parameters, genetics, organ development, fine motor skills, vital signs, height, weight and organ functioning. Physical influences
how a person response to psychosocial stress or illness. The healthier a person is the better he or she can cope with stress or illness. Poor
nutritional status, lack of sleep, or a chronic physical illness may impair a persons ability to cope. Unlike genetic factors, how a person lives
and takes care of himself or herself can alter many of these factors. Personal health practices, such as exercise, can influence the clients
response to illness. According to Keltner (2012), patient with schizophrenia also displays alteration of activity. Patients might be too active;
that is, they are unable to sit still and continually pace, or they might be inactive or catatonic.
Our patient is always prepared before the interaction; he always welcomes us and greets us before the start of the interaction. He
offers a handshake before and after interaction; greets the student nurses by first name and appears happy. When standing, patient
would usually move his feet in a marching manner. He have eaten and taken his medications before the interaction. He is already done
taking a bath and is groomed accordingly with a shirt and shorts on. He is odorless and would brush teeth regularly. Our patients body
exhibits minimal movement; blinks eyes consistently during thought processing and fixes his hand grabbing onto hem of shorts. Looks
toward the interviewers intermittently, but directs his attention back to between the student nurses. When seated during the interaction,
client sits with a slight hunch; patient would usually shift position while sitting. He held the hem of his shorts during the first few
interactions but has been minimized after the next interactions but still holds and rubs his right knee during interactions. He manifests
blank stares when talking with us during the first few interactions but has been minimized on later interactions. He shakes hands with us
after the interaction.
Intellectual Domain
23 | P a g e
Components include: perception, analyze, thinking, language, memory, problem solving, creativity and moral decisions (which includes:
receptive functions, memory and learning, and cognition or thinking).
The common thought disorders of schizophrenia include retardation, blocking, autism, ambivalence, loose associations, delusions,
poverty of speech and concrete thinking (Keltner, p. 262). It is well-established that patients with schizophrenia suffer cognitive impairment.
For example, memory, attention and executive function are affected. Research shows that cognitive deficits are better predictor of declining
abilities to engage in basic activities of daily living than are positive or negative symptoms (Velligan, et. al., 2010).
Our client had finished his course at a university in Kabangkalan. He has not clearly stated his course when he was still
in college (all that he told us was he graduated with a degree of AB). During that time, he had started being drug dependent
by using marijuana with his peers. He had a tattoo on his arm and he stated that he had that tattoo done during his college
days as well. He had also stated that they had struggled while studying; he helped his mother to sell fishes in the market. He
prefers having our interaction in Tagalog since he is from Iloilo and he understands Bisaya slightly; he also speaks English
when the question is in English. He seems to be more expressive when talking in Tagalog than in English.
Our clients thoughts seem to be reality-oriented, is alert and aware of our interaction, the day and his current location.
He is able to recall family, jobs and past experiences while growing up. But there are memories that he cannot recall. For
example, the reason why he was sent to the center.
He had once told us that he had an accident during his 20s; he had bumped his head in the floor while they are on a
martial arts practice. He felt dizzy after what had happened and had just taken a rest without visiting the doctor after the
incident. He told us that he wanted to go home because there is nothing wrong with him, that he is alright. All that he thinks
during his stay in the center is that he wanted one of his siblings to come to the center and get him. He once verbalized (after
he had escaped and was being brought back to the center) that he can actually go home if he only had a fare in going home
and if he only knew where he can ride a bus in Dumaguete since he is not familiar with the place.
Emotional Domain
24 | P a g e
This refers to the clients response to events; ones intrapersonal relationship; self-concept; emotions, feelings, response to frustrations,
self-esteem, self-discipline skills, identity and self-confidence.
Emotions refer to mood and affect that are connected to specific ideas. Emotions are generated from interplay of neural activity among
the hypothalamus of neural activity among the hypothalamus. The hypothalamus, in addition to its hormonal functions, is the emotional
coordinating center. In schizophrenic patients, alterations of affect are varied and include inappropriate, flattened, blunted, or labile affects;
apathy; ambivalence; and overreaction (Keltner, p.263).
Our client seems glad upon initial contact and is content towards the end of interaction. He seems to be anticipating our NPI since
he prepares himself before the interaction. He expresses his thoughts and feelings with us during the interaction but still seems closed
off when asked some questions. He verbalized that he has no problems in expressing his thoughts when asked what he thinks.
He also told us that he had nervous breakdown. He usually gets nervous when he sees something wrong or not right.
There was once that he got nervous while in the center when two of the patients had a quarrel. He said that he calm himself
down by thinking of beautiful things and by praying.
Our client feels lonely while he stays in the center especially that he stays in his room and is only allowed to be out of his
room when there are activities in the chapel. He wanted to just have a freedom of getting out of his room and would be able
to roam around the center to lessen his loneliness while he stays at the center. He even find playing volleyball and talking to
his co-patients some ways to lessen his loneliness.
He had escaped once and told us that he was only brought by his emotion, which is why he did it. He said that his family
had not visited him yet after his admission last October of 2013. He even told us that he is worried over his mother who is sick
back in Kabangkalan. All he wanted is for his siblings to get him in the center and let him stay in his mothers house to take
care of his sick mother.
Social Domain
25 | P a g e
This refers to the external responses to events; ones interpersonal relationships, social skills. Components include: affiliations, peer
relations, play behaviors, status, communication, negotiation skills, social adaptation, roles, and social identity.
This is the ability to form cooperative and interdependent relationships with others. Social problems are often the major source of
concern to families and health care providers because these tangible effects of illness are often more prominent than the symptoms related to
cognition and perception. Social problems may result from the illness directly or indirectly. Direct effects occur when symptoms prevent the
person from socializing within accepted socio - cultural norms or when motivation deteriorates. Regardless, the result is social withdrawal and
isolation from lifes activities. Behaviors directly causing these problems include inability to communicate coherently, loss of drive and
interest, deterioration of social skills, poor personal hygiene and paranoia. Indirect effects on socialization are secondary consequences of the
illness. Specific problems in the development of relationships include social inappropriateness, disinterest in recreational activities,
inappropriate sexual behavior.
Patients with schizophrenia have troubled interpersonal relationships. Often these problems develop over a long period, well before
schizophrenia is diagnosed, and become more pronounced as the illness progresses. Patients become less concerned with their appearance
and might not bathe without persistent prodding. Interpersonal communication becomes inadequate and might be inappropriate. They
withdraw, further compromising their ability to engage in meaningful interactions.
During our interaction, our client converses with us properly. He would greet us by calling our names. He also converses
with his watcher and the other patients in the center. He said that he is happy whenever we had our interaction. During our
first interaction, he seemed nervous and he had hard time expressing his thoughts to us; he would have blank stares during
the interaction. On the later interactions, he had minimized blank stares and would maintain eye contact whenever he
answers questions. He said that he wanted to have someone to talk to since he felt lonely and that his family had not visited
him yet after his admission. He would sometimes feel sad when he cannot get out of his room to join other activities in the
chapel. He said that he wanted to have a freedom of getting out of his room and would roam and converse with the other
patients in the center. He felt isolated inside his room with no one to talk to.
He participates in therapies that the student nurses had prepared for the patients in the center. He verbalized enjoyment
after the therapy and is happy that we are able to help him lessen his loneliness during his stay in the center.
SPIRITUAL DOMAIN
26 | P a g e
This refers to life force, soul, consciousness of existence, ones transcendental relationship. Components include commitment, verve or
resiliency, ethics, survival instincts, faith, ability to love and be loved, purpose/ drive in life, integrity, hope, will.
Spirituality involves the essence of a persons being and his or her beliefs about the meaning if life and the purpose for living. It may
include belief in God or a higher power, the practice of religion, cultural behaviors and practices, and a relationship with the environment.
Although many clients with mental disorders have disturbing religious delusions, for many in the general population, religion and spirituality
are a source of comfort and help in times of stress or trauma. Studies have shown that spirituality is a genuine help to many mentally
challenged adults, serving it as a primary coping device and a source of meaning and coherence in their lives or helping to provide a social
network. Individuals experiencing pathological mistrust are cut off from opportunities to re establish a sense of being connected to a higher
universe. The individual has lost the feeling of connectedness with significant others in his environment, so he no longer has access to
resources critical for maintaining trust.
Our client is a Roman Catholic. He usually joins the mass in the chapel at the center but was not able to join recently
because of the escape that he had done that restricted him from going out of his room. He told us that he prays every day and
that he prays that he can go home. He also prays when he feels lonely to lessen what he is feeling. He prays when his nervous
breakdown would be present to calm himself down. He prays because he believes that by praying his wish that he wanted to
go home would happen and that his mother would be alright even though he is far from their place.
COLLEGE OF NURSING
Silliman University
27 | P a g e
Dumaguete City
Cues and
Evidences
Subjective:
When my
siblings had not
visited me yet
since my
admission. I feel
so alone.
My family has
not visited me
since October
2013, during my
admission.
Giving possible
reasons as to
why his family
has not visited
him; Layo man
gud ang
Kabangkalan
gikan diri maong
dili sila kabisita
Usahay ra ko
muapil nila ug
volleyball
Nursing Diagnosis
Objectives
Risk for social isolation

related to altered
mental status and
absence of significant
others.
At the end of our care,

the client will have
minimized risk for social
isolation as evidenced
by:
Objective:
Verbalization that
feeling of
loneliness is
gone.
Minimized
stuttering during
the interaction.
Maintaining eye
contact and
minimized
holding of the
hem of the shorts
during
interaction.
Minimized
shifting in the
seat.
Answering the
questions without
hesitations and
being able to ask
questions.
Increased
Interventions
Determine the
client's response
to the
conditions,
feelings about
self, concerns or
worries about
the other
person's
response, his
ability to control
the situation,
and a sense of
hope.
Assess the
coping
mechanisms and
methods of
dealing with the
problems of life
previously.
Discuss concerns
about work and
leisure
involvement.
Rationale
How to receive
individual and
relate to the
situation will help
determine
treatment plans
and interventions.
Assessing reveals
successful
techniques that can
be used in the
current situation.
Clients with a
potentially terminal
disease, which
carries a stigma,
faced a big problem
with the possibility
of losing their jobs,
Evaluation
the cliend was able to
have minimized social
interaction as
evidenced by:
GOAL PARTIALLY MET
Verbalization of
being grateful
that client has
someone to talk
to during the
interaction.
Minimized
stuttering during
the interaction.
Maintaining eye
contact only
when answering
the questions.
Minimized
holding the hem
of shorts, holds
hands instead.
Minimized
shifting in the
seat during
interaction.
28 | P a g e
Stutters while
communicating
during the
ineraction.
Holds the hem of
his shorts while
answering.
Stares blankly
ahead while
communicating.
Sad, dull affect.
Shifts from side
to side during
the interaction.
Goes back to his
room after the
interaction and
locks himself up.
Withdrawn;
seems hesitant
in answering
questions.
45 years old,
single.
To have smoked
during teen
years.
Used marijuana
during college.
interaction with
other patients in
the center during
activities and
therapies.
Demonstrating
willingness to
socialize with
others.
Help clients
distinguish
between
isolation and
loneliness or
solitude, which
may be by
choice.
Alert to verbal
cues and
nonverbal, such
as withdrawal, a
statement of
despair, and
sense of
loneliness.
Determine the
presence and
level of risk
for suicidal
health insurance,
housing, and they
become unable to
care for themselves
independently.
To provide an
opportunity for
clients to achieve
the control he must
make a decision
about the choice to
take care of
themselves on this
issue.
Indicators of
despair and suicide
may be present.
When the signal is
recognized, the
clients are usually
willing to express
their thoughts and
feeling of alienation
and despair.
Verbalization of
sharing and
talking with other
patients inthe
center especailly
during activities
or therapies.
Being able to join
the occupational
therapy
organized by the
students.
To provide an
opportunity to
resolve any
29 | P a g e
thoughts.
Identifying
community
resources, selfhelp groups, and
drug
rehabilitation
program or
termination.
Spend time with
client. This may
mean sitting for
a while and
offering self.
problems that may

contribute to a
sense of loneliness
and isolation.
Develop a
therapeutic
nurse-client
relationship
through
frequent, brief
contacts and an
accepting
attitude. Show
unconditional
positive regard.
After client feels
Social isolation
needs social
support that
facilitates the
survival of human
beings by offering
social, emotional
and material
support needed
and recieved by an
individual. (Lin,
1986)
Presence,
acceptance, and
conveyance of
positive regard
enhance the
clients feelings of
self-worth.
The presence of a
trusted individual
provides emotional
security for the
client.
30 | P a g e
comfortable in a
one-to-one
relationship,
encourage
attendance in
group activities.
May need to
attend with
client the first
few times to
offer support.
Accept clients
decision to
remove self from
group situation if
anxiety becomes
too great.
According to
Eriksons
psychosocial
development,
client at this age
(40-65 years
old) may
develop
Generativity or
Stagnation.
Generativity
means
accomplishing
things and
creating things
while stagnation
means failure to
find a way to
contribute to
the world.
Enable for the
client not to feel
uninvolved or
disconnected,
interaction with
other people as
well as
accomplishing
things can help
move the
individual from
31 | P a g e
Provide positive
reinforcement
for clients
voluntary
interactions with
others.
stagnation to
generativity.
Positive
reinforcement
enhances selfesteem and
encourages
repetition of
desirable
behaviors.
COLLEGE OF NURSING
Silliman University
Dumaguete City
Cues and
Evidences
Nursing
Diagnosis
Objectives
Interventions
Rationale
Evaluation
32 | P a g e
Subjective:
States being let

go from his job
on a ship lasting
only 2 months
due to an
altercation with
a co-worker.
States being
admitted into
facility because
of a physical
altercation
involving head
injury with his
brother.
States he
smoked during
teen years and
used marijuana
during college to
deal with stress.
Objective:
45 years old,
single, no
children.
Admitted in
October of 2013
by his family.
Ineffective individual
coping related to
disturbance in
pattern of tension
release as evidenced
by history of
physical altercations
and inability to
conserve adaptive
energies.
At the end of our

nursing care, the client
will develop effective
coping behaviors as
evidenced by:
Verbalize
awareness of his
own coping
abilities.
Expressions of
his feelings in a
safe manner.
Identify
ineffective
coping
behaviors and
consequences.
Determine individual
stressors.
Assist client to identify

present coping patterns
and the
consequences/effective
ness of behaviors.
Encourage to think
through problems and
identify goals for own
care.
In order to
develop coping
mechanisms, it
is important to
find out the
sources of
stress.
A realistic
picture of how
effective current
mechanisms are
provides insight
and enables
client to
acknowledge
ineffectivness of
these methods
and begin to
look at healthy
alternatives.
Learning to
arrive at
thought-out
solutions
provides base
for effective,
satisfying coping
behaviors.
Personal
involvement in
own care
provides a
feeling of

the cliend was able to
develop effective
coping behaviors as
evidenced by:
GOAL PARTIALLY MET
Verbalized the
degree of how
he copes and is
willing to modify
his way of
coping and
dealing with
stressors.
Unable to
express his
feeling fully.
Able to identify
incorrect
methods of
coping with the
the resulting
effect.
States he
understands his
suppressed
emotions can
lead to health
issues.
Able to
somewhat
assess his
33 | P a g e
Holds the hem

of his shorts
while answering.
Stares blankly
ahead while
communicating.
Sad, dull affect.
Withdrawn;
hesitant in
answering
questions.
Difficulty with
deliverying his
information
during the
interactions.
Encourage to assume
control over own
reactions to stressful
event, even though the
circumstances cannot
always be controlled.
control,
increases
chances for
positive
outcome, and
enhances selfesteem.
The client can

learn to control
how much a
stressful even
affects feelings,
behavior, and
becoming upset
by changing the
way these
events are
viewed.
Client may be
intolerant of
others and
aggressive in
relationships,
resulting in
problems
interacting with
others.
Heightening the
awareness of the
Discuss the behaviors

that effect interpersonal
relationships.
Evaluate the effect of

feelings, such as anger,
have had on physical
and emotional health.
current
situation, but
unable to
address
reason(s) for
admission.
34 | P a g e
possible toll on
health and
longevity.
35 | P a g e
COLLEGE OF NURSING
Silliman University
Dumaguete City
Cues and
Evidences
Nursing Diagnosis
Objectives
Interventions
Rationale
Evaluation
Independent:
Subjective:
States being
admitted into
facility because
of a physical
altercation
involving his
brother; states
he did something
he didnt like.
States being
ready to go
home; however,
contradicts his
statement by
saying he needs
to stay and be
treated by the
doctor.
Risk for injury related

to escape/suicide
precautions.
At the end of our 6week care, the client

will be free of injury as
evidenced by:
Verbalizes
understanding of
the dangers of
leaving center
alone.
Demonstrates
returning to room
after being granted
access to come out.
Verbalizes
importance of
treatment at the
center.
Absence of a
repeated escape.
Spend time with

client, listening
with regard and
providing support
for changes
client is making.
Assess mood,
such as
temperament
and aggression.
Implement
writing therapy.
Objective:
45 years old,
Continued,
consistent/accepta
nce will reduce
anxiety and fears
and enable client
to decrease altered
perceptions.
Increased risktaking behavior
may result without
the consideration
of the
consequences.
Helps to express
himself though
writing; we can
identify and
discuss his
thoughts and
feelings, and
intervene when
necessary.

the cliend was free of
injury as evidenced by:
GOAL MET
Able to identify
the risks
involved with
leaving the
facility.
Promptly returns
to room after
therapy sessions.
States he needs
to take his
medication, but
claims to be
healthy enough
to return home.
Did not escape,
however he does
still did not
regret his
previous escape.
Provide external
36 | P a g e
single, no
children.
Admitted in
October of 2013
by his family.
On
suicide/escape
precautions.
Escaped from
Talay
Rehabilitation
Center on
February 5, but
was safely
brought back the
following day by
Mary Ann.
History of visual
and auditory
hallucinations.
Stares blankly
ahead while
communicating.
Sad, dull affect.
Withdrawn;
hesitant in
answering
questions.
controls, such as
a calm and quiet
environment.
Teach about the

risks involved
with leaving the
center.
External limits and

controls must be
provided to protect
client and others
until client regains
control internally.
Knowledge about
the risks of exiting
the center in his
current condition
and situation may
help him
reconsider his
actions.
Prevents potential
harm to client by
ensuring safe
return to and from
his room.
Alters the effects

of dopamine in the
CNS; possesses
significant
anticholinergic and
alpha-adrenergic
blocking activity;
Maintain
suicide/escape
precautions.
Collaborative:
Scheduled antipsychotic
medication:
Chlorpromazine
(CPZ) 1 tab daily.
37 | P a g e
diminished signs
and symptoms of
psychoses
Summary of Nursing Diagnoses
Risk for social isolation related to altered mental status and absence of significant others.
Ineffective individual coping related to disturbance in pattern of tension release as evidenced by history of physical
altercations and inability to conserve adaptive energies.
38 | P a g e
Disturbed visual and auditory perception related to history of hallucinations and panic levels of anxiety as evidenced
by disturbance in thought, perception, flat affect.
RELATED READINGS
A Network-Based System to Improve Care for Schizophrenia: The Medical Informatics Network Tool (MINT)
Alexander S. Young, MD, MSHS, Jim Mintz, PhD, Amy N. Cohen, PhD, and Matthew J. Chinman, PhD
39 | P a g e
Abstract
The Medical Informatics Network Tool (MINT) is a software system that supports the management of care for chronic illness. It is designed
to improve clinical information, facilitate teamwork, and allow management of health care quality. MINT includes a browser interface for
entry and organization of data and preparation of real-time reports. It includes personal computerbased applications that interact with
clinicians. MINT is being used in a project to improve the treatment of schizophrenia. At each patient visit, a nurse briefly assesses
symptoms, side effects, and other key problems and enters this information into MINT. When the physician subsequently opens the
patient's electronic medical record, a window appears with the assessment information, a messaging interface, and access to treatment
guidelines. Clinicians and managers receive reports regarding the quality of patients' treatment. To date, MINT has been used with more
than 165 patients and 29 psychiatrists and has supported practices that are consistent with improvements in the quality of care.
Schizophrenia is a chronic brain disorder that occurs in about 1% of the population and manifests as symptoms of psychosis and
disorganized thinking. It accounts for 10% of all permanently disabled people and 3,200 premature deaths annually in the United
States. During the past two decades, there have been dramatic advances in the treatment of schizophrenia. New medications can improve
symptoms and quality of life while causing fewer unpleasant side effects. Structured psychosocial treatments allow severely ill people to live
successfully in the community and markedly improve their functioning. Unfortunately, the majority of people with schizophrenia are not
receiving appropriate care. While state governments spend approximately $16 billion per year on public mental health services for adults,
outcomes under typical care are much worse than in state-of-the-art care. Quality problems are prevalent nationally in provider
organizations, including the Department of Veterans Affairs (VA).
To address this problem, the VA Health Services Research and Development service and Quality Enhancement Research Initiative (QUERI)
have funded a number of projects, including Enhancing Quality Utilization in Psychosis (EQUIP). The EQUIP project is implementing and
evaluating a collaborative care model designed to improve the quality of care for schizophrenia. Collaborative care models reorganize
practice and typically involve changing the division of labor and responsibility, adopting new care protocols, and becoming more responsive
40 | P a g e
to patients' needs. In a number of chronic medical illnesses and depression, researchers have demonstrated that collaborative care improves
health care processes and patient outcomes by keeping ill patients in care and ensuring the provision of appropriate medication and
psychosocial services. In EQUIP, established collaborative care principles have been applied to the treatment of schizophrenia and are being
evaluated in a randomized, controlled trial.
A central component of EQUIP is the Medical Informatics Network Tool (MINT), a software system that was developed to support both the
EQUIP care model and research evaluation. MINT supports care model implementation by helping clinicians collect, manage, and utilize
patient-specific and scientific information in real time. It facilitates communication among members of the clinical team and provides
reports that are used to manage care. MINT supports the research evaluation by maintaining data on all enrolled patients, their contact
information, and dates for follow-up interviews. The EQUIP project, supported by MINT, is ongoing at the mental health clinics of two large
VA medical centers in Southern California: the Long Beach Healthcare System and the Greater Los Angeles Healthcare System at
Sepulveda. This paper describes the objectives, architecture, and functions of MINT and the utilization and performance of the system.
Future applications are discussed.
Reaction:
Using technology is a one step to patient care. We are now living in this modern world and it is time for the health care providers to
adapt to the modern technologies that are surrounding them. As what has been stated above that Schizophrenia needs a proper assessment
and medications to lessen the symptoms. Through the use of MINT, the Schizophrenic patient can be assessed properly by placing the
information and medications given to the patient. This tool saves time not only to the nurses but also to the physicians of the patients. For us,
this tool would help a lot to Schizophrenic patients in the country since this condition is not rare anymore. By the use of this tool, the nurses
would really know what happened to their patients especially when the patient shows signs and symptoms of the condition. The country would
41 | P a g e
not only need to adapt to this kind of system but also to other newer technologies that other countries had tried for the betterment of nursing
care.
Environment and Schizophrenia: Environmental Factors in Schizophrenia: Childhood TraumaA

Critical Review
Craig Morgan1,2 and Helen Fisher2,3
+Author Affiliations
1. 2Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, UK
2. 3MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, De Crespigny Park, London, UK
42 | P a g e
To whom correspondence should be addressed; Box 63,Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF, UK, tel: 020 7848 0351, fax: 020 77019044, e-mail:spjucrm@iop.kcl.ac.uk.
Abstract
There is renewed interest in the relationship between early childhood trauma and risk of psychosis in adulthood. There are a large number of
studies of psychiatric inpatients, and of outpatients in which a majority has a psychotic disorder, that suggest the prevalence of childhood
trauma in these populations is high. However, these are generally small studies of diagnostically heterogeneous and chronic samples and, as
such, can tell us very little about whether childhood trauma is of etiological importance in psychosis. A small number of recent populationbased studies provide more robust evidence of an association, and there are now plausible biological mechanisms linking childhood trauma
and psychosis. However, there remain a number of conceptual and methodological issues, which mean much more research is needed before
firm conclusions can be drawn about whether childhood trauma is a cause of psychosis.
Introduction
The term childhood trauma has been used to capture a range of severe adverse experiences, including sexual, physical, and emotional abuse,
and neglect. A recent survey in the United Kingdom estimated the prevalence of childhood sexual abuse at around 11% and physical abuse at
around 24%.1 In the United States, estimates tend to be higher.2 The adverse long-term consequences of childhood sexual and physical abuse
have been well documented and include increased risk of adult depression,3 personality disorders,4,5 suicide,6,7 posttraumatic stress disorder
(PTSD),8 and drug and alcohol dependence.9 It is possible, moreover, that specific forms of abuse are linked to particular disorders. For
example, sexual abuse shows strong correlations with later depression3 and borderline personality disorder4 and physical abuse with
antisocial personality disorder.10,11
This review is concerned with the question of whether childhood trauma increases the risk for adult psychosis or, more specifically,
schizophrenia. Our aim is to provide an overview of the most relevant and robust research and, from this, to highlight a number of conceptual
and methodological issues that need to be taken into account in future research.
A Gathering Storm
Interest in this issue has reemerged in recent years and has coalesced around a recent review article by Read et al, 12 in which the authors
claim that the evidence shows: child abuse is a causal factor for psychosis and schizophrenia. (p330) This led one UK psychologist and
journalist to write of this review as providing tectonic plate-shifting evidence.13 Are these claims warranted?
43 | P a g e
The Prevalence of Childhood Trauma in Clinical Populations

It is necessary to begin on a critical note. The overall impression created by the review of Read et al12 is that there is a wealth of evidence
suggestive of a causal relationship between childhood trauma and psychosis. For example, Read et al 12 produce weighted averages for
females and males of reported child sexual abuse (48% females, 28% males), incest (29% females, 7% males), and child physical abuse (48%
females, 50% males) from 51 studies of psychiatric inpatients and of outpatients when half or more were diagnosed with a psychotic illness. In
terms of understanding the relationship between childhood trauma and psychosis, however, these estimates are misleading.
Of the 51 studies included, 8 are of children and adolescent samples, 14 are of inpatient or ex-inpatient samples, in which only a minority, if
any, have a diagnosis of psychosis, and 9 are of outpatient samples in which over 50% have a diagnosis of psychosis. In other words, 31 of the
51 studies are of diagnostically heterogeneous samples in which the numbers with a psychotic disorder are often unclear. Read et al 12 reason
that this is acceptable because, they claim, the prevalence of childhood trauma in those with a psychotic disorder is likely to be higher than in
other groups.(p334) However, when the weighted prevalences are recalculated, using only those studies (n = 20) in which all subjects were
diagnosed with a psychotic mental illness, the estimates reduce for all but one form of abuse (sexual abuse in males, which remains the same)
(see table 1).
Childhood Trauma Among Inpatients and Outpatients With a Psychotic Disorder
This analysis notwithstanding, there remain doubts about whether calculating a weighted prevalence from even this more restricted list of
studies is meaningful. Combining data to produce a single estimate of prevalence carries an implicit assumption that the samples and the
measures of exposure across the studies are comparable. However, the samples used in these studies were invariably small, highly selected
and heterogeneous, and the definitions and measures of abuse varied widely. Furthermore, all but 2 of these studies 14,15 was of chronic
samples, such that, even if the rates of childhood trauma were higher than in comparable population samples, this may reflect the impact of
abuse on illness severity and chronicity or the presence of comorbid affective, substance use, personality, or post-traumatic stress disorders,
all of which have been linked to earlier abuse and all of which are common in those with a psychotic mental illness.16 In a recent study, for
example, of 124 outpatients with a diagnosis of schizophrenia, Scheller-Gelkey et al17 report a 37% prevalence of sexual abuse in those with a
comorbid substance misuse problem compared with 16% in those with no substance misuse problem.
Population-Based Studies
44 | P a g e
Summary of Recent Population-Based Studies of Childhood Trauma and Psychosis

Using data on 8580 subjects aged 1674 from the British National Survey of Psychiatric Morbidity, Bebbington et al18 found that those who
met criteria for a definite or probable psychotic disorder (n = 60) were over 15 times more likely to have been sexually abused at some point
in their lifetime (not restricted to childhood). When the interrelationship between other negative life events and level of depression were
controlled, the odds ratio was markedly reduced, though still significant (Adj. OR 2.9). However, the measure of sexual abuse was crude (a
single question), no account was taken of timing, duration, or severity of abuse, and childhood and adult exposure were not distinguished.
In their analysis of data on 4045 subjects aged 1864 drawn from the Netherlands Mental Health Survey and Incidence Study, Janssen et
al19 found that those who had experienced emotional, physical, or sexual abuse or neglect before the age of 16 were more likely to report
experiencing psychotic symptoms during a 3-year follow-up period. The effect was strongest for the most severe psychosis groups and held
after adjusting for a range of potential confounding variables (eg, need for care level psychosis: Adj. OR 7.3). However, the number of subjects
with psychotic symptoms was very small, particularly those with the most severe symptoms (n = 7), meaning the confidence intervals for
each odds ratio were very wide, and while there was evidence that the risk of developing psychosis increased in a dose-response fashion with
increasing severity of abuse, no formal test for trend across levels of abuse severity was reported. In a more recent study using a similar
design, Spauwen et al,21 using data on 2524 subjects aged 1424 from the Early Developmental Stages of Psychopathology study, found that
the experience of any lifetime trauma (from a list of 9 events, not restricted to childhood) was associated with the development of 3 or more
(but not fewer) psychotic symptoms during an average follow-up period of 42 months (Adj. OR 1.9). The trauma exerting the strongest
independent effect was natural catastrophe (Adj. OR 15.1) followed by physical threat (Adj. OR 2.1). The risk of developing 3 or more psychotic
symptoms was elevated in those who reported sexual abuse (Adj. OR 1.6) but not significantly and by much less than in the studies by
Bebbington et al18 and Janssen et al.19 However, as in the study by Bebbington et al,18 the measure of trauma was relatively crude, again
with no account taken of timing, duration, or severity.
In the only study in which the occurrence of sexual abuse was determined using contemporaneous records, Spataro et al 5 compared rates of
subsequent hospital admissions in those who had been sexually abused before the age of 16 (n = 1612), according to official records, with
admission rates in a large population-based control sample (n = 3 139 745). They found no association between child sexual abuse and later
admission to hospital with a diagnosis of schizophrenia (relative risk 1.2). However, as the majority of cases of sexual abuse go unrecognized,
meaning many cases of sexual abuse will have been included in the control sample, the potential for this study to detect a difference was
limited. Further, by definition, the cases of abuse included were the subject of some form of state intervention, and this may have had
protective effects on later risk of psychopathology.
In another recent large population-based study (n = 17 337), Whitfield et al20 found that respondents reporting a history of hallucinations
were more likely to have been both physically (Adj. OR 1.7) and sexually (Adj. OR 1.7) abused during childhood. The sample size is a strength,
45 | P a g e
but the study is cross-sectional and the measure of hallucinations extremely limited (ie, a single question, see table 2). Nonetheless, this is in
line with findings from a number of previous (much smaller) studies, which have reported higher rates of hallucinations in patients with a
psychotic illness (or in clinical populations more generally) who had experienced various forms of trauma in childhood compared with those
who had not.2224 The evidence regarding delusions is more equivocal. Janssen et al,19 for example, reported higher rates of both
hallucinations and delusional ideation in those who had experienced childhood abuse, but others have found no association between early
trauma and delusions.16 Only a small number of studies have investigated other symptoms, such as negative symptoms, 25,26 and no clear
patterns emerge.
The findings from the recent, more robust, studies of childhood trauma are suggestive of a link with adult psychosis. However, the findings
have not been altogether consistent and a number of complicating conceptual and methodological issues remain.
Conceptual and Methodological Issues
Diagnostic Conundrums
In the main, the recent studies of childhood trauma have focused on psychotic symptoms in the general population, at varying levels of
severity, and whether reported associations will extend to those with symptom clusters meeting criteria for specific psychotic diagnoses
remains unclear. Further, positive psychotic symptoms are reportedly common among those with a primary diagnosis of PTSD27 (and those
with dissociative symptoms28,29), and recent studies suggest there is a high prevalence of PTSD (much of it unrecognised) in patients with a
diagnosed psychotic disorder.30 A key issue for future research is, consequently, the question of whether any link between childhood trauma
and psychosis is diagnosis specific. It may be, as Read et al12 suggest, that Kapur's31 notion of psychosis-in-schizophrenia is relevant here.
That is, childhood trauma may be associated with positive psychotic symptoms in schizophrenia, and as such understanding this link may
have more implications for understanding the occurrence of psychosis in other illnesses (eg, manic psychosis) than it does for understanding
the nonpsychotic (ie, negative and cognitive) symptoms in schizophrenia. (p18) This further ties in with recent movements in cognitive
psychology toward a focus on individual symptoms rather than diagnoses.32Disentangling these complex issues is essential if the relationship
between childhood trauma and psychosis is to be fully understood.
Defining and Measuring Childhood Trauma
Childhood trauma is a broad term, encompassing a range of adverse experiences. The nature, timing, severity, and duration of trauma are
likely to influence its impact on future mental health. As already noted, it is possible that different forms of trauma increase risk for distinct
46 | P a g e
pathological outcomes. In the studies summarized in table 2, there were notable differences in how trauma was defined and measured. This
makes it difficult to directly compare these studies and indeed may explain some of the variability in the findings.
Any estimate of the impact of childhood trauma on risk of psychosis is dependent on accurate assessment of early traumatic experiences. In
the absence of contemporary records, information has to be collected retrospectively. This is particularly problematic if having psychotic
experiences or a psychotic disorder differentially impacts on recall compared with others, for example, because of an effort after meaning or,
more rarely, delusions of abuse. Instruments have been developed and used in the study of other disorders (eg, depression), which employ a
number of strategies to overcome the potential problem of recall bias (eg, use of life history calendar, use of multiple sources of information,
assurances of confidentiality).3 However, this issue has not been addressed in the major studies of childhood trauma and psychosis to date
and the use of relatively crude measures of traumatic experiences, as was the case in the studies discussed above, increases the risk of
systematic information bias.
Mechanisms: Some Tentative Speculations
In the past, the proposition that socioenvironmental factors are of etiological importance in psychosis has been weakened by the lack of any
clearly formulated mechanisms linking the two. One consequence of the recent rapid advances in the neurosciences and genetics is that we
are beginning to understand how social experience across the life course interacts with genes, and impacts on biological development, to
shape adult outcomes. These insights are now being used to produce biological models linking adverse social experiences, including childhood
trauma, and adult psychosis.
Dopamine continues to be implicated in the etiology of psychosis, particularly in the formation of persecutory delusions due to its perceived
role in the interpretation of threat-related stimuli.33 Spauwen et al21 have speculated that extended exposure to trauma may increase risk for
psychosis through direct effects on dopamine function. There is accumulating evidence from animal studies that negative and threatening
events (eg, maternal deprivation in neonatal rats,34 social defeat in mice35) can produce dopaminergic hyperactivity in the
mesocorticolimbic system and that prolonged exposure to such aversive environments can lead to sensitization of this system. 36 In humans,
elevated dopamine metabolism has been found in girls who have been sexually abused compared with nonabused controls. 37This poses the
intriguing question of whether early trauma increases risk of later psychosis through sensitization of the dopaminergic system. Along similar
lines, Read et al12 have suggested that early, prolonged, and severe trauma may increase risk for later psychosis through lasting effects on
the hypothalamic-pituitary-adrenal (HPA) axis. There are studies that have found HPA dysregulation in abused girls38 and in women who were
physically or sexually abused in childhood.39 Heightened sensitivity to stress has been considered a central feature of schizophrenia,40 and
recent research has found patients with a first episode of psychosis to have enlarged pituitary glands compared with normal
controls,41 independent of antipsychotic treatment.42
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It may be, moreover, that some individuals are more prone to develop psychosis following prolonged childhood trauma because of an
underlying genetic susceptibility. Recent research has provided strong evidence that the impact of environmental factors on risk of adult
psychopathology is mediated by an individual's genotype (eg, cannabis and catechol-o-methyltransferaze43), and data from the Finnish
adoption study44 provides some evidence that the effect of problematic family relationships on risk of later schizophrenia is mediated by
genetic risk. There are currently no reported data testing potential gene-trauma interactions in psychosis. Nevertheless, it is possible to
propose, as potential candidates for interaction with childhood trauma in the etiology of psychosis, genes involved in HPA regulation4547and
dopamine levels in the brain.48 Of course, at this stage, this is highly speculative.
Conclusions
The evidence that childhood trauma causes psychosis is controversial and contestable. Child abuse certainly causes prolonged suffering, and
it may increase the distress experienced by those who develop a psychotic mental illness in adulthood and lead to worse outcomes. The
implications of this for clinical practice require careful consideration. There is not, in our view, a large body of research supporting a causal
connection, contrary to the impression gained from the review of Read et al.12 There are a modest number of recent population-based studies
that suggest the risk of experiencing psychotic symptoms is increased in those exposed to early trauma. The plausibility of proposed biological
mechanisms add some weight to these data. The findings from such studies, however, have not been wholly consistent, and a number of
methodological limitations mean we should be cautious in overinterpreting these. That said, this issue is one that certainly merits more
sustained and systematic research.
The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For
permissions, please email: journals.permissions@oxfordjournals.org.
Summary:
The article was about linking childhood trauma to psychosis. It was said that the evidence of the cause and effect between the two
concepts are controversial and contestable. Child abuse surely causes prolonged suffering and distress and lead to worse results but there are
no enough research supporting the causal connection of the two. More research is needed to prove the relationship between childhood trauma
and psychosis.
48 | P a g e
Bibliography
Books:
Deglin, J. & Vallerand, A. (2005). Daviss drug guide for nurses. 9th ed. Philadelphia: Lippincott Williams and Wilkins.
Keltner, N.L, Schwecke, L. H., & Bostrom, C. E. (2012). Psychiatric nursing. 5th ed. Singapore: Elsevier Mosby Inc.
Stuart, G. W. & Laraia, M. T. (2005). Principles and practice of psychiatric nursing. 8th ed. Singapore: Elsevier Mosby Inc.
Townsend, M. (2008). Essentials of psychiatric-mental health nursing. USA: F.A. Davis Company
Videbeck, S.L. (2004). Psychiatric mental health nursing (2nded.). Philadelphia: Lippincott Williams & Wilkins.
Non-books:
49 | P a g e
Fisher, H. & Morgan C. (2006). Environment and Schizophrenia: Environmental Factors in Schizophrenia: Childhood TraumaA Critical
Review. Retrieved on December 12, 2010 at Schizophrenia Bulletin:
http://schizophreniabulletin.oxfordjournals.org/content/33/1/3.full#sec-8.
Ross, M. (2013 May 22). Why are people with schizophrenia receiving worse health care?. The Huffington Post. Retrieved March 10, 2014 from
http://www.huffingtonpost.ca/marvin-ross/schizophrenia-health-care_b_3319804.html
Young, A.S., et al. (2004). A network-based system to improve care for schizophrenia: The Medical Informatics Network Tool (MINT). NCBI
PubMed. Retrieved March 10, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/15187072
APPENDIX
(Process Recording)
50 | P a g e
Orientation Phase
Process Recording (Week 1)

December 19, 2013
Client Information
Name: F. Magellan
Age: 45 years old

Gender: Male
Status: Single
Birthdate: N/A

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Chief Complaint: Admitted for first time with the following manifestations: restlessness, auditory and visual hallucinations, eating and sleep pattern
disturbances realized by SO, bizarre behavior verbalized by SO, behavior aggression realized by SO, self-talk noted, blank stares and not able to groom self
as verbalized by the SO. On suicide and escape precaution, placed inside isolation room B with watcher Esther/ Mary Ann.
Doctors orders: Admit at payward, routine ward care, diet as tolerated, TPR every shift, FD cc IM, CPZ (Dysnur) 100 mg 1 tab twice
a day, Apiden as necessary. Place on suicide/ escape precaution. Refer accordingly.
Seating Arrangement
Positioned 5-6 feet from his room, three chairs were set up for the first interaction which was facing
the center with a distance of 2-3 feet between the client and the student nurses, Charles and Fate.
52 | P a g e
Thoughts and Feelings Prior to Interaction
Before our first interaction with the assigned client, my partner and I were filled with anxiety, worry, and wonder as
to how the first meeting will turn out. As our orientation had showed us last week, there were wandering clients at the
facility who were very interested with having student nurses, but there were also those who were seemingly hostile and
created loud noise as they were locked in their rooms. We tried to put aside any negative thoughts and focused on what
needs to be accomplished. We found it imperative to carry out todays objectives during the encounter, specifically to
establish rapport and have the client cooperate and engage in a 45-minute conversation during the contract setting.
These steps were very important in order to have a healthy student nurse-client relationship, and the success we strive
for in the psych rotation in Talay would rest upon the clients first impression as it reflects the ease or difficulty to be
encountered in future meetings. Having already gone through the clients chart, we had a picture of what kind of
individual he is, so our questions toward the client would be geared toward obtaining the possible reasons for his
admission.
53 | P a g e
Objectives of the Interaction
Objectives for the day

By the end of our 6-hour duty, I will be able to:
Learn the therapeutic communication and phases of the nurse-client relationship effectively.
Establish a good therapeutic relationship with client effectively.
Observe and learn more about our client satisfactorily.
Discuss with partner our clients information effectively.
Nurse-centered objective
By the end of the 45-minute nurse-patient interaction, I will be able to:
54 | P a g e
Learn some therapeutic communication techniques and phases of the nurse-client relationship effectively.
Identify the client efficiently.
Establish rapport and gain trust of the client effectively.
Give the purpose and duration of nurse-patient interaction efficiently.
Use the different therapeutic communication techniques effectively.
Client-centered objective
By the end of the 45-minute nurse-patient interaction, the client will be able to:
Get to know the student nurses he will be able to work with satisfactorily.
Give his trust towards the student nurses effectively.
Understand the purpose and duration of the nurse-patient interaction effectively.
Maintain obedient behavior during the interaction satisfactorily.
Interact with the student nurses satisfactorily.
55 | P a g e
Student Nurses Verbal & Nonverbal Communication

SN: Maayong buntag sir, ako diay si
Charles. (smiling, maintaining eye
contact)
Siya si Fate. Mga estudyante kami
gikan sa Silliman University nianhi
aron muinterview nimo. (smiling,
maintaining eye contact)
Patients Verbal & Non-verbal

Communication
Tagalog lang. Illongo man ko. Galing
ako sa Kabangkalan. (stuttering,
standing, moving his legs, holding
the hem of shirt, staring blankly
ahead)
Communication Technique Used
SN: Sige sir, magtatagalog tayo.

Pero nakakaintindi po ba kayo ng
Bisaya?
Nakaintindi naman. (nodding,

stuttering)
Close ended question
SN: So, ano pa ba ang gusto niyong

lenggwahe habang may interaksyon
tayo?
SN: Sige po. Nandito kami para
mag-interview sa inyo na gaga-mitin
naming upang mapalawak pa ang
pag-aaral para sa inyo ditto. Ngayon,
Tagalog nalang (staring blankly

ahead)
Clarification
Sige, ayos lang. (Blank stares

ahead, right leg swinging from side
to side).
Offering self
Giving recognition
Analysis
Therapeutic: Greeting the client by
name, indicating awareness of
change, or noting efforts the client
has made all show that the nurse
recognizes the client as a person, as
an individual. Such recognition does
not carry the notion of value, that is,
of being good or bad.
Non-therapeutic: elicit a yes, no, or
one word response. Most often they
block communication, but can be
useful when conversation gets off
track.
Therapeutic: asking patient to
elaborate, restate or clarify what was
meant.
Therapeutic: Making self available
and showing interest and concern.
56 | P a g e
mag-uusap tayo tungkol sa kontrata

natin para sa susunod pang mga
araw.
SN: Saan niyo po muna gustong
magkaron ng interaksyon?
(maintaining eye contact)
SN: Sige sir. (Grabbed the chairs
and sat down). Ngayon, mag-uusap
tayo tungkol sa kontrata na
pagsusunduan natin. Kami ang
magiging student nurse niyo sa mga
susunod na interaksyon. Mga
ganitong oras tayo mag-uusap. Papat
pagdating naming nanda nap o kayo
para sa interaksyon natin. Dito po
tayo nagkikita (points the shade
under the tree). Ang interaksyon
natin ay hanggang 45 minutes
lamang po mangyayari ang
interaksyon natin once a week.
Mayroon po tayong mga therapies na
gagawin para masabi nyo po ang
nararamdaman nyo po habang
nandito po kayo. Mangnihingi sana
kami ng permiso tungkol sa isang
bagay.
SN: (Shows the cellphone with
recorder). Sir, ito po ay cellphone na
mayroong recorder. Hihingi sana
kami ng permisyon upang gamitin ito
habang mag-uusap tayo para
makuha naming ang tamang
Dito lang. (Pointing the shade

under a tree outside his room).
Open-ended question
Sige, ayos lang. (Stares blankly

ahead in between the two nursing
students; still stuttering; moving his
right leg from side to side).
Giving information
Wag nalang yan. Mag-uusap nalang

tayo.
Giving Information
Therapeutic: Using of open-ended

questions to achieve relevance and
depth in discussion.
Therapeutic: Stating information to
let client understand the agenda for
the days interaction.
Therapeutic: Informing the client of

facts increases his or her knowledge
about a topic or lets the client know
what to expect. The nurse is
functioning as a resource person.
Giving information also builds trust
57 | P a g e
impormasyon tungkol sa ating

interaksyon. Hindi namin ito ikakalat
o ibibigay sa iba sa atin lamang ito.
Walang ibang makakarinig kundi
kami ng partner ko at teacher ko.
SN: I-eerase naman namin ito
pagkatapos naming gamitin para sa
pag-aaral para mapabuti ang
pagbiday naming ng care sa inyo.
with the client.
Sige nalang. Pero mag-uusap lang

tayo.
Giving Information
Therapeutic: Informing the client of

facts increases his or her knowledge
about a topic or lets the client know
what to expect. The nurse is
functioning as a resource person.
Giving information also builds trust
with the client.
SN: Opo sir, mag-uusap lang tayo.

Ok lang sa iyo?
(Nods head, staring blankly ahead).
Close-ended question

track.
SN: Naiintindihan po ba natin yung

sinasabi ko?
(Nods head again, moving his right

leg from side to side).

track.
SN: Ilang minute po ba ang

interaksyon natin sir?
SN: Tapos mga ganitong oras po
tayo mag-uusap. Dito parin sa lugar
na ito tayo mag-uusap. (Maintains
eye contact). Gusto nyo po dito lang
tayo mag-uusap lagi?
Forty-five. Forty-five. (stuttering,

holds the hem of his shorts)
(Nods head). Ayos lang
Clarification
Therapeutic: Asking patient to

restate, elaborate or repeat ideas.
track.
58 | P a g e
SN: Tapos kami ay babalik sa

susunod na interaksyon natin pero
hindi na sa susunod na semana. Sa
susunod na taon na po. Mga tatlong
semana hindi po tayo magkikita.
Pagkatapos ng tatlong semana saka
tayo magkikita. Naiintindihan po ba
natin?
SN: Okay, so kumusta ka karon sir?
Okay. (Nods head, staring blankly

ahead).

track.
Ayos naman. (Nods head, staring

blankly, holding the hem of his
shorts).
Encouraging description of
Perceptions
SN: Naa kay ganahang iistorya?
Aw, tsk. Sige mag-usap lang tayo.
Perceptions
Therapeutic: Allowing the client to

verbalize feelings, promote
understanding and maybe a key for
appropriate interventions. The smile
of the patient implies acceptance
and recognition of our presence.
and recognition of our presence
SN: Okay mag-usap tayo. Ano ang

gusto mong pag-usapan natin?
(Silent)(Staring blankly ahead, hands

playing in the hem of his shorts)
Exploring
SN: Ano po? (nods head,
(Pause). Yung (swallows) pag-aaral.
General leads
Therapeutic: When clients deal with

topics superficially, exploring can
help them examine the issue more
fully. Any problem or concern can be
better understood if explored in
depth. If the client expresses an
unwillingness to explore a subject,
however, the nurse must respect his
or her wishes.
Therapeutic: Using neutral
59 | P a g e
maintaining eye contact)
(stutters, staring blankly ahead)
SN: Okay po. Yung pag-aaral, sige.

Sabahin nyo po kung ano po ang
nangyari nung nag-aaral po kayo.
Kasi nung nag-aaral ako, mahirap

yung, kuan, yung pag-aaral. Pinaggaga. Pinag-gagaral namin.
Restating
SN: Tapos po?
General leads
SN: Habang nag-aaral kayo

tumutulong kayo sa nanay nyo po?
Kasi yung, yung nanay ko

nagtitindang kuan dun sa palengke.
Nagtitinda ng Nagtitinda ng ah
mga gulay.
Oo, habang nag-aaral ako. Para may
pambayad ako sa high school.
SN: High school po ba kayo nito?
Hindi college na.
Exploring
SN: Ano po ba ang kurso niyo?
AB. Bachelor of Arts. Yan lang ah,

yung kahirapan habang nag-aaral.
Open-ended question
SN: Tapos ilan po kayo sa

magkakapatid?
Sampu kaming magkakapatid.
Exploring
expressions to encourage patients to

continue talking.
Therapeutic: Repeating the exact
words of patients to remind them of
what they said, to let them know that
they are heard.
continue talking.
track.
depth. If the
client expresses an unwillingness to
explore a subject, however, the
nurse must respect his or her wishes.
60 | P a g e
SN: Ikailan po kayo?
Pito.
Exploring
SN: Tapos? Ano po ang susunod na

nagyari?
Nag-aaral ng Nag-graduate din

ako. College. (stuttering, making
knee movements)
(Pause). Meron kaming tindahan
tumutlong ako sa amin. (stutters,
staing blankly ahead, making knee
movements)
Pagkagraduate ko nagtrabaho ako
sa barko (hissing) ga sa overseas
kaso dalawang buwan lang.
General leads
Dalwang buwan lang kay mayKasi

nagsigawan kami ng kasama ko.
Yung kasama ko. Pinabalik kami ditto
General leads
SN: Opo. (maintains eye contact)
SN: Tapos pagkagraduate nyo po?
SN: Tapos, po?
Active listening
Exploring

or her wishes.
or her wishes.
continue talking.
Therapeutic: Paying close attention
to verbal and nonverbal
communications, patterns of
thinking, feelings, behavior.
or her wishes.
continue talking.
61 | P a g e
SN: Saan po kayo nagtatrabaho ong

nag-overseas po kayo?
SN: Saan pong mga lugar?
sa ah Pilipinas.
Sa barko. (Pause)
Open-ended question
Sa (pause) Pupunta kami sa Israel,

Africa tsaka China. Marami rin. Sri
Langka, India, Middle East. (stutters,
swallows, satres blankly ahead
grabbing the hem of his shorts)
(swallows, touching the right eye and
cheek, staring blankly ahead)
Dalawang buwan lang ako.
Ay, hindi na ako bumalik. Matagal
na. (Pause). 1994. 1994 ako sa
barko. Di na ako bumalik.
Clarification
Open-ended question
SN: Tapos asan na po yung mga

kapatid nyo po?
Sa probinsya nalang. (Moves legs,

touches right eye and scratches right
cheek). Dito lang ako sa Negros.
Tumutulong sa aking nanay
nagtitinda doon sa palengke.
Yung iba sa Ilo-Ilo, yung iba sa barko
rin nag-tatrabaho. Yung isa maestra.
SN: So sino na po ba yung nandoon
Kami ng nanay ko tapos yung isa
Open-ended question
SN: (nods) Tapos ano pong
SN: Pagkatapos po ng dalawang

buwan po?
SN: So saan po kayo naninirahan po

pagkatapos nun po?
General leads
Seeking information
Encouraging expression

restate, elaborate or give examples
of ideas.

continue talking.
Therapeutic: The nurse should seek
clarification throughout interactions
with clients. Doing so can help the
nurse to avoid making assumptions
that understanding has occurred
when it has not. It helps the client to
articulate thoughts, feelings, and
ideas more clearly.
Therapeutic: The nurse asks the

client to consider people and events
in light of his or her own values.
Doing so encourages the client to
make his or her own appraisal rather
than accepting the opinion of others.
62 | P a g e
sa inyo?
kong kapatid na lalaki. (Pause).

Matanda na rin ang aking nanay
sitenta y syete na ang edad. Ako
nalang yung tutulong sa kanya.
Kasi nagsigawan kami ng aking
kapatid saka dinala ako sa
headquarters. Sa headquarters
dinala nila ako ditto (pointing the
place).
SN: Ikailan po na kapatid nyo ang

nagdala sa inyo ditto?
Pang ay, yung bunso.
Open-ended question
SN: Ano pa ba ang rason na

pinadala kayo duon po?
Hindi ko alam sa mga kapatid ko.

Kasi yung kapatid kong babe
tumawag doon sa police
headquarters. Mahigit isang taon ako
doon sa headquarters tsaka ditto
naman ako pinadala.
SN: Ano po ba ang iba nyo pong

nararamdaman habang nandito kayo
sa lugar na ito?
(Pause). Siyempre ayaw ko ng kuan.

Gusto kong malapit lang sa pamilya
ko.
perceptions
Therapeutic: To understand the

client, the nurse must see things
from his or her perspective.
Encouraging the client to describe
ideas fully may relieve the tension
the client is feeling, and he or she
might be less likely to take action on
ideas that are harmful or frightening.
SN: Tapos? Hindi po kayo sanay na

malayo po?
(Pause). Siyempre ayaw ko ng kuan.

(pause, swallows, scratching his right
Clarification

elaborate, explain or restate ideas.
SN: Tapos may nangyari po bang

iba?


63 | P a g e
SN: Bumibisita po ba ang pamilya

niyo po?
eye and cheek) Gusto kong malapit

lang sa pamilya ko.
Hindi. Wala pa. Mahagit dalawang
buwan na hindi bumibisita ang aking
mga kapatid.
SN: (nods, maintaining eye contact)
SN: Asa imung pamilya run?
Silence
Sa siyudad sa Kabangkalan City.

Single ako. Wala na akong papa,
namatay na kay matanda na.
Maysakit. (stutters, scratching the
right cheek)
Naglalabas, nag-eexercise. (stares
blankly, swinging legs from side to
side)
Kan-on, isda Naay gulay usahay.
Open-ended question
SN: Hindi po kayo naninigarilyo?
Ay, hindi. Noon, dati pero nawala na.

Katamtaman lang ako magsigarilyo.
Nagstop na ako mga thirty-four.
Exploring
SN: Nagdodroga po ba kayo?
Ay, oo. Noon. Yung mga edad ko

desi-otso hanggang bente ngayon
Exploring
SN: (pause). Unsay imong ganahan

himuon diri?
SN: Unsa pod inyong gipangkaon
diri sir?
Open-ended question
Open-ended question

track.
Therapeutic: Planned absence of
verbal remarks to allow patient to
think or say more about his family.
Therapeutic: Encourages the patient
to answer the question in depth and
relevance than a yes-no questions.

or her wishes.
64 | P a g e
forty na ako pero hindi na ako

gumagamit. Noon yun.
SN: So, desi-otso hanggang bente

po kayo nagdroga, pero ngayon hindi
na?
(Nods head, staring blankly).

Marijuana. Parang free-user lang.
Kung wala, wala naman. Kasi marami
naman gumagamit nyan eh.
Clarification
SN: Ano po ba ang rason kung bakit

kayo nagdodroga?
(making knee movements, holding

the hem of his shorts) Ay, noon man
yun. (pause, swallows) Nacucurious
lang ako kung ano yun. Pero ngayon,
wala na. Wala na.
Exploring
SN: Saan po kayo nag-aaral?
Sa high school ug college sa

Kabangkalan City. (Silence)
Open-ended question
SN: Baka may gusto po kayong

sasabihin sir? Nandito lang po kami.
Wala naman. Ayos lang. (Silence).
Offering self
SN: May gusto po ba kayong

sasahibin tungkol sa pamilya nyo
po?
Yung mga kapatid ko, may hindi

pagkakaintindihan. (stutters, staring
blankly ahead)
perception

or her wishes.
elaborate, explain or restate ideas.

or her wishes.
Therapeutic: Showing self available
and showing interest and concern to
the patient.
65 | P a g e
SN: Ano pa ba ang problema po?
Minsan nagsisigawan. (staring

blankly ahead)
Open-ended question
SN: Ano po ang dahilan?
Kunting pagkakamali lang

nagsisigawan agad. (swallows,
staring blankly ahead, grabbing the
hem of his shorts)
Exploring
SN: Ano pa ba ang ibang rason kung

bakit kayo nag-aaway?
Hindi ko alam kung bakit.
perception
SN: (pause)Naa pa kay pangutana

namo sir?
(Shakes head) Wala naman.
SN: Nandito lang po kami sir.
(Silence)
Silence
SN: Kapag nakakalabas po kayo sa

kwarto nyo po, ano po ginagawa
ninyo?
SN: Ano po ba ang nararamdaman
nyo po kapag nasa kwarto nyo po
kayo?
Nag-eexercise, nagsuroy-suroy, nagexercise.
Open-ended question
Nalulungkot pero kailangan

magpasensya. Tiyaga lang.
perceptions

or her wishes.
track.
Therapeutic: Giving patient the time
to express himself.
Therapeutic: Asking a question that
can give depth discussion about an
idea.
Therapeutic: Asking patients view
about his situation may help in
expressing his thoughts and feelings
toward the issue.
66 | P a g e
SN: Ano po ba ang nakakasaya sa

inyo dito?
Pag-exercise, paggawas sa akoang

kwarto.
Open-ended question
SN: Ano po ang nararamdaman

ninyo na nandito kami?
perceptions
SN: Sino po ang nag-aalaga sa

kanya ngayon?
Ayos naman. Para may kausap ako.

Mawawala ang lungkot ko. Iniisip ko
ang akin pamilya pag akoy
nalulungkot. Naaawa ako sa mama
ko, matanda na siya. Sitenta y syete
na ang edad.
Ang pamilya ko saka may mga
katulong din.
SN: Ano po yong mga ginigiliwan o

nakakalibang po sa ninyo?
Volleyball, chess, exercise, walkingwalking.
Open-ended question
SN: Mudula pa ka og chess run?
Kung meron, naglalaro ako.
SN: May chess ba sila dito?
Wala dito pero naglalaro ako kaso

kaunti lang ang alam ko. (stares
blankly, blinks few times, holds the
hem of the shorts)
SN: May iba pang laro na

nakakapasaya sa inyo?
Volleyball dyan sa kabila (points at

his right, stuttering) pero minsan
lang ako naglalaro hindi kasi kaunti
nalang ang naglalaro. Paminsanminsan naman akong sumasali.
(holding his hands)
Exploring
Open-ended question

idea.
toward the issue.

idea.
idea.
track.
track.
67 | P a g e

or her wishes.
toward the issue.
idea.
SN: Ano po ba ang pakiramdam nyo

pagkatapos nyo pong maglaro?
Okay naman. Ayos lang.

Nababawasan ang lungkot. (silence)
perceptions
SN: Ano po yung pangarap niyo?
Yung makabalik sa trabaho.

Magkaroon ng trabaho. Kaso lang
nagsisigawan kami sa bako ng
kasama ko.(pause) Wala na akong
trabaho.
Wala. Nakapagtapos lang sa
college.(stuttering, blinks few times)
Open-ended question
Nung nakagraduate ako ang edad

ko ay twenty-two. Nakatrabaho na
ako mga twenty-six.
Ayos naman. Tumutulong ako sa
mama ko sa palengke sa
pagtitinda.
Placing an event in time or sequence
Wala na. Tumutulong nalang sa

palengke. Sa nanay ko. Kaso dinala
ako sa headquarters sa police.
Exploring

fully.
Forty-four. Mag-iisang taon linipat

ako dito ng aking mga kapatid. Hindi
sumama ang mama ko dahil
matanda na. Hindi na makalakad ng
malayo.
Ayos naman. Dinala ako dito para
Open-ended question
Therapeutic: Asking a question to

gain information about the issue for
the patient to elaborate.
SN: Ano po yung mga naachieve

nyo po pagkagraduate nyo?
SN: Kailan po nakapagtrabaho
pagkatapos nyong makagraduate?
SN: Nung nangyari po sa inyo ng
kasamahan niyo po, tapos pinabalik
kayo, ano po ang reaksyon ng
pamilya nyo?
SN: Naghananap po ba kayo ulit ng
trabaho pagkatapos po ng nangyari?
SN: Ano po ang edad nyo nang

dinala kayo sa police headquarters?
SN: Ano po yung pakiramdam nyo
Open-ended question
Placing an event in time or sequence

idea.
Therapeutic: Asking relationship of
events can help patient elaborate
the situation more.
Therapeutic: Asking relationship of
events can help patient elaborate
the situation more.
68 | P a g e
nang dinala kayo dito?
mag-ah magpagamot. (stuttering,

grabs the hem of his shorts))
perceptions
SN: Anong mga bagay ang

kinatatakutan niyo po?
Mga bagyo, mga lindol pero paplayo

lang tayo diyam. (Silence).
Open-ended question
SN: Ano pong mga gamot ang

iniinom nyo?
Nakalimutan ko. Pero umiinom ako

sa umaga at sa gabi.
Open-ended question
SN: So, umiinom kayo ng gamut, isa

sa umaga at isa sa gabi?
Oo. Para akoy (pause, swallows)

gumaling. (Silence)
Clarification
SN: Ano po ang nararamdaman niyo

na may interaksyon tayo ngayon
po?
Ayos naman. Okay naman.
perceptions
SN: Ano pong mga talents meron

kayo?
Nagkakanta at nagsasayaw.
Open-ended question
SN: Naggigitara po ba kayo?
Ay hindi. Hindi ako marunong

maggitara.
Magkaroon ng magandang buhay
Mamuhay ng tahimik (pause).
SN: Sino pa ang inspirasyon nyo?
Open-ended question
SN: So ang ibig nyo pong sabahin

na ang pangarap nyo ay inspirasyon
nyo rin?
(Nods head).
SN: Sino po ang iniidolo nyo po

kahit hindi artista?
Mga boksingero. Pacquiao, Nietes,

Donaire.
Open-ended question

toward the issue.
Therapeutic: Asking the same words
that are heard from the patient helps
in stating the answer clearly.
toward the situation.

track.
69 | P a g e
SN: Ano po ang rason na sila ang

napili nyong idolo?
Kasi champion sila para sa

Pilipinas.
Exploring

fully.
SN: (Nods head) Sino pa po?
Si Aquino.
General leads
SN: Sinong Aquino po ba?
Yung presidente ngayon. Si Noynoy.

Siyempre siya ang tumatakbo sa
Pilipinas.
Ah, wala na. Salamat sa inyo
(shakes head).
Open-ended question
(starts to stand up and waves)
Acknowledging/Accepting

continue talking.
Therapeutic: An accepting response
indicates the nurse has heard and
followed the train of thought. It does
not indicate agreement but is
nonjudgmental.
Therapeutic: An accepting response
indicates the nurse has heard and
followed the train of thought. It does
not indicate agreement but is
nonjudgmental.
SN: So, sir, malapit ng matapos ang

oras natin. Ano pong mga bagay ang
gusto nyo pong malinawan kayo?
SN: Salamat din po. (Shakes hands).

Sige sir, mauuna na po kami.
Acknowledging/Accepting
70 | P a g e
Synthesis
We marked the beginning of our first official duty day in Talay with our assigned client, F.M. This man was admitted back in October of 2013 and we
successfully carried out the goals in the orientation phase, which began by meeting the client and will eventually end when the client begins to identify his
problems to examine. Having already seen his patients chart, we reviewed the medications and reasons for admission, which helped indicated possible
schizophrenia and/or other psychotic disorders. Once my partner and I introduced ourselves to F.M., we were able to communicate in a manner that
facilitated trust and understanding with the client using of therapeutic communication. After we agreed on the nurse-client contract of meeting every
Wednesday to interact for 45-minutes, and that the information gathered from him may be shared with the clinical instructor, peers, and staff at clinical
conference, he was able to confirm and repeat the information. Although, we did encounter an issue of using a voice recording unit to record the
conversations since he initially refused, but after re-assuring him that it would only be my partner and I listening to the conversation for learning purposes
and then will be deleted, he then agreed.
During the seated interaction, the client requested to speak in Tagalog. Luckily, we were able to still communicate with him. He was coherent, but
spoke low and fidgeted with the hem of his shorts frequently, possibly as a sign that trust needs more time, which we hope to attain in future interactions.
He would also stare blankly between my partner and me. We attempted to utilize open-ended and exploring questions, but the majority of the answers
remained very brief, so for some of the answers he replied with, we tried to use general leads. Most importantly, we made it known to him that we offer
71 | P a g e
ourselves available to him and encouraged discussing anything he was interested in talking about. F.M. revealed to us his use of marijuana during his
younger years, his college education, where he had traveled before as a seaman, his single status, and the relationship he has with his immediate family
members. He was unable to state the reason for his admission, although we hope to delve deeper into his thoughts and history when we come back for the
next meetings.
Working Phase
January 8, 2014
72 | P a g e
Client Information
Name: F. Magellan
Age: 45 years old

bed no.: Isolation C, Room 9
Gender: Male
Status: Single
Birthdate: N/A
Room &

73 | P a g e
Seating Arrangement
Legend:
= Client
= Student
nurse
= Clients
room
74 | P a g e
C
C
Positioned approximately 6 meters from his room, the student nurses, Charles and Fate, were sitting on a bench alongside the client for the second
interaction. Due to the limited number of available chairs, we settled for the bench located at Isolation D lobby area. According to Videbeck, Sitting beside
or across from the client can put the client at ease (2004, p. 122). The student nurses were within the intimate zone (0-18 inches) with the client as he had
chosen where to sit after the student nurses had sat down. In relation to the intimate zone, Videbeck also states This amount of space is comfortable for
[] people who mutually desire personal contact, or people whispering (2004, p. 113). The clients body was facing the student nurses. The student
nurses showed open body posture by leaving the knees uncrossed and hands at the side, and leaning toward the client.
75 | P a g e
Thoughts and Feelings Prior to Interaction

Before our second interaction on Wednesday, January 8, 2014 with the F.M., my partner and I were less anxious and
worried as we had already successfully completed our contract setting and established rapport from the previous
interaction. For this interaction, we found it important to carry out todays objectives during the encounter, specifically to
re-establish rapport and have the client cooperate and engage in a 45-minute conversation. We hope that our client will
be willing to engage with us in a more insightful conversation about his thoughts and feelings during his current stay in
the mental facility. We also hope he will be able to open up more than last session with the broad opening questions we
give in order to encourage him to lead the interaction in topics that go deeper into his family, perception on situations,
expressions, and his view on the reason why he is admitted into the mental facility. It is fairly difficult to stimulate him to
lead the interaction, but we will continue to apply the therapeutic communication techniques and see if he will eventually
have more of an initiative to verbalize his own thoughts and feelings.
76 | P a g e

Objectives for the day
Learn the therapeutic communication and phases of the nurse-client relationship effectively.
Establish a good therapeutic relationship with client effectively.
Observe and learn more about our client satisfactorily.
Discuss with partner our clients information effectively.
Nurse-centered objective
Learn some therapeutic communication techniques and phases of the nurse-client relationship effectively.
Identify the client efficiently.
Establish rapport and gain trust of the client effectively.
Give the purpose and duration of nurse-patient interaction efficiently.
Use the different therapeutic communication techniques effectively.
77 | P a g e
Get to know the student nurses he will be able to work with satisfactorily.
Give his trust towards the student nurses effectively.
Understand the purpose and duration of the nurse-patient interaction effectively.
Maintain obedient behavior during the interaction satisfactorily.
Interact with the student nurses satisfactorily.

SN: Good Morning Sir. Happy New
Year. (smiling)
SN: Kumusta man ta Sir?

Communication
Good morning din. Happy New
year. (stands up from his room and
goes out holding the hem of his
shorts at the right side, making a
movement of his feet like he is
walking in place, blinking)
Okay naman. (nodding, making
eye contact, stutters)
Communication Technique Used
Analysis
Giving recognition
Therapeutic. We student nurses

greeted the client upon arriving to
begin the second interaction in this
new year.
Therapeutic. We student nurses

asked the client to consider people
and events in light of his own values.
Therapeutic. We sought clarification
from the client to avoid assuming he
still remembers who we are.
Therapeutic. We encouraged the
client to make his own appraisal of
his experience during the new years
holiday.
Therapeutic. The client dealt with our
previous question superficially, so in
order to examine how his new year
really went, we further asked about
the activities participated in.
SN: Kahinumdum paka namo Sir?
Oo. (nods head, blinking, making

eye contact)
Seeking information
SN: Kumusta atong New Year Sir?
Okay naman. Ayos.
SN: Unsa inyong gihimu atong New

Year diri Sir?
Ah, diri lang. Yung Christmas

nagcelebrate kami. NagChrismas
party.
Exploring
78 | P a g e
SN: Nakakaintindi man ka ug English

Sir sa?
Oo. (nods, still holding the hem of

his shorts)
Seeking information
SN: Okay ra na akoang partner ang

muinterview nimo karon Sir?
Ayos lang. Ayos lang. (nods)
Giving information
SN: Unsa inyong gihimo bag-o mi

niabot diri Sir?
Ah, wala naman. Natutulog.

Nagpapahinga. Nag-iisip ng mga
magaganda. (touching the right side
of his face, blinking)
Broad openings
SN: Sir, makig-istorya akong partner

nimo.
SN: Sir, ako diay si Charles.
Makasabot raka ug English?
(nods, silent)
Giving information
Oo. Ayos lang.
Seeking information
SN: So, how was your Christmas

break?
SN: What did you do during your
Christmas break?
Fine. (nodding)
Broad openings
We celebrated Christmas here. We

celebrate the Christmas. Singing and
dancing.
Exploring
SN: Did you enjoy singing and

dancing?
Yes. (nods head, making eye

contact)
SN: Did your family come and

celebrate with you?
No, no. They are very far from here.

They live at Kabangkalan City. It is
Exploring
Therapeutic. We wanted to seek

clarification of whether he knew or
understood English to avoid the
assumption of his ability to speak
only Filipino dialects.
Therapeutic. We informed the client
that Charles will be continuing the
interaction in order for him to know
what to expect.
Therapeutic. We allowed the client to
take the initiative to lead the
interaction by asking about what
hes been occupying himself with
lately.
Therapeutic. Informed client that
Charles will now converse.
Therapeutic. Clarifying with the client
to avoid misunderstanding his
language capabilities.
Therapeutic. Stimulates the client to
take the initiative in the interaction.
Therapeutic. Since the client had a
closed-ended response to the
previous open-ended question, we
delved deeper into the topic of
Christmas break.
Therapeutic. Asking the client to
appraise the quality of the activities
he participated in during the
Christmas break.
Therapeutic. Further inquiring about
his break, we asked if family came to
79 | P a g e
SN: Do you have any stories you

would like to share on what
happened during the break?
SN: (nods) Do you pray?
SN: What other things did you do
during the Christmas break?
SN: Kinsa imung kuyog sa
pagcelebrate Sir?
SN: So where is your family right
now?
far from Dumaguete City.

We celebrate here. (Silence)
We celebrated the birth of Jesus
Christ.
(nods) Yes I pray.
Broad openings
Exploring
Nag-Christmas party.
Nagcecelebrate.
Mga kauban ko diri.
Exploring
They are in Kabangkalan City. Very

far from Dumaguete City. It takes five
hours, more than four hours to ride a
vehicle.
(nods)
Broad openings
We are ten in the family. Ten

children. (pause)
Yes, ten children. My father is dead
already. I have no father. (blinks,
moving legs from side to side,
holding the hem of the shorts at the
right side)
My brothers are working. My sister
is working in the office.
Exploring
SN: Ikapila ka Sir?
Im the seventh in the family.
Exploring
SN: When was the last time that

youve seen your family?
Last October ninth. (silence) They

sent me here.
Exploring
SN: That sounds really far.

SN: So tell me more about your
family, Sir.
SN: Ten children Sir?
SN: And then?
Broad openings
Reflection
Restating
General leads
visit.
Therapeutic. Client seemed hesitant
about conversing, so we allowed him
to again lead in the interaction.
Therapeutic. Delving further into the
idea of Christmas.
Therapeutic. Helps to examine more
activities he participated in.
Therapeutic. Allows the client to lead
the interaction.
Therapeutic. Allows the client to
discuss about his family and lead the
interaction.
Therapeutic. This will indicate that
the clients point of view has values.
Therapeutic. Helps to further
examine the topic of family.
Therapeutic. Repeating what the
client said about being one of ten
children lets the client know that he
communicated the idea effectively
and encourages him to continue.
Therapeutic. Indicates the student
nurses are listening and following
what the client is saying. Also
encourages him to continue speaking
about his family.
Therapeutic. Helps the client
examine the subject more fully.
Therapeutic. Helped the client to,
again, examine the subject of family
80 | P a g e
SN: Last October ninth was when

they sent you here, Sir?
Yes, when they sent me here.

(nods head, staring ahead)
Restating
SN: Do you have anything you

wanted to talk about Sir?
SN: (nods head) Sige Sir, go on.
(Silence) When I was young. When I

started my elementary.
I help my Mama in the market.
Broad openings
SN: (nods head, maintaining eye

contact, leaning forward) (silence)
I help there with the fisherman and

fish vendor for me to study in
elementary.
Silence
SN: How about in High School?
Exploring
SN: (nods head) Can I ask the names

of your brothers and sisters Sir?
I help also in the market. This is to

support my education.
(nods head) Adonis is 44 years old.
(pause)
SN: Your next brother Sir?
Danilo, 50 years old. (pause)
General leads
SN: Kinsa pa Sir?
(silence) Francisco, 55 years old.

Julius, 39 years old. Luisita, 60 years
old. Annie, 57 years old. (pause,
blinks, stares blankly ahead) Alec.
Alec, 53 years old. Sol, 48. 48 years
old. Diana. (pause) Diana, 39.
(blinking, holds the hem of his
shorts, rubbing it up in down his right
thigh)
General leads
SN: (nods head) Thank you for that

information Sir. Is there anything you
wanted to talk about?
General leads
Exploring
Broad openings
more fully.
Therapeutic. Repeating what the
client stated in nearly the same
words he used to encourage the
client to continue.
Therapeutic. Used to stimulate him
to take the lead in the interaction.
Therapeutic. Giving the client
encouragement to continue talking
about when he was young in
elementary.
Therapeutic. Remained absent of
verbal communication, but we
maintained eye contact and
conveyed interest with how he
helped his mother in the market.
Therapeutic. To help the client
examine more about his upbringing.
Therapeutic. To delve further into the
subject of family and his siblings.
Therapeutic. Indicated that we were
listening and didnt take away the
initiative for interaction.
Therapeutic. Indicated the student
nurses were listening and gave
encouragement to continue the
listing of his brothers and sisters.
Therapeutic. Invited the client take

the initiative in introducing the topic
of his interest and to lead the
81 | P a g e
SN: (Silence)
Ano, trabaho. Sa trabaho.
Silence
SN: How about your work Sir?
Kay sa trabaho, sige mig away. Dili

magsinabtanay. Sige ug shagitanay.
(Silence)
Exploring
SN: Unsa pa imung ganahan

istoryahan sa trabaho Sir?
(Silence) (stares blankly ahead,

moving legs from side to side)
Broad openings
SN: So Sir, where did you get your

education after High School?
SN: (nods head) Your college Sir?
I study my High School since 1985.
Exploring
My college is 1990.
Exploring
SN: Did you enjoy your high school?
I study in high school. (makes eye

contact) (pause)
SN: What kind of things did you do in

High School?
SN: What is your favorite subject?
I study my subjects. Math and

Science.
Filipino
and
English.
(pause)
Filipino is my favorite subject.
Exploring
SN: (nods head) What did you do for

fun in high school?
About the intramurals, we play

volleyball. (pause) I play sports,
volleyball.
Broad openings
SN: What did you like most in high

school?
In high school we study. I enjoyed

studying. (stares blankly ahead)
SN: How about your college Sir?
Its okay, I also enjoyed.
Exploring
interaction.
Therapeutic. Provided time for client
to put thoughts into words and
continue talking.
Therapeutic. Delving deeper into the
work he was involved with.
Therapeutic. Allows the client to take

the initiative in introducing a new
topic.
Therapeutic. Going further into the
subject of his education.
Therapeutic. Going further into
education by discussing about his
college.
appraise the quality of his high
school experiences.
Therapeutic. Going deeper into the
activities he did in high school.
Therapeutic. Helps the client to
examine the topic of high school
more fully.
the initiative into introducing the
things he liked to do for fun in high
school.
Therapeutic. We asked the client to
make his own appraisal of the quality
of his high school experiences.
Therapeutic. Following up on the
82 | P a g e
SN: Naa pakay nahinumduman sa

imung college Sir?
I remembered studying English and

other languages. (moves legs from
side to side, making eye contact)
Exploring
SN: Do you have friends during your

college pud Sir?
SN: So what did you do outside your
school Sir?
Yes, I have friends. We talk about

our education.
I work. I help my mother selling in
the market.
Exploring
SN: In your family Sir, is there any

conflict between your siblings?
My other sibling, we shouted at

each other.
Exploring
SN: Sino po?
Si Julius.
Exploring
SN: What is the reason you shouted

at each other?
Kay gidala man ko sa headquarters,

sa Philippine National Police, tapos
diri napud.
Broad openings
SN: Unsay rason na gidala ka didto

Sir?
Wala ko kabalo.
Exploring
SN: Unsa diay rason na

nagshagitanay mo sa imuhang
igsuon Sir?
SN: Dayun Sir.
(silence) Akong giayo ang alad sa

balay.
perceptions
Dayun
nagshagitanay
mi.
(scratches the right side of the face)
General leads
Broad openings
previous question, we asked for his

appraisal of the quality of his college
time.
Therapeutic. As he deals with the
topics we ask about in a superficial
manner, it will help him try to
examine the topics more closely.
Therapeutic. Going further into topic
of high school, we included friends.
Therapeutic. The client again is
hesitant about communicating, so
we allowed him to take the initiative.
Therapeutic. We allowed him to
speak more about his family to assist
in examining the situation.
Therapeutic. We followed up the
previous question to allow him to
speak more about his sibling
situation.
Therapeutic. Asking for the reason
about the conflict may stimulate the
client to take the initiative in
discussing why the shouting took
place.
Therapeutic. As a follow up, we
further asked about why he was
brought to the mental facility.
Therapeutic. We asked how the client
would describe the reason fully from
his perspective
Therapeutic. Indicates the nurse is
listening and attentive to what he is
83 | P a g e
saying, encouraging him to continue.

SN: Ikaw ang naggama sa alad Sir?
SN: Unsay nahitabo na

nagshagitanay mo Sir?
SN: Unsay giingon niya sa patrol Sir?
SN: Unsay giingon sa imung mga

igsuon atong nadetain ka Sir?
SN: Unsay rason na gidetain ka Sir?
SN: How do you feel about staying
here?
Oo,
ako
ang
nagkarpentero.
(pause) Tapos , nagshagitanay lan mi
sa akoang igsuon.
Nangisug siya. Gishagitan nako niya
dayon. Nitawag siya ug patrol.
Ay, ako mang mga babaye na
igsuon ang nag-istoryahanay ato.
Nadetain ko sa headquarters mga
one year. Dayon gidala ko diri.
Gidala ko nila diri para matambalan
ko.
Nagshagitanay mi sa akong igsuon.
Dayun, ila kong gidala diri.
To take my medicine. (pause) My
family brought me here to treat me
and I will take my medicine.
SN: Do you know the reason why

youre here Sir?
(silence) Gidala ko diri kay kabalo

man sila na (pause, scratches the
right face) Kay akong ulo nabangga.
Exploring
SN: Nabangga Sir?
(nods head) Oo, nabangga ni siya

atong nagmatial arts ko. Pagpractice
namo, nabangga ni siya. Mga 20
years old ko ato, dugay na.
Exploring
SN: Dayun Sir?
(making
eye
contact)
Tapos,
nakaexperience pud ko ug gutom
atong naa ko sa Manila.
(blinks, pause) Mga 26 ko ani.
General leads
SN: Pila imung edad ani Sir?
Exploring
Therapeutic. Allowing the client to

make his own appraisal about the
quality of his experience in the
mental facility.
topic of staying in the facility, this
can help examine the issue more
fully.
Therapeutic. As he states that the
reason for his admission was due to
his head being hit, we further ask
about the situation surrounding the
incident.
Therapeutic. After he explains the
event, we give him further
encouragement to continue.
Therapeutic. Following up the
situation with the age it happened,
84 | P a g e
SN: Gaunsa ka didto Sir?
Ah, nangita ko ug trabaho. (moves

legs from side to side, hold the hem
of his shorts)
Nakaexperience pud ko sa barko
kaso 2 months rako didto. (making
eye contact)
Galain akong paminaw ato. Maygani
nakarecover ko.
Exploring
SN: Nagpahospital ka ani Sir?
Ay wala. Sa balay ra. (making eye

contact, moves hide to the sides)
Exploring
SN: Balik ta sa Maynila Sir. Unsay

nahitabo didto?
Nakaexperience ko ug gutom.
Broad openings
SN: Kinsa imung kuyog ani Sir?
Si Francisco.
Exploring
SN: Asa mo nagpuyo Sir?
Sa balay sa akong Auntie.
Exploring
SN: Unsay mga nahitabo nimo didto

Sir?
Nagtrabaho
sa
restaurant.
Nagconstruction pud ko.
Broad openings
SN: (silence)
Naa poy usahay na walay trabaho.

Naa ra ko sa balay, standby.
Silence
SN: Unsay imung mafeel Sir atong

wala kay trabaho?
Malungkot kung wlay trabaho.
Encourage expression
SN: (Silence)
SN: (nods head) Sir, balik ta sa

imung martial arts. Unsay rason na
nabangga imung ulo?
Silence
Seeking information
going deeper into the issue.

Therapeutic. Further going into the
reasons for going to Manila.
Therapeutic. Provided him time to
formulate his thoughts into words for
verbal communication.
Therapeutic. We focused the
attention back onto the reason for
his head being hit, seeking
clarification.
Therapeutic. Following up the
previous question with if he was
admitted in order to go deeper into
the topic.
Therapeutic. Allows client to talk
openly about what happened in
Manila.
subject of his Manila adventure.
Therapeutic. Seeking information
about where he lives.
Therapeutic. Allows the client to
openly communicate and lead in the
interaction.
Therapeutic. Verbal communication
is withheld to allow the client to
encourage client to verbalize his
activities.
Therapeutic. Offers the client the
opportunity to appraise the quality of
his experience of having no job.
85 | P a g e
SN: Tapos po?
(silence) Naghuna-huna ug asa mi

makatrabaho.
General leads
SN: Unsay trabaho ni Francisco?
Kauban pud siya sa barko. Kaso nay

problema kay nag-away man mi sa
akong co-crew.
Yes I enjoyed it. (nods head,
making eye contact)
Exploring
General leads
SN: Do you enjoy cooking?
(silence) Kaso nag-away miss a

chief cook. We shouted at each
other. Thats the reason why I lasted
for 2 months only.
Yes, I enjoy cooking.
SN: Do you help cooking here?
Yes, I help when I have time.
Exploring
SN: What is your specialty?
Chicken. Chicken adobo.
Broad openings
SN: So what is your work at the ship

Sir?
Chef boy ko didto. Sa stewards

department.
Exploring
SN: So what is your course in college

sir?
AB Bachelor of Arts. I read about

Shakespeare. I read his poems.
Exploring
SN: Do you write poems, Sir?
(Shakes head) No, I dont write

poems. I read.
Seeking information
SN: Did you enjoy working on the

boat?
SN: What other things did you do
there Sir?
Therapeutic. Indicates that we are

listening to him talking and
encourages him to continue
speaking.
topic of Francisco, it can help
examine the situation more carefully.
make his own appraisal toward
working on a boat.
Therapeutic. This indicates the nurse
is listening and following what the
client is saying in regards to working
on a boat.
Therapeutic. Allows client to consider
activities in light of his own views.
Therapeutic. Invites the client to
discuss further his own likes.
the initiative about what he likes to
cook.
Therapeutic. Going back to the
subject of working on the ship, this
allows client to discuss more about
his duties.
Therapeutic. This enables the client
to speak openly about the course he
took in college.
Therapeutic. Seeking clarification
about his interest in poems helps to
avoid assumptions and helps client
to articulate thoughts and ideas
86 | P a g e
more clearly.
SN: Mubalik ta sa imung trabaho Sir.
Unsa imung gibati atong nadawat
nimo ang trabaho?
SN: Sir, hapit naman ta mahuman.
Naa kay laing pangutana?
Wala ra. Kaso nay problema. Nagaway mi sa akoang kauban dayon

nagresign ko. Nibalik ko diri.
Wala naman. Okay ra.
SN: How do you feek about our

second interaction?
Nakakashare
ng
ideas
para
magamit sa atong kinabuhi. Naenjoy
ko,
SN: Salamat kaayo Sir sa imung

cooperation Sir. Mubalik napud mi
Karong Wednesday. (smiling, shakes
hand with client)
Thank you pud ninyo. (Making eye

contact, shakes hands, stands up)
Giving information
Broad openings
Therapeutic. Toward the end of our

interaction, we allow the client to
take any final initiatives for any
desired topics or for him to ask any
questions about us, the student
nurses.
Therapeutic. Encouragement from
the student nurses for the client to
express his feelings and thoughts
about the second meeting.
Therapeutic. We informed the client
we are ending the interaction and
the next meeting date. This further
builds trust between the student
nurses and client.
87 | P a g e
Synthesis
After our second official duty day in Talay with our assigned client, F.M., we successfully carried out the goals in the orientation phase, which began
by meeting the client and will eventually end when the client begins to identify his problems to examine. After my partner and I re-introduced ourselves to
F.M., we were able to communicate in a manner that facilitated trust and understanding with the client using of therapeutic communication.
During the seated interaction at the isolation lobby, the client revealed that he is willing and able to communicate in English; but, we feel he will go
more into details speaking his primary language of Tagalog. He was coherent, less fidgety with his clothing, and showed more comfort in this interaction in
comparison to the previous. He still would stare blankly out facing away at certain times when the questions we gave him were difficult for him to respond.
We again utilized many open-ended and exploring questions, but the majority of the answers remained very brief, so for some of the answers he replied
with, we tried to use general leads. Most importantly, we made it known to him that we offer ourselves available to him, and from time to time, encouraged
discussing anything he was interested in talking about. F.M opened up to us and gave his reason for his admission as being involved in a domestic
disturbance, although we hope to delve deeper into his thoughts and history when we come back for the next meetings. By the end of our interaction, the
client seemed comfortable with us and even extended his own hand to shake before we headed back to the main lobby as we ended our visit.
88 | P a g e
Working Phase

Summary of Interaction
January 15, 2014
89 | P a g e
Client Information
Name: F. Magellan
Age: 45 years old

Isolation C, Room 8
Gender: Male
Status: Single
Birthdate: N/A
Room & bed no.:

as verbalized by the SO. On suicide and escape precaution, placed inside isolation room C room 8 with watcher Esther/ Mary Ann.
90 | P a g e
Seating Arrangement
Cells
Cells
Legend:
= Client
= Student
nurse
= Clients
C
room
Lobby
= Bench
Isolation C
91 | P a g e
Positioned approximately 6 meters from his room, the student nurses, Charles and Fate, were sitting on a bench facing the client seated in a chair for
the third interaction. We agreed to situate at the bench located in the Isolation C lobby area. According to Videbeck, Sitting beside or across from the client
can put the client at ease (2004, p. 122). The student nurses were within the intimate zone (0-18 inches) with the client as he had chosen where to sit
after the student nurses had sat down. In relation to the intimate zone, Videbeck also states This amount of space is comfortable for [] people who
mutually desire personal contact, or people whispering (2004, p. 113). The clients body was facing the student nurses. The student nurses showed open
body posture by leaving the knees uncrossed and hands at the side, and leaning toward the client. The eye level was the same for both the student nurses
and the client.
SUMMARY OF THE INTERACTION

92 | P a g e
We began the third meeting on Wednesday, January 15 at 9:45am. We started by approaching our client at his room, and to our amazement
before we had the chance to greet him, he was already one step ahead us by greeting us by first name, followed the ritualistic handshake which we had
originally developed on the first day of interaction. This promising early sign would hopefully encourage our client to further express his own thoughts and
feelings, whether it be current or new ones, during this interaction. As we searched for a suitable location to proceed with the interaction, my partner and I
decided to have it at the same lobby used last week, except with us student nurses sitting beside one another, and the client facing us as he sat in a chair.
First, we initiated the interaction by asking about how he was feeling during that present time, and he replied back that he was fine. We then
proceeded by recalling his previous work as a seaman, and asked about what happened to end that career. He recalled the time it had occurredhe states
getting into a fight with the chief cook, which led him to be sent back to the Philippines. We asked about the reason why it happened, he replied the chief
cook was so arrogant, claiming the chief cook had done something during their work that seemed wrong in the eyes of our client, so he corrected him, and
that led to an argument. Further exploring more about the situation, our client seemed hesitant about giving us the reason that started their argument
during his work. We recognized his reluctance and decided not to push him harder into telling us about this issue. Instead, we asked if he regretted about
what happened at that time, for which he replied he never regretted what happened on the ship. We then asked what he would do if given the chance to
go back to that time, and he replied it would have been better if they had just kept quiet and talked about their problem in a calm way and come to an
understanding.
Next, we asked was about his relationship with his mother. We recalled previously discussing about how he helped his mother at the fish
market in order for him to be sent in school. We asked furthermore about what were the other things that he and his mother shared aside from helping out
in the market, and he replied that he loves his mother and he really places importance on his relationship with her. He stated that his mother is already old
with hypertension and diabetes. It seemed that he was really concerned with the condition of his mother that he does not want his mother to work on her
own.
After further questioning about his mother, the next that followed was about his relationship with his father. He explained to us about the
death of his father; that his father died due to cardiac arrest at the age of 66 years old. His father was a farmer at their place. He was 23-years-old during
this time and was in Manila to look for a job with his younger brother, Francisco. He then returned back to their province after receiving a call from his
sibling about the death of his father. He stated that before his father died, their relationship was fine; they also understood each other and would talk about
and solve their problems together. His father also had helped him out with the financial issues for his school. It also seems that he also gave importance to
his father because he talked with him about his problems.
We proceeded on by asking him about how he handles his emotions. We first asked about what he does when he is upset or angry; he said
that if it was fine with him, he will just let it pass. Although, when he is angry, he shouts. We asked further on what are the other things that he does when
93 | P a g e
he is angryhe replied that he talks with his siblings when he feels that way. He added that when these situations occur, he also expresses or releases his
anger through shouting. We asked about what he does when he is happy. He said that when his problem is solved, he is happy. In regards to his coping, he
states he copes with his stay at the center, adding that it is fine since he has people to talk to and share his thoughts with among the other patients in the
facility. He mentioned about the last time that he saw his family back in October of the previous year, the same month when he was admitted at the center.
He told us that they have not yet came back to visit him after the incidence since their home is very far from Dumaguete City. We then asked about how he
handles his feeling of loneliness, for which he replied that he talks to God and would take a rest; he also sometimes talks with his friends whom he made in
the center. He mentioned about how he handled his loneliness before he was admitted, and he said that he talked to his mother and his siblings whenever
he feels lonely, and that his siblings help him with his loneliness. Whenever he tends to feel sad, he also talks to God, thinks about beautiful things, and
would exercise. We asked about the possible reasons that caused his sadness, and he said that his siblings had not visited him since his admission and he
feels lonely because of it.
SN: What causes your loneliness?
Patient: When my siblings had not visited me yet since my admission. I feel so alone.
SN: So the last time they visited you was during your admission?
Patient: Yes, since Kabangkalan is so far from here.
It appears that our client feels so alone without the visitation from his siblings, and the only reason they are unable to visit is because their
place is very far from Dumaguete. It seems that his loneliness can be eased by the visit of his siblings.
We asked about the reason why he is happy. He said that when he had someone to talk to and share his feelings and thoughts to his
companions in the center, he feels happy. We asked him if he feels happy whenever we talk to him, he replied that talking to us also makes him happy. It
seems that he just wanted someone to listen to him and to talk to him since he feels so alone, especially since he is placed in a cell.
We asked again what causes his anger. He said that when he feels that a certain thing a person would do is wrong, he would assert his opinion
about the wrongness. He wants to correct a persons deed by arguing back at him that he had done it in a wrong way. We asked about how he handles it:
SN: Unsa imong himuon Sir kung maglagot ka?
Patient: Musyagit ko inig maglagot ko.
94 | P a g e
SN: Unsa paman ang lain nimong himuon inig maglagot ka Sir?
Patient: (paused) Ang bangko ako ilabay atong naa ko sa amoa.
SN: Unsay rason na imung gilabay ang silya Sir?
Patient: Kay naglagot man gud ko.
SN: So mao ni ang usa ka pamaagi na imung ipagawas ang imuhang kalagot Sir?
Patient: Oo, kung maglagot ko.
It seems that our client does not only shout when he becomes angry, but he also becomes violent to an extent that he would throw a chair to
show how mad he is. He shows this to make a point that a certain thing is not right.
We asked him if he has any current problems while staying in the center, and he replied none. At this point of the interaction, in order to find
out his thoughts, feelings, or anything he would like to bring up and discuss, we asked him if there is anything that he would like to talk about:
SN: Is there anything you would like to talk about Sir?
Patient: When the doctor checks me up here.
SN: What about it Sir?
Patient: Of course, he asks me about my condition.
SN: For you Sir, what can you say about your condition?
Patient: Its okay (paused). But when I was in Manila I experienced not being able to eat meals because we have no work there. It is one of the
reasons why I have this condition.
SN: So that is how you feel about you being admitted here?
Patient: I also experienced taking illegal drugs while I was studying. I experienced using marijuana, just a little.
SN: What is the reason why you used marijuana?
95 | P a g e
Patient: When I have a problem studying in college, I used marijuana. It is also because my friends used it in school.
It seems that our client had opened up about the reasons why he was sent to the center. He said that marijuana helped him in escaping from
his problems during his college years and also because of the influence his friends.
Lastly, our interaction ended by asking him if he has any questions about our interaction. He replied he did not have any and that he is happy
that he was able to talk with us once again.
96 | P a g e
Working Phase

January 22, 2014
Client Information
Name: F. Magellan
Age: 45 years old
Gender: Male
97 | P a g e

Status: Single
Birthdate: N/A

as verbalized by the SO. On suicide and escape precaution, placed inside isolation room C with watcher Esther/ Mary Ann.
General Impression: Client calm, alert and oriented to time and place. Moderate build, short stature. Ambulates independently. Communicates
coherently in low monotone voice.
Doctors orders: Admit at payward, routine ward care, diet as tolerated, TPR every shift, FD cc IM, CPZ (Dysnur) 100 mg 1 tab twice a day,
Apiden as necessary. Place on suicide/ escape precaution. Refer accordingly.
Legend:
= Client
SETTING ARRANGEMENT
Cells
Cells
= Student
nurse
= Clients
room
98 | P a g e
Isolation C
Lobby
Positioned approximately 6 meters from his room, the student nurses, Charles and Fate, were sitting on a bench alongside the client for the fourth
interaction. Due to the limited number of available chairs, we settled for the bench located at Isolation C lobby area. According to Videbeck, Sitting beside
or across from the client can put the client at ease (2004, p. 122). The student nurses were within the intimate zone (0-18 inches) with the client as he had
chosen where to sit after the student nurses had sat down. In relation to the intimate zone, Videbeck also states This amount of space is comfortable for
[] people who mutually desire personal contact, or people whispering (2004, p. 113). The clients body was facing the student nurses. The student
nurses also faced the client, showed open body posture by leaving the knees uncrossed and hands at the side, and leaned toward the client.
99 | P a g e
Thoughts and Feelings Prior to the Interaction

Charles Deans Thoughts and Feelings:
Before our next interaction with F.M. for the fourth meeting, I felt that we have successfully established a trusting relationship with our client
as he is gradually revealing to us more about his own perceived thoughts about his situation. Having discussed the possible reasons for his
admission in the previous interaction, we have decided to explore further into his stressors and his methods of managing them. While he is away
from his home in Kabangkalan, Negros Occidental, we think the domestic disturbance that led him to being at the mental facility may be a key to
uncovering his ability to cope with stress or stressors. I hope that during this interaction we will have, we can find out more about the triggers that
begin with stress and eventually lead to emotional turmoil. Also, we make it a priority to review with the client our contract setting and especially the
possible issue with the recorder when on during the interaction. In no way do we want our client to feel uncomfortable as this may cause a hidden
100 | P a g e
communication barrier, so we can feel safe knowing that we can progress further in the nurse-patient interactions with established good rapport and
a trusting relationship.
Fate Oiras Thoughts and Feelings:

Before our interaction, Im still feeling a bit nervous because the last interaction that we had we talked about how he would manage his
emotions. We talked about how he managed his anger and he mentioned about throwing a chair one time when he was angry. He was a little
hesitant to talk about it. I was nervous because maybe he will do something during our interaction like being more hesitant to answer our questions
if we continue on asking him about his anger management. I was also glad that we are having a progress in gathering more data about our client. I
felt that asking him more about himself would help us identify more of his problems. I was hoping that he would still feel comfortable during our
interaction and would give us more information about how he would handle his emotions in a safer manner. As the interviewer for the day, I was also
trying to organize the questions that I am going to ask and making it not to be a reason for his hesitation when answering the questions that we are
going to ask.

Nurse-centered objective:
During our 45-minute nurse-patient interaction, we would be able to:

Maintain eye contact and minimize unnecessary actions or gestures effectively.
101 | P a g e
Use all therapeutic communication techniques efficiently.

Minimize non-therapeutic communication techniques.
Maintain neutral expression during interaction effectively.
Accurately note the verbal and non-verbal cues that the client has shown.
Ask or get more information from our client:
About his previous actions in their place:
1. What was the reason that you threw a chair?
2. What were you thinking during that time?
3. What happened?
4. How did you feel about it?
5. Do you think of violence during this time?
6. What could be the other ways to release your anger?
About his recent stay in the center:
1. What was the reason that you are being put into that room?
2. What are the things that give you a reason to stay only or for you to go out of your room?
3. Do you still throw things here when youre angry?
4. What are the other things that you do to release your anger in this center?
About his feeling of loneliness for his family:
1. What do you think about the people who stayed here?
2. Do you interact with them when you can get out of your room?
3. Do you talk to them and communicate your problems?
4. How do you deal your loneliness in the center?
Client- centered objective:
102 | P a g e
During our 45-minute nurse-patient interaction would be able to:
Answer the questions satisfactorily.

Cooperate with the interaction effectively.
Open up and narrate any happenings about an event without hesitations.
Minimize staring blankly ahead and maintain good behavior satisfactorily.
Talk and answer our questions comfortably.

SN: Good morning, Sir (smiling,
maintain eye contact).

Communication
Good morning pud. (sits on the
bench)
Communication
Technique Used
V: Giving Recognition
NV: Smiling
Analysis
Therapeutic. Greeting the client by
name [] show that the nurse
recognizes the client as a person, as an
individual (Videbeck, p. 117). We, the
student nurses, greeted the client upon
the fourth interaction.
Eye contact [] is used to assess the
other person and the environment and to
indicate whose turn it is to speak
(Videbeck, p. 123). As we formally
103 | P a g e
SN: Kumusta man ta karon, Sir?
Okay lang. (nodding, staring

blankly ahead)
V: Broad openings
SN: Humana na ta og ligo, Sir?
Oo, humana na. (nodding,

sways left leg, maintains eye
contact)
V: Making observations
SN: Unsa diay imung gihimo

ganiha before mi nangari?
Wala ra. Nagpahuway lang.
V: Broad openings
SN: Ah, natulog (nods). Kumusta

man ang imong tulog, Sir?
Okay raman. (maintains eye

contact)
V: Restating/Exploring
NV: Nodding
greeted F.M., we maintained eye contact

to find out his current emotional state.
Therapeutic. We gave the client an
opportunity to verbalize his current state
as we allowed the client to take the
initiative to lead the interaction
(Videbeck, p. 116). We hoped to elicit an
open response by asking him how he
was doing.
Therapeutic. Since he was unable to
elaborate how he was feeling from the
previous question, the client may not be
ready to talk (Videbeck, p. 117). We
perceived the client had bathed and
verbalized that observation.
Therapeutic. In another attempt to have
the client lead the interaction, we asked
about what he was doing before our
arrival. Videbeck states For the client
who is hesitant about talking, broad
openings may stimulate him or her to
take the initiative (p. 116).
Therapeutic. As we restated his response
of rest, this lets the client know that he
communicated the idea effectively. This
encourages the client to continue
(Videbeck, p. 117). To supplement the
encouragement, we explored further by
asking how his rest was to him. The
nodding was used to complement the
encouragement for the client to
continue.
104 | P a g e
SN: (nods) So, Sir, diba last

interaction nato kay
naghisgutanay ta kabahin sa
imung mga emosyon ug unsaon
nimo pagpagawas nila.
(nods, stares blankly ahead)
V: Focusing
NV: Nodding
SN: Unsaon gani to nimu

pagpagawas sa imung kalagot?
Nisyagit ko.(pause)
V: Exploring
SN: (nods) Nisyagit ka. Dayun Sir?
Akong gilabay tong silya. (holds

hem of shorts)
V: General leads
NV: Nodding
SN: Atong imuhang gilabay tong

silya, Sir, unsa imung gibati
paghuman?
Malungkot. (still holding the

hem of the shorts, staring blankly
ahead)
V: Encouraging expression
SN: Malungkot Sir?
Nagmahay sa akong gihimo.

(staring blankly ahead, sliding his
right palm of his hand in his right
lap up and down)
V: Restating
SN: Unsa ang reaksyon sa mga
Wala man. Akong mama ra.
V: Exploring
Therapeutic. Based on our previous

interaction, we brought back the topic of
releasing emotions. This, in turn,
encourages the client to concentrate
his energies on a single point
(Videbeck, p. 116), which will allow the
client to concentrate his attention
towards emotional release. The nodding
was used to accept the clients response
to the previous question.
Therapeutic. To explore his ways of
releasing anger, we can further delve
into his methods of dealing with
emotions.
Therapeutic. Without taking away the
clients initiative for the interaction
(Videbeck, p. 116), the student nurses
are acknowledging he shouts when
angry and allows him to continue talking.
Nodding to indicate reception.
Therapeutic. By asking the client how he
feels after throwing a chair, it
encourages the client to make his own
appraisal of his experience.
Therapeutic. The student nurses
repeated what he said and let the client
know that he communicated the idea
effectively (Videbeck, p. 117). After he
replied not feeling content about
throwing chairs, he expresses remorse
for what he has done.
Therapeutic. By exploring how he
105 | P a g e
nakakita nimo atong imung

gilabay ang silya, Sir?
(making eye contact, still moving

his right hand in his lap)
SN: Ang imuhang mama ra ang

nakakita, Sir?
Oo. Kami sa akong mama ug

mga igsuon.
V: Restating
SN: (nods) Ah, kuyog imung mga

igsuon. Unsa man ilang reaksyon
atong imung gilabay ang silya Sir?
Wala raman. Giistoryahan lang

ko nila. (Making eye contact)
V: Listening
Restating/Exploring
NV: Nodding
SN: Unsa man ang ilang giingon

nimo, Sir?
Kung ngano akong gilabay ng

silya.
V: Exploring
SN: Unsa diay
Kay naguba man gud nako ang

silya.
V: General leads
SN: Oo Sir. Dayun unsa ang

giingon nila pagguba nimo sa
sillya Sir?
Ay, wala raman. (shakes head)
V: General leads
perceived the reactions of others who

were around during his throwing of the
chair episode, we can find out how he
feels about his own reaction.
Therapeutic. The client has
communicated his idea effectively of
only his mother seeing what happened,
he can either continue or clarify his
thoughts. He then clarifies it was his
mother and sibling that were around
during the time it occurred.
Therapeutic. According to Stuart (2005),
listening is a way of communicating to
the patient that shows interest and
acceptance to the client. Further going
into the reactions of others during his
throwing of the chair, we verify his
sibling was also present at the time.
Nodding to indicate reception of what he
said.
Therapeutic. Sticking with the reactions,
we go deeper into what his family
members who witnessed his emotional
outburst.
Therapeutic. This assisted the client to
continue what he was explaining. He
mentions that they asked why he broke
the chair.
Therapeutic. Indicating that we were
listening and following the client
(Videbeck, p. 116), allowing him to give
more insights and thoughts about
106 | P a g e
SN: (nods)So Sir, kung balikon

nato to, unsa dapat ang angay na
imung himuon?
Maypa amo nalang giistoryahan

ang problema namo.
V: Active Listening
Broad openings
SN: Ah, so naa diay moy problema

atong panahona, Sir?
Oo. (nods head)
V: Clarification
Restating
SN: Unsa man ang inyong

problema ato, Sir, na nagresulta
sa paglabay nimo sa silya?
Nagshagitanay mis akong

igsuon. (stares blankly ahead)
V: Exploring
SN: Mao ni atong panahona, Sir,

na nagshagitanay mo sa imung
igsuon bag-o ka giadmit diri?
Oo, katong bag-o ko gidala diri.

(nods head, making eye contact)
V: Restating
Placing an event in
time and sequence
anything else his family members might

have mentioned.
Therapeutic. We are paying attention to
the client as well as considering his
nonverbal behaviors. (Keltner, p.65) It
appeared the client was finished
discussing the incident, so we introduced
the topic of things that he enjoys doing.
Surprisingly, the client wanted to
continue describing the conversation
about the problem.
Therapeutic. We are trying to ask him a
question that confuses us by putting
the vague ideas into words. (Stuart, p.
34) We ask him the question for us to
get a clearer idea of what he is talking
about or what he is referring to. This
(restating) encourages the client to
continue talking; he has more to say
about the problem at that time.
Therapeutic. Since the client was willing
to continue discussing this topic, we
continued to ask about what led to
throwing the chair. He replies that he
and his sibling were shouting at each
other.
Therapeutic. Client reveals his reason for
admission was sparked by the episode of
throwing a chair and shouting with his
sibling.
We ask him about which part the event
happened if it was before his admission
107 | P a g e
SN: (nods) So, pag-in-ani na

sitwasyon, Sir, unsa dapat unta
ang imung angay buhaton?
Istoryahan nalang ang problema

ug iagi nalang sa maayong
pagsolbar sa problema. Maghilum
nalang. (stares blankly ahead,
still holding the hem of shorts)
V: Formulating a plan of
action
NV: Nodding
SN: (nods) Diri sa, Sir,

nakaexperience ba ka ug kalagot
while naa ka diri?
Ay, wala raman.
V: Encouraging
experience
SN: So Sir, kung maglagot ka, naa

bay masakitan?
Ay wala raman. Kato rang akong

gilabay ang silya. Wala raman.
(shakes head, making eye
contact)
V: Focusing
SN: So Sir, katong naglagot ka

imung gilabay ang silya. Dayun
imung ingon namo kay dapat nagistoryahanay nalang mo sa imung
mga igsuon atong inyong
problema og mas mayo na
naghilum nalang ka.
Oo, maypa naghilum lang ko

ato. (nods head)
V: Reflecting
Summarizing
or still a very long time ago.

Therapeutic. After F.M. revealed that his
actions led him to be admitted into the
facility, it may be helpful for the client
to plan in advance what he might do in
future similar situations (Videbeck, p.
116), so that this would increase the
likelihood of more effective coping. He
admits it would have been better to talk
it out, or just stay quiet. Nodding to
indicate reception of thought.
Therapeutic. After finding out his anger
potential, we asked F.M. to appraise the
quality of his experience in the facility
and see if he has experienced anger in
the duration of his stay.
Therapeutic. By encouraging the client
to concentrate on a single point, such as
if anything may get hurt if client
becomes upset, we were able to find out
that only the chair would be affected.
Therapeutic. The client stated he should
have just been silent about the situation
that escalated to the chair being thrown;
this then encourages the client to
recognize and accept his own feelings
(Videbeck, p. 117).
After the discussion of the main topic
which was about how he handles his
anger, we reviewed the main points or
ideas that we had collected from him to
know if what we heard were true by the
108 | P a g e
SN: (nods) Okay Sir, anhi napud ta

aning sa imuahang pagguol.
(stares blankly ahead)
V: Focusing
SN: Atong last interaction nato

naghisgot ka na naguol ka?
(nods head) Kay katong wala pa

nibisita ang akong mga igsuon
diri.
V: Exploring
SN: (nods) Oo Sir. Unsa man

imung ginabuhat diri na
makapawala sa imung kaguol Sir?
Nagpahaway nalang. Matulog

ra. (making eye contact)
V: Exploring
SN: Makig-istoryahanay pud ka sa

imung mga kauban diri Sir kung
maguol ka?
Oo, mag-istoryahanay rapud mi.
V: Exploring
SN: Imu pung iingon nila kung

unsa imung gihuna-huna or gibati
inig maguol ka?
SN: So, dili nimo iingon nila imung
mga problema ilabi na nga naguol
ka?
Ay dili. Mag-istoryahanay lang mi

ug laing butang.
V: Exploring
Ay dili. Wala ra nako sila

giistoryahan. (shakes head)
V: Restating
Clarification
SN: Unsa diay ang imung buhaton

kung maguol ka Sir?
Naa ras akong kwarto, magampo. Mag-exercise pud.
V: Exploring
SN: Pagawson pud ka sa imuhang

kwarto Sir aron makalibot-libot ka
Pagawson man pud mi.
V: Exploring
client who also nods his head.

Therapeutic. Moving on to another topic,
we aimed to focus on what are his
stressors.
Therapeutic. We asked if he was stressed
out in our previous interaction, and he
replied that he was since his siblings did
not come to visit.
Therapeutic. Given the fact that he feels
stressed at times in the facility, we
asked if theres anything to do to
alleviate or make the worries go away.
This will hopefully encourage his
expression of thought and feeling.
subject of becoming stressed, we asked
if he talks to the other people in the
facility.
Therapeutic. When the client is troubled
with stress, we went further to find out if
he voices his thoughts with others.
Therapeutic. We clarified his way by
restating if he mentions the source of his
worries during the conversations he has
with the others.
Therapeutic. By exploring the other ways
he can deal with being stressed, the
concern can be better understood since
more of a depth was reached (Videbeck,
p. 116).
Therapeutic. In addition to dealing with
his stress, we explored the possibility of
109 | P a g e
diri inig maguol ka?

SN: Sa unsang rason ka pwede
pagawson sa imung kwarto Sir?
Kung naa ni, inig mag-interaction

ta. (making eye contact, still
holding the hem of shorts)
V: Exploring
SN: (nods) Naa pay laing activity

na pwede kang pagawson sa
imuhang kwarto Sir?
SN: So unsa man ang imung
gipanghimo Sir kung naa lang ka
sa imuhang kwarto?
(silence) Usahay lang mi

pagawson.
V: Broad openings
Nag-ampo ug pahuway lang.

Maghuna-huna ug mga maayong
butang.
V: Broad openings
SN: Unsa ang naas imung hunahuna inig naa rakas kwarto nimo
Sir?
Siyempre maguol ko kay dili ko

kagawas. Ganahan pud ko
mugawas.
V: Exploring
SN: Ganahan ka mugawas Sir ug

makalibot-libot diri sa center Sir?
Oo, mulibot-libot unta diri.

Maglakaw-lakaw unta. (nods
head)
V: Reflecting
SN: Oo, pero dili ka sugtan na

pagawson Sir? (nods head)
Oo, gibawalan mi. Pero kung naa

tay interaction kay pagawson lang
mi. (nods head, stares blankly
ahead)
V: Exploring
Encouraging
comparisons
him roaming around to alleviate any

experienced stress.
Therapeutic. To find out if he is able to
deal with stress by being let out of his
room, we explored if there are any
restrictions imposed. This goes further
into examining the stress issue.
Therapeutic. Exploring any other
possible reasons that would allow him to
leave his room.
Therapeutic. After discussing being
outside the room, we asked about the
activities he does while inside his room;
attempt to have him open up his
thoughts.
Therapeutic. Client states thinking of
good things in his room, so we went
further to find out what kind of things he
tend to ponder about. He responds that
he is always stressed because he would
like to leave the room.
Therapeutic. After reflecting by directing
the clients thoughts back to the client
(Videbeck, p. 117) of leaving his room,
we asked if he liked to wander in the
facility. He replied that he does indeed
like to walk around.
Therapeutic. We inquire about why he is
unable to leave the room; this could
possibly reveal any tendencies he may
have when allowed to leave his room.
We ask him also if he can get outside his
110 | P a g e
SN: Oo. Kung wala mi Sir,

pagawson pud mo diri?
Usahay, kung naay activity. Nagistoryahanay pud mi sa akong

mga kauban diri.
V: Exploring
SN: Asa man mo magistoryahanay Sir?
Diri lang. (moves palm upward

as if emphasizing the place where
he talks with other people in the
center)
(nods head)
V: Broad openings
SN: Ang imong himuon inig

maguol ka kay mag-ampo lang ka
or di ba matulog. Maghuna-huna
ka ug mga maayong butang?
Oo. (nods head, staring blankly

ahead) Kay wala paman gud
nagbisita akong mga igsuon nako.
Ganahan naman ko na makauli ko
sa balay.
V: Reflecting/Broad
openings
SN: So ganahan ka makauli sa

balay Sir?
Oo, ganahan nako muuli.
V: Restating/Reflecting
SN: Unsa man ang atong angay

buhaton Sir aron makauli na ka?
Ganahan ko muari ang akong

mga igsuon ug kwaon ko diri.
V: Exploring
SN: Ganahan ka na mubisita ang

imung igsuon ug dad-on ka
Oo, kay dugay na kayo sila wala

nakabisita nako. Dayun tigulang
V: Restating
SN: (nods) So Sir, balik ta sa

imuhang pagkaguol no.
V: Focusing
room when we are not around.

Therapeutic. Since our presence is
required for him to leave, we further
asked if there would be any other reason
they would allow him to come out.
Therapeutic. Asking about the locations
in order for the client to possibly lead the
interaction.
Therapeutic. After inquiring about when
he leaves his room and where he likes to
go, we redirect the topic back to what
stresses him out.
Therapeutic. In regards to praying or
resting to cope with stress, we had
encourage(d) the client to recognize
and accept his own feelings (Videbeck,
p. 117), further asking if he thinks about
good things.
Therapeutic. After client expressed
missing his sibling whom have yet to
visit, we repeated back to him how he
would like to return home; this then
indicates that the clients point of view
has value (Videbeck, p. 117) for which
he does indeed desires to return home.
Therapeutic. Since client wants to go
home, we further asked what he would
like to happen so that he can return
home.
Therapeutic. Repeating the main desire
our client, which is for his sibling to visit
111 | P a g e
pabalik sa inyoha Sir?
SN: So mao na ang imuhang

gihuna-huna Sir inig ganahan
naka muuli?
naman gud ang akoang mama.

Tapos mutabang man pud kos
akoang mama kay naa man siyay
sakit run.
Oo, tigulang naman gud ang
akoang mama dayun ako ang
tagatimpla sa iyahang gatas.
and bring him back home, encourages

the client to continue (Videbeck, p. 117).
V: Reflecting
SN: Ikaw diay ang tigbantay niya

Sir?
Oo, mutabang pud kog galam

niya. Siya raman gud ang naa sa
balay.
V: Reflecting
SN: Asa diay ang imung ubang

mga igsuon Sir?
V: Broad openings
SN: Kinsa diay ang naa ra sa

inyohang balay Sir?
Ay naay trabaho. Ang uban tagaIlo-Ilo ug sa Bacolod. Layo man

sila sa amoa.
Ako ug katong usa nako na
igsuon.
SN: Si kinsa man Sir?
Si Julius.
V: Exploring
SN: Ah, so nag-worry ka Sir na

walay mubantay sa imuhang
mama since layo imung mga
Oo. Okay raman na naa si Julius

magbantay sa akong mama pero
ganahan pud ko na ako ang
V: Reflecting
V: Exploring
Therapeutic. By encouraging the client

to recognize and accept his own feelings
(Videbeck, p. 117) on what he thinks
about when it comes to returning back
home, this can let the client know he has
the right to have opinions and think
independently.
Therapeutic. Client states helping his
elderly mother to make milk, so we
redirect that thought back to the client in
the sense that he takes care of her.
Therapeutic. Asking about his siblings
whereabouts may stimulate him to talk
about them in any way he wants to.
Therapeutic. With the client stating his
mother needing assistance, it seems this
adds to the desire he has to return
home. We further asked if there is
anyone else occupying his home, in
order to explore his situation more fully.
Therapeutic. As a follow up to his sibling
being the other occupant of their house,
we further inquired who it was. He could
possibly explain his thoughts about this
certain sibling.
Therapeutic. By piecing together the
information our client has presented to
us, we clarified with F.M. if the stressor
112 | P a g e
igsuon dayun si Julius ra ang

nabilin na mubantay sa imuhang
mama, Sir?
SN: Ganahan ka na ikaw ang
mubantay sa imung mama Sir?
mugalam niya.
Oo, kay ako man ang muhatag

niya ug sabon dayun ako ang
mulimpyo niya. Ako pud ang
mulabay sa iyahang mga tae inig
malibang siya. Ako pud ang
muhatag ug tambal niya. Seventyseven naman gud siya.
V: Reflecting
Interpreting
SN: Maglisod na diay imung

mama ug galam sa iyang
kaugalingon mao ng ikaw ang
gaasikaso niya Sir?
SN: So, mubalik ta Sir. Ganahan
ka muuli aron makatabang ka ug
asikaso sa imuhang mama.
Oo, mutabang ko ug galam

niya.
V: Reflecting
Oo.(stares blankly ahead)
V: Focusing
SN: Unsa man imung buhaton

kung muarii imung mga igsuon ug
papaulion naka?
Mutabang nako ug asikaso sa

akong mama.
V: Exploring
SN: Mao na ang naas imung hunahuna Sir?
Oo, kaso katong October pa ko

naa diri. Maluoy unta ang Ginoo
ug mutabang nako aron
makagawas nako diri. Mao na ang
V: General leads
he experiences is knowing that his mom

is left home alone, with the exception of
his brother, Julius.
Therapeutic. As we again indicate that
the clients point of view has values; by
asking if he would prefer being the one
to watch over his mother, we
acknowledge his current stressor.
According to Keltner (2012), interpreting
provides a view of the meaning or
importance of the topic. We ask him the
question to know if the matter about his
mother is very important for him that
gives him also a reason to become
lonely.
Therapeutic. Directing the clients
thoughts of his mother having difficulty
taking care of herself, we restate his
tending to her needs.
Therapeutic. Bringing back the topic of
wanting to return home in order to tend
to his mothers needs, we encourage our
client to concentrate on this topic.
Therapeutic. We further ask the client for
his plans once his sibling comes by to
bring him back home; this will hopefully
be explained more in depth about his
desire once outside of this facility.
Therapeutic. In addition to wanting to
help his mother, we encouraged him to
describe any other kinds of thinking he
might have.
113 | P a g e
SN: Kanus-a man ka mag-ampo

Sir?
sige nakong giampo.

Bag-o ko matulog, mag-ampo
ko.
V: Exploring
SN: (nods)Naa pa kay laing

iistorya namo Sir?
Maayo unta na pagawson ko diri.

Diri sa akong kwarto aron
makalakaw-lakaw ko,
makaexercise. Kaso usahay rami
diri pagawson kung naa ni. Kaning
okasyon, interaction or nay
samba.
V: Broad openings
NV: Nodding
SN: Saan po kayo nagsisimba?
Didto. (points at the east side)

Katong duol sa opisina.
V: Exploring
SN: So ang imu rang ganahan Sir

kay makagawas ka sa imung
kwarto ug makalakaw-lakaw?
(nods head) Makaexercise.

V: Restating
SN: Unsa man ang naas imung

huna-huna inig makagawas ka sa
imong kwarto Sir?
Siyempre mawala ang akong

kaguol ug kamingaw.
V: Exploring
SN: (Silence, nods)
Malingaw pud ko diri sa gawas.

(silence)
V: Accepting/Silence
SN: Unsa pa ang lain nimong

mahuna-hunaan inig makagawas
ka Sir?
Mastretch akong kalawasan,

makexercise sama sa walking.
V: Exploring
Therapeutic. Since he constantly prays

to God to help him leave the facility, we
followed up by asking when he prays.
Therapeutic. We gave the client an
opportunity to initiate any kind of topic
he currently would like to give his
thoughts about with us, after discussing
the situation he is in with him presently
at the facility and his mother at home
who supposedly needs assistance.
Nodding to indicate accepting his
response.
Therapeutic. By delving further into the
idea (Videbeck, p. 116) of going to
church, we asked where it usually takes
place.
Therapeutic. Repeating his desire to
leave his room, we encourage the client
to elaborate his plan to just walk around
if the opportunity came.
Therapeutic. When our client is released
from his room, we ask further about his
thoughts and feelings, which may
become better understood.
Therapeutic. We indicated the reception
of his thoughts and feeling of releasing
his stress and loneliness through
remaining silent and nodding.
Therapeutic. Asking further about what
he usually thinks about may encourage
him to reveal more of his thought
114 | P a g e
SN: Kinsa man imung kuyog inig

magwalking ka Sir?
Ah, wala. (shakes head) Ako

lang.
V: Exploring
SN: Asa man ka maglakaw-lakaw

diri Sir?
Dinhi lang. (points at the north)

Dinhi sa, tsk, sa libot.
V: Broad openings
SN: Inig magwalking ka Sir, unsa

man ang naas imong huna-huna?
Kanang mayo akong panglawas.

Tapos mawala ang akong kaguol.
V: Exploring
SN: Hmm (nods), ganahan ka

maglakaw-lakaw ta inig naa mi
diri Sir?
Ay, ayaw ra. Diri rata magistoryahanay.
V: Exploring
NV: Nodding
SN: Ay sige Sir. (nods) Karon,

muadto tas imung paghisgot
kabahin atong imung pagtabang
sa pagluto diri sa center.
O. (nods head) Usahay raman

ko mutabang nila. Katong sauna
nuan sa barko nagtabang ko ug
luto.
V: Broad opening
SN: Hmm. (nods) Makapawala pud

ni ug kaguol nimo Sir?
Oo. (nods head, stares blankly

ahead)
processes.
Therapeutic. In addition to what he
thinks about when outside of his room,
we also go into his social tendencies,
which can explain how he may interact
with others.
Therapeutic. Stimulating him to take the
initiative (Videbeck, p. 116) in the
interaction, he may talk about his
favorite places to go and the reason
behind it.
Therapeutic. During the times he is out
of the room, we wonder what the client
may be thinking about or the feelings
that he may encounter.
Therapeutic. Since he enjoys wandering
outside of his room, we ask if thats
something he would like to do in our
presence. This may encourage
expression from the clients end if he
enjoys walking and chatting.
Therapeutic. One of the activities he
likes and takes part in is preparing food.
Introducing this topic may help him to
mention or express feelings or thoughts
associated with cooking.
Therapeutic. The client being asked to
consider if stress goes away with
preparing food/cooking can encourage
the client to make his own appraisal
(Videbeck, p. 116); this information will
let the student nurses know stress
115 | P a g e
SN: Atong therapy pud na

nahitabo last time Sir, unsa man
ang atong gibati paghuman ato?
Okay ra. Among gipanggama

tong mga beads. Nalingaw raman
pud ko na parte ko sa therapy.
SN: Unsa man ang naas imung

huna-huna atong naggama ka sa
bracelet Sir?
Okay ra, naexercise ang among

skills.
V: Broad openings
SN: Nakipag-istoryahanay pud mo

sa imung mga kauban atong
naghimu mo ug bracelet Sir?
Oo. (nods head)
V: Exploring
SN: Unsa man ang imong gibati

paghumana sa therapy Sir?
Okay ra. Nalingaw rapud ko.
V: Exploring
SN: Hmm. (nods)
(silence)
V: Accepting
SN: Sir, Mubalik ta sa relationship

nimo sa imung brother, kumusta
man inyong relationship?
Okay ra. Fine.
V: Broad openings
SN: (nods head)
I respect him as my brother.
V: Accepting
NV: Nodding
relievers as well as the stress itself that

may be relieved.
Therapeutic. In the search for more
stress relievers, we further asked about
the occupational therapy he was
involved with last week. His reaction
towards it can determine if it helps him
cope with stress.
Therapeutic. After he validated bracelet
making as a stress reliever, we wanted
him to elaborate further on any thoughts
that might have ran through his mind.
therapy that took place, we wondered if
he chatted with any of the others and if
he possibly expressed any thoughts or
feelings with them.
Therapeutic. Another way to encourage
him to talk about the conversations he
had with the others after the therapy,
since he states not usually talking about
personal matters.
Therapeutic. The student nurse indicated
hearing the client, giving him another
chance to express any more thoughts.
Therapeutic. We wanted him to express
any feelings or thoughts associated with
the people responsible for him being
sent to the facility.
Therapeutic. Gives him more time to
explain because of his limited effort to
expand on his relationship with his
116 | P a g e
SN: Kung papilion ka, kinsa imung

paboritong igsuon Sir?
My brothers and sisters, I treated

them all the same. I have no
favorite, I treat them all the
same. (stutters, stares blankly
ahead)We understand each
other, sharing and giving. Kay
mag-igsuon man mi, in-ana man
na, magsinabtanay lang.
(paused) Ina-ana man gud na,
nay problema, pero inig
istoryahan, masolbar lang.
Yes, I feel satisfied with them.
V: Focusing
SN: Naa pakay laing iistorya namo

Sir?
Ay, wala naman. (shakes head)
V: Broad openings
SN: Sige Sir, among balikon tong

kontrata na among giingon nimo
atong una natong pagkita.

ahead)
V: Restating
SN: Ang atong interaksyon kay

forty-five minutes lang every
Wednesday, Sir, mga ina-ani na
orasaha. Magpadayon ta sa atong
interaksyon until March lang.
Dayun, dapat andam nata pag in-
Okay. (nods head, stares blankly

ahead)
V: Giving information
SN: So, you feel satisfied with

your relationship with your
igsuon?
V: Reflecting
brother in the previous question.

Therapeutic. We wanted the client to
concentrate more on his siblings in order
to explain more about his relationship
with them. This could possibly explain
more about the characteristics of people
he can deal with, and his view on the
current situation with his brothers.
Therapeutic. Regardless of the events

that led to his situation, we directed
back to the client his feelings toward his
brothers to confirm if a positive
relationship still exists.
Therapeutic. After asking questions that
relate to his feelings, we wanted him to
introduce any topic in order for him to
lead the conversation (Videbeck, p. 116)
to his liking, preferably the stressors.
Therapeutic. In case our contract setting
was not explained properly, we want to
restate it further in a more
comprehensive and informative manner.
Therapeutic. To make sure we have
established trust and rapport with our
client, we informed him when we would
come to visit for a certain length of time
at a comfortable location to have an
interaction. By doing this, we are
117 | P a g e
ani na na orasaha para sa atong

interaksyon. Diri ra japon ta maginteraksyon.
informing the client of facts [which]

increases his knowledge about a topic or
lets the client know what to expect
(Videbeck, p. 117).
Therapeutic. Initially, he was reluctant to
have the recorder on, but accepted it
after discussing its purpose. Realizing
that this could be a reason that hampers
his responses during the interaction, we,
again, asked for his permission.
Therapeutic. We recalled his reaction
during our first meeting and wanted to
see if it further caused a block during
past interactions.
SN: Dayun, kabahin napud sa

pagrecord Sir.
Oo. (nods head)
SN: Atong nananghid mi nimo,

niana ka namo na dili nalang ta
mugamit sa recorder kay ganahan
ra ka makig-istorya namo. Unsa
diay imung gihuna-huna atong
nangutana mi Sir?
SN: Kaning recorder Sir, para man
ni sya makatabang nimo. Gamiton
ni namo para makabalo mi kung
unsaon namo paghatag ug care
nimo. Paghuman namo ug
paminaw ani, amo raman pung
ierase. Ang makabalo raman ani
kay kami sa akong partner og sa
akong maestro. Dili rani namo
ihatag sa laing tawo.
SN: Unsa diay ang naa sa imung
huna-huna atong nananghid mi
nimo na gamiton ang recorder
Sir?
SN: So, komportable lang ka na
maggamit mi sa recorder Sir?
Ay, wala. Gusto lang ko makigistorya ninyo. Ayaw nalang ng

recorder. Pero okay raman pud.
V: Exploring
Ay okay raman pud. (nods head)
Therapeutic. Our effort to build trust with

the client continues. In order to make
available the facts the client needs
(Videbeck, p. 117), we explained in
further detail about the purpose of
having a recorder on during the
interaction.
Wala raman. Okay raman na

maggamit mo ana.
(pause) Pwede unta na dili ra ng

recorder kay ganahan ra ko mag-
V: Reflecting
Therapeutic. If client does have any

uncomfortable feelings about having the
recorder present, we wanted him to
express any feelings about it.
Therapeutic. Used to encourage client to
recognize and accept his own feelings in
118 | P a g e
istoryahanay rata.
Ay okay ra. Basta kay magistoryahanay rata.
SN: Pero, komportable man dagay

ta karon Sir na naggamit mi sa
recorder?
Oo, komportable lang ko.
V: Exploring
SN: (nods) Okay Sir, salamat.

Karon kay hapit nata mahuman sa
atong therapy, unsa man ang
imung gibati run?
Okay ra ko. Komportable lang.

mayo kay nakapagshare tau g
ideas karon. (paused) Nalingaw
ko ug nawala gamay ang akoang
kaguol.
V: Giving recognition
Broad openings
SN: Ah, maayo Sir. Salamat kaayo

sa imung kooperasyon karong
interaksyon nato.
Salamat pud ninyo kay

nagkaistoryahanay napud ta.
(gives handshake)
SN: For educational purposes man

ni siya Sir. For us to learn pud Sir.
regards to the recorder.

Therapeutic. We asserted the purpose is
just for the care we give to him and the
education we as students receive from
the interaction.
Therapeutic. To make sure his comfort
level is unaffected by the recorder, we
asked him if he is still ok with it being
present.
Therapeutic. We thank the client after he
had agreed to the usage of the recorder
during the interaction.
Before we end the interaction, we
offered the client an opportunity to bring
forth any comments, responses to the
interaction, or what his current feelings
are.
Therapeutic. After thanking the client for
his time, we acknowledged ending our
interaction session together with the
client.
119 | P a g e
SYNTHESIS
After the interaction, we had gathered more information from our client. We first found out that he was being put into the isolation room not because
of our clients suicide and escape attempts but because, according to the nurse on duty, he was put into the isolation room because the significant other of
the client told them that he might escape and would go back to their place due to his mothers condition. We had discovered also, during our interaction
with the client that he was really worrying about his mother since he was the one who took care of her bedridden and dependent mother. The reason that
he was lonely because he wanted to go home and he wanted to take care of his mother. It seems that our client was talking more about letting his siblings
get him from the center and bring him home.
Our client also wants to be outside his room when he wanted to get out and think about things because it seems that he gets lonelier without
interacting enough with other people in the center. He even verbalized about how being outside his room is better than being inside it all the time. As
therapeutic as it may seem for him to leave the room, the nurse on duty informed us that by allowing him to constantly go outside without being escorted
may give our client ideas of escaping and running away. According to Townsend, there appears to exist some truth to what she mentioned as Common
symptoms of depression []are inappropriately expressed anger, aggressiveness, running away, delinquency, social withdrawal, sexually acting out,
substance abuse, restlessness, and apathy (p. 343); since our client was admitted due to the domestic fight with his sibling, social withdrawal with others
to an extent, and a history of substance abuse, it could very well be possible he may attempt to run away. We will try to deliver some other methods of
coping with his stressors in our future interventions.
Additionally, we were successful in talking about the contract setting and making sure the client was content with the agreement. We were mostly
concerned about the tape recording since he was initially reluctant with having one present during the interaction of day one; so, we again made sure that
allowing it to be there would not affect our communication with the client. He seemed to be ok with the fact that it helps us with our care for him, and we
believe that he still has our trust. We will continue to utilize the recorder for future interactions as we progress into the working phase of our next meetings.
120 | P a g e
Working Phase

February 5, 2014
121 | P a g e
Client Information
Name: F. M.
Age: 45 years old
Gender: Male

Status: Single

bed no.: Isolation C, Room 8
Birthdate: N/A
Room &

Chief Complaint:Admitted for first time with the following manifestations: restlessness, auditory and visual hallucinations, eating and sleep pattern
General Impression:Client calm, alert and oriented to time and place. Moderate build, short stature.Ambulates
independently.Communicates coherently in low monotone voice.
Seating Arrangement
122 | P a g e
Cells
Cells
Legend:
= Client
= Student nurse
= Clients room
Lobby
= Bench
Isolation C
Positioned approximately 6 meters from his room, the student nurses, Charles and Fate, were sitting on a bench facing the client seated in a chair for
the fifth interaction. We agreed tosituate at the bench located in the Isolation C lobby area. According to Videbeck, Sitting beside or across from the client
123 | P a g e
can put the client at ease (2004, p. 122). The student nurses were within the intimate zone (0-18 inches) with the client as he had chosen where to sit
after the student nurses had sat down. In relation to the intimate zone, Videbeck also states This amount of space is comfortable for [] people who
mutually desire personal contact, or people whispering (2004, p. 113). The clients body was facing the student nurses. The student nurses showed open
body posture by leaving the knees uncrossed and hands at the side, and leaning toward the client. The eye level was the same for both the student nurses
and the client.
Thoughts and Feelings Prior to the Interaction

Charles Deans Thoughts and Feelings:
124 | P a g e
Before our next interaction with F.M. for the fifth meeting, we have been successful in establishing a trusting
relationship with our client as he is gradually opening up to us about his own perceived thoughts about his situation.
We have decided to explore further into his stressors and his methods of managing them. While he is away from his
home in Kabangkalan, we think the domestic disturbance that led him to being at the mental facility may reveal
more towards uncovering his ability or inability to cope with certain stressors. I hope that during this interaction we
will have, we can uncover more of his history and identify any trends developing throughout the course of his life,
and find out what he would like to change about himself since he has had the time to think about why he is in the
Talay facility. Since we did not have the opportunity to have an interaction last week, we hope to gather any new
data from our client that he would be willing to share with us. We can take a look at certain ways he has handled any
situations that possibly happened, comparing it with the way he has handled stressors in the past. I have also
prepared a question directed at what he would like to change about himself, plus his reasons. Since we have had
numerous interactions already, Im really hoping that we will be able to express himself more and elaborate more on
his thoughts and feelings.
Fate Oiras Thoughts and Feelings:
Before our fifth interaction, I was really thinking hard of possible questions that I wanted to ask our client. We already
gathered enough information and were able to come up with nursing care plans for him. But I still felt that there are still
information that we need to gather to strengthen the information we already had. I have a hard time formulating
questions to be asked for this interaction. I formulated some questions that relates to his reaction about the last therapy
which was the play therapy that we facilitated. I also formulated questions that pertain to his coping mechanism
especially on how he handles his loneliness and anger; and how he is ready for a change in the problems we formulated
from our observations and interactions. When I was done formulating the questions, I was ready and trying to remember
those questions for the interaction. Since I was the recorder for the day, I also readied myself to supplement questions (as
well as asking the questions I have formulated) and how I would translate the questions that my partner would ask
whenever our client would get confused.
125 | P a g e
Objectives for the day:

126 | P a g e
Arrive to class on time.

Listen to conference topics attentively.
Pass the quiz with 76% competency level.
Ask questions related to topic discussed.
Get more information from our client effectively.
Transcribe our interaction at least 35% for the process recording.
Communicate with the client using verbal and nonverbal therapeutic techniques.
Maintain rapport and trust of the client effectively.
Situate seating arrangements in a therapeutic way to facilitate interaction.
Accurately note verbal and nonverbal cues that patient have shown.
Ask questions:
About recent stay in the institution:
How are you feeling today?
What is making you feel that certain way?
Have you shared your feelings with anyone else lately?
Has anything happened lately to cause you to become upset?
If so, how did you handle yourself in the situation?
How are the others treating you?
Have you engaged in any stress relieving activities lately?
127 | P a g e
How can we make your stay in this facility better?

About the client:
What are some things that stress you out and you find intolerable?
How do you feel about the way you handle stress that you encounter?
What are some ways you can express your emotions without letting your emotions control you?
Do you read magazines or books to keep you away from loneliness?
Do you have a specific place in the center that you wanted to go whenever youre lonely?
What do you think need s to be accomplished in order for you to go back home?
What are some things you would like to change about yourself?
If you were to see your family soon, how would you react to them?
About the reaction of the last therapy:
How were you during the therapy?
Have you enjoyed the therapy?
What were you feeling after the therapy?
What was on your mind while doing the therapy?
128 | P a g e
Express his thoughts about what has happened during his stay in the facility.
State stressors and relieving methods for the certain factors.
Explain his coping mechanisms in changes with his emotions.
Interact with the nursing students effectively.
Identify with the client any positive kinds of changes he would like to make about himself

SN: Good morning sir. (smiles)

Communication
Good morning Charles. Good morning
Fate. (nodding, maintains eye contact
Communication
Technique Used
V: Giving Recognition
NV: Accepting
Analysis
-Therapeutic. Greeting the client
by name [] shows that the nurse
129 | P a g e
while speaking)
SN: Asa man nimo ganahan

mulingkod run, Sir?
Ay diri ra dapita. (moves the chair to

the other side of the tambayan)
V: Suggesting
collaboration
SN: Aw, sige Sir.
(Silence)
V: Accepting
SN: Kumusta man ta Sir?
Okay lang.
V: Broad openings
recognizes the client as a person,

as an individual (Videbeck, p.
117). We, the student nurses,
greeted the client upon the fifth
interaction.
Eye contact [] is used to assess
the other person and the
environment and to indicate
whose turn it is to speak
(Videbeck, p. 123). As we
formally greeted F.M., we smiled
and maintained eye contact to
find out his current emotional
state.
Therapeutic. We want to find an
area where the client feels
comfortable in order to have an
efficient interaction. Videbeck
states, offering to share, to
strive, to work with the client for
his benefit (p. 118), so,
collaborating with the client
where he would like to sit with
us can facilitate this process.
Therapeutic. Indicating we heard
the client and that we will have
the interaction at his desired
location.
Therapeutic. We gave the client
an opportunity to verbalize his
current state as we allowed the
client to take the initiative to
130 | P a g e
SN: Okay ranimo Sir na magistoryahanay ta in English?
Okay ra.
V: Consensual validation -
SN: So, how are you doing today?
Im fine. Umm, I stay in my room.
V: Broad openings
SN: What were you doing before

we arrive here Sir?
I stay in my room. I take a rest.

(maintains eye contact)
V: Placing event in time

or sequence
SN: Is there anything that

happened to you lately that made
you upset or happy?
I feel happy when I go out and exercise.

(paused) Inside the, inside the center
here. I, uh, exercise.
V: Encouraging
expression
lead the interaction (Videbeck,

p. 116). We hoped to elicit an
open response by asking him
how he was doing.
Therapeutic. To ensure we have an
efficient interaction, we asked if
it was ok to speak in English.
Videbeck states: For verbal
communication to be
meaningful, it is essential that
the words being used have the
same meaning for both (all)
participants (p. 116), so the
student nurses wanted to verify
if its ok with F.M.
Therapeutic. We aimed to give the
patient an opportunity to
verbalize his state and to
determine the degree of his
response using English.
Therapeutic. The nurse may gain
information about recurrent
patterns or themes in the
clients behavior or relationships
(Videbeck, p. 117). We have not
seen F.M. in two weeks, so we
wanted to find out if there were
any new activities or situations
that may affect his current state.
Therapeutic. We are asking the
client to appraise the quality of
his experiences lately. The nurse
131 | P a g e
SN: So you go exercise at the

center?
Yeah. Yes. Walking, walking. (nods

head)
V: Restating
SN: Where do you walk sir?
Naglakaw-lakaw ra diha sa kitchen.

Naglakaw pud ko diha sa may ah payag.
(points the direction where the kitchen
and payag are located)
Yes. I show my feelings, yes. With my
companion here.
V: Exploring
V: Broad opening
Tiyago.
V: Exploring
SN: Have you shared your feelings

with anybody lately?
SN: Kinsa man imung kaistorya

diri Sir?
asks the client to consider

people and events in light of his
own values (Videbeck, p. 116).
This will then encourage F.M. to
make his own appraisal, as well
as give the student nurses an
update on his current state.
Therapeutic. Repeating the main
idea lets the client know that he
communicated the idea
affectively (Videbeck, p. 117);
this encourages him to continue
or clarify his response.
Therapeutic. Since the client
responded in a superficial way,
we used exploring to help
examine the topic further.
Therapeutic. By allowing the client
to discuss if he shares his
feelings with anyone, this can
stimulate the client to take the
initiative (Videbeck, p. 116). He
had stated in the past of not
sharing his feelings with anyone,
but with our absence last week,
we wanted to find out if he had
engaged in any conversations
with the others.
Therapeutic. After telling us that
he did, in fact, shared his
feelings/thoughts to someone
else, we wanted to find out more
132 | P a g e
SN: So you talk with Tiyago lately?
Yes. I express my feelings to him.
V: Exploring
SN: Unsa man ang inyong gipangistoryahan Sir?
Kanang akoang mga gipangbati na naa

ko diri ug pagpuyo nako diri.
V: Exploring
SN: Unsa pud inyong mga gipangistoryahan Sir?
Kanang inig muinom ko ug tambal.
V: General leads
SN: Hmm. (nods) Unsa man

imuhang bation inig nakainom
naka ug tambal Sir?
Okay ra.
V: Encouraging
expression
SN: So, nakainom naka ug tambal

run Sir?
Oo. Humana na. Okay raman.
V: Exploring
about who this individual was.

Therapeutic. In addition to
speaking with Tiyago, we
wanted to find out how often he
speaks with him; this is also to
encourage further discussion on
what he may talk about with
Tiyago.
Therapeutic. Finding out what the
client and Tiyago can help
examine his feelings lately.
Videbeck states Any problem or
concern can be better
understood if explored in depth
(p. 116), so we delved deeper
into that topic.
Therapeutic. To indicate that we
have been listening to him
speaking and following what he
is saying. This is to give
encouragement to continue
(Videbeck, p. 116).
Therapeutic. We want the client to
express how he feels once he
takes his medication. We also
encourage him to explain more
about the reason behind taking
his medications.
Therapeutic. Delving more into
the subject of taking his
medicine. This can encourage
our client to examine his issue
133 | P a g e
SN: (nods) So, Sir, how can we

make your stay here better? How
can we make it better for you?
Just to talk with my companion here.
V: Broad openings/
Formulating a plan of
action
NV: Nodding
SN: So mao na ang imung

ganahan na among himuon para
nimo Sir?
Oo. (nods, faced Fate who asked him)
V: Reflecting
SN: Unsa man ang among

matabang para nimo Sir?
Okay ra. Kanang makaistoryahanay lang

ta.
V: Broad openings
SN: We have not been here last

week, so we apologize for that.
Was there anything you wanted to
tell us about what happened last
week?
Its just the stay here. At the center.
V: Broad openings
more closely.
Therapeutic. To promote the client
to lead in the conversation in a
way he feels comfortable in the
environment. It may be helpful
for the client to help us plan out
activities for him that would
allow him to open up more and
uncover any information that he
can potentially express, which in
turn could help out our care for
F.M.
Therapeutic. Speaking with his
companion is what he wants to
do, as well as with us student
nurses. The nurse indicates that
the clients point of view has
value, and that the client has
the right to have opinions
(Videbeck, p. 117).
Therapeutic. The client seems
slightly hesitant to go deeper
into what we can do to assist
him in the facility, so we allow
him to lead in the interaction.
Therapeutic. Due to not being
available for F.M. last week, we
wanted our client to fill us in on
any happenings with him during
that time. This also encourages
any feelings, thoughts, or
experiences for him to openly
134 | P a g e
SN: Naa ba kay ganahan i-share

namo sir atong wala mi kaari nimo
last week?
Nagsimba lang mi diha. (points at the

location of the chapel, making eye
contact) Nanimati sa pari. (pause) Diri ra
mi sa center.
V: Exploring
SN: So, pagawson diay ka sa

imuhang kwarto inig nay misa,
Sir?
(leans forward; facing Fate, making eye

contact) Kung nay samba, pagawson
lang mi.
V: Exploring
SN: Atong last week Sir, unsa man

ang inyong lain pang gihimu last
week Sir?
Wala raman. Naa rami sa among

kwarto. (making eye contact)
V: General leads
SN: (nods) So Sir, lets go back to

your emotions. Do you feel
stressed lately?
(shifts position, facing Charles) When we

(pause) are stressed, I, uh, stay in my
room thinking about going home.
V: Encouraging
expression
NV: Nodding
SN: What do you think you need

to do so that you can go back
home, Sir?
I want to go back because I need to take

care of my mother. I want to see my
mother because she is old enough. I take
care of her too.
V: Focusing
share.
Therapeutic. English evidently
yields to very short responses,
although speaking in his dialect,
we are asking him about any
happenings that have occurred
last week.
Therapeutic. After the client
revealed going to the chapel
service, we further asked if this
is a condition where they would
allow him to leave his room.
Therapeutic. In addition to what
he has told us, we wanted to
encourage F.M. to continue
talking about any other
activities/events occurring last
week.
Therapeutic. Based on his
appraisal of feelings, we can find
out if it had stemmed off from
any recent experiences. The
nurse asks the client to consider
people and events in light of his
own values (Videbeck, p. 116).
Nodding indicates reception of
what client is saying.
Therapeutic. Concentrating on a
single point (Videbeck, p. 116),
we can encourage the client to
concentrate on the reason
behind his stay in the facility
135 | P a g e
SN: Unsa man ang mga pamaagi

aron makauli ka sa inyoha Sir?
Kanang muanhi ang akoang igsuon ug

kwaon ko niya. Mubalik sa Kabangkalan.
V: Focusing
SN: Kung muari ang imuhang

sister Sir, unsa man ang imung
reaksyon?
Thank my sister for coming here.
V: Encouraging
expression
SN: Naay ni bisita nimo last week

Sir?
Wala because Kabangkalan is so far

from here.
V: Exploring
SN: Ah (nods head). Lets go back

to your emotions Sir. Diba you
said last time that you threw a
chair when you were upset at that
time. How would you react if you
are to be angry here at the
center?
Okay raman.
V: Formulating a plan of
action
SN: Giunsa na nimo paghandle

ang imuhang kalagot karon na
naa ka diri sa center?
Gibaliwala lang nako. Mawala

ramanpud. Naa raman pud na.Depende
kung maglagot ang usa katawo.
V: Exploring
SN: Naa kay gikalagutan diri Sir?
(shakes head) Ay, wala man.
V: Broad openings
and express his intent on

progressing to a level where he
may be discharged.
Therapeutic. His response, aside
from his English response,
points to his thinking that his
sibling needs to come for him
and bring him back home.
Therapeutic. To express his
thoughts and feelings about his
family members, we asked
about his possible reaction if he
were to see his sister.
Therapeutic. Speaking on the
topic of having visitors, we
asked F.M. if he had any visitors
in lieu of our absence.
Therapeutic. Videbeck states that
making definite plans increases
the likelihood that the client will
cope more effectively in a
similar situation (p. 116);
therefore, I asked the client if he
would react appropriately if
anger was to be experienced
again.
Therapeutic. Finding out his
methods of handling stress can
help us assist the client in
dealing with his stressors in a
healthy, appropriate way.
136 | P a g e
Nagsinabtanay raman pud mi diri. Okay

raman.
SN: (nods head) Sir, atong una ani

nakaexperience naka ug mga
therapies or naa kay mga
ganahan na therapies?
Sauna sa amoa naa pud. Sa Bacolod.

Usa ka bulan ko didto pero nakagawas
raman pud ko. Karun, diri napud ko
naadmit.
V: Exploring
SN: Naay mga therapies na

gipanghimu didto Sir?
Siyempre naa pud. Naa ning, unsay

tawagani? Uh, interaction didto sa
Bacolod.
V: Exploring
SN: Naa tong mga therapy na

gipanghimu nato diri Sir?
Oo, naa man.Naadmit man ko ug usa ka

bulan didto sa Bacolod mga five years
ago.
V: Exploring
SN: Unsa may paborito ninyong

himuon na therapy Sir?
Kanang naa sa programa.
V: Encouraging
expression
SN: Sa program Sir, unsa man ang

imuhang paborito?
Wala raman. Okay ra.
V: Exploring
explain any reasons for feeling a

certain way in the facility can
give him an opportunity to
express himself.
Therapeutic. We asked about any
other alternative therapies that
he has undergone. Any problem
or concern can be better
(Videbeck, p. 116).
Therapeutic. Client has just
revealed being admitted
previously in another institution
in Bacolod, being treated for a
month. We want to find out
more of his history there,
beginning with the therapies he
has encountered.
Therapeutic. In relation to his
previous admission to the
Bacolod facility, we were
seeking information regarding
the types of treatment he
received.
Therapeutic. Finding a therapy he
feels content with will help us
formulate a better approach
toward interacting with F.M. We
wanted him to make his own
appraisal.
Therapeutic. Based on his favorite
therapy of having programs, the
137 | P a g e
SN: Sa pagsayaw Sir?
Okay raman. (silence) Okay lang,

makaexercise ka.
V: Encouraging
expression
SN: Mawala ang imuhang gibati na

negative Sir?
Okay raman. Pareho ani, naa koy

kaistorya kaysa wala.
V: Exploring
SN: Mubasa pud ka ug magazine

Sir?
Wala poy magazine diri.
V: Exploring
SN: Ganahan ka musulat pud Sir?
Oo. Sauna, sauna. (nods, stares blankly

ahead)
V: Exploring
SN: Sir, nakahisgut man ka na

kung naa kay problema muduol ka
sa imuhang igsuon, unsa man
iyang iingon nimo?
Okay raman, ako man iingon niya ang

akoang problema. Okay man na iya pud
kong hatagan ug solusyon.
V: Focusing
SN: (nods head) Is there anything

youd like to change about
yourself?
(silence) I want to change my life. My,

uh, attitude.
V: Broad openings
type of program or therapy he is

interested in can guide us in
future interactions.
consider people and events in
light of his own values to
encourage making his appraisal
(Videbeck, p. 116) can show us
how he feels about the dance
therapy.
Therapeutic. Relating the dance
therapy to making the negative
thoughts go away, we explore
the issue more fully.
Therapeutic. Delving further into
an idea (Videbeck, p. 116) in
order to find out if magazine
reading is a stress reliever.
an idea in order to find out if
writing is a stress reliever.
Therapeutic. The nurse
encourages the client to
concentrate his energies on a
single point (Videbeck, p. 166).
In this case, we want to focus
our attention towards his sibling
and his view on him.
Therapeutic. By allowing the client
to talk about what he feels he
should change about, this may
stimulate him to discuss his
138 | P a g e
SN: Sa unsang rason na attitude

nimu ang ganahan na machange
sa imung life?
(Silence) Ah, ang attitude. (staring

blankly ahead)
V: Exploring
SN: Sa unsang rason na ang

imung attitude imung gipili Sir?
Ganahan pud ko na mabuotan.
V: Exploring
SN: Kung ikumpara diay nato ang

imuhang attitude sauna ug karon
Sir, unsa diay ang sauna?
Kay kung maglagot ko, musyagit man ko

ug mulabay ug, ah, ah, silya.
V: Encouraging
comparison
SN: Unsay rason na makaabot ana

nimo Sir na kanang maglabay
naka ug silya?
Kung kakita ko ug dili mayo na gihimu sa

usa ka tawo.
V: Exploring
SN: Dali langmomangisugmiskan

simple angrason?
Dili man. (shakes head) Kung simple,

dililangkomangisug.
V: Reflecting
view towards himself and his

characteristics.
Therapeutic. His decision to
change his attitude is intriguing,
and we want to find out why he
would like to change his
attitude.
Therapeutic. His choice of
choosing attitude on top of
everything else can provide
information about his view
towards himself, and possibly
what he feels needs change.
Therapeutic. Comparing ideas,
experiences, or relationships
brings out many recurring
themes (Videbeck, p. 116). The
client might recall past coping
strategies that were effective.
Therapeutic. Finding out why he
dealt with his stressors in the
past by throwing chairs can
reveal the stressors themselves.
This topic can be explored more
in depth.
Therapeutic. Directing the client
thoughts and feeling back to
client (Videbeck, p. 117) of
becoming upset when he sees
someone doing something
wrong encourages the client to
recognize and accept his own
139 | P a g e
SN: Kung ikumpara sauna Sir,

unsa naman ka grabe ang imung
pagpangisug?
Ay, mas okay na run. Dili man ko

mushagit.
V: Encouraging
comparison
SN: Unsa paman ang ganahan

nimu usobon Sir?
Katong sauna namu shagit ko, muhilum

nalang ko para dili na mudako ang away.
V: General leads
SN: Do you consider taking

medications and taking therapies
ways for you to be discharged in
the center?
Okay man pud na pero ganahan ko na

naa ang akoang igsuon ug kwaon nako
diri.
V: Focusing
SN: Uhm, mubalik ta atong imung

giingon na naadmit ka saunsa
Bacolod sa usa ka bulan, sa
unsang rason nga giadmit ka didto
Sir?
Oo. Sa rehabilitation sa Bacolod City.
V: Exploring
SN: Sa unsang rason ka naadmit

Sir?
Para matambalan ko. (Silence)

Nabangga akoang ulo dayun nagnervous
breakdown ko.
V: Exploring
SN: Sa unsang rason na

nagnervous breakdown man ka
Sir?
Kay nabangga man gud akoang side sa

ulo atong nagpractice mi ug martial
arts. (Stutters but making eye contact)
Katong nagpractice mi, nabangga.
V: Exploring
feelings.
Therapeutic. In comparison to his
older extreme ways in the past
of dealing with stress, we look
further into his current ways of
confronting his stressors.
Therapeutic. Encouraging the
client to continue discussing
what he would have rather done
in the past to express himself
more appropriately.
Therapeutic. By concentrating on
what needs to be done in order
for him to be discharged from
the facility, we can narrow down
the problem area and focus on
it.
Therapeutic. Before Talay, F.M.
was admitted to the Bacolod
facility. We want to find out the
reason behind his admission to
identify any trends our client
may be showing.
Therapeutic. Again, seeking the
reason for admission from the
other facility in Bacolod. This
may reveal a trend.
Therapeutic. Our client stated he
was medicated for the nervous
breakdown he encountered.
Therefore, we delved deeper
into the issue of what may have
140 | P a g e
SN: Unsay nahitabo paghumana

to Sir?
Pagbangga sa akong ulo, nagngitngit

akoang panan-aw.
V: General leads
SN: Gidala dayun kasa hospital

Sir?
Ay wala ra, sa balay lang. Paglabay rag

tuig usa ko nagpatambal.
V: General leads
SN: Unsa imong edad na

nabangga imung ulo?
Mga twenty.
V: Exploring
SN: Hmm, pila ka years ang

nilabay bag-o ka gidala sa center
sa Bacolod Sir?
Mga after two years. Gidala ko nila sa

rehabilitation center.
V: Placing event in time

or sequence
SN: So 20 kaatong nabangga

imung ulo dayun after two years
kay naadmit ka.
Oo, wala rako gidala sa hospital atong

panahona.
V: Restating
SN: Unsa ang rason na usa
Usa ka bulan rako didto sa rehabilitation
V: Exploring
precipitated it.
Therapeutic. We indicated that we
were listening and following
what the client was saying
(Videbeck, p. 116). We also
encouraged him to explain what
happened after the martial arts
incident.
Therapeutic. After the incident
occurred, we were curious if he
received immediate care at a
hospital or not.
Therapeutic. We were seeking his
age at the time the situation
happened in order to determine
the recentness of this
occurrence.
Therapeutic. The client may gain
insight into cause-and-effect
behavior and consequences
(Videbeck, p. 117). Identifying
how many years went by until
he was sent to the Bacolod
center would clarify relationship
of events in time.
Therapeutic. We restated what he
said so that he may clarify or
continue with his thoughts and
feelings that led to being
admitted two years later at the
age of 20.
141 | P a g e
kabulan raka sa rehabilitation

center?
sa Bacolod City.
SN: Unsay ingon sa imung doctor

after usa ka bulan Sir?
Ana siya na okay raman, pwede na

mauli.
V: Exploring
SN: Unsa man ang imung gihimu

didto Sir?
Parehas ani, nay interaksyon.
V: Exploring
SN: Naa pud moy kwarto didto?
Oo, naa pud mi kwarto pero gipapauli

naman pud ko sa balay.
V: Exploring
SN: Unsa man ang imuhang

gihimu diri atong una na naadmit
na diay ka sa Bacolod na
rehabilitation center?
Nag-aadjust man pud.
V: Exploring
SN: So Sir, hapit naman mahuman

ang atoang interaction, naa kay
mga pangutana namo?
Ay, wala naman.
V: Broad openings
SN: Naay mga butang na
Aw, wala ra man. I take good care of my
V: Exploring
the subject of why he was

admitted before for only a
month would be better
understood if explored in depth.
Therapeutic. By delving further
into a subject or idea (Videbeck,
p. 116), we may be able to
discover more about our client
based on what he recalls his
doctor said about him in
Bacolod.
Therapeutic. By identifying the
methods used at the other
facility, we can further use that
information in our future
interactions.
Therapeutic. Identifies if he was
treated the same way in Bacolod
as he currently is in Talay. He
may possibly explain the living
situation at the other facility.
Therapeutic. His description of
what he did when admitted in
Bacolod can further assist with
our future interactions with our
client.
Therapeutic. Nearing the end of
our conversation, we
encouraged our client to ask us
anything that he feels is worth
mentioning.
Therapeutic. Finding out if he has
142 | P a g e
makastress nimo?
stress.
SN: Unsa may mga pamaagi na

imung mawala ang stress?
Sama sa exercise.
V: Broad openings
SN: Makaimagine pa ba ka na
mahimu nimo tong imuhang
gihimu sauna inig mangisug ka?
Ay dili na. Ako himuon kay dili ko

mulabay na ug silya.
V: Exploring
SN: (nod head) Ay sige Sir,

humana na ang atong
interaksyon, ato nya ning
icontinue next week.
SN: Salamat pud sa imuhang
cooperation Sir, sasunod napud.
Ganahan ka muapil sa therapy
karon Sir?
Okay, salamat kayo Charles, Fate.
Pwedepud. (stands up)

Muadtolangnyako. (Walks towards the
venue)
any stressors currently affecting

him can help us in the direction
of our interaction as we are
there to listen.
Therapeutic. If stress is affecting
him, it would be beneficial to
hear about his stress relieving
methods.
Therapeutic. Finding out if he still
has the urge to throw chairs can
signal either a progression in his
treatment or worsening.
Therapeutic. Acknowledging the
fact that our interaction time for
this week is coming to a close,
and will continue on next week.
Therapeutic. After ending the
interaction, we informed our
client that we will have another
therapy session and invite him
to be part of it.
143 | P a g e
Synthesis
After our fifth interaction with our client, F.M., we have made some progress in exploring more about how our client
responds stressors, comparing it from current time to before his admission into Talay. He had also revealed to us that this
is, in fact, his second admission into a psychiatric facility, the first time being at the Bacolod center 20 years ago. He
stated that he was involved in an martial arts incident that caused head injury, but then states not being admitted until
two years later in the Bacolod center for a mere month. It seems physical aggression has been evident throughout his life
due to his inability to handle his anger. According to Videbeck, Both verbal and physical aggression are meant to harm or
punish another person or to force someone into compliance (p. 193), so his method of throwing chairs and shouting to
express his anger is a real threat to society when F.M. states he feels upset when someone does something wrong.
Anger is a normal and healthy response when situations may be viewed as unfair, but if expressed inappropriately, it can
be dangerous to people around him as well as himself. We hope to reach out to F.M. and guide him in his way of dealing
with stressors and expressing them in an appropriate manner.
144 | P a g e
Working Phase

February 12, 2014
Client Information
Name: F. Magellan
Age: 45 years old
Gender: Male
145 | P a g e

Status: Single
Birthdate: N/A
General Impression: Client calm, alert and oriented to time and place. Moderate build, short stature. Ambulates independently. Communicates coherently
in low monotone voice.
Doctors orders: Admit at payward, routine ward care, diet as tolerated, TPR every shift, FD cc IM, CPZ (Dysnur) 100 mg 1 tab twice a day, Apiden as
necessary. Place on suicide/ escape precaution. Refer accordingly.
SEATING ARRANGEMENT
LEGEND
= Toilet
146 | P a g e
ISOLATION C, ROOM 8
= Bed
= Client
= Student
= Chair
= Gate
Due to his escape last week, we were unable to release our client out of his room for this interaction. Positioned approximately 3 feet from
F.M., we were seated on chairs next to the gate of his room in isolation section C while the client was seated on his bed inside his room, at eye level.
According to Videbeck, The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart (p. 113), so we
were situated appropriately for this interaction. Even when we were unable to sit down at our usual lobby area, we were still able to communicate
efficiently with our client. Videbeck states, Sitting beside or across from the client can put the client at easy, while behind a desk (creating a physical
barrier) can increase the formality of the setting and may decrease the clients willingness to open up and communicate freely (p. 122); the bars that
stood between us created a barrier, but the established rapport and trust we have developed over the past interactions did not seem to have an effect on
our interaction today.
THOUGHTS AND FEELINGS PRIOR TO INTERACTION

Charles Deans thoughts and feelings:
Before our sixth interaction with F.M., we were prepared to discuss last weeks revelation that he had been admitted before at the Bacolod center for
his condition. We wanted to find out more about the events, thoughts, and feelings surrounding that occurrence, but we were cut short on time last
interaction. However, upon arrival to the Talay facility, we discovered that he had escaped shortly after the dance therapy last week and went to tiangge
147 | P a g e
market. Luckily, he was found and brought back to his room where he would not be allowed to leave. On that note, we decided to gear our questions
toward this incidence and find out his thought process that would lead him to do want to leave. I felt that the nurse we had spoken to in the past was right
about letting him freely walk about, where he may formulate a plan to escape. Sure enough, she was correct. I hope that with this interaction held at the
gate of his room will not interfere with our communication, as it is already difficult enough to obtain information from our client, which he usually answers
the questions to his liking. We hope to find out more information about this escape that consequently took his roaming privileges away.
Fate Oiras thoughts and feelings:

Before the interaction, my partner and I were agreeing as to who would be the one who would interview our client for the next interaction. I
volunteered to do the interview since I had so many questions that I wanted to ask to our client especially all about the information he had opened up last
interaction- his first admission at a rehabilitation center in Bacolod. I was excited to ask him about it but there was information that I got from the staff in
the rehabilitation center when I asked them about opening the room of our client for us to have an interaction to our usual setting. It was about the escape
that our client had done last week. They told us that he went outside without getting noticed and was brought back to the center. Just before the
interaction, I suddenly changed the questions to be asked to our client and set aside those questions I had prepared for our interaction. I felt nervous
maybe because our client cannot get out from his cell that he might not want to talk with us or would show some inappropriate behavior during our
interaction. I was nervous that maybe he may act differently towards us during the interaction.
OBJECTIVES
Objective of the day:
Within our 6-hour duty, I will be able to:
Come to class on time.
Pass the quiz at 76% competency level.
Listen to the conference topics to be discussed satisfactorily.
Ask questions about the topic.
148 | P a g e
Perform my role during the art therapy effectively.

Attentive enough in assessing our client during the therapy.
Interviewer: Fate Lee Oira

Recorder: Charles Ian Deans
Nurse-client objective:
During our 45-minute nurse-patient interaction, I would be able to:
Use all the therapeutic techniques effectively.
Minimize non-therapeutic verbal and non-verbal communication techniques effectively.
Accurately note for verbal and nonverbal cues from our client.
Ask questions in an organized manner:
About the last therapy and about his stay during the day:
How are you today?
Anything you want to talk about that happened lately?
How are you during the last therapy?
What can you say about the last therapy?
About his first stay at Bacolod rehabilitation Center:
You told us youve got admitted at Bacolod Rehabilitation Center, what was the reason you were admitted?
What was the reason that on the second time to get admitted you were bought at Talay Rehabilitation Center?
Did you shoan aggressive behavior that resulted to your admission at Bacolod Rehabilitation Center?
Who was the one admitted you to the center at Bacolod?
About how ready he can be in knowing the problem we had observed from him:
We wanted to know if you are ready to face the problems we have observed and be ready to solve it with us.
Would you like to have a change in yourself to keep you from loneliness?
Aside from praying and resting, what are the other ways that may help you get through loneliness?
Aside from your sibling that you wanted them to get you, can you tell us some other ways to keep you happy or away from loneliness?
How can we help you get through what you are feeling?
Client-centered objective:
During the 45-minute nurse-patient interaction, the client will be able to:
Answer the questions about his first admission satisfactorily.
Maintain eye contact satisfactorily.
149 | P a g e
Be comfortable with communicating or interacting with the student nurses.

Minimize stuttering when answering.
Get prepared before the interaction (was able to take a bath and eat breakfast as well as taking his medications).
Join the therapy prepared by the student nurses for the clients at the center.
Student Nurses Verbal &

Non-verbal Communication
SN: Good morning, Sir. (smiles)

Communication
Good morning din Charles (nods
to Charles), Fate (turns to Fate)
Communication Technique
Used
NV: Accepting
Analysis
by name [] shows that the
nurse recognizes the client as a
person, as an individual
(Videbeck, p. 117). We, the
student nurses, greeted the client
150 | P a g e
SN: Kumusta man ta karun Sir?
Okay ra. (maintains eye

contact)
Broad openings
SN: Nakaligo nata run Sir?
Ay, wala pa. (shakes head no)
V: Exploring
SN: Unsa may rason na wa pa ta

kaligo karun?
Ay, gitugnaw man ko.
V: Exploring
SN: Maligo nya ta unya Sir ha.
Oh. (stares blankly ahead)
V: Formulating a plan of action
upon the fifth interaction.

Eye contact [] is used to
assess the other person and the
state.
how he was doing.
greeting and went further by
asking about his hygiene, since
it smelled like he did not take a
shower.
Therapeutic. Our client confirms
the odor we noticed, so we
wanted to further ask about the
reason behind it. According to
Videbeck, Any problem or
concern can be better
(p. 116).
Therapeutic. According to
151 | P a g e
SN: (nods head) Nakakaon nata

run Sir?
Oh. (nods head, stares blankly

ahead)
V: Exploring
NV: Accepting
SN: Ang tambal pud nimo Sir?
Ay, unya pa. (scratches the right

cheeks, stares blankly ahead)
V: Exploring
SN: Unya pa Sir?
Oo.
V: Restating
SN: Unsang orasaha man?
Unya pang gabie.
V: Exploring
Videbeck, Making definite

plans increases the likelihood
that the client will cope more
effectively in a similar situation
(p. 116), so despite his reason
of not bathing, its best to
promote basic hygiene as soon
as possible.
Therapeutic. Aside from his
hygienic practice, we inquired
about his eating and if he had
consumed his meal. Nodding
head conveys acknowledgment
of receiving the clients
communication.
Therapeutic. We gradually led to
this topic after the greeting. We
wanted to find out if he adheres
to the medication regimen
aimed to treat his condition.
Therapeutic. This restatement
lets the client know that he or
she communicated the idea
effectively (Videbeck, p. 117)
and also allows the client to
clarify if he wishes, or continue
with what he says.
his claim, we were seeking
more information about the
time his medication is usually
taken.
152 | P a g e
SN: Naghisgut ka namo Sir na sa

buntag ug gabie imuhang pagiinom ug tambal, karun kay sa
gabie nalang?
Usahay naa, usahay wala.

(stares blankly, swallows)
V: Reflecting
SN: Ah (nods head) Kabalo ka sa

pangalan sa imung tambal Sir?
Sinor man dagay to. (maintains

eye contact)
V: Exploring
NV: Accepting
SN: Unsa man imung mabati after

mag-inom ug tambal Sir?
Murag, murag dili mayo akong

gibati. Pero okay na sa gabie.
SN: Idescribe kuno Sir kung unsa

imung bation paghuman nimo ug
inom sa imuhang tambal.
Maglain ang akoang gibati.

(pause) Murag ah katulgon ko.
SN: (nods head) Unsa man imung

himuon paghuman nimo ug inom
sa imung tambal?
Magpahuway. Matulog.
V: Exploring
- Therapeutic. This directs the

clients actions, thoughts, and
feelings back to the client. We
wanted to clarify the timing,
since before he claimed taking
it in the morning and evening,
but now its only in the evening.
- Therapeutic. Delving more into
the topic of the medication, we
wanted to know if he had the
knowledge about the
medication he is taking.
Nodding head to indicate
reception (Videbeck, p. 116).
- Therapeutic. Discussing
medications, we asked about
how he felt after being given
the medicine. This can explain
side effects that may affect his
adherence.
- Therapeutic. Videbeck states this
is asking the client to appraise
the quality of his experiences
(116), so we hoped to illicit how
he feels after medication
administration.
- Therapeutic. After the medication
is taken, we wanted to know his
activities afterwards. In relation
to the main effect and side
effects, we can further study his
reaction towards it.
153 | P a g e
SN: So, diba last week kay

nagtherapy man ta, katong sa
chapel. Dance therapy man to
Sir, unsa man ang imuhang gibati
while naghimu ka ato?
Okay raman.
V: Placing event in time or

sequence
SN: Unsa may imung gihuna-huna

atong nagtherapy mo?
Okay ra. Nalipay ko.
SN: Unsay rason na nalipay man

ka atong nagtherapy Sir?
Kay gitan-aw among abilidad ug

skills sa pagsayaw. (maintains
eye contact)
V: Exploring
SN: Naa moy gaistorya while

nagtherapy ta?
Ay oh, akoang mga kauban diri.
V: Exploring
SN: (nods head) Uhm, unsay
(silence) Okay raman. (stares
V: Broad openings
- Therapeutic. We had heard from

the nurse on duty that he had
escaped last week, later on in
the day, following our dance
therapy session. We wanted to
find out more about this
occurrence, so to gain more
information, Videbeck states
The client may gain insight into
cause-and-effect behavior and
consequences, or the client may
be able to see that perhaps
some things are not related (p.
117); therefore, we wanted to
see if he would openly
acknowledge and explain his
actions.
- Therapeutic. If there was anything
running in his mind at that time,
we were interested to see if he
would share his thoughts on the
day of his escape.
- Therapeutic. By delving deeper
into the topic of last weeks
therapy, we were hoping to
trigger any kinds of thoughts.
- Therapeutic. If there was a
possibility that talking with the
other clients would have led to
his escape, we wanted him to
express/explain his thoughts.
- Therapeutic. His responses about
154 | P a g e
nahitabo atong last week Sir? Naa

kay ganahan ishare? (maintains
eye contact)
blankly ahead)
NV: Acceptance
SN: Pagkahuman sa interaction

nato, nay nahitabo?
(silence) Ah, atong about sa

akoang pagkangisug.
Nagshagitanay mi.
SN: Last week ni Sir na nagshagit

ka?
Sa bahay. Kami sa akoang

igsuon. (stares blankly ahead)
V: Restating
SN: Kanus-a ni Sir?
Katong October.

sequence
last week have been superficial,

as both the student nurses and
the client secretly already knew
of the happenings last week.
This was another attempt to
have him come forward with
this seemingly withheld
information. Nodding of the
head indicated reception, and
we maintained eye contact as it
is used to assess the other
person and the environment
and to indicate whose turn it is
to speak (Videbeck, p. 123).
- Therapeutic. Since the client
withheld the information from
what happened after the dance
therapy, we used the
interaction point to find out if he
would recall the escape and
anything else associated with it.
- Therapeutic. By restating what
the client says, this lets the
client know he communicated
the idea effectively. This
encourages the client to
continue (Videbeck, p. 117), so
this would help him to either
clarify or proceed with his
original response.
- Therapeutic. Putting events in
proper sequence helps both the
155 | P a g e
SN: (nods head) Ah, katong last

week Sir?
(silence) Wala raman. Okay ra.

(shakes head no)
V: Seeking information
SN: Sa among nahibal-an Sir kay

nigawas ka sa center.
(silence) Nilayas ko eh. Niadto ko

sa tiangge. Pero nakit-an ko nilang
Mary Ann dayon nibalik ra ko.
(stares blankly ahead, scratches
the right cheek)
SN: Kanus-a man ni nahitabo Sir?
Last week, Miyerkules sa hapon.

sequence
SN: Ato ning paghuman sa atong

interaction Sir?
(silence) Nagkita mi didto ni

Mary Ann. (pause) Nadala

sequence
nurse and client to see them in

perspective (Videbeck, p. 117);
by the client stating he was
yelling at his brother last week
at his house, it seemed as
though he did not understand
our question.
Therapeutic. The nurse should
seek clarification throughout
interaction with clients
(Videbeck, p. 117); with this, we
wanted him to explain what had
happened last week, not in
October at the time he was
admitted.
Therapeutic. Informing the client
of facts increases his knowledge
about a topic or lets the client
know what to expect (Videbeck,
p. 117), so in that regard, we
directly informed him of what
we were told. This was finally
used since he was straying
away from discussing his
escape.
Therapeutic. Now that he has
acknowledged his escape last
week, we are clarifying with him
when this happened and at
what time.
Therapeutic. Putting events in
proper sequence helps both the
156 | P a g e
SN: Gaunsa man ka pag-abot

nimo sa tiangge Sir?
raman gud kos akong kaguol mao

ng niadto ko sa tiangge. Kaso layo
kayo ang Kabangkalan City sa
Dumaguete. (stares blankly
ahead)
Ay wala, nagsuroy-suroy ra.
SN: (nods head) Tungod ni sa

kaguol mao ng nilayas ka Sir?
V: Exploring
Oo, kay naguol man ko.

V: Reflecting
SN: Sa unsa mang rason niadto

kag tiangge Sir?
(silence) Naguol man gud ko

diri.
V: Exploring
SN: Wala nimo ingni imong

watcher na naguol ka diri?
(shakes head) Wala ra.(pause)

Ganahan man gud ko muuli.
Wala paman gud ko gikuha sa
akoang igsuon diri. Naguol raman
gud ko.
V: Reflecting
SN: (nods head) Ah, so kinsa man

imung kuyog paingon sa tiangge?
Ako ra usa.
V: Exploring
NV: Accepting
SN: Di ka ganahan na magsuroy-
Kay dugay naman gud mi wala
V: Reflecting
nurse and client to see them in

perspective (Videbeck, p. 117),
so this should encourage him to
specifically explain what
happened later on that day.
Therapeutic. To further explain
why he ended up in tiangge, we
asked what he did upon arriving
there to piece together the
situation.
Therapeutic. His action of wanting
to go roam around made us
direct that thought back to him
to figure out his thinking that
led to his escaping.
Therapeutic. Going deeper into
the details, we were trying to
find out what led him to venture
off to tiangge.
Therapeutic. He felt sad about
being in the mental health
facility and this is why he fled.
We directed back his thoughts
along with asking why he didnt
inform his watcher about his
feelings at that time.
Therapeutic. Further on the topic
of his adventure, we wanted to
know if he was alone on this
plan he had or not. Nodding
indicates reception.
Therapeutic. His decision to run
157 | P a g e
suroy ra diri sa sulod sa center

Sir?
nagkita sa akoang mama.

Tigulang naman gud siya, sixtyseven na ang edad. (blank
stares)
SN: So ganahan najud nimo

diayng makita imung mama?

ahead)
V: Reflecting
SN: (nods head) Si Mary Ann ray

nangita nimo Sir?
Oo, sila ni Romeo. (maintains

eye contact)
V: Restating
NV: Accepting
SN: (nods head) Uhm, unsa may

imung gibati while nahitabo to
Sir?
Nikuyog rako nila balik pagkita

nila nako didto.
SN: Atong naa pakas tiangge Sir,

unsa imung gibati?
Nakafeel ko na nalipay k okay

nakagawas ko, Nawala ang akong
kaguol.
away instead of staying at the

facility and managing his
worries must have a reason.
This encourages him to speak
his opinion and think
independently.
Therapeutic. The nurse indicates
that the clients point of view
has value, and that the client
has the right to have opinions,
make decisions, and think
independently (Videbeck, p.
117), so directing the feelings of
his mother back to the client
assists in that regard.
Therapeutic. The client had stated
Mary Ann had found him at
tiangge. To encourage him to
explain more on the account of
what happened, we restated
what he had said. Nodding
indicates reception.
Therapeutic. The nurse asks the
client to consider people and
events in light of his or her own
values (Videbeck, p. 116). We
wanted to know what was going
on in his mind during the time
of his escape.
Therapeutic. We repeated the
previous question since his
answer did not explain his
158 | P a g e
SN: So nawala imung kaguol

atong paggawas nimo ug
pagsuroy-suroy sa tiangge.
Oo. (nods head)
V: Restating
SN: Dili ka ganahan magpundo

diri sa center ug maglakawlakaw?
Okay raman. Mawala ang, ah,

ang akong kaguol.
V: Reflecting
SN: Sa imung buot pasabot kay

mas mawala ang imung kaguol
inig makagawas ka sa imung
kwarto Sir?
Oo. (maintains eye contact,

nods head)
V: Restating
SN: Ganahan raka makalakawlakaw ra diri sa center Sir.
Oo. (blank stare)
V: Exploring
SN: Pero kung pagawson ka sa

imung kwarto Sir, himuon pa ba
nimo ang paglayas?
Di na nako himuon to. Nadala

raman gud ko sa akong kaguol
mao nako nahimo to.
V: Reflecting
SN: So, dinhi raka magsuroy-
Oo.
V: Exploring
thoughts.
Therapeutic. We restated what he
mentioned to encourage him to
continue on about why he went
to tiangge. This can also be
clarified if incorrectly stated.
Therapeutic. His need to roam
around could have been
accomplished in the center,
although he decided to venture
off to tiangge. We reflected his
thoughts about it to find out if it
is effective in the center.
Therapeutic. The restatement lets
the client know that he
communicated the idea
effectively (Videbeck, p. 117),
so we directed his thought
about how his roaming outside
of his room will set his worries
free.
Therapeutic. Since he does, in
fact, use roaming to rid his
worries, we then asked if he
likes to walk around the center.
leave his room to walk around
may be therapeutic, but we
reflected back to the client
whether this would lead him to
try and run away.
Therapeutic. By going deeper into
159 | P a g e
suroy kung paggawson ka sa

imung kwarto?
SN: Sir, so uhm, unsa may dapat

namong himuon na makapawala
sa imung kaguol? Karon na naa ta
sa center.
Gusto raman gud ko dira sa

gawas gud. (points the outside
using the head) Makalakaw ra ug
normal.
V: Exploring
SN: Imung naingnan ang imung

watcher ani Sir?
Oo, ako man siyang giingnan.
V: Exploring
SN: Unsa man ang iyang giingon

nimo?
Naa daw sa nagdala sa susi ang

abrihan ang among kwarto.
V: Exploring
SN: Nagkita namo sa imong

doctor karun Sir?
Wala pa karun pero nagkita mi

last week.
V: Focusing
SN: Nakabalo ba imong doctor na

nilayas ka?
Wala pa. (shakes head no)
V: Exploring
SN: Uhm, balik ta sa last week

atong nieskapo ka Sir, nitawag ba
Ay wala man. Wala ko kabalo

Pero wa pa to siya nakabalo, di
V: Focusing
the method of roaming around,

we wanted to find out if he
would try to escape again if
given the opportunity to leave
his room.
Therapeutic. Since his worries
seem to be his biggest problem,
we wanted to know any other
ways he can get rid of it in the
center without leaving.
- Therapeutic. To find out if he
states his concerns with the
watcher, we ask if the client
shares his thoughts with the
watcher.
Therapeutic. To follow up his
response, we asked what
exactly it is that the watcher
tells him.
Therapeutic. By encouraging the
client to concentrate his
energies on a single point
(Videbeck, p. 116), we can
prevent overwhelming the client
about the escape as we
introduced discussing about the
doctor visiting him.
Therapeutic. We wanted to know
further if his doctor knew what
happened to him last week.
Therapeutic. We went back to the
previous topic about his escape
160 | P a g e
imung igsuon diri?
man siya mutawag.
SN: Unsa man ang imung gibati

pagkahuman atong gibalik ka
diri?
Okay raman. (stares blankly

ahead)
SN: Gaunsa man ka pagbalik

nimo diri?
Ay wala raman pud, nagpahuway

ra diri. (pause) Wala man pud
koy mahimu didto sa gawas mao
ng nikuyog lamang ko nila balik.
Wala raman pud koy gihimu atong
nagsuroy-suroy ra ko sa tiangge.
Ganahan rako dira sa gawas.
V: Exploring
SN: Basun ganahan ka na

magtherapy ta Sir? Kanang kitang
tulo kuyog akong partner.
Ay, ayaw ra, mag-istoryahanay ra

ta.
V: Suggesting collaboration
SN: Basun ganahan ka na

magdala mi ug magazines or mga
libro na mabasa arun mawala
gamay imung kaguol?
(silence) Ay ayaw ra. (blank

stares)
NV: Silence
SN: Para nimo Sir, naa kay

ganahan na himuon namo para
mawala ang imung kaguol?
by making the client

concentrate about a single point
(Stuart and Laraia, p.32) which
is about his escapade. We asked
more if his siblings knew what
he has done.
- Therapeutic. Asking the client
about how he feels about what
he had experienced. (Videbeck,
p.116) We wanted to know how
he feels about getting back to
the center.
- Therapeutic. We wanted to know
what he did after he was
brought back to the center.
- Therapeutic. Telling the client

some suggestions to work with
the client about his problem
(Videbeck, p.118). We asked the
client what he wanted us to do
with him to relieve his sadness.
some activities that he may
want to do to relieve his
sadness.
more about alternative ways to
turn his attention away from
sadness.
161 | P a g e
SN: Gibisita naka diri sa imung

mga igsuon?
Ay wala pa, dugay na. October

paman tong last, wala pa sila
nibisita.
Ay wala pa. Pero ganahan ko na
mutawag sila nako. Naa bitaw
telepono sa opisina. Ganahan
lang ko makig-istorya nila.
V: Exploring

iingon nila kung mutawag sila?
Na okay naman ko. Okay na

akong gibati. (pause) Kaya
raman nako na mulakaw ug
musakay paingon sa
Kabangkalan. Kaso wala lang koy
kwarta para pampliti pauli.
SN: Karon na naa tay interaction

dayon naghisgut ta ug about sa
imung pag-eskapo, unsa man ang
imung gibati?
Okay raman. (pause) Kay

nadala raman gud kos akoang
emosyon. (maintains eye
contact)
SN: Imung giingnan ang mga

nurse diri na naguol ka?
Oo, pero baliwala raman pud

nila.
V: Exploring
SN: (nods head) Uhm, sa akong

nabantayan kay ganahan najud
ka muuli. Pero imung gihulat ang
imung igsuon na anhion ka. Kay
Oo. Dugay nakong wala nila

gibisita. Nadala rako sa akong
kaguol mao ng nieskapo ko.
V: Reflecting
NV: Accepting
SN: Nakatry na sila na mutawag

diri ug i-kumusta ka?
V: Exploring
- Silence gives time for the client to

think (Stuart and Laraia, p. 35)
about the options we had given
to him.
- Therapeutic. We changed the
topic to another one and asked
about his siblings.
if his siblings had visited him
just last week to know if this is
also the reason why he had
escaped.
- Therapeutic. Asking him about it
can let the client make an
appraisal about his experience
(Videbeck, p. 116) or what he
wanted to tell to his siblings
rather than accepting opinions
from others.
how he feels about the ongoing
interaction that we had and if
he feels uncomfortable or not
about the topic of his escape.
if he told the nurses in the
facility and not just his
companions about his sadness.
- Therapeutic. The student nurses
bring back the thought that the
client had said to know if the
thoughts are same and knowing
162 | P a g e
dugay na silang wala nakabisita

nimo, nieskapo ka.
more about it if the client

corrects some of the
information understood by the
student nurses.
Therapeutic. We continued on
telling him what we had
observed and understood about
what he said about missing his
siblings.
Therapeutic. We shifted to
another topic about what was
his reason that he chose to go
to the market.
Therapeutic. We told the client
that we are there for him to
listen to him whenever he feels
sad. We make ourselves
available for him to share what
he thinks or what he feels
(Videbeck, p.117).
Therapeutic. We are asking our
client about possible ways to
lessen his sadness.
Therapeutic. We asked the client
about the exact happenings
during his escape.
SN: Kay ganahan ka makakita ka

sa imung pamilya Sir, niadto kag
tiangge kay aron mawala ang
imung kaguol?
Oo.
V: Reflecting
SN: Sa unsang rason na sa

tiangge man ka niadto?
Wala ra. Nagsuroy-suroy ra.
V: Exploring
SN: Kung naguol ka Sir, naa

raman mi diri aron imung
kaistorya. Dili man mi kabalo
kung kanus-a ka makauli pero
while naa mi diri ganahan mi
mutabang na mawala ginagmay
ang imung kaguol na gibati.
SN: Unsa man ang ganahan nimo
na himuon para mawala imung
kaguol?
SN: So balik ta sa nahitabo Sir ha.
Unsay nahitabo diay atong
hapona to na nieskapo man ka?
(silence)
V: Offering self
(silence) (client stares blankly

ahead) Mag-istoryahanay ra ta.
Niaagi ko anang sa gate. Kanang

sa pikas gate. (points at the
direction where the other gate is
located.) Dili man na lock.
Ay dili. (shakes head no,
maintains eye contact) Pero din a
nako himuon na. Di na nako
himuon na katong, ah, mulayas.
Wala man pud koy mahimu didto
V: Exploring
V: Exploring
- Therapeutic. We go deeper about

the information of his escape.
V: Exploring
- Therapeutic. Since our client had
SN: Di diay na lock Sir?
SN: Unsa may rason na dili naka
163 | P a g e
mubalik pa ug gawas?
SN: So nakarealize ka Sir na

mubalik nalang ka sa center kay
layo ang Kabangkalan?
SN: Ang imung buot pasabot Sir
kay nibalik nalang ka diri sa
center kay kabalo ka na ang usa
ka pamaagi aron makauli ka kay
ang center rapud?
SN: Unsang orasaha ka nakauli
diri Sir?
SN: Pagkabuntag na Sir? Unsay

nahitabo diay na dugay ka niuli
pa?
SN: Unsa ang naa sa imung hunahuna atong pagkagabie Sir?
SN: Imuhong gituohan kay ang

usa ka pamaagi aron makauli ka
sa Kabangkalan ka yang pagstay
diri sa center mao ng nibalik ka?
SN: If Mary Ann did not find you,
sa gawas. Mao nibalik nalang pud

ko diri. Layo man gud ang
Kabangkalan City sa Dumaguete
City.
Oo. (nods head, maintains eye
contact)
V: Restating
told us about not going to

escape again, we asked about
his reason of not doing the
action again.
- Therapeutic. We put his answers
in simpler words as how we
understood it.
- Therapeutic. We are trying to put
the vague words of the client
into more understandable ones.
Oo.
V: Restating
Pagkabuntag na.

sequence
Didto man ko natulog sa tiangge.

Pagkabuntag nako nila nakit-an.

sequence
Nahuna-hunaan nako na maypa

nibalik nalang ko sa center kay
wala raman pud koy gihimo sa
tiangge. Mao ng nikuyog nalang
ko nila pag-uli sa rehabilitation
center. Nagmahay ko na maypa
nibalik nalang ko diri.
Oo. (maintains eye contact)
V: Reflecting
- Therapeutic. We told him what we

understood from his reply.
Yes, I want to come back--- come
V: Exploring

the time he came back. This
means we clarify things by
asking for the time or sequence
of events (Videbeck, p.117).
- Therapeutic. Clarifying about the
event helps us know the
sequence.
what was he thinking while he
was sleeping in an unfamiliar
environment.
164 | P a g e
would you want to come back

here?
SN: Do you believe that there is a

reason for you to come back
here?
back here. I wanted to go back to

Kabangkalan but I dont have a
money so I cant manage to go
back to ride a bus. No money to
pay. So when the watcher saw me
in the market, I, I go back here.
Yes. (nods head) So that the
doctor can heal me.
what could have happened to

our client if he was not found by
his watcher.
V: Exploring
SN: Para nimo Sir, unsa man

imung sakit na icure sa doctor?
Nervous, ah, nervous breakdown.

But my feeling is okay.
SN: Do you experience nervous

breakdown?
Before, but now a little nervous

breakdown.
SN: When was the last time you

had a nervous breakdown?
Tungod man ni atong nabangga

akong ulo atong nagpractice mig
self-defense.

sequence
SN: Unsa man imung bation inig

magnervous breakdown?
Pag nay lainna dili mayo akong

makita, makuyawan ko.
V: Encouraging description of
perceptions
SN: Diri sa center Sir,

nakaeperience ba ka ug nervous
breakdown?
Oo, atong naay nag-away diri

dayon nagdala sila ug sundang ug
palakol na gikan sa kusina.
Nakuyawan ko. Pero si Cecille kay
niuli na nuan. Naa raman ko ato

more about why he came back
willingly to the center with his
watcher.
- Therapeutic. Asking this helps
client express what he
understands about his
condition.
if what we heard is correct and
to seek clarity of the vague
response (Videbeck, p.117)
- Therapeutic. We asked about the
last time he had a nervous
breakdown to know if it has a
relation with his current
admission.
what were his behaviors
whenever he have nervous
breakdown.
if it happened to him inside the
facility.
165 | P a g e
SN: Unsa man imung himuon inig

magnervous breakdown ka?
SN: Ay Sir, mana na ang atong

interaction karon, ato lang ning
ipadayun next week.
SN: Sige Sir. (nods head) Dayun
ayaw ug kalimot na maligo ka ha.
SN: Salamat kaayo sa imung
kooperasyon Sir. Mubalik lang nya
mi next week. (gets up from
sitting)
SN: Sige sir, muuna na mi. (starts
walking)
diri sa akong kwarto, nag-ampo

lang ko.
Okay raman, kaya raman nako.
Makuyawan rako ana kay
magsakitanay nya sila. Mahospital
unya sila. (maintains eye
contact)
Aw sige. Pero dili na nako himuon
tong pag-eskapo nako next time.
V: Exploring

how he calm himself whenever
his nervous breakdown sets in.
- Therapeutic. We told the client

that the interaction has come to
an end.
- Therapeutic. We reminded him to
take his bath for the day.
- Therapeutic. Being grateful for
the interaction and it tells that
the interaction is nearly coming
to an end.
- Therapeutic. We finally told the
client that we are going.
Okay.
Okay. (stands up from sitting)

Salamat Charles ,Fate.
V: Acknowledging
Okay. (waves)
166 | P a g e
SYNTHESIS
During our sixth interaction, we had gathered more information from our client. Just before our interaction with our client, we had discovered that our
client had escaped from the facility in the afternoon on Wednesday (the day we had our interaction with the client). The staff told us that they cannot let
our client leave his cell due to escape precautions. Because of that newly discovered information, we had changed the questions that we are going to ask
to our client. Instead of questioning him about his first admission in Bacolod, we focused more on the reason as to why he escaped and about how he felt
about it. Our client said that he was lonely during that time that he wanted to go home and ended up in the market where he slept for a night. He misses
his family stated he wanted to catch a bus and go home; we talked more about it and asked him what he thought about the whole thing. He said that he is
not inclined to do repeat his stunt again; he was just driven by his sadness, which led him to escape. We asked him how we can help him, but he
consistently tells us that having an interaction with him is fine.
We also observed the changes of our clients nonverbal cues. He seldom rubbed his legs; he would sometimes hold the hem of his shorts. He
maintains eye contact whenever he answers the questions. Despite having the bars separating our client from us, the student nurses, we continued to
maintain active listening. According to Townsend, With active listening, the nurse communicates acceptance and respect for the client, and trust is
enhanced (p. 106); so even with the divider between the conversation, our communication was not hampered by this obstacle present. He would engage
in the same superficial responses unless we focused on a topic to the point where he realizes we will not stray from the questions to which his unrelated
responses are a waste of energy. Unfortunately, by him not admitting to us that he escaped last week, despite the questions surrounding the events of his
escape, we were forced to inform him that we were personally informed about his escape. With that being clear, he was then open to elaborate, to an
extent, of his thought process and made it clear that he came back to the center voluntarily. By introducing to our client the knowledge we possess, this
then lets the client realize that his superficial tactics are ineffective and we are willing to delve deeper to find out more and more about him so that we can
use these findings to accurately assess him, plan and implement interventions, and evaluate our results from the initial interactions held with F.M. We hope
that he decides to reveal more in future interactions in order to increase our understanding about our client and to ultimately help him mentally. As we
have mentioned with him during the orientation phase, we are there to help him.
167 | P a g e
Termination Phase

February 26, 2014
168 | P a g e
Client Information
Name: F. Magellan
Age: 45 years old
Gender: Male
Status: Single
Birthdate: N/A
General Impression: Client calm, alert and oriented to time and place. Moderate build, short stature. Ambulates independently. Communicates coherently
in low monotone voice.
Doctors orders: Admit at payward, routine ward care, diet as tolerated, TPR every shift, FD cc IM, CPZ (Dysnur) 100 mg 1 tab twice a day, Apiden as
necessary. Place on suicide/ escape precaution. Refer accordingly.
SEATING ARRANGEMENT
169 | P a g e
LEGEND
= Toilet
ISOLATION C, ROOM 8
= Bed
= Client
= Student
= Chair
= Gate
Due to his escape last week, we were unable to release our client out of his room for this interaction. Positioned approximately 3 feet from
F.M., we were seated on chairs next to the gate of his room in isolation section C while the client was seated on his bed inside his room, at eye level.
According to Videbeck, The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart (p. 113), so we
were situated appropriately for this interaction. Even when we were unable to sit down at our usual lobby area, we were still able to communicate
efficiently with our client. Videbeck states, Sitting beside or across from the client can put the client at easy, while behind a desk (creating a physical
barrier) can increase the formality of the setting and may decrease the clients willingness to open up and communicate freely (p. 122); the bars that
stood between us created a barrier, but the established rapport and trust we have developed over the past interactions did not seem to have an effect on
our interaction today.
THOUGHTS AND FEELINGS PRIOR TO INTERACTION

170 | P a g e
Charles Deans thoughts and feelings:

In preparation for our final interaction in the termination phase, we planned to reflect with the client the progress that has been made with the
combined interactions within our agreed contract setting which took place about two months ago. I am personally unsure of what kind of emotions the
client will display for the last interaction, although most likely it will be the same ayos naman attitude he has shown to us repeatedly in each interaction. I
can only hope that he does not avoid answering our questions to the point where his answers do not correlate appropriately.
Fate Oiras thoughts and feelings:

Before our last interaction with our client, my partner and I talked about how we are going to tell to our client that it will be the last interaction that
we will have with him. I was a bit confused and nervous because I dont know what to say and I dont know how to properly end our contract with our
patient. I was thinking that he might withdraw once he will know that our contract has ended. He might not answer our questions anymore. Because of this,
I asked my partner how Im going to tell him about it since I was the interviewer for the day. He told me what to say to our client, but still I was still nervous.
I might not be able to deliver those questions properly. But, with my partner with me, I know that he would help how to say those things to our patient.
OBJECTIVES
Within our 45-minute NPI, I will be able to:
171 | P a g e
Use all therapeutic communication techniques effectively.

Avoid nontherapeutic communication techniques satisfactorily.
Record or note any nonverbal cues client may show.
Perform our roles efficiently.
Formulate questions effectively:
Ask some questions for clarification:
About his family:
What are the names of your grandparents on both sides of your parents?
What are the names of your parents siblings?
What are their age and disease condition and if they are dead or still alive?
About the whole interaction:
What can you say about the entire interaction that we had?
Do you feel accomplished with everything that we had done in the center?
Do you think that we are of help on your stay in the center?
What are the changes that youve noticed in you from the start of our interaction to the end?
What are your thoughts and feelings now that this is our last interaction?
Client-centered objectives:
Within our 45-minute NPI, our client will be able to:
Maintain a friendly behavior.
Maintain eye contact satisfactorily.
Prepare himself prior to interaction.
Answer the questions satisfactorily.
Would open up about his thoughts and feelings about the end of our interaction with him.
Student Nurses Verbal &

Non-verbal Communication
SN: Good morning, Sir. (smiles)

Communication
Good morning din Charles (nods
to Charles), Fate (turns to Fate)
Communication Technique
Used
NV: Accepting
Analysis
by name [] shows that the
nurse recognizes the client as a
172 | P a g e
SN: Kamusta man ta run Sir?
Okay ra. (stands up, maintains

eye contact)
Broad openings
SN: Nakaligo ug nakapamahaw

nata Sir?
Oo. (nods head, sits down on his

the side of his bed near the door
of his room)
V: Exploring
SN: Nakainom nakag tambal Sir?
Oo, ganihang buntag. Psynor ang

ngalan sa tambal.
V: Exploring
SN: Unsa man imung paminaw

pagkahuman nimo ug tumar sa
tambal Sir?
Okay raman.
person, as an individual
(Videbeck, p. 117). We, the
student nurses, greeted the client
upon the fifth interaction.
Eye contact [] is used to
assess the other person and the
state.
how he was doing.
greeting and went further by
asking about his hygiene to
know if hes prepared for the
interaction for the day.
-Therapeutic. We wanted to know
if our client was informed in every
medications he is taking.
Therapeutic. Videbeck states this
is asking the client to appraise
the quality of his experiences
173 | P a g e
(116), so we hoped to illicit how

he feels after medication
administration.
-Therapeutic. Informing the client
of facts increases his knowledge
about a topic or lets the client
know what to expect (Videbeck,
p. 117), so in that regard, we
directly informed him of what we
were told. This was used since we
wanted him to know what are the
things that would cover our whole
interaction.
SN: So, karong buntaga Sir, atong

istoryahan ang tanan natong
giistoryahan atong una natong
interaksyon hantod karon.
Amongh ipahibalo nimo na karon
na diay ang last nato na
interaksyon. Diba nagsabot man
ta atong una na mga hapit sa
bulan sa Marso mahuman ang
atong inbteraksyon. Pero bag-o
nato humanon ang atuong
kontrata, naa lang mi mga
pangutana na among nalimtan ug
pangutana atong niaging
interaksyon nato.
SN: So, mubalik ta atong gabahin
sa imung pamilya. Mangutana
unta mi kung unsay pangalan sa
imung mga lolo ug lola ug kung
naa ba silay sakit ug edad Sir.
Sugod ta sa side sa imung papa
Sir.
SN: Naa ni silay sakit Sir?
Sige, okay ra.
Si Marshal Mayang ug si Lola

Besyang.
-Therapeutic. The nurse should

interaction with clients (Videbeck,
p. 117); with this, we wanted
know more about his family.
Tigulang naman sila.
V: Exploring
SN: Unsa may sakit ni Lolo

Marshal Sir?
Ay namatay kay tigulang na.

nalimut lang ko sa edad.
V: Exploring
SN: Si Lola Besyang Sir?
Namatay pud kay tigulang na,

nalimut ko sa edad pud.
V: Exploring

more about grandparents.
- Therapeutic. Going deeper into
the details, we were trying to find
out more about his family.
-Therapeutic. W wanted to know if
he can remember something
174 | P a g e
SN: Sa side sa imung mama Sir?
SN: Pila man kabuok managsuon

ang sa side sa imung papa Sir?
SN: So six diay silang managsuon

Sir?
SN: Sa side sa imuhang mama
Sir?
SN: Unsa diay pangalan sa imung

mama Sir?
SN: Ikapila diay siya Sir?
SN: Ah, ikatulo. (nods head) Si
papa nimo Sir?
SN: (nods head) Sige Sir, balik tas
igsuon sa imung mama. Kinsay
sunod ni Luisito Sir?
Lolo Luis, namatay napud.

Nalimut ko sa edad. Si Lola
Visitacion, namatay napud.
Nalimut pud ko sa edad niya.
Si Tatay, sixty-six namatay.
Nagcardiac arrest siya. Si Beking,
nalimut ko sa edad. Si Morito,
nalimut ko sa edad, namatay na.
Si Kulong, buhi pa siya run,
nalimut ko sa edad. Si Nenita,
nalimut ko sa edad ug buhi pa
siya. Si Milly kay buhi pa pero
nalimut ko sa edad.
Oo.
V: Exploring
Ernesto, nalimut ko sa edad.

Namatay napud na siya. Si Angel,
nalimut ko sa edad, pero buhi pa
siya. Si Luisito, buhi pa pero
nalimut ko sa edad.
Si Luisa.
V: Exploring
Ikatulo.
V: Exploring
Siya ang kinamagulangan.
V: Exploring
Si Carmen, patay na, nalimut pud

ko sa edad. Si Anita ang sunod,
nalimut ko sa edad pero buhi pa
siya. Si mama ang nisunod, sixty-
V: Focusing
about his grandparents.

-Therapeutic. We now move to ask
him about his grandparents on his
mothers side.
V: Exploring

more about the siblings of his
father.
V: Clarification
-Therapeutic. We used this since

we wanted to clarify the vague
ideas we had gotten from him.
-Therapeutic. Since we were done
asking about his fathers siblings,
we asked him about his mothers
siblings.
V: Exploring

the name of his mother.
more about his mother.
-Therapeutic: We wanted to know
about his father.
-Therapeutic. After asking about
his parents and interrupting the
topic at hand, we went back on
the topic.
175 | P a g e
SN: Sa side sa imung papa Sir,

kinsay naay sakit nila?
SN: Sa side sa imung mama Sir?
seven siya. Si Deti, patay na.

Feudita ang sunod. Nalimut pud
ko sa edad pero buhi pa siya.
Milagros, buhi pa pero nalimut ko
sa edad.
Si papa raman akong
nahinumduman na naay sakit.
V: Exploring
Si Luisito, naa pud siyay sakit.

Naniwang ra siya. Wala pud ko
kabalo sa iyang sakit jud pero
naniwang lang siya before siya
namatay.
Mao raman to.
V: Exploring
SN: Si mama nimo Sir, unsay

sakit niya?
Diabetes man to pero naa man to

siyay tambal giingon.
V: Exploring
SN: Sige Sir, mao lang na among

mga pangutana kabahin sa
imung pamilya. So, muadto nata
aning about sa atong mga last
interactions ug atoang tan-awon
kung unsay mga nangahitabo.
SN: Sa atong interaksyon sukad
sa una hangtod karon Sir, unsa
man ang imuhang gibati?
(nods head, stares blankly ahead,

touches right knee with both
hands)
Okay raman. Nalipay ra ko.

V: Broad openings
- Encouraging expression
SN: Sa uban na igsuon sa imung

mama Sir?
V: Exploring

if some of the siblings of his
father have disease conditions.
if some of the siblings of his
mother have disease conditions.

more if there are other siblings of
his mother who have disease
condition.
if his mother have other disease
condition since he has been
talking about how ill his mother
was way back home.
-Therapeutic. Giving information
would help client know about the
next topic that we are going to
discuss.
-Therapeutic. To let the client

know that the nurse is there to
listen to his expression of
feelings (Stuart and Laraia, p.30)
176 | P a g e
about the whole interaction from

the start until the last.
-Therapeutic. The nurse should
interaction with clients (Videbeck,
p. 117) With this, we wanted to
know more about the reasons that
he was glad about the whole
interaction with him.
more about the reason of his
happiness and by nodding our
heads we show him that we
understood what he was saying.
if there are changes that he had
observed on his own self in the
course of our interaction.
SN: Pwede ba nimong

maelaborate ang rason na
nalipay ka?
Kay nag-istoryahanay man ta

ug nagshare ta ug mga ideas.
SN: (nods head) Unsa paman Sir?
Nag-istoryahanay lang ta,
V: Exploring
NV: Accepting
SN: Kung imung ikompara tong

una na nag-interaksyon ta ug
karon Sir, naa ba kay mga
nabantayan na nausab sa imung
kaugalingon?
SN: Oo (nods head). Unsa diay
imung behavior sauna Sir?
(silence) Nausab ang akong

attitude.
Sauna, katong sige rako

mangisug pero karon kay dili na.
Sauna pwede ra ko makagawas
karon kay usahay nalang, inig naa
ray activities sa chapel.
Kung magsimba lang mi,
makagawas lang ko. Depende
man gud sa mga watcher kung
pagawson ba mi or dili.
Ay wala man. Kamo raman.
V: Accepting
- Exploring
-Therapeutic. This means that we

heard him right and we wanted to
know about his behavior before.
V: Silence
-Therapeutic. Silence gives time

for the client to think (Stuart and
Laraia, p. 35) about his behavior.
V: Exploring

if there are other students who
have interactions with him except
us to assess how he interacts with
SN: (nods head) (silence)
SN: Naay laing mga estudyante

ang makig-interaction nimo Sir?
177 | P a g e
SN: So, dili ka pagawason sa

imung kwarto except kung naay
simba dayun walay laing
estudyante ang naay interaction
nimo except namo.

ahead)
V: Reflecting
SN: Unsa man ang imung gibati

ani Sir?
(silence) Okay raman, at least

nag-istoryahanay tau g nagshare
ug ideas.
Broad openings
SN: Sige, balik ta about atong

past interactions nato. Unsay
mga nausab nimo Sir?
(silence)
Encouraging comparison
SN: Para nimo Sir, unsay changes

na imung nabantayan sa imung
kaugalingon while naa mi diri?
While nag-interaction ta, daghang

nausab sa akong kinabuhi.
SN: Sama sa unsa Sir?
Makig-istorya ug tarong sa laing

tawo.
Exploring
other people.
-Therapeutic. Reflecting lets the
patient that the nurse heard him
right and understood him thus
repeating what he says to also
gain validation of information
received. (Stuart and Laraia,
p.31) We told him this to also
know if we had missed some
information that he might want to
add on his previous statements.
Therapeutic. Since the client
seems hesitant about talking, this
may stimulate him to take the
initiative (Videbeck, p. 116)
toward expressing his thoughts
about anything he has on his
mind.
Therapeutic. This is encouraging
the client to verbalize what he
perceives (Videbeck, p. 116) from
the changes that he has noticed
from the first interaction on day
one, up until todays termination
period.
Therapeutic. He continues to have
difficulty voicing his thoughts, so
we formulated the question in a
way that would better illicit a
response from our client.
Therapeutic. By delving further
into the subject (Videbeck, p.
178 | P a g e
SN: Dili diay ka makig-istorya sa

imung mga kauban diri Sir?
Nakig-istorya man. Pero atong sa

balay namo, sa akong mga igsuon
lang ko tig-istorya kay sa balay
raman ko sigeg pundo.
Reflecting
SN: Sa atong interaksyon Sir, apil

ba ang makig-istorya sa mga
behaviors na nausab nimo?
(silence)
Exploring
SN: Sige Sir, iistorya lang namo.
Aning interaksyon, nakaistorya ko

sa akong mga gipangbati.
Nagshare ta ug ideas.
General leads
SN: (silence)
Silence
SN: Sige Sir, iingon lang namo ug

unsa ang naa sa imung hunahuna.
Sa akong attitude.
Broad openings
SN: Unsa man about sa imung

attitude?
Sauna kay dali ra ko mangisug.
Exploring
116), we can find out what he

thinks has changed.
Therapeutic. By directing his
thought of being only able to
have conversations with the
student nurses, rather than other
people, this encourages the client
to recognize and accept his own
feelings.
Therapeutic. Asking the client
about his behaviors that may
have changed may encourage
him to elaborate.
Therapeutic. To show him we are
still interested and encourages
him to continue conversing with
us.
Therapeutic. Silence gives our
client time to think about the
direction of where he would like to
continue the interaction or say
what hes thinking.
Therapeutic. The time he is taking
to think about how he responds to
our questions may be related to
the difficulty in coming up with
answers. This may stimulate him
to take the initiative.
Therapeutic. He is beginning to
voice out that his attitude has
changed over the course of our
interactions, so we delve further
179 | P a g e
SN: Miskan nga naa ka diri Sir?
Ay, dili kaayo atong pag-abot

nako, pero nausab jud kay kabalo
nako mucontrol sa akong kalagot
karon.
Reflecting
SN: Namong mga student nurse

Sir. Nakatabang ba mi nimo sa
pagsolbar sa imung mga
problema especially ang imung
kaguol na naa ka diri sa center?
Nakatabang man mo nako kay

nakig-istorya mo nako.
Seeking information
SN: So, among presensiya

nakatabang kanimo Sir?
Oo, nakatabang.
Reflecting
SN: Sa unsang pamaagi

nakatabang mi nimo Sir?
(silence)Pinaagi sa pagshare sa
atong mga ideas.
Exploring
SN: (silence)
Nagseshare tau g ideas ug

nitabang mo diri namo sa center.
Silence
SN: (nods head) Sa atong

interaksyon sukad sa una
hangtod karon, naa ba kay
naachieve or nabuhat parea sa
imung kaugalingon na mayo?
(silence)
Exploring
into that subject (Videbeck, p.

116).
Therapeutic. By directing the
clients thought back to him about
his attitude, we encourage the
client to recognize and accept his
own feelings.
Therapeutic. The fact that he
feels that his attitude has
changed and he still feels uneasy
being in the center, we want to
know if our presence with him is
helping him with his situation.
Therapeutic. We directed the
thoughts back to F.M. when he
stated that we do in fact help him
by having interactions with him.
Therapeutic. After he admits that
our presence is helping him, we
delve further into the subject by
asking him what exactly we do
that helps him.
Therapeutic. In pursuit of having
him continue speaking his
thoughts, we allow him to
continue speaking by keeping
silent and have him speak.
Therapeutic. In addition to the
interactions being helpful, we
want to further look into what our
client does to improve himself.
180 | P a g e
SN: Sige Sir, iistorya lang unsa

imung ganahan iingon namo.
(silence)
Offering self
SN: Do you have any difficulty in

expressing your thoughts to us?
My emotion is that we understand

each other. (stares blankly ahead)
SN: Naa kay kalisud sa pagexpress sa imung gihuna-huna

Sir?
I express my (silent,rubs both

hands to the right knee)
Exploring
SN: Sige Sir, you express your

emotions through?
I express my emotions when Im

happy. I express my emotions by
sharing and talking it to you.
General leads
SN: Sir, Ive noticed that you

touch your right knee so often.
Do you feel anxious or
uncomfortable when talking with
us?
Wala man pud ko nakuyawan inig

mag-istoryahanay ta. (stares
blankly ahead, stops touching the
right knee) Ganahan rajud ko
muhikap sa akong tuhod.
Making observations

gibati na nag-interaksyon ta
karon?
Nalipay ko kay naay tay

interaksyon karon ug nagshare ta
ug ideas ug wala ko naguol kay
naa koy kaistorya.
Therapeutic. His lengthy response

time led us to simply state that
we are here to listen to what he
has to say or even have a
conversation about any topic he
desires.
Therapeutic. His inability to reply
to our previous questions led us
to question him to make his own
appraisal with the current
experience.
Therapeutic. His response is not
congruent with what was asked,
so we ask him again in his dialect
if he is having difficulty in
expressing himself.
Therapeutic. Giving him the
encouragement to continue
(Videbeck, p. 116) will hopefully
allow him to complete his train of
thought.
Therapeutic. If the client cannot
verbalize or make themselves
understood, the nurse verbalizes
what he perceives (Videbeck, p.
117), so in this case, his frequent
grasping of the knee during all of
our interactions.
Therapeutic. While we have our
final interaction, we want to know
how the client appraises his
experience with us.
181 | P a g e
SN: So, wala raka nakuyawan

karon na nag-inteaksyon ta
karon?
Wala raman. Komportable raman

ko.
Reflecting
SN: Unsa ng naa sa imung left

arm na murag naay sulat Sir?
Ay, lion king na.
Making observations
SN: Unsa diay nahitabo na imung

gipatattooan imung arm Sir?
Ay, ako rang gisulatan.
Exploring
SN: Daun Sir?
Dugay naman ni atong high

school paman ko ani. Cross man
unta na pero tuldok-tuldok lang.
Ay, wala raman kay high school
rako ato.
General leads
Okay raman na mubalik ko sa

Kabangkalan.
Oo, okay raman ko. Pwede naman

ko makauli sa Kabangkalan kaso
wala paman ko gikuha sa akong
Restating
SN: Ah, unsa man imung gibati na

imung gibutangan ug tattoo
imung kaugalingon Sir?
SN: So mubalik ta sa imung

pagstay diri Sir. Do you think that
returning home to Kabangkalan
without completing you
treatment here is a good
decision?
SN: So sa imong paminaw kay
okay naka run Sir?
Exploring
Therapeutic. To confirm that our

presence is therapeutic, we ask if
he feels anxiety about interacting
with him.
Therapeutic. By verbalizing what
the student nurse perceives on
the client, which seemed like a
tattoo, he can hopefully give us
an explanation that may describe
our client more fully.
the topic of the tattoo appearing
mark on his arm, we wanted him
to continue leading the
conversation.
Therapeutic. We asked him to
continue speaking about the
history of the tattoo.
Therapeutic. To have him lead the
conversation about the tattoo, we
ask more about his thinking
process during the tattooing
event.
Therapeutic. After his escape a
few weeks ago, we wanted our
client to make his own appraisal
toward his own condition.
Therapeutic. Repeating the main

idea expressed (Videbeck, p. 117)
lets the client know that he
182 | P a g e
manghod run.
SN: So okay ra nimo na dili

mahuman ang imung treatment
diri?
(silent, no reponse from client;

stares blankly ahead)
Reflecting
SN: So Sir, hapit naman ta

mahuman sa atong interaksyon
run, naa pa ba kay ganahan
ishare namo?
Ay wala naman.
Broad openings
SN: Sige Sir. Diba nagsabot man

ta na magtherapy ta last time?
Ay, ayaw nalang. (shakes head)
Offering self
SN: Unsa may rason na dili

nalang ta magtherapy?
Ayaw ra kay madugay pa ta.
Exploring
SN: Okay Sir. Since dili raman ka

ganahan na magtherapy ta, naa
kay ganahan ishare about sa
imung gibati during sa atong
intertaction karon?
Nalipay ko kay nag-istoryahanay

ta karon.
Exploring
SN: (nods head) Okay Sir,
Salamat pud ninyo Charles or
Giving recognition
communicated that he is indeed

ready to go home. This can be
worrisome as he may have the
desire to attempt another escape.
Therapeutic. Directing his own
thoughts back to the client
himself can either make him
accept or deny the statement he
made that he is ready to go
home.
Therapeutic. After our final
interaction day, we want to know
if there is anything he would like
to say to us or make a
conversation about.
Therapeutic. In addition to the
interaction, we presented again
the plan to have art therapy and
in this process, making ourselves
available to him.
Therapeutic. His refusal to carry
on the planned activity made us
curious. We went further into the
subject of why he did not want to
participate in the agreed therapy.
Therapeutic. After he declined the
proposed therapy, we wanted to
deeper into the topic of his
thoughts and feelings. Any
problem or concern can be better
understood if explored in depth.
Therapeutic. Mutually
183 | P a g e
salamat kayo sa pagkoopera

namo karong inetarakston nato
ug katong miaagi na mga
interaksyon.
SN: Sige Sir, muuna na mi.
Fate.
Sge Charles, Fate. Salamat. (nods

head)
acknowledging that the

interaction is over with our client.
Giving recognition
Therapeutic. Informing the client

that we are leaving to indicate
awareness.
Synthesis
For our seventh and final interaction with F.M., we have reached the final stage in the nurse-client relationship. Even though the
termination phase is considered the resolution phase, we feel that more time and treatment is needed to properly connect with our client. We
believe that we have done the best we could do to effectively establish rapport and maintain a trusting relationship with our client; however,
he obviously has blocked away a big portion of his thoughts and feelings during every interaction. He limited his words and replied to our
questions in simple responses that lacked any sort of elaboration. For example, when we had asked him about the events that had occurred on
the day he escaped from Talay, he withdrew that important information until we mentioned how we were informed of his escape, which then
allowed him to respond elaborately in a way where he eventually stated regret toward the end. This regret was then void once he later stated
he did not regret his escape. Currently, he states being OK and is ready to leave the center once his brother comes to fetch him. These kinds
of incidences is what us student nurses wanted our client to openly admit and discuss. The fact that he hides this critical information implied
that what he verbalizes to us is just the tip of the iceberg. We have offered our presence and time in a calm manner, and used therapeutic
communication throughout each visit. Nevertheless, he verbalized that our presence and interactions with him helped him out with his stay in
the Talay Mental Rehabilitation Center. We are glad to have the opportunity of interacting with F.M. and being able to talk to him on a weekly
basis. We can only hope that his continued treatment will prevent him from having another nervous breakdown and potentially cause injury to
himself or others around him.
184 | P a g e

Behavioral Analysis Final

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COLLEGE OF NURSING

Psychiatric Nursing Rotation

MRS. NOYME LOUR ABEGIL L. LAVISTE

DEANS, Charles Ian E.

March 12, 2013

Topic Description & Objectives

Psychiatric-Mental Health Observation Checklist

Growth & Development

Assessment of the 5 Domains

Nursing Care Plans

Summary of Nursing Diagnoses

March 12, 2014

MRS. NOYME LOUR ABEGIL L. LAVISTE, RN, MN

Define clearly the various terminologies related to the discussion.

Analyze factors that led to the maladaptive behaviors of the patient.

Critically examine the patients growth and development.

Identify behavioral problems presented by our patient.

Discuss and apply appropriately the theories learned.

Identify behavioral problems presented by our patient.

Successfully trace the psychodynamics of the patient.

Evaluate the nursing care given to the patient.

Evaluate the behavioral analysis as a whole.

Age: 45 years old

Patient cannot recall the ages and cause of death of grandparents.

Patient cannot recall the ages

Patient cannot recall the ages and cause of death of

Patient cannot recall her age,

Facial Expression Shows

Stands up when we are nearing him and would greet

Sits down with a slight hunch.

Appears to be physically well-kempt.

Changes clothes when client has taken a bath, as

Body exhibits minimal movement; blinks eyes

DEVELOPMENTAL STAGE AND ANALYSIS

Autonomy vs. shame/doubt (toddler)

Industry vs. inferiority (school age)

Freuds Personality Components

Sullivans Interpersonal Relationships

Birth to onset of language

Primary need for bodily contact and tenderness

Need for special sharing relationship shifts to the

Utilizing VULNERABILITY-STRESS MODEL OF SCHIZOPHRENIA

Stressful Life Events

The patient is currently unemployed. He is

Selyes Stress-Adaptation Model

Lazarus Interactional Model

Ineffective immediate defense

Experiences and develops

Selyes Stress-Adaptation Model

Attempts to cope up with habitual

COGNITIVE AND AFFECTIVE

According to Abraham Maslow, a basic

Lazarus Interactional Model

Coping mechanisms are defined as the

Family resources such as parental and

Ego defense/coping mechanisms

Voluntary exclusion from awareness, anxietyproducing feelings, ideas, and situations/

Attempting to make excuses or formulate logical reasons

Separating a thought or memory from the feeling

When asked about or to further explain his

Verbalized that he was brought to TMRC because he

After the aggressive event of throwing chairs and

Prolonged use of coping

Selyes Stress-Adaptation Model