CENTRO ESCOLAR UNIVERSITY

COLLEGE OF NURSING
MENDIOLA, MANILA

In Partial Fulfillment of the requirement in

NCM 104

Community Mental Health Nursing

Family Problem

“MISCARRIAGE”

Prepared by:
PASTOR, Carl Anthony U.
UMALI Jr., Alberico D.

Submitted to:
Mr. Israel Jiel Fedelicio R.N
 ACKNOWLEDGEMENT

We would like to take this opportunity to thank the following:

Mr. Israel Jiel Fedelicio our community clinical instructor, for his patience

in relaying the information and suggestions to make this case study a success.

And for always being there and guiding us to carry out the task and also for the

bonding when we are in the community.

To our foster parents who cooperates in the course of interview and

Family therapy because without their cooperation this will not be possible, and

thank you for letting us stay in your humble place.

Our Family for their relentless support financially and emotionally in our

studies and thru their guidance and being an inspiration to continue our practice

in nursing in order to help them and other people in providing the proper health

care service to the fullest.

Finally, we must thank Almighty God for his guidance and our own family

for sustaining us with everything that we need in making this very useful work.

A grateful appreciation for their boundless compassion, encouragement

love and devotion.

 TABLE OF CONTENTS

CHAPTER 1 – Introduction

A. Discussion

 Concept of Community Mental Health ----------------------------------------

 Present Programs of DOH in relation to Community Mental Health ------

 Relevance of NCM104 Activities to Community Mental Health ----------

B. Application of Theories

 Application of Theories per Family Member ---------------------------------

 Application of Theories for High Risk Individual ---------------------------

C. Description of the Community

 General Description of the Community ---------------------------------------

 Spot Map ---------------------------------------------------------------------------

D. Definition of Terms ------------------------------------------------------------------------

CHAPTER 2 – Related Literature

A. (2) Related Literature regarding the Identified Case ---------------------------

 Summary ------------------------------------------------------------------------

 Significance of the Literature-------------------------------------------------

 Personal Viewpoints or Reaction--------------------------------------------

CHAPTER 3 – Presentation, Interpretation and Data Analysis

A. Tabular Presentation of Mental Health Aspects per Family Member -------

B. Summary of Mental Health Aspects per Family Member ----------------------

C. Summary of Mental Health Aspects for the Whole Family --------------------

D. Kaplan’s Paradigm for High Risk Individual -------------------------------------

E. Adaptive Functioning for High Risk Individual ---------------------------------

CHAPTER 4 – Family Therapy

A. Discussion

 Definition ------------------------------------------------------------------------

 Theories Applied in the Family -----------------------------------------------

B. Objectives ----------------------------------------------------------------------------

C. Sociogram ----------------------------------------------------------------------------

D. Family Tree --------------------------------------------------------------------------

E. Process Recording of the Family Therapy --------------------------------------

 CHAPTER 1

INTRODUCTION
DISCUSSION

CONCEPT OF COMMUNITY MENTAL HEALTH

Community mental health is a decentralized pattern of mental health,

mental health care, or other services for people with mental illnesses.

Community-based care is designed to supplement and decrease the need for

more costly inpatient mental health care delivered in hospitals. Community

mental health care may be more accessible and responsive to local needs

because it is based in a variety of community settings rather than aggregating

and isolating patients and patient care in central hospitals. Community mental

health assessment, which has grown into a science called psychiatric

epidemiology, is a field of research measuring rates of mental disorder upon

which mental health care systems can be developed and evaluated.

The programs of DOH regarding community mental health are the

following. Establish new and upgrade existing mental health facilities. Upgrade

existing competences on mental health for mental health professionals and

health care providers. Increase the percentage of health facilities, workplace and

communities that provide mental health services. Develop self- help and family

care programs. Increase the capability of health facilities for psychosocial

assessment and screening of mental disorders. In addition, emphasis was focus

on National Mental Health Program. These are the National Mental Health

Program (NMHP) now, under the Degenerative Disease Office of the National

Center for Disease Prevention and Control (NCDPC), Department of Health. It

aims at integrating mental health within the total health system, initially within the

DOH system, and the local health system. Within the DOH, it has initiated and

sustained the integration process within the hospital and public health systems,

both at the central and regional level. Furthermore, it aims at ensuring equity in
the availability, accessibility, appropriateness and affordability of mental health

and psychiatric services in the country.

Mental health is an integral component of total health. Issues on mental

health includes not only the traditional mental disorders but as important are the

concerns of target populations vulnerable to psychosocial risks brought about by

extreme life experiences (e.g. disasters, near death experiences, heinous and

violent crimes, internal displacement brought about by religious and civil unrest)

as well as the psychosocial concerns of daily living (e.g. maintaining a sense of

well being in these difficult times).

Services for mental health must be available within the public health as

well as the hospital system of the country. Such services must have primitive,

preventive, curative and rehabilitative component.

Mission

The purpose of the Community Mental Health is to: enhance the mental

health and developmental potential of the different community residents;

establish an appropriate continuum of community support service; and manage

local resources in a fiscally responsible manner.

Vision Statement

The Community Mental Health Board shall provide leadership to develop a

comprehensive array of community based services, which are cost-effective,

systematically evaluated, and responsive to evolving community needs. This

requires a flexible network of easily accessible services for the treatment and

prevention of mental illness, developmental disabilities, and substance abuse.

In pursuit of this vision, the board endorses the following concepts:

• Accessible, community focused network of care.

 • Development of a continuum of care, responsive to the community

and the evolving needs of clients-children or adults.

• Client centered approach to the provision of care provided in a

coordinated fashion responsive to presenting issues of clients.

• Providing choice within an array of community-based alternatives.

• Services must offer the opportunity to build on clients’ strengths as

well as their handicaps/disabilities.

• Improve the quality of life for the residents with disabilities.

PRESENT PROGRAMS OF DOH IN RELATION TO COMMUNITY MENTAL

HEALTH

National Mental Health Program

Program/Project

The National Mental Health Program (NMHP) now, under the

Degenerative Disease Office of the National Center for Disease Prevention

and Control (NCDPC), Department of Health. It aims at integrating mental

health within the total health system, initially within the DOH system, and the

local health system. Within the DOH, it has initiated and sustained the integration

process within the hospital and public health systems, both at the central and

regional level. Furthermore, it aims at ensuring equity in the availability,

accessibility, appropriateness and affordability of mental health and psychiatric

services in the country.

Brief Situationer

Mental health is an integral component of total health. Issues on mental

health includes not only the traditional mental disorders but as important are the

concerns of target populations vulnerable to psychosocial risks brought about by

extreme life experiences (e.g. disasters, near death experiences, heinous and

violent crimes, internal displacement brought about by religious and civil unrest)

as well as the psychosocial concerns of daily living (e.g. maintaining a sense of

well being in these difficult times).

Services for mental health must be available within the public health as well as

the hospital system of the country. Such services must have promotive,

preventive, curative and rehabilitative component.

Vision

Full integration of Mental Health in the national system

Mission

To make available, accessible, affordable and equitable quality mental

health care/services to the Filipinos especially the poor, the underserved and

high risk populations.

Mandate

To provide the Department of Health with necessary services related to

planning, programming and project development in mental health.

Functions

1. Advisory body to the Secretary of Health regarding mental health

concerns.

2. Acts as a policy making body regarding mental health concerns

3. Involves itself in training, research, supervision and, monitoring of mental

health resources/programs services.

 4. Mobilizes mental health resources for advocacy, planning, implementation

and service delivery.

Guiding Principles

• Mental health is not only limited to traditional mental illnesses but also

includes the psychosocial concomitants of daily living.

• Mental health programs must recognize the importance of community

efforts with multisectoral and multidisciplinary involvement.

• Mental health programs must address the promotive, preventive, curative

and rehabilitative aspects of care.

• Psychiatric patient care extends beyond the mental hospitals, and must be

made available in general hospitals, health centers and homes.

• Mental health activities and interventions must be done closest to where

the need or the patient is.

Strategies

• National diffusion and democratization of capabilities of mental health

facilities.

• Intensification and strengthening the training in psychiatry and mental

health.

• Peripheral development

• Development of clinical policies

• Institution building

• Focus on research

• Advocacy

• Networking

Priority Areas of Concern

• Substance abuse
 • Disaster and crisis management

• Women and children and other vulnerable groups

• Traditional mental illnesses (schizophrenia, depression and anxiety)

• Epilepsy and other neurological disorders

• Overseas Filipino workers

Goals

• Promotion of mental health

• Decrease health related effects of stressful lifestyle

• Reduction of prevalence of mentally ill and other health disorders in the

Philippines.

“Isang Dosenang S”

“Isang Dosenang S”, in which an individual must be healthy in order to

fulfill life. The 12 S is composed of: SPIRITUALITY, STRESS DEBRIEFING,

SPORTS, SELF-AWARENESS, SCHEDULING, SIESTA, SENSATION,

SOCIAL, SMILE, SOUNDS and SONGS, STRETCHING and SPEAK TO ME,

these things are followed and done, this can help the individual to be away from

stressful moments in life. Basically, these things will determine how the person

may handle his own decisions to endure problems physically, emotionally,

psychologically and mentally.

The 12 S with their meaning and significance:

1. Spirituality – is a state of being spiritual. It is pure, holy, relating of

matters of sacred nature, not worthy, ecclesiastical, possessing the nature or

qualities of a spirit.

2. Stress Debriefing - critical incident stress debriefing means to assist

crisis workers/ team member to deal positively with the emotional impact of a
severe event/disaster and to provide education about current and anticipated

stress response, as well as information about stress management.

3. Sports – are skills and games, which involve the participation of the

group of people or a person, competing with others for a common goal.

4. Self-awareness – means knowing yourself, getting in touch with your

feeling, or being open to experience. It increases your sensitivity to inner self

and your relationship with the world around you., how you respond to people

and what you have on them.

5. Scheduling (Time Management) – many people refer to time as a

resource. A resource is something that lies ready for use, or something that can

be drawn upon for aid. Time is a tool that can be drawn upon to help accomplish

results and that it can take care of a need, an assistant in solving problems.

6. Siesta – means taking a nap, short rest, a break or recharging or

“battery” in order to improve productivity. It helps relax the mind and the body

muscles. Rest or siesta is an important as giving enough exercise. Rest is

necessary to support human life. Rest refreshes the whole body and person

feels a sense of well-being.

7. Stretching - are simple movements performed at a rhythmical and slow

pave executed at the start of demanding activity to loosen muscles, lubricate

joints, increase body’s oxygen supply. It requires no special requirement, no

special skills and can be done anywhere and anytime.

8. Socials – socialization plays a very important role in the development of

interpersonal relationship. Through socialization life becomes meaningful,

happy and worthy. Dance is a form of social activity. Through dance, man

enjoys his body’s love and express gestures and releases tension through

rhythmic moves.

9. Smile – it has been observed that individual workers who always smile

are healthy people. A healthy worker, which provides an atmosphere, that is

favorable, conductive to the attainment of goals and objectives of the

organizations.

10. Speak to me – communication is the means by which people make their

needs known. It is the way they obtain understanding, reinforcement and

assistive from others. Communication is aimed at a goal, so it must remain open

until the goal is reached.

11. Sounds and Songs – music plays an important part in everyday life of

every citizen. It provides a medium of expression of thoughts and emotions.

Music is believed to have tremendous moral and social forces, arousing man

into action and giving them awareness of the world of peace and liberty of music

add to the quality of living every man needs.

Sensations Techniques (Massage) – massage helps to soothe away to

stress unknotting tense and aching muscles relieving headaches and

helping sleep problems. Massage s also invigorating, it improves the

functioning of many of the body’s systems promotes and tones muscles,

leaving with a feeling of renewed energy.

National Objectives

Health Status

• Reduce by 1 percent the prevalence of mental health problems:

major depressive disorders, schizophrenia, and alcohol and drug abuse.

• Reduce by 5 percent the members of the workforce who have

experienced adverse life experiences as consequences of stress in the

workplace. (Special target group: government employees).

Risk Reduction
 • Increase the proportion of high – risk population (victims of violence

and disaster, OFWs, children in extremely difficult circumstances and

adolescents) who seek help for personal and emotional problems.

• Increase the proportion of children who avail of psychological

stimulation and assessment for mental health.

• Increase the proportion of members of the workforce who avail of

stress management services. (Special target group: government

employees).

Services and Programs

• Establish new and upgrade existing mental health facilities.

• Upgrade existing competencies on mental health, for mental health

professionals and health care providers.

• Increase the percentage of health facilities, workplace and

communities that provide mental health services.

• Develop self-help and family care programs.

• Increase the capability of health facilities for psychosocial

assessment and screening of mental disorders.

• The modern management of mentally ill patients is similar to other

chronic diseases. Home care management is promoted. Acute cases are

referred to the National Care for Mental Health (NCMH) or hospitals with

psychiatric facilities for proper management. They are screened and after

a few days they are assessed and discharged if they can be managed at

home. Cases needing continuing supervision and care may be confined. A

team from the NCMH follows up their discharged patients in the provinces.

Nursing Responsibilities and Functions

In Mental Health Promotion

 • Participate in the promotion of mental health among families and

the community.

• Utilize opportunities in his/her everyday contacts with other

members of the community to extend the general knowledge on mental

hygiene.

• Help people in the community understand basic emotional needs

and the factors that promote mental well being.

• Teach parents the importance of providing emotional support to

their children during critical periods in their lives (i.e. first day in school,

graduation, etc).

In Prevention and Control

• Recognize mental health hazards and stress situations as

unemployment, divorce or abandonment of children, vices, long standing

physical illness, all of which may make heavy demands on the emotional

resources of the persons concerned.

• Recognize pathological deviations form normal in terms of acting,

thinking and feeling and make early referral so that diagnosis and

treatment could be done early.

• Be aware of the potential causes of breakdown and when

necessary take some possible preventive action.

• Help the family to understand and accept the patient’s health status

and behavior so that all its members may offer as much support in the

readjustment to home and community.

• Help patient assess his/her capacities and his/her handicaps in

working towards a solution of his/her problem.

• Encourage feeling of achievement by setting health goals that

patient can attain.

 • Encourage the patient to express his/her anxieties so that fears and

misconceptions can be cleared up.

• Impart information and guidance about the treatment plan of the

patient, the desired and undesirable effects of the tranquilizers, psychiatric

emergency management and other basic nursing care.

Rehabilitation

• Initiate patient participation in occupational activities best suited to

patient’s capabilities, education, experience and training, capacities and

interest.

• Encourage and initiate patients to participate in activities of civic

organization in the community through the cooperation of patient’s family.

• Advise the family about the importance of regular follow-up/ check-

up at the clinic.

• Make regular home visits to observe patient’s condition during

conversation and follow-up medication.

In research and Epidemiology

• Participate actively in the epidemiological survey to be aware of the

size and extent of mental health problems of the community and organize

a program for better preventive, curative and rehabilitative measures.

Relevance of NCM-104 Activities To Community Mental Health

Scope of NCM 104

NCM104 deals with the concepts and principles of nursing care

management of clients with alteration in human functioning across the life span in

various settings. It helps the students to acquire skills, knowledge and attitude in
the care of a sick client in all stages of growth and in any health care situation

utilizing the nursing process.

Community Mental Health and the concept of deinstitutionalization

At the patient level, deinstitutionalization refers to the transfer of a patient

hospitalized for extended periods of time to a community setting. At the mental

health care system level, it refers to a shift of focus of care from long-term

institution to community, accompanied by discharging long-term patients and

avoiding unnecessary admissions.

Why is community mental health relevant to NCM 104 activities?

Every student must learn how to deal with patients in various settings. It is

common that one should think of mental hospitals when they hear about mental

health. However, we should not overlook the fact that every mental disturbance

starts in the community setting. It may be provoked by family problems, peer

pressure, and others. Hence, it is but natural that the promotive or preventive

level of care should be done to the community. It involves mental health

education, stress management, and family therapy. NCM 104 (RLE) also

operates on the concept that all aspects of a person’s life needs to be identified

and cared for this includes one’s basic human needs, physical health needs,

needs for psychiatric treatment and rehabilitation, and the need to have an

increased social support systems.

Relevance of NCM-104 Activities To Community Mental Health

1. Provides students the opportunity to analyze theories, concepts,

research, and issues and trends in psychiatric-mental health nursing.

Focus is on internal and external factors affecting the mental health of

children, adolescents, adults, and families. Emphasis is on the role of the

professional nurse in health promotion and maintenance, illness care, and

rehabilitation of children, adolescents, adults, and families experiencing

psychiatric-mental health concerns.

2. Provides students an in-depth exploration of community health

nursing concepts and principles from an aggregate health care

perspective. Focus is on the prevention of disease and the promotion of

health. The changing needs of an increasingly culturally diverse

population within the social context of the community are examined.

Emphasizes the use of the nursing process to assess the complex factors

in the community that affect the health of aggregates.

3. Provides students an opportunity to analyze a selected

community. Students will apply the nursing process to identify factors

within communities that influence the health of aggregates. Students

investigate and evaluate resources which support disease prevention and

health

4. The relevance of Community Mental Health to N-104 is to

expand the Psychiatric-Mental Health nursing students to have knowledge

and skills for obtaining and recording a systematic health assessment of

adults with psychiatric-mental health concerns. Emphasis is placed on

synthesis and application of nursing and related theories and scientific

knowledge to the development of differential/ nursing diagnoses as a

basis for health promotion and management.

5. Specialist student to identify and implement appropriate health

promotion and disease prevention strategies across the lifespan. The

focus is on the advanced practice nursing of individuals in primary care

settings. Emphasis is placed on health promotion/disease prevention with

strategic planning at the primary, secondary, and tertiary levels of

prevention. Various issues are explored which are pertinent to the

advanced practice role.

B. APPLICATION OF THEORIES

Johnette Mary Olilia

Age: 20

Sex: Female

Major Developmental Application

Theory Stage
Task Past Present

Psychosexual Theory by Infancy: (birth to 18 months) Mouth is the center of Client is into breast feeding Client is not into smoking.

Sigmund Freud Oral stage pleasure and it is the major when he was in the years of And it ‘s a sign that she is

source of gratification and infancy. She experienced not orally fixated.

exploration. Security is bottle feeding and she said

primary need. Major conflict that during her infancy time

is weaning. Feeding their life is very simple.

produces pleasure and

 sense of comfort and

safety. Feeding should be

pleasurable and provided

when required

Toddler: (1 to 3 years old) The focus of pleasure At this early stage, the She can obviously control

Anal stage changes to the anal zone. client was toilet trained with her bowel & bladder

Through the toilet-training the assistance of her eliminations.

process the child is asked parents, although not that Their house is clean and

to delay gratification in enough time was given to things are not cluttered

order to meet parental & her because she still have even if it’s not spacious.

societal expectations. other siblings that needs This is a sign that she is not

more attention than her. the expulsive type of person

She was expected to be because she was able to

independent about her achieve resolution of this

 toileting. stage.

The child’s genitals are the She is closer to her mother Now she has her own

Preschooler: (3 to 5 years center of pleasure. than her father. She family. She is now happy

old) Masturbation offers claimed that it’s because and secured with his live in

Phallic stage pleasure. Other activities her father is not always at partner .

include fantasy, home because of work.

experimentation with peers

and questioning adults

about sexual topic. Major

conflict is the Electra

complex. The child

identifies with the parent of

the opposite sex and later

takes on a love relationship

 outside the family.

Encourage identity.
Energy is directed to She had many friends She is still friendly. She

School-age: (6 to 12 years physical and intellectual during her school-age. And doesn’t do the same things

old) activities. Sexual impulses she’s fond of making friends she was doing her school-

Latency stage tend to be repressed. and playing with them. As a age. She now explores

Develop relationships child. She’s very active and more appropriate to her age

between peers of the same school. She always mingle especially now she’s

sex. Encourage child with with her friends.. pregnant again

physical and intellectual

pursuits. Encourage sports

and other activities with

same sex peers.

Adolescent: (13/ puberty & Freud’s final stage wherein Her partner was the first. She’s now living with her

after) earlier sexual urges Although she had some partner. She was able to
 Genital stage reawaken & are directed to crushes before, she did go form a mature relationship.

an individual outside the into early relationship. This taught her how to love

family circle. and value partnership

Energy is directed toward despite of all the trials they

sexual maturity and function encountered.

and development of skills

needed to cope with the

environment. Encourage

separation from parents,

achievement of

independence and decision

making.
Psychosocial theory by Erik Infancy: (birth to 18 months) Infants depend on the She developed trust It is easy for her to trust a

Erikson parents for all their because she was well loved person because she doesn’t

Trust versus mistrust physiologic and by her parents. She said want to be judgmental and
psychological needs. that she well understand want to know if a person is

Fulfillment of these needs is how hard their life before for really trustworthy.

required for the infant to all their needs to be

develop a basic sense of attended immediately.

trust. Parents can enhance

this by responding

consistently to an infant’s

needs, providing a

predictable environment in

which routines are

established, and being

sensitive to these needs

skillfully and promptly.

The newborns react socially

 to caregivers by paying

attention to the face or

voice and by cuddling when

held. It is able to interact

with the environment by

responding to various

stimuli such as touch and

sound.
Toddler: (1 to 3 years old) Toddlers begin to develop She was also given the The client now is living with

their sense of autonomy by chance to decide and chose her partner. She is also

Autonomy versus shame & asserting themselves with something for herself. She one responsible for the

doubt the frequent use of the word was able to accomplish decision making because

“no”. Self concept is made some basic self care she is pregnant.

up of body image activities. Like feeding and

development, feelings toileting through training of

 about self, adaptive and her parents.

defensive mechanisms,

reaction from others, and

one’s perception of these

reactions, attitudes, and

values, and many life

experiences.
Preschooler: (3 to 5 years Stage where children As a child, she remembered Now her hobbies are

old) learned initiatively like to herself playing with her watching TV, reading

Initiative versus guilt pretend & try out new roles. brothers and sisters, their pocket books, listening to

Fantasy & imagination allow neighbors. She was allowed the radio, and chatting with

children to further explore to play around with her her relatives and friends.

their environment. With friends. She has already done

their conscience. Their exploring those little things

personalities develop. during her childhood and

 Erikson views the crisis at now that she is pregnant

this time as important for she stay always inside the

the development of the house.

individual’s self-concept.

According to Erikson,

preschoolers must imitate

behavior, and their

imaginations and creativity

became lively.
At this time children begin She was tasked to do some Now she’s pregnant, her

School-age: (6 to 12 years to create and develop a of the household chores like partner understands that

old) sense of competence and Doing the household chores she needs to take a rest

perseverance. School-age and she was being praised and take care the baby

Industry versus inferiority children are motivated by for a job well done. inside her womb. Her

activities that provide a partner is doing the chores

 sense of worth. They in the house.

concentrate on mastering

the skills that will help them

function in the adult world.

Although children at this

age work hard to succeed,

they are always faced with

the possibility of failure,

which can lead to a sense

of inferiority.
Adolescent: (12 to 20 years The psychosocial task of an The client claimed that She is sure of her role as a

old) adolescent is the during her adolescent mother and a member of

establishment of identity. years, she already thinks the community even though

Identity versus role The danger at this stage is mature and it’s maybe she admits that she can’t

confusion role confusion. The inability because of many trials they avoid shortcomings.
to settle on an occupational had gone through. She tried

identity commonly disturbs to do every task that was

the adolescent. Less assigned to her.

commonly, doubts about

sexual identity arise.

Because of the

adolescent’s dramatic body

changes, the development

of a stable identity is

difficult. Erikson says that

adolescents help one

another through this identity

crisis by forming cliques

and a separate youth

 culture.

Young adulthood: (18 to 25 In this stage, the most She met her husband Now, She has a family of

years old) important events are love before and was able to his own. She is residing at

Intimacy versus isolation relationships. Intimacy have an intimate his partner. She said that it

refers to one's ability to relationship. She is not is a blessing that she met

relate to another human afraid committing into a her partner and now she’s

being on a deep, personal relationship and ready to pregnant. She also said that

level. An individual who has explore new things. their relationship with his

not developed a sense of partner is strong.

identity usually will fear a

committed relationship and

may retreat into isolation. It

is important to mention that

having a sexual relationship

 does not indicate intimacy.

People can be sexually

intimate without being

committed and open with

another. True intimacy

requires personal

commitment. However,

mutual satisfaction will

increase the closeness of

people in a true intimate

relationship.
Interpersonal theory by Infancy: (birth to the Experience maternal She was well loved as a She feels secure because

Harry Stack Sullivan appearance of articulate tenderness & intuitions. child, though sometimes, his husband is very caring

speech) Maternal anxiety. Struggles her parents can’t really but she is very thankful to

to achieve feelings of support of their needs the God w/ all the blessings
 anxiety & to avoid anxiety because of poverty or they got and still pray that

financial constraints. they will be able to

overcome all the challenges

of their lives.

Childhood (articulate Modifies actions to suit As a child, she claimed that She releases her tension by

speech to need for social demands in sex roles she is a cry baby. She doing some other things or

playmate) training, peer play, family tantrums whenever she leisure like watching TV,

events. Uses language & needs attention. listening to radio, reading

movement to avoid anxiety. pocket books. She focuses

on how her new baby will

be healthy. Most of the time

she prays to God all of her

problems in life when ever

she’s mad and feel alone.

Juvenile( first 5 to 6 years Learns to accept She always follows the She admitted that she

old) subordinate to authority rules and advice of her sometimes can’t avoid

figures outside the family. parents. She always follow disregarding the law

More focus in self-status & her parents whenever she although she knows that it’s

roles was asked to do something against already, especially

like household chores The fifth commandment

because she knows that it though shall not commit

is right. adultery because she loved

her partner so much.

Preadolescence Capable of participating in She was able to build Patient is now very

(7 years old to genuine love relationships friendship with others and considerate w/ her family

adolescence) with others. Develop she experience a dramatic and she tries to understand

considerations & concerns change in his body what is happening around

outside of self. and take opinions of others.

Late adolescence Begins when a person is She said that when she has Now if she has a problem

(15 to 18 years old & able to feel both intimacy problem, she just hang out she always pray to God and

above) and lust toward the same with her friends and share she try to solve it and talk to

person. her problems. her partner and friends to

share about it.

Characterized by a stable

pattern of sexual activity

and the growth of the

 syntaxic mode (having

ideas and opinions

validated or repudiated) as

young people learn how to

live in the adult world.

Rodel Lucillo

Age: 28

Sex: Male

THEORY STAGE MAJOR DEVELOPMENTAL TASK APPLICATION

PAST PRESENT
  Energy is directed toward full

Psychosexual Theory by Genital stage sexual maturity and function and The client is single and The client is happily

Sigmund Freud (puberty and after) development of skills needed to lives with her family. married and soon to be a

cope with the environment. father again. He is now

happy that he has a

partner in life.

The client is a tricycle

Psychosocial theory by Adulthood  Willingness to share with The client is working at driver. The client

Erik Erikson (Generativity versus another person. Johnson and Johnson’s sometimes participates

Stagnation)  Creativity, productivity, concern company. He likes in their community

for others having a good chat with activities. He gives the

 Establishing priority needs, his friends and cousins most of his time to take

 Recognizing both self and after work. care of his wife

others. especially now that she

 is pregnant and his work.

And he never forgets to

look after his mother.

Interpersonal theory by Adulthood (ages 23 and  Financial Security, career and His family is very He now have his own

Harry stack Sullivan up) family. important to him family but still lives with

especially his mother her mother.

even thou he has his

own family.
C. Description of the Community

Brief History

Noong unang panahon, ang Barangay San Pedro I at San Pedro II ay

iisang barangay. Ang namumuno dito ay Barangay Captain Ciriaco Morfe,
Crisanto Lenga at Rufino Morfe. Ang pangalan nito ay San Galio at Muson. Ang
sumusunod dito ay ginawang dalawang Barangay, San Pedro at I at San Pedro
II. Ang namumuno dito ay si Capt. Crispulo Mendoza. Ang sumusunod ay
Maximo Custudio Sr. Di niya natapos sa kadahilanang siya ay namatay kaya
ang nagpatuloy ay si Kon. Ernesto Campano. Ang sumunod na naging
Baranggy Captain ay si Capt. Miguel Morfe Sr. Natapos niya ang termino ng
kanyang panunungkulan at ang pumalit ay ang kasalukuyan na nanunungkulan
na si Baranggay Capt. Aileen Saludo. Ngayon ang aming Baranggay ay puno ng
kasaganaan at nanalo ito sa Clean and Green at nagyon din nagkaroon ng
sariling simbahan, waiting shed, ilaw sa kalsada, tubig, at dito rin ginaganap ang
seminar at napalawig niya ang iba’t-ibang proyekto dito sa Brgy. Ang layo ng
San Pedro II sa highway ay 2 kilometro at kalahati.
Ito ang kasalukuyan na naganap sa Barangay San Pedro II.

 Spot Map
 Organizational Structure

BARANGAY SAN PEDRO 2

MALVAR, BATANGAS OFFICIALS
D. Definition of Terms

Mental Health

• "a state of well-being in which the individual realizes his or her own

abilities, can cope with the normal stresses of life, can work productively

and fruitfully, and is able to make a contribution to his or her community”.

(Defined by WHO)

• A state of emotional and psychological well-being in which an individual is

able to use his or her cognitive and emotional capabilities, function in

society, and meet the ordinary demands of everyday life

• A positive state of mind engendering a sense of well being that enables a

person to function effectively within society. Individuals who have good

mental health are well-adjusted to society, are able to relate well to others,

and basically feel satisfied with themselves and their role in society.

Mental Illness: State in which an individual shows deficit in functioning (cannot

view environment and self clearly) and is unable to maintain personal

relationship.

Community mental health nursing: is the synthesis of community health

nursing and public health with particular emphasis on mental health.

Family Therapy: a term of group therapy in which the client and his or her family

members participate. Its goal includes understanding how family dynamics

contribute to the client psychotherapy, mobilizing the family inherent strengths

and functional resources, and restructuring maladaptive family problem solving.

On the other hand, the purpose of family therapy is to improve interpersonal

skills, communication, behavior and functioning.

Conjoint Family Therapy is the treatment of partners in joint sessions

conducted by either one or two therapists; it is the treatment method most

frequently used in marital therapy. Cotherapy with therapists of both sexes

prevents a particular patient from feeling ganged up on when confronted by 2

members of opposite sex.

Family: social system composed of two or more persons who coexist within the

context of some expectations of reciprocal affection, mutual responsibility, and

temporal duration

Genogram: graphic depiction of a family tree that records information over at

least three generations.

Mental Hygiene: science which deals with the measures employed to promote

mental health, to reduce the incidence of mental illness through prevention and

early treatment and ensure effective management and rehabilitation.

Psychiatric nursing: Concerned with the promotion of mental health, prevention

of mental disorders, and the nursing care of patients during mental illness and

rehabilitation.

Therapeutic communication: purposeful use of dialogue to bring about the

client’s insight, control symptoms, and healing. It is also a kind of communication

that builds a trusting relationship.

Defense mechanisms are psychological strategies brought into play by various

entities to cope with reality and to maintain self-image. Healthy persons normally

use different defenses throughout life

CHAPTER 2

Related

Literature
 A. Related Literature regarding the Identified Case (2)

BellaOnline's Miscarriage Editor:

Christine Beauchain

Caffeine and Miscarriage

A new study has recently been published exploring the link between
caffeine and miscarriage. This new study, conducted by Kaiser Permanente
Division of Research and published in the American Journal of Obstetrics and
Gynecology shows that even comparatively low doses of caffeine may increase a
woman's risk of miscarriage. Doctors have suspected a caffeine miscarriage
connection for a long time. However, previous studies showed caffeine to be
problematic only in large doses. For a long time, two cups of coffee (or a
comparable amount of another beverage with caffeine such as cola) was the
“gold standard” of what was acceptable during pregnancy. My own OB told me
not to drink more than two or three cups of coffee per day. However, I decided it
was in my best interest to cut it out entirely.This new study is notable apparently
for two reasons. Firstly, it found a smaller dose of caffeine to be problematic than
the amount of caffeine in previous studies. Secondly, this is the first study which
takes morning sickness into account. In some cases, there seems to be in
inverse relationship between miscarriage and morning sickness. In other words,
women who had a lot of morning sickness seem less likely to miscarry. The way I
understand it it that women who experienced morning sickness tended to eschew
coffee which in turn skewed the results of earlier studies.Studies have also been
done about a possible link between caffeine and infertility although these studies
remain inconclusive. Some doctors even say that this most recent study does not
definitely prove a link between caffeine and miscarriage. As with the release of
any study results, not all professionals are convinced and many suggest that
further study is needed. It is still unknown how exactly caffeine consumption
adversely effects a pregnancy and could be responsible for miscarriage. It was
unclear if the study referred only to first trimester miscarriages or if caffeine might
be responsible for later miscarriages as well.
So, caffeine remains on the list of potentially troublesome substances during
pregnancy. If you're trying again, you probably want to check with your doctor
about caffeine. Or, if you're able, you may want to cut caffeine out altogether. If
you're feeling tired, taking a walk, a power nap or even drinking some water, may
provide a pick-me-up. Coffee, tea, hot chocolate, cola and chocolate all contain
caffeine in varying amounts. Even decaffeinated beverages are not 100% free of
caffeine.

Refference:http://www.bellaonline.com/articles/art55184.asp

SUMMARY

This journal is about the miscarriage editor who talks about her reaction in
caffeine and miscarriage. The Author shared about the link between caffeine and
miscarriage. In this journal she also talk about how caffeine affect a pregnant
woman. She also talks about the two reason of a new study which is women who
had a lot of morning sickness seem less likely to miscarry. She also shared about
a possible link between caffeine and infertility but its is inconclusive. The author
said that caffeine remains on the list of potentially troublesome substances
during pregnancy. She also said that if u want to cut caffeine altogether is that
take a powernap or drink some water to provide energy.
Significance of the Literature

The significance of this literature in our client is to know about how

caffeine affect a pregnant woman. There also a alternative to cut caffeine

altogether by having pa power nap and by drinking water. Another significance of

this is to know different views of person who already experience such event like

miscarriage. They could be the best teacher when it comes to this topic because

they already experience it so to the fact they can really say how it is.

Personal Viewpoints or Reaction

We all know that life is very important and we must treasure it. Miscarriage
is a burden in the part of the mother and the family because having this situation
it is difficult to accept. Miscarriage has a big impact not only in the mother and
also to the family on how to cope with a lost love one. We must take care each
and everyone belongs in the family because life has no second chance. I
believed in saying that “prevention is better than cure”.
B. Mental Health Risks for Young Women Who Miscarry
BellaOnline's Miscarriage Editor:
Christine Beauchain

Caffeine and Miscarriage

A recent study suggests that young women who experience miscarriage

may be at a higher risk for mental health issues later in life. Kaeleen Dingle, a
researcher at the University of Queensland in Australia found that “young women
who lost a pregnancy were more susceptible to depression, anxiety, alcohol
dependency and illicit substance abuse than women who had never been
pregnant,” according to the school's website.

Ms. Dingle studied 280 women from the ages of 18 and 23 who had been
pregnant using data from a larger, long-running study begun in Brisbane,
Australia in 1981. Initial research conducted in 2006 suggested that young
women who'd had abortions were at higher risk for these issues. Ms. Dingle
decided to expand on this research to see if these issues were present in young
women who'd had miscarriages as well.

“Our findings suggest that this increased risk of psychiatric problems in some
women after abortion may be associated with pregnancy loss rather than caused
by the experience of having an induced abortion,” Ms. Dingle is quoted as saying
on the school's website. The risks for subsequent mental health issues seemed
to be the same regardless of whether the women had an abortion or miscarriage.
The risks were increased for the rest of the women's lifetimes.

The study found that young women who experienced a pregnancy loss were up
to three times more likely to abuse alcohol or drugs than their peers who had not
experienced a loss. The risk of depression and anxiety also increases for these
young women, the research found.

The study suggests that young women may need more support and counseling
in order to cope with these losses. Additionally, the study suggests that
professionals counseling young women should make sure they have complete
histories as these histories may be more “complex” than counselors suspect. If
miscarriage or other pregnancy losses exist in a young woman's past, the study
suggests that may be why they sought support or counseling in the first place.

Refference: http://www.bellaonline.com/articles/art60448.asp
 Summary

This journal is all bout mental health risk in young woman who miscarry. In
this journal, it says that a young woman who is experiencing miscarry may be at
a higher risk for mental health issue later in life. The study found that young
women who experienced a pregnancy loss were up to three times more likely to
abuse alcohol or drugs than their peers who had not experienced a loss. This
journal says that young women may need more support and counseling to cope
up with this situation (miscarriage).

Significant of the literature

The significance of this journal in our client is that they have same
situation ( miscarry). Our client is 20 yrs. Old when she experienced miscarry.
It has a big impact on her and also to the family. Anxiety and Depression was
experienced by our client. Its hard to cope up with miscarry she needs support
and counseling, the family gave it to her and little by little our client is coping up.

Personal Viewpoints or Reaction

it’s hard to loose someone that u loved specially when it came to you.
Anxiety and depression is your best enemy when u experienced miscarriage.
Now, in our generation, young pregnancy can lead to miscarriage. Early Marriage
can lead also in miscarry. My point here is having a family or having a child is a
big responsibility. Its not a candy that u can spit if u don’t like always think twice. I
think these miscarry/miscarriage can test a family relationship on how a family
cope up when this situation occur.
 CHAPTER 3

Presentation,

Interpretation and Data

Analysis
 A. Tabular Presentation of Mental Health Aspects per Family Member

Johnette Mary S. Orilla

Table 1. Pagkabalisa (Tension)

Computation:

Question Scores COMPUTATION

1 10 80/5= 16
2 10
3.1 20
3.2 20
3.3 0 REMARKS
4 20 EMERGENCY
5 0
6 0

Interpretation:
 Table 1 shows that question 1 & 2 got a score of 10 that is under the

normal status. Question 3.1, 3.2 and 4 got a score of 20 which means at

emergency. Question 3.3, 5 and 6 got a score of 0 that pertains to none.

Analysis:

The client claimed that her activities for everyday are not that affected by

any tension even after that unfaithful incident that happened. Because as she

verbalized that “Kung di talaga siya para sa amin tatangapin ko na lang baka

may iba pang plano ang Diyos sa amin ni mahal. But even though that she

pregnant currently traces of being worried are detected for she is cautious also to

avoid that incident to happen again.

Theory:

According to Betty Newman’s system model, the individual’s reaction to

stressors depends on the strength of the line of defense. The lines of resistance

represents the internal factors that help the patient defend against the stressors,

the normal line of defense represents the person’s state of equilibrium, and the

flexible line of defense depicts the dynamic nature that can rapidly alter a short

period of time.

Table 2. Damdamin (Mood)

Computation:

Question Scores COMPUTATION

1 10 50/5= 12.5
2 10
3 20
4.1 0
4.2 0
5 0 REMARKS

6 0 EMERGENCY
7 0
8 0
9 0
10 0
11 0
12 0

Interpretation:
 Table 2 shows that questions 1 to 3 got a score of 10 w/c are under the

normal mental status. Ques. 4.1 got a score of 20 that falls under emergency

mental status. Ques. 4.2 up to 12 got a score of 0 w/c means none.

Analysis:

In this category, the client is in emergency state since she experiences

changes in mood in just a little time it still doesn’t interfere with her relationship to

his husband and her family-in-law, but at times when she is left alone because

his husband is at work she do admit that she cries but positively thinking that her

lost baby maybe at a good place now, so she goes out to socialize with their

relatives.

Theory:

According to Cal Jung, the persona represents your public image. So, the

persona is the mask you put yourself on before you show yourself to the outside

world. Although it begins as archetype, by the time we’re finished realizing it. It is

the part of us most distant from the collective unconscious.

Table 3. Pag-iisip (Thought)

Computation:

Question Scores COMPUTATION

1 10 30/5=10
2 10
3 10
4 0 REMARKS

5 0 NORMAL
6 0
7 0
8 0

Interpretation:
 Table 3 shows that questions 1 to 3 got a score of 10 which is under the

normal status. Questions 4 to 8 got 0 w/c means none.

Analysis:

The client focuses her attention immediately to that problem if she

encounters one. Sometimes she do feels stressed because if she thinks too

much but she relays it to her husband to help her and as what the couple said

after that incident that had just happened they’re relationship just got stronger

and more open to both of them.

Theory:

Alfred Alder used to refer to basic motivation was compensation. Since we

all have problems, short-comings, etc. Alder felt earlier in his writing, that our

personalities could be accounted by the ways in which we do or don’t

compensate or overcome those problems.

Table 4. Gawain (Activity)

Computation:

Question Scores COMPUTATION

1 0
2 0 160/7=22.858 or 23

3 0
4 10 REMARKS

5 20
6 20 NEUROTIC
7 20 COPING
8 30
9 30
10 30
Interpretation:

Table 4 shows that question 1 to 3 are scored 0 that is none while 4 got a

score of 10 that falls under normal mental status. Question 5 to 7 is under 20

mental status and 8 to 10 that is under neurotic coping.

Analysis:
 The client claimed that sometimes her emotions affect her work especially

during when the incident was still fresh at her she don’t even want to see her

husband. She does sometimes make any unusual things when she is stressed

unconsciously like crying without her noticing it in the middle of her chores. She

do has inspirations to be able to have a good performance on her work. She do

let herself to explore new activities instead of avoiding it.

Theory:

In Maslow’s hierarchy of needs, the physiologic needs there is the need to

be active, to rest, and to sleep. The love and belongingness. When physiologic

needs and safety needs are satisfied, then a third layer starts to grow up.

Table 5. Organisasyon (Organization/ Control)

Computation:

Question Scores COMPUTATION

1 10
2 10 50/5=10

3 10
4 10
5 10
6 0 REMARKS

7 0
8 0
9 0 NORMAL
10 0
11 0
12 0

Interpretation:
 Table 5 shows that ques.1 to 5 got a score of 10 w/c is normal mental

status. Ques. 6 to 12 got 0 w/c is none.

Analysis:

The client stated that she can work with eased and organized, and doesn’t

think any negatives thoughts which could lead to disturbance of her mood and

performance level. The given devotion that was shown by his husband.

Theory:

According to Carl Roger’s theory, the built-in motivation present in every

life form to develop its potentials to the fullest extent possible. Rogers believes

that all creatures strive to make the very best if their existence. If they failed to do

so, it is not for a lack of desire.

Table 6. Pakikipagrelasyon (Relationship)

Computation:

Question Scores COMPUTATION

1 10
2 10 30/3 = 10

3 10
4 0
5 0
6 0
7 0 REMARKS
8 0
9 0 NORMAL

10 0
11 0
12 0
13 0
14 0
15 0
16 0

Interpretation:

Table 6 shows that ques. 1 to 3 got a score of 10, w/c is normal mental

status. Ques. 7 to 16 got 0 w/c is none.

Analysis:

The client is a loving person and has the average type in terms of having a

relationship to her husband, regarding on the event that had happen to them they

don’t blame each other or whose the one that is responsible for it but instead

their love grow stronger and better and more likely attached to each other.

Theory:

In Maslow’s hierarchy of needs, the love and belongingness needs, when

physiological needs and safety needs are taken care of, you begin to feel the

need for friends, children, and relationships in general, even a sense of

community.

Table 7. Pisikal (Physical)

Computation:

Question Scores COMPUTATION

1 10
2 10 90/6= 15

3 10
4 0
5 0
6 0
6.1 0 REMARKS
6.2 0
6.3 0 EMERGENCY

6.4 0
6.5 0
7 0
8 0
9 0
10 0

Interpretation:
 Table 7 shows that questions 1 to 3 got a score of 10 that is in normal

mental status. While in questions 4, 5 and 6.4 has scored 20 w/c is in emergency

mental status. And questions 6 to 10 got 0 w/c means none.

Analysis:

The client doesn’t have any problems with her sleeping pattern. She

claims that she do not have any problem in digestion, skin, breathing and weight.

She never use any prohibited drugs.

Theory:

According to Parse’s human becoming theory focuses on humanly lived

experiences of health. In this theoretical system, each human being is versed as

the expert on his/her personality/personal health.

Rodel G. Lucillo
 Table 1. Pagkabalisa (Tension)

Computation:

Question Scores COMPUTATION

1 10 20/2= 10
2 10
3.1 0
3.2 0
3.3 0 REMARKS
4 0 NORMAL
5 0
6 0

Interpretation:

Table 1 shows that question 1 and 2 got a score of 10 that is under the

normal status. Question 3 to 6 and got a score of 0 which means none.

Analysis:

The client stated that he doesn’t feel any changes nor stress in his current

state but he do feels bad for what had happened to their supposed to be first

baby. But life goes on he must continue to work for the future of his family. With

that event he even get closed and expressed his love more to his wife. He is the

man of the house therefore he got to be strong for their future.

Theory:

According to Betty Newman’s system model, the individual’s reaction to

stressors depends on the strength of the line of defense. The lines of resistance

represents the internal factors that help the patient defend against the stressors,

the normal line of defense represents the person’s state of equilibrium, and the

flexible line of defense depicts the dynamic nature that can rapidly alter a short

period of time.

Table 2. Damdamin (Mood)

Computation:
Question Scores COMPUTATION
1 0 20/2=10
2 10
3 10
4.1 0
4.2 0
5 0 REMARKS

6 0 NORMAL
7 0
8 0
9 0
10 0
11 0
12 0

Interpretation:

A table 2 show that questions 2 and 3 got a score of 10 w/c is under the

normal mental status. Questions.1, 4 to 12 got a score of 0 w/c means none.

Analysis:

The client stated that he has positive outcomes in life, so whenever he is

bothered he shares it first with his wife and family even to his siblings, but likely

he resorts his moods by himself wherein he just take a deep breath until he had

cool down from that certain disturbance, also even if he is irritated to somebody

he just walks away from it to avoid a conflict.

Theory:

According to Cal Jung, the persona represents your public image. So, the

persona is the mask you put yourself on before you show yourself to the outside

world. Although it begins as archetype, by the time we’re finished realizing it. It is

the part of us most distant from the collective unconscious.

Table 3. Pag-iisip (Thought)

Computation:

Question Scores COMPUTATION

1 10 30/3=10
2 10
3 10
4 0 REMARKS

5 0 NORMAL
6 0
7 0
8 0

Interpretation:

Table 3 shows that 1 to 3 got a score of 10 which is under the normal

status. Questions 4 to 8 got a score of 0 which means none.

Analysis:

The client exclaimed that he is the head of his family that’s why he has to

have a strong mind and will, he also stated that if he has something to focused

with he will offer it without undivided attention just like what happened to their

experience, he never showed any uncomfortable emotions but instead he even

made his wife to realize that God has a will and maybe the child is isn’t for them.

Theory:

Alfred Alder used to refer to basic motivation was compensation. Since we

all have problems, short-comings, etc. Alder felt earlier in his writing, that our

personalities could be accounted by the ways in which we do or don’t

compensate or overcome those problems.

Table 4. Gawain (Activity)

Computation:

Question Scores COMPUTATION

1 10
2 10 40/4=10

3 10
4 10 REMARKS

5 0
6 0 NORMAL
7 0
8 0
9 0
10 0

Interpretation:

Table 4 shows that ques. 1 to 4 got a score of 10 that falls under normal

mental status. Questions 5 to 10 got a score which means none.

Analysis:

The client claimed that he shows interest and tries his best to attend to his

activities for he is the source of their family income. He also verbalized that the

source of his devotion to his work is his wife. From after that incident happened

their relationship got stronger than ever.

Theory:

In Maslow’s hierarchy of needs, the physiologic needs there are the need

to be active, to rest, and to sleep. The love and belongingness. When physiologic

needs and safety needs are satisfied, then a third layer starts to grow up.

Table 5. Oraganisasyon (Organization/Control)

Computation:

Question Scores COMPUTATION

1 10
2 10 50/5=10

3 10
4 10
5 10
6 0 REMARKS

7 0
8 0
9 0 NORMAL
10 0
11 0
12 0

Interpretation:

Table 5 shows that ques.1 to 5 got a score of 10 w/c is normal mental

status. Question 6 got 0 w/c is none.

Analysis:

He claimed that he can finish a task without any hindrances, and also he

has organization in all of his work, and also he do verbalized that experience is

better than theory this means that the person really do learns base from his

experience.

Theory:

According to Carl Roger’s theory, the built-in motivation present in every

life form to develop its potentials to the fullest extent possible. Rogers believes

that all creatures strive to make the very best if their existence. If they failed to do

so, it is not for a lack of desire.

Table 6. Pakikipagrelasyon (Relationship)

Computation:

Question Scores COMPUTATION

1 10
2 10 30/3 = 10

3 10
4 0
5 0
6 0
7 0 REMARKS
8 0
9 0 NORMAL

10 0
11 0
12 0
13 0
14 0
15 0
16 0

Interpretation:

Table 6 shows that questions 1 to 3 got a score of 10, w/c is normal

mental status. Question 4 to 16 got 0 which is none.

Analysis:

The client claimed that he has a lot of friends and have a good relationship

with them he has a good social life for all of their neighbors are his cousins and

relatives. He doesn’t start any argument and don’t want it to be complicated. Also

he has no problems with his relationship with his family most specially to his wife

whom he loved the most.

Theory:

In Maslow’s hierarchy of needs, the love and belongingness needs, when

physiological needs and safety needs are taken care of, you begin to feel the

need for friends, children, and relationships in general, even a sense of

community.

Table 7. Pisikal (Physical)

Computation:

Question Scores COMPUTATION

1 10
2 10 30/3= 10

3 10
4 0
5 0
6 0
6.1 0 REMARKS
6.2 0
6.3 0 NORMAL

6.4 0
6.5 0
7 0
8 0
9 0
10 0
Interpretation:

Table 7 shows that questions 1 to 3 got a score of 10 that is in normal

mental status. While questions 4 to 10 got 0 w/c means none.

Analysis:
 The client claimed that he doesn’t have any physical problems nor

deformities and based also from the observation he has an average health status

of a average normal person. No unreasonable feelings of pain and aches in any

parts of his body.

Theory:

According to Parse’s human becoming theory focuses on humanly lived

experiences of health. In this theoretical system, each human being is versed as

the expert on his/her personality/personal health.

B. Summary of Mental Health Aspects per Family Member

JOHNETTE MARY S. ORILLA

Interpretation:

Table 8 shows that Tension got 16, Mood got 12.5; Thought is 10, Activity

which is the highest 23, Organization and Relationship are both 10 and Physical

that is 15.

Analysis:

The client’s highest score revealed is her Activity which got a score of 23.

This falls under neurotic coping thus making the client as the high risk individual.

Theory:

According to Parse’s human becoming theory focuses on humanly lived

experiences of health. In this theoretical system, each human being is versed as

the expert on his/her personality/personal health.

Rodel G. Lucillo
Interpretation:

The graph shows that under tension, the client got a score of 10 which is

the highest. And the rest are stationary in the score of 10.

Analysis:

The client’s score revealed that his Tension is the highest among the

aspects of MSE but this score falls under emergency coping thus does not

consider as a high risk individual.

Theory:

Accdg. To Carl Rofers, the fully functioning person acknowledges that

feeling of freedom, and takes responsibility for his choices.

C. Summary of Mental Health Aspects for the Whole Family

Analysis:

This graph shows that Ate Johnette got the highest score among the

entire family member especially the in the Activity category and therefore she is

considered as the high risk individual, while kuya Rodel got only a highest score

of 12 which means he is not at risk and had already moved on about the incident

but still 12 is still under the criteria for emergency state wherein it shows that he

still thinks of it very often.

D. Caplan’s Paradigm for High Risk Individual

Johnette Mary Olilia

20 years old (Miscarriage)
Activity

Predisposing event
-Retroversion upon medical Dx r/t spontaneous abortion
- Miscarriage of 3 months fetus (1st baby)
-Pregnant Cognitive Appraisal

Primary appraisal

-No response -Watching TV -Def mechanism

-Inability to perform house chores -Reading pocket books which is repression
-Listening to music
-Isolation No response Verbalization of
-Unnoticed falling of tears “Focusing on the new baby coming”
-not functional in house chores

Secondary Appraisal

-Dreaming of having a simple life livelihood,

a family with 2 children

-Sharing problems and thoughts with her husband

Quality of Response

ADAPTIVE MALADAPTIVE
-Strong Relationship with her spouse -No Response
-Being more religious
E. Adaptive Functioning for High Risk Individual

UNEDITED

Johnette Mary Orillo

20 years old

Female

a. Communication

The client uses simple words in communicating. She was able to express her

feelings. She has a good eye contact and delivered words clearly. She showed

both verbal and non-verbal communication appropriate to her emotions wherein

she is a person that you could easily read her thoughts by simply observing her.

Communication is a process of transferring information from one entity to

another. Communication processes are sign-mediated interactions between at

least two agents which share a repertoire of signs and semiotic rules.

Communication is commonly defined as "the imparting or interchange of

thoughts, opinions, or information by speech, writing, or signs". Communication

can be perceived as a two-way process in which there is an exchange and

progression of thoughts, feelings or ideas towards a mutually accepted goal or

direction.

b. Self-care

According to the client, she learned self-care at a very young age. As

observed, because she is under the stage of young adulthood she do gives

concern about herself and grooming as what she verbalized she must still stay

nice and pretty for her husband’s happiness and pleasure wherein what she is

happy about for being with her around 2 years.

 Self-care behavior, a key concept in health promotion, refers to decisions and

actions that an individual can take to cope with a health problem or to improve

his or her health.

c. Social interaction

The client is a very friendly person. She said that she has a lot of friends in

their work place before and she has a harmonious relationship with them. She

never starts an argument with her colleagues. During her spare time she likes

going around the community and visit her relatives and friends.

Social interactions are the acts, actions, or practices of two or more people

mutually oriented towards each other's selves, that is, any behavior that tries to

affect or take account of each other's subjective experiences or intentions. This

means that the parties to the social interaction must be aware of each other--

have each other's self in mind. This does not mean being in sight of or directly

behaving towards each other.

d. Self direction

She verbalized that she has her directions in her life and do looks forward for

being an independent person until he met his spouse that also guided her about

the a nice life that they will share as they prepare to have a family and 2 children.

This is her family goals but she do wants to continue his studies in order to gave

honor to his family.

The core idea of personal autonomy or self direction is to have personal rule

of the self while remaining free from controlling interference by others. The

autonomous person acts in accordance with a freely self-chosen and informed

plan. A person of diminished autonomy, by contrast, is in at least some respects

controlled by others or is incapable of deliberating or acting on the basis of his or

her own plans.

 e. Functional Academic Skills

The client stated that her highest educational attainment was 2 yrs in college

and do knows all the basic academic skills, because she knows that being

educated is a factor to survive nowadays. But her MASCOM course stopped

when her side of the family experienced.

Functional academic skills (environmental print and basic instructions, writing

one’s own name and personal information, basic math calculations, etc.) are

strategically placed during task analyzed breakdowns and drills of daily life skills

instruction.

f. Work

The client before works as a clerk in Lipa before but when she got pregnant of

they’re supposed to be 1st child she stopped working because of the incident that

occurred her husband stopped her from working and to just stay home and do

chores that aren’t going to make her overstressed.

Manual labor is physical work done with the hands, especially in an unskilled

job such as fruit and vegetable picking, road building, or any other field where the

work may be considered physically arduous, and which has as a profitable

objective, usually the production of goods.

g. Leisure

Her leisures are paying Bingo, watching television, and chatting with her

friends or doing the household chores. She do these things during her spare time

and to entertain herself because now a day’s most of the time she just stays

home because she doesn’t have a work. As same as above situation

overstressed can affect to her childbearing.

 That time left over after time taken for work and other obligations. The term

indicates that this time is spent on activities which are worthwhile in themselves

to the individual.

h. Health

The client has a small frame body built but doesn’t look ill or any deformities

in her physical aspect, she has only the problem in her childbearing because of a

vulnerable uterus but there are no history of miscarriage at her side of the family

but in the side of her husband there was a history, but for the client’s safety she

should not overdue herself to avoid this incident to happen again.

i. Safety

The client is living together with her husband’s family and safety is observed

because of their setting is appropriate for all of her neighbors there are her

spouse’s family and relatives and they are both in good condition considering the

area of their house settlement.

Safety is the state of being "safe" , the condition of being protected against

physical, social, spiritual, financial, political, emotional, occupational,

psychological, educational or other types or consequences of failure, damage,

error, accidents, harm or any other event which could be considered non-

desirable. This can take the form of being protected from the event or from

exposure to something that causes health or economical losses. It can include

protection of people or of possessions.

 CHAPTER 4

Family Therapy
A. Discussion

Definition of Family Therapy

Family Therapy is, as it sounds, therapy which involves the whole,

or part of, a family. It can take place in a family home, or more commonly

in a hospital or clinic. Sometimes there is one therapist present and

sometimes more than one. In some circumstances, there may also be a

team of people, sitting behind a one-way mirror, in another room, who are

watching what is going on, and helping the therapist(s) conduct the

session. The sessions may also be recorded. We know this sounds a bit

worrying, but people generally quickly get used to it, and nothing should

ever be done without getting the family's permission first. The therapists

can be any number of health professionals. They may be psychologists,

psychiatrists, social workers, nurses or simply people who have been

trained in the use of one or more types of family therapy.

Usually, the therapist will have received some specific training in

family therapy, and may have a specific qualification relating to it. Family

therapy is usually recommended by a health professional (i.e. a doctor), or

sometimes you can go directly to a specialist centre who practice family

therapy. It often takes place when there is a problem with a child.

However, a child doesn't have to be involved; sometimes family therapy

takes place with only adults present.

Initial Consultation

Family Therapy is well enough known that families with a high level

of conflict may request it specifically. When the initial complaint is about

an individual family member, however, pretreatment work may be

necessary. Typical fears underlying resistance to a family approach are

fears (1) by parent that they will be blamed for their child’s difficulties, (2)
 that the entire family will be pronounced sick; (3) that a spouse will object

(4) that open discussion of one child’s misbehavior will have a negative

influence on younger siblings. Refusal by an adolescent on young adult

patient to participate in family therapy is frequently a disguised collusion

with the fears of one or both parents.

Interview Technique

The special quality of the family interview proceeds from two

important facts (1) the family comes to treatment with its history and

dynamics firmly in place. To the family therapist, it is the established

nature of the group, more than the symptoms, that constitutes the clinical

problem (2) family members usually live together, and at some level

depend on one another for their physical and emotional well-being

whatever transpires in the therapy session is known to all. Central

principles of technique derive from those facts. For example, the therapist

must carefully channel the catharsis of anger by one family member

toward another. The person who is the object of the anger is present and

will react to the attack, running the danger of escalation toward violence,

fractured relationships, and withdrawal from therapy. Free association is

likewise not appropriate, because it would encourage one person to

dominate the session. For those reason the therapist must always control

and direct the family interview. Virginia Satir recommended initiating at

least the first two sessions of family therapy with a family- life chronology.

The technique reflects many family therapy precepts.

Frequency and Length of Treatment

Unless an emergency arises, sessions are usually held no more

than once a week. Each session, however, may require as much as two

hours. Long sessions can include an intermission to give the therapist time

to organize the material and plan a response. A flexible schedule is

necessary when geography or personal circumstances make it physically

difficult for the family to get together. The length of treatment depends not

only on the nature of the problem but also on the therapeutic model.

Therapist who use problem solving models exclusively may accomplish

their goals in a few sessions; therapist using growth oriented model may

work with a family for years, with sessions at long intervals

Theories Applied

Family therapy is based on family systems theory, which

understands the family to be a living organism that is more than the sum

of its individual members. Family therapy uses "systems" theory to

evaluate family members in terms of their position or role within the

system as a whole. Problems are treated by changing the way the system

works rather than trying to "fix" a specific member. Family systems theory

is based on several major concepts and theory of Murry Bowen as follows:

General systems model

This theory attempts to identify the problems and relationships,

ideas and attitudes of all the family to get an idea about what is going on

for the whole family. Once these areas are clear the therapist(s) will

sometimes attempt to shift the problem(s), attitudes, relationships, to a

position that is more beneficial, less damaging, or simply more realistic.

They may do this in a number of ways, which may include education,

homework tasks, experimentation (e.g. suggesting that the family try

behaving or relating in a different way), or attempting to provide some

insight to the family members about what is really going on. The emphasis

is on the whole family, and not blaming one or more individuals, for the

problem.
Homeostasis (balance)

The concept of homeostasis means that the family system seeks

to maintain its customary organization and functioning over time. It tends

to resist change. The family therapist can use the concept of homeostasis

to explain why a certain family symptom has surfaced at a given time, why

a specific member has become the IP, and what is likely to happen when

the family begins to change.

The extended family field

The extended family field refers to the nuclear family, plus the

network of grandparents and other members of the extended family. This

concept is used to explain the intergenerational transmission of attitudes,

problems, behaviors, and other issues. And is still practiced by most

Filipino families.

Differentiation

Differentiation refers to the ability of each family member to

maintain his or her own sense of self, while remaining emotionally

connected to the family. One mark of a healthy family is its capacity to

allow members to differentiate; while family members still feel that they are

"members in good standing" of the family.

Triangular relationships

Family systems theory maintains that emotional relationships in

families are usually triangular. Whenever any two persons in the family

system have problems with each other, they will "triangle in" a third

member as a way of stabilizing their own relationship. The triangles in a

family system usually interlock in a way that maintains family homeostasis.

Common family triangles include a child and its parents; two children and

one parent; a parent, a child, and a grandparent; three siblings; or,

husband, wife, and an in-law.

Procedures

Family therapy is a form of psychotherapy that involves all the

members of a nuclear or extended family. It may be conducted by a pair or

team of therapists. In many cases the team consists of a man and a

woman in order to treat gender-related issues or serve as role models for

family members. Although some forms of family therapy are based on

behavioral or psychodynamic principles, the most widespread form is

based on family systems theory. This approach regards the family, as a

whole, as the unit of treatment, and emphasizes such factors as

relationships and communication patterns rather than traits or symptoms

in individual members.

Family therapy is a relatively recent development in

psychotherapy. It began shortly after World War II, when doctors, who

were treating schizophrenic patients, noticed that the patients' families

communicated in disturbed ways. The doctors also found that the patients'

symptoms rose or fell according to the level of tension between their

parents. These observations led to considering a family as an organism or

system with its own internal rules, patterns of functioning, and tendency to

resist change. The therapists started to treat the families of schizophrenic

patients as whole units rather than focusing on the hospitalized member.

They found that in many cases the family member with schizophrenia

improved when the "patient" was the family system. (This should not be

misunderstood to mean that schizophrenia is caused by family problems,

although family problems may worsen the condition.) This approach of

involving the entire family in the treatment plan and therapy was then

applied to families with problems other than the presence of

schizophrenia.

Family therapy is becoming an increasingly common form of

treatment as changes in American society are reflected in family

structures. It has led to two further developments: couples therapy, which

treats relationship problems between marriage partners or gay couples;

and the extension of family therapy to religious communities or other

groups that resemble families.

Supportive Family Therapy is often used as a way of allowing

family members to say how they feel about a problem in a safe, caring

setting. Sometimes, the problem can be really difficult to deal with at home

(for example, caring for a sick child), and this provides an opportunity for

families to get together, and openly talk about it, as well as offer practical

advice and information about further sources of help. Family therapy using

Cognitive-Behavioural Therapy (CBT) techniques attempts to change the

ways people think or behave in order to reduce or get rid of the problem.

Homework tasks may be set, or specific behavioural programs might be

drawn up. Family therapy using Psychodynamic ideas tends to look more

into the individual's own unconscious (sometimes called subconscious)

minds. It attempts to reduce the problem(s) by uncovering what is really

going on 'under the surface'. It is hoped that by providing the individuals in

the family with, if you like, the 'real' reasons behind what is going on,

people will be able to deal with their difficulties more successfully.

 B. Objectives

The family therapy aims to:

• Establish a good rapport and trusting relationship with the family

• Verbalize feelings and emotions according to reality

• Talk what is really the situation of the family

• Express what is inside the clients heart and mind

• Help the family to identify problems and situation that made them worry or

bothered

• Acquired lesson from the past experience

• Share past events whether it is good or bad

• Relax and be sensitive for what you are doing

• Respect each other while they are taking and sharing their thoughts

• Consider the feeling of others

• Empathize with the client

• Enhance the proper way of listening

• Inculcate values such as kindness, humility and respect

• Help the family in choosing what appropriate response in dealing with their

present situation.

After 2 weeks of community immersion, the students are expected to:

• Established a good rapport to their foster parents in order to immersed

oneself thoroughly to their foster parents and also to their client for the

family therapy so that the information are valid and precise

• Done the mental health assessment correctly and properly to the patient.

• Conducted a family therapy that was suitable to the family problem based

on the assessment that is being conducted.

• Immersed oneself to the life and environment of the community people

living in the said place.

• Know the norms of the community and basic functioning as a member of

the family and community.

• Developed a leadership quality as a member of the group.

SOCIOGRAM Legend:
Rodel
Gonzeles Question 1
Lucillo
Question 2

Question 3

Johnette Question 4
Mary S
Ovilla Question 5

Question 6
C.I

SN 1
facilitator SN 2
Recorder
 J.M.O

J.M. M.O

E.C T.G H.D L.T

Process Recording of the Family Therapy
 Nurse Client/ Family Observation and

Member Analysis

Response

SN1: “Magandang Ate Beffie : - They welcome us

Hapon po Ate Magandang hapon easily

Beffie, Kuya Rodel. din, at sa inyo din sir. With a smile

Ako po si Carl

Pastor.” Kuya Constantino: Trust VS. Mistrust

(ngumite, at na pa - The client can

SN2: ” At ako tungo). Sa inyo din easily trust other

naman po si Bok Sir. people. So he

Umali” develop faith and

optimism

SN1: “Narito po ulit

kami para sa isang

family therapy

kasama ang aming

CI na si Mr.

Fedelicio makikinig

lang po sa ating

usapan”

(Q1) Ate Beffie and Kuya

SN1: “Pag usapan Ate: ayun kasi nuon Rodel uses a

po nating kung pa man eh kilala ko problem solving for

paano kayo nag ka na siya dahil nga stress

kilala?” tropa ako nga kapatid management. An

niya, hangang sa extremely adaptive

hinihinge na nya ang coping strategy is to

number ko ayun. view the situation in

an objective manner

Kuya: Tulad nga ng

sinabe ang ate nyo

ganun nga kame nag

APPENDICES
 BIBLIOGRAPHY

WEB :

• www.yahoo.com

• www.google.com

• www.wikipedia.com

Links

• http://www.bellaonline.com/articles/art60448.asp

• http://www.bellaonline.com/articles/art55184.asp

Books

• Fundamentals of nursing 5th edition Carol taylor

• Psychiatric Nursing 8th edition author Gail W. Stuart

• Nursing Theories and their works 5th edition author Ann Mariner tomey