VERBALIZING THE IMPLIED

PSYCHIATRIC & ❒ CLIENT: “I can’t talk to you or anyone. It’s

a waste of time”
MENTAL HEALTH ❒ NURSE: “Do you feel that no one

NURSING understands?”
✔ ASSERTIVENESS: able to express
yourself without being emotional.
THERAPEUTIC COMMUNICATION
SEEKING CLARIFICATION
SYMPATHY EMPATHY
❒ CLIENT: “I’m feeling sick inside”
“I feel sorry for you” “I see you are sad”
❒ NURSE: “What do you mean by ‘feeling
“ I know how it felt like “It must have been
to lose a sister, I lost difficult for you to lose sick inside’?”
mine I was 6” your sister when you
CONSENSUAL VALIDATION
needed her most”
FOCUS: Nurse’s own FOCUS: Patient’s ❒ CLIENT: “I am way out in the ocean”
feelings feelings ❒ NURSE: “You seem to feel lonely”
Acknowledges the
IDENTIFYING THEMES
patient’s feelings
❒ This is to determine the patterns of
thoughts (this influences on the patient’s
OFFERING SELF behavior)
❒ “I’ll sit with you for a while” ❒ “What comes into your mind each time
❒ Remain SILENCE. you…”
✔ Patient: able to organize his/her ❒ “What do you do each time you argue
thoughts. with your wife?”
✔ Nurse: observes for non-verbal cues. ❒ Cognitive Behavioral Therapy (CBT)
✔ Maintain eye contact. ✔ Able to correct the thinking of himself
to bring out the positive change of
BROAD OPENING
their behavior.
❒ “How are you feeling today?”
❒ “Is there something you’d like to talk REFLECTING
about?” ❒ CLIENT: “Do you think I should tell my
✔ Patient: able to choose the topic. dad”
❒ NURSE: “Do you think you should?”
EXPLORING
❒ “Tell me more about you and your
boyfriend”

RESTATING
❒ CLIENT: “I can’t sleep. I stay awake all
night”
❒ NURSE: “ You have difficulty sleeping”
✔ Patient: able to realize that he/she
able to communicate effectively
✔ Patient: realize that there is
someone was able to understand
FORMULATING A PLAN PHASES OF NURSE-PATIENT
❒ FOCUS: Anger management issues
❒ “What could you do to let your anger out
RELATIONSHIP
harmlessly” A. PRE-ORIENTATION PHASE
❒ Nurse reads the patient’s chart (for
SUPPORTIVE CONFRONTATION comprehensive background)
❒ FOCUS: Acknowledge the feelings before ❒ GOAL: Introspection
motivating the patient ✔ Inspecting of self-awareness
❒ “i know this isn’t easy to do, but i think ✔ Explore your own thoughts, feelings,
you can do it” values, beliefs, etc.
❒ “It would be difficult at first, but you’ll get ✔ Determining preconceptions
through it (preconceived judgments/prejudices)
❒ Toxic Positivity: Romanticizes resilience ❒ PROBLEM: Reluctance of the Nurse

ENCOURAGING COMPARISON
B. ORIENTATION PHASE
❒ FOCUS: Evaluation of the effectiveness of
used interventions
❒ “What is different about your feelings
today”
NON-THERAPEUTIC
COMMUNICATION
1) Stereotyping: Just Have A Positive Attitude C. WORKING PHASE
2) Reassuring: Everything Will Be Alright
3) Requesting an explanation: Why
NURSE-PATIENT RELATIONSHIP
❒ MOST IMPORTANT ELEMENT: Acceptance
✔ PURPOSE: to facilitate helping
relationship
❒ PROFESSIONAL RELATIONSHIP:
✔ Elements of a Contract:
a) Time, Day, Venue of sessions
b) Termination of the relationship
c) Participants
d) Registered Nurses and Patient’s
Responsibilities
D. TERMINATION PHASE
❒ First face-to-face contact of the patient
❒ GOAL: Establish Rapport
(Trust/Congruence)
1) Mutually set the contract
2) Involve the patient in planning
❒ PROBLEM: Resistance of the Patient
❒ Longest phase of NPR
❒ GOAL: Explore patient’s feelings/ Verbalize
feelings of patient
❒ PROBLEM: Emotional Attachment
1) Transference (attachment of patient to
nurse)
✔ MANAGEMENT:
a) Always remind patient about the
professional contract (able to set
boundaries)
b) Redirect the emotions of the patient
2) Countertransference (attachment of
nurse to patient)
3) Cross transference (attachment of both
nurse and patient)
❒ GOAL: Evaluation of the effectiveness of
interventions
❒ PROBLEM: Separation Anxiety
✔ MANAGEMENT:
1) Constantly remind patient about
the professional contrac.t
COPING MECHANISMS CRISIS FREUD’S STRUCTURAL THEORY
Conscious mechanisms When coping
to stressful events mechanisms become OF PERSONALITY
INEFFECTIVE A. ID
❒ Pleasure seeking of the mind
❒ Demands immediate gratification
TYPE OF CRISIS ❒ Developed in INFANCY
1) SITUATIONAL CRISIS
❒ Unexpected events ❒ PROBLEMS (Id > Superego)::
❒ E.g. Sudden death of a loved one, Loss a) Antisocial Disorder
of jobs b) Narcissistic Disorder
B. EGO
2) ADVENTITIOUS CRISIS (SOCIAL CRISIS) ❒ Balancer
❒ Natural calamities ❒ Developed at 2 YEARS OLD: Selfish
❒ E.g. Rape, War, Pandemic ❒ Reality (real you)
❒ PROBLEMS (Ego has been destroyed):
3) MATURATIONAL CRISIS a) Schizophrenia
❒ Expected events C. SUPEREGO
❒ E.g. Marriage, Retirement, Menopause ❒ Conscience
❒ “Guilt feeling”
CRISIS INTERVENTION ❒ Developed at 3 YEARS OLD
❒ PRIORITY ASSESSMENT: ❒ PROBLEMS (Id < Superego):
1) Assess perception of the event
a) Anorexia Nervosa
2) Presence of Support System
b) Obsessive Compulsive Disorder
3) Availability of the coping
mechanism/s
EXAMPLE:
❒ DURATION OF CRISIS: 4-6 WEEKS
❒ ID: I want chocolate
(Self-limiting)
❒ SUPEREGO: You’re on a diet
❒ GOAL: Help client return to pre-crisis
❒ EGO: ate a small bar of chocolate
level
✔ Experiences guilt and anxiety
❒ FOCUS: Here & Now (Immediate problem
✔ EGO develops ego defense
of the patient)
mechanisms
❒ GESTALT THERAPY: focuses the
✔ PURPOSE: To protect itself.
individual’s problem in the PRESENT
moment.
❒ APPROACH:
a) Directive (Education of stress &
stress management)
b) Supportive
EGO DEFENSE MECHANISMS b) Boyfriend is cheating, to relieve his
guilt, he starts to give flowers to his
DENIAL girlfriend.
❒ Refusal to accept the truth
❒ EXAMPLE: alcoholism SUPPRESSION
❒ CONSCIOUS forgetting
REGRESSION ❒ “I don’t want to talk about it”
❒ Return to earlier stage of development ❒ EXAMPLES:
❒ EXAMPLES: a) Anorexia nervosa (they suppress that
a) Dementia (Alzheimer’s) they are hungry in fear of getting fat)
b) 5 yr. old acted like a toddler by
“temper tantrums” knowing that his REPRESSION
mother is now having another baby ❒ UNCONSCIOUS forgetting
brother/sister. ❒ EXAMPLES:
✔ MANAGEMENT: involve the child a) Dissociative Amnesia (totally forgotten
in preparing the baby details of the event yet still increases
anxiety)
INTROJECTION
❒ Blaming SELF RATIONALIZATION
❒ EXAMPLES: ❒ Making unreasonable/unjustifiable
a) Major Depression excuses
❒ “Nagdadahilan”
PROJECTION ❒ EXAMPLES:
❒ Blaming OTHERS
❒ EXAMPLES: INTELLECTUALIZATION
a) Paranoid patients ❒ Disregarding the emotions
❒ “It is God’s Will”
DISPLACEMENT ❒ EXAMPLES:
❒ Redirecting emotions to a less threatening
object or person SPLITTING
❒ “Kick the cat” Phenomenon ❒ Seeing others as either GOOD or BAD
❒ EXAMPLES: (NOT neutral)
a) Phobia ❒ EXAMPLES:
a) Borderline Personality Disorder
REACTION FORMATION (unpredictable mood)
❒ Acting the OPPOSITE of your true
emotions SUBSTITUTION
❒ EXAMPLES: ❒ Replacing unattained goals with easily
a) Hugging someone you hate achievable goals
b) Bipolar Disorder ❒ To something that is High to something
that is Low
UNDOING ❒ EXAMPLES:
❒ Doing something to relieve the a) DREAM: Doctor
guilt/anxiety CURRENT JOB: Janitor in Hospital
❒ EXAMPLES: b) A unfertile woman wants to have a
a) Obsessive Compulsive Disorder baby turns into having adopting a dog
COMPENSATION LEVELS OF ANXIETY
❒ Overachieving in a different field 1) MILD
❒ EXAMPLES: ❒ (N) level
a) A failed bar examiner turned into a ❒ Manifestation:
multi-billionaire a) Increased alertness
SUBLIMATION b) Effective in learning
❒ Unacceptable drive to something which is 2) MODERATE
acceptable actions ❒ Manifestation:
❒ EXAMPLES: a) Selective attention
a) PAST: Rapist b) Narrowed perception
CURRENT: Priest c) Pacing
b) PAST: Prostitute ❒ MANAGEMENT:
CURRENT: DSWD volunteer a) Redirect the patient
b) Oral anxiolytics
REACTION FORMATION ❒ Parasympathetic stimulation:
❒ Imitate other person (like/dislike) a) Para tae (diarrhea)
❒ EXAMPLES: b) Para ihi (urinary frequency)
a) Bullies c) Para dura (increased salivation)
3) SEVERE
ANXIETY ❒ Manifestation:
❒ NEUROTRANSMITTER: Gamma Amino a) Unable to perform tasks
Butyric Acid b) Unable to redirect
✔ Decrease of GABA c) Unable to decide
❒ CHARACTERISTIC: Contagious ❒ MANAGEMENT:
❒ INITIAL NURSING ACTION: Assess own a) IM anxiolytics
level of anxiety 4) PANIC
❒ PRIORITY: ❒ Manifestation:
a) SAFETY a) Delusional hallucinations
b) STAY with the patient b) Violence/suicide
❒ DRUG OF CHOICE: ❒ MANAGEMENT:
a) Benzodiazepines (-lam, -pam) a) Take control “restraints”
✔ Alprazolam
GENERALIZED ANXIETY DISORDER
✔ Diazepam
❒ Uncontrollable worry for at least 6
✔ Clonazepam months with physical symptoms:
❒ NURSING EDUCATION: a) Palpitations
a) Avoid alcohol (respiratory b) Anorexia
depressant) c) Difficulty of sleeping
✔ COMPLICATION: Respiratory d) Easy fatigability
arrest
ANXIETY RELATED DISORDERS EATING DISORDERS
❒ PSYCHODYNAMICS: Parental
OBSESSIVE COMPULSIVE DISORDER
Harassment/Antagonism
❒ OBSESSION: repetitive thoughts
❒ SOCIAL CULTURAL FACTORS:
❒ COMPULSION: repetitive actions (rituals)
a) Developmental pressure
✔ This decreases level of guilt/anxiety
❒ NEUROTRANSMITTER: Decrease
❒ Defense Mechanism: UNDOING Serotonin & Decrease norepinephrine
❒ MANAGEMENT: ❒ AGE GROUP: Adolescence (Females)
a) Allow the patient perform the rituals ANOREXIA BULIMIA
(prevent panic attacks)
NERVOSA NERVOSA
b) Adjust the schedule of the patient
Perfectionist Hunger-Anger Cycle
c) Gradually limit the rituals
Self-restricted diet Binge-Purge Syndrome
d) CBT
❒ Ate too much
PHOBIC DISORDER (Bingeing)
❒ Irrational fear ❒ After too much
❒ 3 MAIN TYPES: eating, patient
a) Social Phobia have “guilt
✔ Irrational fear of dealing or speaking with feeling”
strangers ❒ Patient
b) Agoraphobia self-vomits
✔ Fear of inescapable places regardless of (Purging)
closed or open
Compulsive exercising Tooth decay
c) Specific Phobia ❒ Due to self-vomiting,
✔ Claustrophobia (fear of closed spaces) ❒ MANAGEMENT: HCl rises up and
❒ Defense Mechanism: DISPLACEMENT ✔ Distract the destroys the tooth
❒ MANAGEMENT: patient enamel
Systematic Desensitization (Gradual ✔ Invite patient for a ❒ Dentist is one of the
exposure of the feared object) first to suspect
walk
a) Talk frequently about the feared someone with
object bulimia nervosa

Alopecia Use of laxatives &

Enemas
Anemia Hypokalemia
Life-threatening! Ability to maintain
normal body weight
Russel’s Sign

❒ Scarring of knuckles
d/t self-vomiting

❒ NURSING DIAGNOSES:
a) Altered Nutrition
b) Electrolyte Imbalance (#1 PRIORITY)
 c) Body Image Disturbance (perception BORDERLINE ❒ Instability
PERSONALITY ❒ Unpredictable
of the patient) DISORDER Mood
❒ INTERVENTIONS:
❒ Suicidal
a) Involve the patient in planning meals BAD
❒ Impulsivity
B
b) Set time limit during meals DRAMATIC/ ❒ Identity
c) Supervise the client after eating ERRATIC Disturbance
d) Accompany patient to bathroom ❒ “I Cannot
❒ PSYCHOTHERAPEUTIC MANAGEMENT: Control Anger”
a) Self-monitoring
✔ Diary of food intake
✔ Journal (Record of
emotions/reflections)
✔ Patient will be able to relate his
food intake and his emotions ANTISOCIAL ❒ Lack Of Control
❒ EVALUATION: PERSONALITY ❒ Lawbreakers
DISORDER ❒ Shows No
✔ Body mass index:
Remorse
✔ (N) BMI: 18.5-24.9 ❒ Manipulative
❒ MEDICAL TREATMENT:
✔ SSRIs (Selective Serotonin Reuptake HISTRIONIC ❒ Sexually
Inhibitors) PERSONALITY Seductive
DISORDER ❒
− E.g. Fluoxetine (Prozac) Overly
Dramatic
❒ Attention
Seekers (Use
PERSONALITY DISORDERS own bodies to
gain attention
❒ Patterns of behavior disrupts
to others)
interpersonal relationships
❒ DIAGNOSIS: Adolescent Age NARCISSISTIC ❒ Self Is “Special”
PERSONALITY ❒ Sense Of
❒ Improves in 40-50 years DISORDER Self-Entitleme
nt
CLUSTER TERMED AS PERSONALITY SYMPTOMS ❒ Grandiosity
DISORDER ❒ Deny any form
PARANOID ❒ Suspicious of weakness
PERSONALITY ❒ Unforgiving
DISORDER
SCHIZOID ❒ Distant DEPENDENT ❒ Does Not
A ODD/ PERSONALITY PERSONALITY
❒ Loner Decide
ECCENTRIC DISORDER DISORDER
❒ Aloof ❒ Relies On
❒ No Interest In Others For
Relationships Support And
❒ Lifelong Social Validation
Withdrawal C ANXIOUS/
(Asocial) FEARFUL OBSESSIVE ❒ Perfectionists
COMPULSIVE ❒ “My Way”
SCHIZOTYPAL ❒ Magical Fear of PERSONALITY ❒ Ego-Syntonic
PERSONALITY rejection DISORDER
Thinking ❒ Must Follow
DISORDER ❒ Superstitious Rules
Fear of
❒ Believes in criticism ❒ Rules Cannot
lucky charms Be Bent
❒ Dresses Fear of
Weirdly failure AVOIDANT ❒ Desires
❒ “Sixth Sense” PERSONALITY Relationships
DISORDER But Extreme
Belief
 Anxiety Kicks b) Acknowledge the feelings, not the
In
❒ Insecure
delusion
❒ Avoids c) Voicing doubt
Responsibility d) Validate the statement of the patient
❒ Inferior
❒ Fear Of
e) Engage in reality activities
Rejection
IDEAS OF REFERENCE/REFERENTIAL
❒ MANAGEMENT: BEHAVIORAL THERAPY DELUSION
(Role Playing) ❒ Give meaning to the action of others
❒ GOAL OF MANAGEMENT: ❒ E.g. CLIENT: “Nurse, those two guys are
a) Able to return to the community planning to do something bad to me”
b) Establish meaningful relationships

DISTURBANCE IN THOUGHT:
1) CIRCUMSTANTIAL THINKING
(circumstantiality)
❒ Providing unnecessary details
❒ Returns to the original topic
❒ Answers the question
2) TANGENTIAL THINKING (Tangentiality)
❒ Providing unnecessary details
ILLUSION ❒ Lack of focus
❒ Problem of perception ❒ Does not return to the original
❒ Misinterpretation of external stimulus topic
❒ Did not answer the question
HALLUCINATION 3) ASSOCIATIVE LOOSENESS
❒ Problem of perception (DERAILMENT)
❒ False sensory perception ❒ Fragmented thoughts
❒ MANAGEMENT: HARDER (yamete) ❒ Does not have connectivity of
a) Hallucination must be recognized thought
b) Assess the content of hallucination 4) FLIGHT OF IDEAS
✔ To determine if to institute safety ❒ Rapid speech (jumps from one
precautions topic to another)
c) Reality Presentation 5) ECHOLALIA
d) Distract Immediately ❒ Repeating words of OTHERS
e) Engage patient in reality-based 6) PALILALIA
activities ❒ Repeating OWN words
f) Reintegrate with therapeutic milieu 7) ECHOPRAXIA
(environment) ❒ Repeating actions of OTHERS
8) MANNERISM
DELUSION ❒ Repeating own actions
❒ False belief
❒ MANAGEMENT: CAVVE
a) Clarify the delusion