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Date: November 24, 2009, Day 1 Setting: The nurse- patient interaction took place at the National Center for Mental Health, Pavilion 1. It was preceded by the morning exercises, newspaper therapy, music and art therapy and the client¶s snacks. My client and I stayed at the ³open field´ together with some of my group members. Approximately, after 10 minutes, we went for a walk around the area. Then, we settled ourselves adjacent to the foot of the basketball court. After quite some time again, we finally stayed at the foot of the basketball court where we spent the last minutes of the nurse- client interaction. Having a distance of at least 2 feet from the client, it was easy to talk to him without raising my voice because the place we chose was far from other clients and student members. The client wore the blue uniform and his white rubber slippers. Objectives: At the end of the nurse- patient interaction, the client will be able to: a. Display signs of recognition about the purpose of visits of the student nurse/s b. Respond to some basic queries c. Speak out present concern At the end of the nurse- patient interaction, the student nurse will be able to: a. Establish rapport with the client by utilizing therapeutic communication b. Set a contract about the time, frequency and place of the sessions c. Actively listen to client¶s concerns d. Develop a deeper sense of understanding and empathy to the client Insights Prior to Interaction: I was one of the few students who preferred to have a ³challenging patient´. It was so unnerving before I got to meet him because I learned some of his previous behaviour. Slowly, I started to feel sick especially when I first saw him at breakfast. I was excited and nervous at the same time. What if I say something wrong that might agitate him? Or what if I would be unable to say anything at all? These thoughts flooded my mind.
Nurse¶s Verbal and Non- Verbal Communication
Client¶s Verbal and Non- Verbal Communication
Therapeutic Communication Used
Theoretical: According to Manfreda and Krampitz (1977). I understood his condition but I admit that I felt quite disappointed.uusap tayo ng mga 30 minuto hanggang isang oras. (Smiled and tried to establish eye contact) Sige Michael. I called my client by his first name which indicated that I acknowledge and respect him as an individual. Also. frequently becomes suspicious. I still carried on with what I was saying because I was thinking that he might react.aaral ako sa St. Though he was unresponsive. I noticed all his actions and made a mental note to remember all of them. anong gusto mong pagusapan ngayon? (Smiled and leaned forward) Giving information Giving information Situational: It was my first meeting with my client so I kept all nervousness inside me and put on my best smile. kumusta ka na? (Smiled and established eye contact) The client looked at me briefly then shifted his gaze on the ground. I know it will take a long while to gain his trust as it was just our first interaction. Michael. tried to establish eye contact. Because of his loss of ability to affect a Broad openings . Dito lamang tayo sa loob maaring magusap. He kept rocking back and forth and his feet were in constant motion. an individual with schizophrenia maintains strong negative attitudes. He did not utter a single word or response. Nag. and actively or passively resists persons who attempt to form a therapeutic relationship with him. mag. I tried to establish eye contact but the client did not return the gesture. (Smiled. I feel his negativism towards other people not just with me. Ganun din bukas at sa susunod na Martes at Miyerkules. Babalik ulit kami sa susunod na lingo. paused for a while) Ngayong araw ng Martes. I also asked how he is doing as I tried to convey that I care about his welfare. Nandito kami ngayon at bukas. Aside from greeting him. Ako ang magiging student nurse mo. Paul University Manila at 3rd year college student na. Giving recognition Ako si Shane. sa araw ng Martes at Miyerkules.Magandang umaga Michael.
I was thinking that he might need some silence. may art and music therapy tayo kanina. I asked him about it but he just consciously stared at the picture. it frequently hinders him to make a positive transference to his therapist. I dwelled about his artwork. I stretched my patience meter and thought of other ways to make him express himself.satisfactory communicative feeling toward others. in reference to Manfreda and Kampritz. Maari mo bang ibahagi ang dahilan kung kaya¶t ganito ang iginuhit mong larawan? (Gave the picture to him) Napansin kong isang kulay lang yung ginamit mo. I was having a difficult time with him though we have only spent a couple of minutes. He was still rocking back and forth and was shuffling his feet on the ground. And according to Videbeck (2008). moving away or telling the person to leave are some of the attempts that a client usually does. clients lack trust and confidence to other persons. He also started to giggle by himself. anong dahilan ng kulay na ito? (Looked at him. Also. slight pause) Paborito mo ba ang kulay black? (Pointed at the drawing and tried to maintain eye contact) The student nurse paused then smiled at the client. Ignoring the nurse¶s presence. I paused for a while to think of other means to communicate with him. The client took the picture in his hands and stared at it. Ay oo nga pala. Theoretical: Again. the Silence . He was unresponsive and has very poor eye contact. I thought he had a hallucination when he laughed by himself. The client may exhibit negative methods to test the nurses/ therapist¶s sincerity and interest in him. Encouraging description of perceptions Making observations Encouraging description of perceptions Situational: Due to the lack of verbal communication.
halika. (Smiled and tried to establish eye contact) The client was still unresponsive and Making observations no changes in movements. In the end. Lakad muna tayo sandali. His strides were very long and went to wrong paths. It can be achieved by spending time with the client through some periods of silence. bukas. At this point. I was unsure on how our nurse. Michael.client relationship will flow. Ang student nurse mo para sa ngayong araw. I was very careful in touching him to guide him where to go because he might misinterpret my actions. sabi ni Sir Arianne magaling ka daw kumanta. It is manifested by laughing frivolously for no obvious reason at all. We walked around the area and he seemed to be unsure where to go. Additionally. Theoretical: .Michael. he followed and his pace slowed down. (Smiled at him and clapped hands softly) Pwede bang makahiling ng isang kanta. I introduced myself to him and oriented him again on the schedule of our meetings. Situational: I felt a tinge of hope when our clinical instructor offered some words of advice and informed me that the client loves to sing. He was verbally unresponsive but when asked to slow down during walking. he stood up and walked side by side with the student nurse. Michael? Kahit maikli lang? (Smiled and tried to establish eye contact) Sige. at sa susunod na Martes at Miyerkules. Encouraging expressions Giving information Giving information client may show variances in mood and affect. The affect may be described as something silly. When asked to walk around the pavilion. (Stood up and guided the client to the right direction) Ako nga pala ulit si Shane. the nurse must maintain a nonverbal communication with the client if verbal communication is not effective. I used that to reconnect with him but it didn¶t work.
So. Gusto mong dagdagan? Nandito yung crayons. The nurse must work hard to encourage the client by utilizing different means. In addition. Ano sa tingin mo Michael? (Pointed at the sky then turned to the client) Encouraging expressions As said by Manfreda and Krampitz. dito na lang muna tayo umupo. Situational: I gave him time of his own and with silence as I let him express his feelings through drawing. I paused for a while and stayed quiet together with him. Many clients come to enjoy choosing their own colors for their drawing and creating new designs. according to Videbeck. Ito nga pala ulit ung drawing mo kanina. he would not appreciate it. he laughed by himself. Furthermore. The client took one of the crayons but did nothing. Encouraging description of perceptions Using Silence . the client may not be ready to socialize with others particularly at the beginning. Taking a short walk might also appeal to the client. (Smiled. tried to establish eye contact and opened the box of crayons) The student nurse paused and arranged the crayons for the client. He just took hold of it and stared around the area. He kept fidgeting in his seat. Marami na kasing masyadong tao dun sa kanina nating pwesto eh. Again. it should also be noted that because some persons suffer from an urge to Sige. initiating activities to clients stimulate intellectual and creative functions. assessment to the client¶s response to the use of touch should be carefully done. I was afraid that if I do so much talking. pili ka ng gusto mong kulay. Theoretical: According to Manfreda and Kampritz. Caring and concern are the types of feelings implied with the use of touch. There are times when the client may misinterpret the nurse¶s touch as a threatening act which leads to becoming undesirable.Mukhan makulimlim ngayong Martes ah.
appear tayo. Kung okay lang sayo. Theoretical: Once more.uusap ulit tayo at maglalaro. Maybe it was my desperate plea to hear a word from his mouth that I thought I heard him mumbled something. I anticipated his negativism so it did not give me that much of a shock when he µrejected¶ the therapeutic relationship I¶m trying to build with him.Michael. di ba? Babalik ulit ako bukas tapos mag. naku. I was not sure and no one heard him as well. Stating that might also be a useful tool in conveying to him that I am sincere in my actions and communication with him.usap. (Pointed at the foot of the basketball court) Gusto mo ba kong maging kaibigan? Kasi ako gustong gusto kitang maging kaibigan. He was glancing around the area and had minimal eye contact with the nurse. Mukhang mas mahangin dun eh. Withdrawal is a defense mechanism against rejection. babye! Bukas ulit. This type of reaction is what the client has grown to expect in all types of . clients are unconsciously defending themselves and attempting to communicate something to the nursing personnel through their behaviour. (Smiled and waved at him) The client complied with the student nurse¶s request but mumbled something along the lines of ³Hay. Giving information Offering self maintain negative attitudes. in reference with Manfreda and Krampitz. I told him that I want to be his friend because in that way. the great wall of ice in between of us might melt in due time. I felt highly challenged to make him converse with me. Sige. Situational: I encouraged him again to talk in another place. Sana bukas mas maganda ang panahon para mas maganda ang simula ng araw natin. For some reason.´ He did not return the initial gesture of the nurse and remained affixed in his position. (Smiled and tried to gain the client¶s attention and eye contact) Mukhang matatapos yata ang araw na ito ng hindi tayo nakakapag. it will be difficult for the client to cooperate. lipat ulit tayo dun sa may ilalim ng basketball court.
I understood him and allowed myself to be 100% committed to his care. Shiela. Through all the silence we have passed through. Anticipation and acceptance of client¶s negative responses must always be remembered on the part of the nurse. I failed in helping him to talk about his concerns. I took that opportunity to observe him and keep those observations in mind to help me in my succeeding interactions with him.patient interaction. S. I was able to establish the contract and maintained therapeutic communication with him through the utility of both verbal and non verbal communication. and Krampitz. F. Time Span: 35 minutes Evaluation: The first day of my encounter with my client proved to be a challenging one. The nursing personnel play a very influential and active role in the client¶s recovery.relationships. L. (2008) Psychiatric. Source: Videbeck.mental Health Nursing (4th edition).A Davis Company. However. due to client¶s negative responses/ negativism as it is the beginning of our nurse. Lippincott Williams & Wilkins. (1977) Psychiatric Nursing (10th edition). Philadelphia . A nurse who is attempting to establish a relationship with this type of clients will find it tough to persevere unless she realizes that the clients may use negative methods to test her. Though he did not utter any verbalizations. Manfreda.
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