1. Mrs.

Leila DEFORT, a mother of a 2-month old infant named Totoy, is frantic because he seems to ignore her and
her husband when they talk to him. She tells Bogart, a psychiatric nurse, that she is afraid her son is mentally
retarded and blames herself, saying that she must have done something wrong during her pregnancy. Leila tells
nurse Bogart that she definitely knows her son is mentally retarded because her sister’s daughter acted the same
way and she was diagnosed with mental retardation. She is heartbroken and does not know what to do.

A. Why should Leila be concerned?

 She should be concern because according to her, her sister’s daughter is acting the same way and
was diagnosed to have mental retardation; therefore, it proves to have problems in their family.
One factor that shows concern is her son does not react to them, which it shouldn’t because
normal babies do not ignore their parents.

B. What information should Nurse Bogart gather from the parent?

 Nurse Bogart should ask both parents if they have other family member or history of mental
problem in their family. Also, he should ask them how often their baby cry in a day and what are
the responses of their son whenever they hold him and breastfeed him.

C. What might be the reason for Totoy’s lack of response to sound?

 Possibly their child might be having problem with his auditory because a person does not usually
response if they can’t properly hear. In addition, he might not be able to properly see them.
Furthermore, he might be mentally retarded because of what the mother told the nurse about her
sister having a retarded child.

2. Mrs. Fe Dimagiba, 43 year old woman was watching television. Suddenly she rushes and locks all the doors and
all the windows, and draws all the shades before turning off the television and all but one light off. She sits still in the
chair and falls asleep. Mrs. Dimagiba now tells her practitioner about the experience, concerned that she is “losing
her mind” as she explains to the practitioner.

A. What should the practitioner suspect have occurred?

 She should suspect that Mrs. Dimagiba is having fear of the dark problem and she might be scared
to be in the dark. In addition, Mrs. Dimagiba is having paranoia, scared about someone might enter
in her house to do harm. Also, Mrs. Dimagiba was affected by the show on the television and got
scared. Furthermore, other speculation is, the patient has had history of burglary at their home or
other close by resident.

B. What should the practitioner do first?

 Assess if Mrs. Dimagiba is having anxiety every night and what causing her to act the way she did.
Determine if the patient is taking any psychotic drugs or had history of depression or anxiety, if so,
ask if she still taking it. Ask the client about environment she is living in, whether, populated or
unpopulated.
 The practitioner should prescribe anti-anxiety medication and sleeping medications to help her to
sleep.
C. What might have caused the patient to react in such a way?
 The patient might be having an episode of depression or the patient had history of depression and
was not able to take medication. The patient had history of burglary at their home or other close by
resident. Furthermore, the patient is having paranoia, thinking that there is someone wanting to
enter in her house. In addition, she is mentally ill because she sleeps sitting in the chair and
staying still. Any normal person would not sleep the way she does, therefore, she could very well
be mentally retarded.
A. Definition of therapeutic communication
 The therapist provides corrective interpersonal relationship for the client. Sullivan coined the term participant
observer for the therapist’s role, meaning that the therapist both participates in and observes the progress of
the relationship. In the concept of therapeutic community or milieu, the interaction among clients is seen as
beneficial, and treatment emphasizes the role of this client-to-client interaction. Therapeutic communication
is an interpersonal interaction between the nurse and the client during which the nurse focuses on the
client’s specific needs to promote an effective exchange of information.

B. Requirements for therapeutic relationship

 It involved clients’ interactions with one another, including practicing interpersonal relationship skill, giving
one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems.
Management of the milieu, or environment, is still a primary role for the nurse in terms of providing safety
and protection for all clients and promoting social interactions.

C. Phases of therapeutic nurse client relationship

 Orientation phase – the orientation phase is directed by the nurse and involves engaging the client in
treatment, providing explanations and information, and answering questions.
 Identification phase – the identification phase begins when the client works interdependently with the nurse,
expresses feelings, and begins to feel stronger.
 Exploitation phase – The exploitation phase the client makes full use of the services offered
 Resolution phase – the resolution phase the client no longer needs professional services and gives up
dependent behavior. The relationship ends.

D. Interpersonal communication
 Interpersonal communication is a dynamic and complex human phenomenon that includes at least two
communicators. These communicators intentionally orient toward each other as both subject and object
whose actions embody each other’s perspectives both toward self and toward other. Interpersonal
communication is a goal-driven interaction between at least two people that typically occurs in a face to face
environment.

E. Verbal and nonverbal communication

 Verbal communication - consists of the words a person uses to speak to one or more listeners. Words
represent the objects and concepts being discussed. Placement of words into phrases and sentences that
are understandable to both speaker and listeners gives and order and a meaning to these symbols.
 Non-verbal communications – Is the behavior that accompanies verbal content such as body language, eye
contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance
from the listeners. Nonverbal communication can indicate the speaker’s thoughts, feelings, needs, and
values that he or she acts out mostly unconsciously.

F. Therapeutic communication techniques

 Accepting – indicating reception
 Broad openings - allowing the client to take the initiative in introducing the topic
 Consensual validation – searching for mutual understanding, for accord in the meaning of the words
 Encouraging comparison – asking that similarities and differences be noted
  Encouraging description of perceptions – asking the client to verbalize what he or she perceives
 Encouraging expression – asking the client to appraise the quality of his or her experiences
 Exploring – delving further into a subject or an idea
 Focusing – concentrating on a single point
 Formulating a plan of action – asking the client to consider kinds of behavior likely to be appropriate in future
situations
 General leads- giving encouragement to continue
 Giving information – making available the facts that the client needs
 Giving recognition – acknowledging, indicating awareness
 Making observations – verbalizing what the nurse perceives
 Offering self – making one-self available
 Placing event in time or sequence – clarifying the relationship of events in time
 Presenting reality – offering for consideration that which is real
 Reflecting – directing client actions, thoughts, and feelings back to client
 Restating – repeating the main idea expressed
 Seeking information – seeking to make a clear that which is not meaningful or that which is vague
 Silence - absence of verbal communication, which provides time for the client to put thoughts or feelings
into words, to regain composure or to continue talking
 Suggesting collaboration – offering to share, to strive, and to work with the client for his or her benefit
 Summarizing – organizing and summing up that which has gone before
 Translating into feelings – seeking to verbalize client’s feelings that he or she expresses only indirectly
 Verbalizing the implied – voicing what the client has hinted at or suggested
 Voicing doubt – expressing uncertainty about the reality of the client’s perceptions.

G. Non-Therapeutic communication techniques

 Advising – telling the client what to do
 Agreeing – indicating accord with the client
 Belittling feelings expressed – misjudging the degree of the client’s discomfort
 Challenging – demanding proof from the client
 Defending – attempting to protect someone or something from verbal attack
 Disagreeing – opposing the client’s ideas
 Disapproving – denouncing the client’s behavior or ideas
 Giving approval – sanctioning the client’s behavior or ideas
 Giving literal responses – responding to a figurative comment as though it were a statement of fact
 Indicating the existence of an external source – attributing the source of thoughts, feelings, and behavior to
others or to outside influences
 Interpreting – asking to make conscious that which is unconscious; telling the client the meaning of his or
her experience
 Introducing an unrelated topic – changing the subject
 Making stereotyped comments – offering meaningless clichés or trite comments
 Proving – persistent questioning of the client
 Reassuring – indicating there is no reason for anxiety or other feelings of discomfort
  Rejecting – refusing to consider or showing contempt for the client’s ideas or behaviors
 Requesting an explanation – asking the client to provide reasons for thoughts, feelings, behaviors, events
 Testing – appraising the client’s degree of insight
 Using denial – refusing to admit that a problem exists.

H. Nursing barriers to communication

 Competing demands, lack of privacy, and background noise are all potential barriers to effective
communication between nurses and patients. Patients’ ability to communicate effectively may also be
affected by their conditions, medication, pain and anxiety.
 Physical barriers - physical environment can make a huge difference in successful communication.
 Psychological barriers – obesity, sexual, disease, and death. The anxiety and stress that comes from
addressing sensitive topics can block effective communication in nursing
 Social Barriers – gender, education, religion, and age all drive human behavior.