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ORIENTATION PHASE

Description of Phase:

• Problem defining phase

• Starts when client meets nurse as stranger

• Defining problem and deciding type of service needed

• Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences

• Nurse responds, explains roles to client, helps to identify problems and to use available
resources and services

Objectives:

After the orientation phase, the nurse will be able to:

 Determine why the patient sought help


 Establish trust, acceptance, and open communication
 Mutually formulate a contract with the patient
 Explore patient’s thoughts, feelings, and actions
 Identify patient’s problems
 Define goals with the patient

Date/ Time/ Venue: November 25, 2009 at National Center for Mental Health, Pavilion 1
Ward 9
RATIONALE OF THE
NURSE’S ANALYSIS OF THE
NURSE-PATIENT PATIENT’S RESPONSE
COMMUNICATION
INTERACTION
TECHNIQUE

Nurse: Magandang umaga J. Therapeutic:


Ako si Ran. Estudyante ako
Giving Information
mula sa Centro Escolar
University, Manila. Student  Making available the facts
nurse mo ako ngayon. that the client needs
Magkikita at mag-uusap tayo Use names
simula Miyerkules hanggang
 Using a person's name
Biyernes sa susunod na
makes her feel more
linggo, mula alas-siyete
valued, and introducing
hanggang alas-tres ng hapon.
yourself is a basic step in
Mag-uusap ulit tayo bukas ha.
establishing a therapeutic
interaction.

Patient: Opo…Opo…Opo
(with nodding)

Nurse: Puwede ko bang


malaman ang buong pangalan  Patient is conscious and
Therapeutic:
mo? comprehending
Exploring

 Encourages the speaker to


expand upon their
Patient: (stated the name) remarks/ question
Nurse: Ano ulit ang pangalan
ko J?

 Patient is responsive
Patient: Ran po. (somnolence)

Nurse: Sige. Ako ang student


nurse mo tapos ikaw ang
pasyente. Therapeutic:
 Patient is drowsy and
Help to orient
comprehending
 Illness and hospitalization  According to Jung,
can be very disorienting perception involves all the
Patient: Opo.
for patients, especially the ways of becoming aware
elderly. of things, people,

Nurse: Mag-uusap tayo J ha. happenings, or ideas.

Magkukwentuhan lang tayo. Judgment involves all the


ways of coming to
conclusions about what

Patient: Opo. Opo. has been perceived. If


people differ
systematically in what they

Nurse: Alam mo ba kung perceive and in how they

anong petsa at araw ngayon? reach conclusions, then it


Therapeutic: is only reasonable for them

Help to orient to differ correspondingly


in their interests, reactions,
 Illness and hospitalization values, motivations, and
can be very disorienting skills.
Patient: Sabado for patients.  Patient is responsive

Therapeutic:
Nurse: J Huwebes ngayon.
November 26, 2009. Presenting Reality

 When it is obvious that the  He is analyzing the


patient is misinterpreting information
reality, the nurse can
Patient: (stares only) indicate that which is real.
 Patient had
He does this not by way of
established/formed fixated
arguing with the patient or
Nurse: Ano ulit ang petsa idea with regards
belittling his own
ngayon J? experiences, but rather by
calmly and quietly  Patient is responsive
Patient: Sabado
expressing her own
Nurse: Huwebes ngayon, perceptions or the facts
November 26, 2009 J.

Therapeutic:  He has a difficulty to recall


personal information and
Patient: Opo Asking Direct Questions: is often confused.

 This allows the patient to

Nurse: Ilang taon ka na pala J? try answering a direct


question directly, briefly
and correctly

Patient: Napulo Therapeutic:  He has a difficulty to recall

Reframing the question: personal information and


is often confused.
 This allows the patient to
try answering a direct
question directly, briefly
Nurse: Anong taon nuong and correctly
ipinanganak ka? Therapeutic:
 Patient has difficulty in
Asking Direct Questions: memory skills

Patient: Marso  This allows the patient to


try answering a direct
question directly, briefly
and correctly
Therapeutic:
Nurse: Ano ang birthday mo?
Kelan ka ipinanganak? Help to orient  Disoriented to place

 Illness and hospitalization


can be very disorienting
Patient: Hulyo, Agosto
for patients.

Therapeutic:

Nurse: alam mo ba J kung ano Asking Direct Questions:


ang ginagawa mo dito?  Misleading answer
 This allows the patient to
try answering a direct

Patient: (looses eye contact, question directly, briefly

tumingin sa malayo) and correctly


Therapeutic:

Asking Direct Questions:


Nurse: Anong lugar to J?
 This allows the patient to
try answering a direct  Trying to recall personal

Patient: (silence. Spits saliva).. question directly, briefly information

Ambot and correctly


Therapeutic:
Asking Direct Questions:

 This allows the patient to


try answering a direct
Nurse: Saan ka pala nakatira  Patient is responsive
question directly, briefly
J?
and correctly
Therapeutic:

Patient: sa bahay Asking Direct Questions:

 This allows the patient to


try answering a direct
question directly, briefly
Nurse: Saan ka galing na and correctly
probinsiya?
 Patient is responsive
Therapeutic:

Patient: doon Asking Direct Questions:

 This allows the patient to


try answering a direct
question directly, briefly
Nurse: Saan yung doon na and correctly
sinasabi mo J? Yung lugar Therapeutic:
 Patient is responsive
kung saan ka dati nakatira
bago ka napunta dito? Asking Direct Questions:

 This allows the patient to


try answering a direct
Patient: Bitano
question directly, briefly
and correctly

Nurse: Saan yung Bitano J?


Therapeutic:
Using Broad Opening
Statements The use of a broad
Patient: Sorsogon
opening statement allows the
patient to set the direction of
the conversation.

Therapeutic:

Asking Direct Questions:


Nurse: alam mo ba kung
nasaan ang Sorsogon?  This allows the patient to
try answering a direct
question directly, briefly
Patient: sa Mindanao and correctly

 Somnolence

Nurse: Naaalala mo pa ba ang  The patient can’t justify


mga nangyari bago ka napunta Therapeutic: Piaget’s cognitive theory.
dito?
Observation:
 According to Piaget, the
 To help with awareness of
formal operational period
Patient: (looses focus, drowsy) feelings, encourage
is the fourth and final of
verbalization of feelings,
the periods of cognitive
conveys concern and
Nurse: Sino ang kasama mo development in Piaget's
interest.
pagpunta mo dito? theory. This stage, which
Verbalizing Implied Thoughts
follows the Concrete
and Feelings
Operational stage,

Patient: (focus returned)  The nurse voices what the commences at around 11
patient seems to have years of age (puberty) and
fairly obviously implied, continues into adulthood.
rather than what he has In this stage, individuals
actually said. move beyond concrete
Nurse: J mag-usap pa tayo ha? Therapeutic: experiences and begin to
think abstractly, reason
Asking Direct Questions:
logically and draw
Patient: Opo.  This allows the patient to conclusions from the
try answering a direct information available, as
question directly, briefly well as apply all these
Nurse: Okay ka pa? and correctly processes to hypothetical
situations.

Therapeutic:
Patient: Opo.
 It is observable that the
Exploring or delving further
patient has an
into a subject or idea:
inappropriate affect
Nurse: Inaantok ka ba J?
 The nurse should
recognize when to delve

Patient: hindi po further. If the patient


chooses not to elaborate,
the nurse should respect

Nurse: Napapagod ka na ba? the patient’s wishes.


 Some questions with
regards to personal
information can be
Patient: Hindi po.
Therapeutic: answered correctly by the
patient.
Focusing:
Nurse: Nag-enjoy ka ba knina
J?  It will help the client
expand on a topic
Therapeutic:
Patient: Opo (flat affect) Sequencing:

 Helps to identify cause and


effect, recurring pattern of
Nurse: Nag-exercise ka rin ba?
interpersonal difficulties.
Therapeutic:

Patient: Opo Exploring or delving further


into a subject or idea:

 The nurse should


Nurse: Kamusta naman ang  Flight of ideas
recognize when to delve
pag-ehersisyo mo kanina J?  a nearly continuous flow
further – she should refrain
of rapid speech that jumps
from probing or prying. If
from topic to topic, usually
the patient chooses not to
Patient: Okay lang po based on discernible
elaborate, the nurse should
associations, distractions,
respect the patient’s
or plays on words, but in
Nurse: Sino pala ang kasama wishes. Probing usually
severe cases so rapid as to
no J pagpunta mo dito? occurs when the nurse
be disorganized and
introduces a topic because
incoherent.
she is anxious.

Patient: Suseng Therapeutic:


 Patient is fixated with
Sequencing:
certain numbers like 5 and

Nurse: Kaano-ano mo si  Helps to identify cause and 10.

Suseng J? effect, recurring pattern of


interpersonal difficulties.
 When we feel safe and
secure in our world then
Patient: nanay
we begin to seek out
friendships in order to feel
a sense of belonging.
Nurse: Nanay mo siya?
Maslow's third level, the
Therapeutic: need for belonging and
love, focuses on our desire
Patient: Opo Exploring or delving further
to be accepted, to fit in,
into a subject or idea:
and to feel like we have a
 The nurse should place in the world.
Nurse: Tapos ano ang
recognize when to delve
nangyari?
further – she should refrain  Persons may be called both
from probing or prying. If mentally retarded and
the patient chooses not to learning disabled, meaning
Patient: may red na bag, blue
elaborate, the nurse should that their overall IQ is
respect the patient’s lower than average, but
wishes. Probing usually that they have strengths
Nurse: Tapos?
occurs when the nurse and weaknesses on various
introduces a topic because skills.
she is anxious.
Patient: isang bag lang dala
Therapeutic:
ko, namin

Asking Direct Questions:

Nurse: Ilang taon ka na dito?  This allows the patient to


try answering a direct
 Cognitive development is
question directly, briefly
defined as thinking,
Patient: lima and correctly
problem solving, concept
Therapeutic:
understanding, and

Asking Direct Questions: information processing


Nurse: Si Suseng nasaan? and overall intelligence.
 This allows the patient to Many mentally retarded
try answering a direct clients have cognitive
Patient: Doon question directly, briefly weaknesses. Their overall
and correctly potential may be lower
than that of their peers and
siblings. They still have
Nurse: Saan yung nanay mo J? patterns of strengths and
weaknesses in their
development and may do
Patient: sa bahay, dun very well with certain
types of learning.
Therapeutic:

Nurse: Sa Bitano? Sequencing:

 Helps to identify cause and


effect, recurring pattern of
Patient: Opo (nods)
interpersonal difficulties.  Adaptive skills are the
skills needed for daily life
and include the ability to
Nurse: may mga gamot ka ba
produce and understand
na iniinom?
Therapeutic: language
(communication); home-
Sequencing:
living skills; use of
Patient: oo, kanina
Helps to identify cause and community resources;
effect, recurring pattern of health, safety, leisure, self-
interpersonal difficulties care, and social skills; self-
Nurse: Ano daw yun J?
direction; functional
academic skills (reading,
writing, and arithmetic);
Patient: aspilit, isa lang
and work skills.
Therapeutic:

Acknowledging the patient’s


Patient: gamot, gamot,
Feeling:
(showed both arms)
 The nurse helps the patient
to know that his feelings
Nurse: may asawa ka naba J? are understood and
accepted and encouraged
him to continue expressing
them. If communication is
Patient: wala
to be successful, it is
essential that the nurse
accept the thoughts and
feelings her patient is
expressing.

Nurse: Nakatapos ka na ba ng
elementary o high school J?

Patient: oo, elementary

Include the patient

Nurse: Hanggang anong grade  You must remember that


natapos mo? patient care should be
collaborative and include
the patient in decision
Patient: Grade 1 making whenever
possible. The patient often
feels at the mercy of the
Nurse: ano pala palagi mo system, but you can help
ginagawa dito J? him find ways to feel in
control.

Patient: Toothbrush (acting),


ligo, kain

Nurse: Tuwing umaga?


Patient: kain

Nurse: kapag hapon?

Patient: tulog

Nurse: ano ang gusto mong


pagkain J?

Patient: monggo’

Nurse: ano ang kinain mo


kanina?

Patient: monggo

Nurse: Masarap ba J?

Patient: Opo

Nurse: ano ang mga ayaw mo


kainin?

Patient: monggo, kanin, apple

Nurse: Di ba sabi mo gusto


mo ng monggo knina?

Nurse: Usap ulit tayo bukas


ha!

Patient: Opo.

WORKING PHASE

Description of Phase:

At this point, the client’s problems are identified and solutions are explored,
applied and evaluated. The focus of the assessment and of the relationship is the client’s behavior
and the focus of the interaction is the client’s feelings.

Objective:
After the working phase, the nurse will be able to:

 Explore relevant stressors for the patient


 Promote patient’s development of insight and use of constructive coping
mechanisms
 Overcome resistance behavior

Date/ Time/ Venue: November 26, 2009 at National Center for Mental Health, Pavilion 1
Ward 9

RATIONALE OF THE
NURSE’S ANALYSIS OF THE
NURSE-PATIENT PATIENT’S RESPONSE
COMMUNICATION
INTERACTION
TECHNIQUE

Nurse: Magandang umaga sa Therapeutic:  Patient is disoriented to


yo J! time, place and person
Use names:

 Using a person's name


Patient: Magandang umaga makes her feel more
din po. valued, and introducing  MEMORY AND
yourself is a basic step in ATTENTION. Memory
establishing a therapeutic deficiencies interfere with
Nurse: Ano ulit ang pangalan interaction. learning rote material such
ko J? as days of the week,
months of the year, and
Therapeutic:
times tables. Basic facts
Patient: (Kran) Help to orient are hard to remember and
there is a lack in
 Illness and hospitalization
knowledge of general
can be very disorienting
Nurse: Ran ako for patients. information. There are
Therapeutic: deficits in attention that
interfere with ability to
Using Broad Opening
Patient: Ran focus and concentrate on
Statements:
tasks.
 The use of a broad
Nurse: Kamusta naman ang opening statement allows
tulog mo J? the patient to set the
direction of the
conversation. Give the
Patient: Maayos patient an opportunity to
begin expressing himself.
In using a broad opening
Nurse: eh ang gising? statement, the nurse
focuses the conversation
directly on the patient and
Patient: ayos communicates to him that
she is interested in him
and his problems. Upon
Nurse: Anong araw pala sensing that the patient
ngayon J? may have a need, the nurse
can use a broad opening
statement to initiate
Patient: Martes discussion, while at the
same time allowing the
patient to determine what
Nurse: J, Biyernes ngayon.
will be discussed.
Ang petsa ay November 27,
Therapeutic:
2009.
Giving Information  The patient can’t justify

 Studies have shown that a Piaget’s cognitive theory


Nurse: Anong araw ang major cause of anxiety or
sumunod sa Biyernes? discomfort in hospitalized
 According to Piaget, the
patients is lack of
formal operational period
information or
is the fourth and final of
Patient: Martes misconceptions about their
the periods of cognitive
condition, treatment, or
development in Piaget's
hospital routines. When
theory. This stage, which
Nurse: Kung Biyernes ngayon, the patient is in need of
follows the Concrete
ano ang araw bukas? Bukas information to relieve
Operational stage,
ay? anxiety, form realistic
commences at around 11
conclusions, or make
years of age (puberty) and
decisions, this need will
continues into adulthood.
Patient: Martes often be revealed during
In this stage, individuals
the interaction by
move beyond concrete
statements he makes. By
experiences and begin to
Nurse: Sabado bukas J. providing such
think abstractly, reason
Sundan mo ko ha. information as she
logically and draw
prudently can, admitting
conclusions from the
and finding out what she
information available, as
Nurse: Lunes doesn’t know, or referring
well as apply all these
the patient to someone
processes to hypothetical
who can assist him, the
Patient: Lunes situations.
nurse can do much to
establish an atmosphere of
helpfulness and trust in her
Nurse: Martes relationship with the
patient.

Patient: Martes
Nurse: Miyerkules

Patient: Miyerkules Therapeutic:

Using Broad Opening


Statements:
Nurse: Huwebes
 The use of a broad
opening statement allows
Patient: Huwebes the patient to set the
direction of the
conversation. Give the
Nurse: Biyernes patient an opportunity to
begin expressing himself.
 Patient is responsive.
Therapeutic:
Patient: Biyernes
Sequencing:

 Helps to identify cause and


Nurse: Sabado effect, recurring pattern of
interpersonal difficulties.  According to Piaget, the
formal operational period
Patient: Sabado is the fourth and final of
the periods of cognitive
development in Piaget's
Nurse: Linggo theory. This stage, which
follows the Concrete
Therapeutic: Operational stage,
Patient: Linggo Sharing Observations commences at around 11
 The nurse shares with the years of age (puberty) and
patient observations continues into adulthood.
Nurse: Anu-ano pala mga In this stage, individuals
regarding behavior. The
ginawa mo ngayong umaga? patient who has a need is move beyond concrete
often unaware of the experiences and begin to
source of this distress, or think abstractly, reason
Patient: Kain, toothbrush, ligo reluctant to communicate logically and draw
it verbally. However, the conclusions from the
tension or anxiety created information available, as
Nurse: Ano yung mga kinain by his need creates energy well as apply all these
mo? which is transformed into processes to hypothetical
some kind of behavior, situations.

Patient: Spanish Therapeutic:

Sequencing:

Nurse: Spanish bread?  Helps to identify cause and


effect, recurring pattern of
interpersonal difficulties
Patient: Opo

Nurse: masarap ba? Reflecting:


 Patient is responsive and
In reflecting, all or part of answers questions with
the patient’s statement is comprehension.
repeated to encourage him
Patient: Opo to go on. Reflecting can be
overused, and the patient
is likely to become
annoyed if his own words
Nurse: pag-usapan natin ang or statements are
continually repeated to
drawing mo kanina. him

Patient: iskindi (ice candy)


Nurse: ice candy yung
drawing mo?  MEMORY AND
ATTENTION. Memory
deficiencies interfere with
Patient: Opo. learning rote material such
as days of the week,
months of the year, and
Nurse: Anong meron sa ice times tables. Basic facts
Therapeutic:
candy at yun ang dinrawing are hard to remember and
mo? Exploring or delving further
there is a lack in
into a subject or idea:
knowledge of general
Ang ice candy ay?
 The nurse should information. There are
recognize when to delve deficits in attention that
further – she should refrain
from probing or prying. If interfere with ability to
Patient: matamis, lamig
the patient chooses not to focus and concentrate on
elaborate, the nurse should
respect the patient’s tasks.
wishes. Probing usually
Nurse: ano pa? occurs when the nurse
introduces a topic because
she is anxious

Patient: tigas, tamis

Nurse: may naalala ka ba sa Therapeutic:  MEMORY AND


ice candy? ATTENTION. Memory
Asking Direct Questions:
deficiencies interfere with
 This allows the patient to learning rote material such
Patient: (silence) try answering a direct as days of the week,
question directly, briefly months of the year, and
and correctly times tables. Basic facts
Nurse: paborito mo ba ang ice are hard to remember and
candy? there is a lack in
knowledge of general
information. There are
Patient: Opo. deficits in attention that
interfere with ability to
focus and concentrate on
Nurse: ano ang paborito mo na tasks.
lasa ng ice candy?

Patient: monggo

Nurse: Anu-ano pala ang mga


kulay ng ice candy? Diyan sa
drawing mo J?

Patient: (Points on the lines


while identifying its colors,
with some mistakes)

Nurse: (corrects the mistakes)

Nurse: okay J, very well.


Magaling!
Nurse: Nagtitinda ka ba dati
ng ice candy J?

Patient: Hu..

Nurse: Pagod ka na ba J?

Patient: Opo.

Nurse: Okay sige. Pahinga ka


na J. Hintayin lana muna natin
ang iba na matapos ha.

Patient: Opo.
TERMINATION PHASE

Description of Phase:

The nurse terminates the relationship when the mutually agreed goals are met, the
patient is discharged or transferred or the rotation is finished. The focus of this stage is the
growth that has occurred in the client and the nurse helps the patient to become independent and
responsible in making his own decisions. The relationship and the growth or change that has
occurred in both the nurse and the patient is summarized.

Objective:

During the termination phase, the nurse will be able to:

 Establish reality of separation


 Review progress of therapy and attainment of goal
 Mutually explore feelings of rejection, loss, sadness, and anger and related
behaviors

Date/ Time/ Venue: December 3, 2009 at National Center for Mental Health, Pavilion 1
Ward 9

Nurse-Patient Interaction Rationale of the Nurse’s Analysis of the Patient’s


Communication Technique Response

Nurse: Magandang umaga sa Therapeutic:  The patient is conscious.


yo J.
Use names
Patient: Gandang umaga din  The patient talks rapidly.
po.  Using a person's name
makes her feel more  Adaptive skills are the

Nurse: Kumusta ang tulog valued, and introducing skills needed for daily life
mo? yourself is a basic step in and include the ability to

Patient: Ok lang. establishing a therapeutic produce and understand


interaction. language
Therapeutic: (communication); home-
Nurse: Maayos ba naman ang
living skills; use of
gising? Using Broad Opening
community resources;
Statements:
Patient: Opo. health, safety, leisure, self-
The use of a broad opening care, and social skills; self-
statement allows the patient to
Nurse: Anu-ano ang mga direction; functional
set the direction of the
ginawa mo kanina? conversation. Give the patient academic skills (reading,

Patient: toothbrush, ligo, kain an opportunity to begin writing, and arithmetic);


expressing himself. and work skills.

Nurse: Ano ang kinain mo J?


Therapeutic:
 Cognitive development is
Patient: tinapay
Focusing: defined as thinking,
problem solving, concept
Nurse: masarap ba J?  It will help the client understanding, and
expand on a topic information processing
Patient: Opo.
Therapeutic: and overall intelligence.

Exploring or delving further Many mentally retarded


Nurse: nabusog ka ba?
into a subject or idea: clients have cognitive
Patient: (nods) weaknesses. Their overall
 The nurse should potential may be lower
recognize when to delve than that of their peers and
Nurse: Pag-usapan natin J
further – she should refrain siblings. They still have
yung tungkol sa niyog. Ano
nga ang mga parte ng niyog? from probing or prying. If patterns of strengths and
the patient chooses not to weaknesses in their
Patient: dahon
elaborate, the nurse should development and may do
respect the patient’s
Nurse: Ahh. Magbigay ka nga wishes. Probing usually very well with certain
ng isang gamit ng dahon. occurs when the nurse types of learning.
Patient: bubong introduces a topic because
she is anxious.

Nurse: Ano pa J? Magsabi ka


pa nga ng isang parte pa ng  MEMORY AND
puno ng niyog? ATTENTION. Memory
Therapeutic: deficiencies interfere with
Patient: puno
learning rote material such
Sequencing:
as days of the week,
Nurse: Anong gamit ng kahoy  Helps to identify cause and months of the year, and
ng niyog J?
effect, recurring pattern of times tables. Basic facts
Patient: bahay. interpersonal difficulties. are hard to remember and
there is a lack in

Nurse: Oo. Ginagamit nga to Therapeutic: knowledge of general


sa paggawa ng bahay. information. There are
Focusing:
deficits in attention that

 It will help the client interfere with ability to


Nurse: Puwede ka bang
expand on a topic focus and concentrate on
magkuwento ng tungkol sa
mga magulang at mga kapatid tasks.
mo J? Therapeutic:

Patient: … Asking Direct Questions:

 This allows the patient to  According to Piaget, the


Nurse: Namimiss mo ba sila try answering a direct formal operational period
J?
question directly, briefly is the fourth and final of
Patient: … and correctly the periods of cognitive
development in Piaget's
Nurse: Ano ulit pangalan nung theory. This stage, which
nanay mo? follows the Concrete
Operational stage,
Patient: Suseng commences at around 11
years of age (puberty) and
continues into adulthood.
Nurse: Ano naman ang
pangalan ng tatay mo J? In this stage, individuals
move beyond concrete
Patient: Mario
experiences and begin to

Therapeutic: think abstractly, reason


Nurse: Ang mga kapatid mo? logically and draw
Naaalala mo ba mga pangalan Acknowledging the patient’s conclusions from the
nila? Feeling: information available, as
Patient: Ricoy, Marichu well as apply all these
 The nurse helps the patient
to know that his feelings processes to hypothetical

are understood and situations.


Nurse: Nasaan na sila ngayon
J? accepted and encouraged
Patient: Ambot. him to continue expressing
them. If communication is
to be successful, it is
Nurse: Napaano pala yang
essential that the nurse
mga sugat mo sa kamay J?
accept the thoughts and
Patient: kadena
feelings her patient is
expressing.
Nurse: Sino ang nagkadena sa
yo J?

Patient: nanay  MEMORY AND


ATTENTION. Memory
deficiencies interfere with
Nurse: Ano daw ang dahilan
ni Suseng dahil kinadena ka learning rote material such
nya? May nagawa ka ba na as days of the week,
kasalanan?
months of the year, and
Patient: Ambot lang. times tables. Basic facts
are hard to remember and
there is a lack in

Nurse: Ano pa ang mga knowledge of general


nangyari J. Sige magkuwento information. There are
ka pa. Makikinig ako. deficits in attention that
Patient: Kinulong ako. interfere with ability to
focus and concentrate on
tasks.
Nurse: Kinulong ka J?

Patient: …

Nurse: Ano ang naramdaman


mo?
 According to Piaget, the
Patient: Nagalit. formal operational period
is the fourth and final of

Nurse: Kanino ka nagalit? the periods of cognitive


development in Piaget's
Patient: Suseng
theory. This stage, which
follows the Concrete
Nurse: Tapos ano na ang Operational stage,
nangyari? commences at around 11
Patient: Ambot. years of age (puberty) and
continues into adulthood.
In this stage, individuals
Nurse: J huling beses na pala
move beyond concrete
kita makakausap ng ganito.
experiences and begin to
Patient: …
think abstractly, reason
logically and draw
Nurse: Socialization na bukas conclusions from the
at huling araw na rin na information available, as
pupunta ako dito bukas.
well as apply all these
processes to hypothetical
Patient: …. situations.

Nurse: May gusto ka pa ba na


sabihin o ikuwento sa akin?

Patient: Wala na.

Nurse: Sige J. Hintayin na


lang natin ang iba na matapos.