You are on page 1of 30

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

Patient: I.C. Age: 30 Gender: F Date of Care: February 9-10, 2012 Diagnosis: Psychosis NOS r/o Delusional Disorder; Post Traumatic Stress Disorder Date of Admission: May 2011

I. OVERVIEW: In our 2nd and 3rd rotation in Estrellas, I was assigned to the same patient, I.C., a 30 yearold female client with Psychosis NOS r/o Delusional D/O; Post Traumatic Stress D/O. On the first day, I found her sitting on the corridor while doing her artworks. I approached her but she seemed not in the mood to talk. She was just focused on her drawing and didnt even bother to look at me. She was wearing a pink blouse and leggings. I noticed that she hasnt taken a bath yet. When she said that shes not willing to talk, I asked the help of our C.I. I honestly dont know what to do. So our C.I. talked to her and then she agreed to talk to me. As we talk, I noticed that her approach to me has changed. She was more willing to talk about her feelings and she shared some private things to me. Shes even said that shes comfortable with me.

During our conversation, shes calm and cooperates well. She responds to my questions and eventually opens up herself even more compared to our first meeting weeks ago. I noticed that she already has good eye contact, but still with mumbling episodes and verbalized that there were times that shes anxious.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

II.EXCHANGES DAY 1 Feb. 9, 2012 INTERATION #1: During our first day, the client showed interest in the conversation. She seemed glad to see me again. She shared more things about her life and experiences. At first she was not in the mood to talk to me. Our C.I. talked to her and allowed me to spare sometime with her to talk. 1) NURSE: Good morning, Irene! Natatandaan mo pa ako? Ako si Jeannine yung student nurse galing sa Arellano university. Kamusta ka naman? Nandito ulit ako para makapagusap tayo. Good morning, Irene! Do you still remember me? Im Jeannine, the student nurse from Arellano University. How are you? Im here again so we could talk.

(Offering self: This is a way of expressing a desire to understand and collaborate with the client. I also made boundaries during this phase of our conversation.) (Giving Information makes available facts the patient needs. Supplies knowledge from which decisions can be made or conclusions drawn. I used this technique to introduce myself to my patient and for her to know my purpose of being there.)

CLIENT: Oo naman, ikaw pa! Okay lang ako. Sorry sa nangyari kanina kasi medyo wala lang ako gana makipag-usap. Ikaw kamusta na? Bakit ang tagal niyo bumalik? Of course! Im okay. Sorry about what happened a while ago. Im not just in the mood to talk. How are you? What took you so long to come back?

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

2) NURSE: Okay lang yon. Okay ka na ba ngayon? Okay lang naman ako. Medyo matagal nga kasi nagduty din kami sa ibang hospitals. Its okay. Are you okay now? Im doing fine. It took us weeks before we come back because we also had our duties in other hospitals

(Restating: Repeats the main idea expressed. Gives the client an idea of what have been communicated. I used this so I could clarify my understanding.) (Reflecting: Directs questions, feelings, and ideas back to the client. Encourages the client to accept her own ideas and feelings.)

CLIENT: Ah. Kala ko kasi hindi na kayo babalik. Masaya ako kasi nandito ulit kayo. Medyo nalungkot kasi ako nung hindi ka na bumalik Ah. I thought youre not coming back anymore. Im happy because youre here again. I was a lil bit sad when you didnt come back

3) NURSE: Konti lang talaga duty naming dito. Hindi ko ba nasabi sayo na ilang lingo din bago kami makabalik? Ano mga pinagkaabalahan mo o yung mga ginawa mo nung wala kami? We really have few duties here. Didnt I tell you that Ill be back after few weeks? What did you do during the times that were not here?

(Exploring: Examines certain ideas, experiences, or relationships more fully.)

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

CLIENT: Sinabi mo siguro pero nawala sa isip ko. Madami din kasi ako iniisip mga ilang araw na. Syempre nung hindi pa kayo bumabalik nalungkot ako. Tapos nung medyo matagal na akong naghihintay , kala ko hindi ka na babalik. Sabi ko nalang sa sarili ko na kailangan ko na magmove-on You told me but I guess it slipped my mind. I was also thinking about many things these past days. During the times that youre not here, I was sad. Then when I realized that I was waiting for a long time already, I thought that youd never come back. I just told myself that I have to move-on. 4) NURSE: Sabi mo madami kang iniisip na mga bagay netong mga nakaraang araw. Pwede mo ba sabihin sakin yung tungkol sa mga bagay na yun? You said you were thinking about many things these past days. Could you tell me about the things that you were thinking? (Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual understanding between nurse and patient)

CLIENT: Yung mga NBI kasi, lagi parin nila ako ginugulo. Tapos lagi pa nila ako binabantayan. Tapos parang hindi sila napapagod The NBI keeps on bothering me. They always look after me. And it seems like theyre not getting tired of it.

5) NURSE: Ano mga ginagawa ng mga NBI sayo? What do they do to you?

(Exploring: Examines certain ideas, experiences, or relationships more fully.)

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

CLIENT: Manipulating me and the people around me. They will do anything para isipin ng mga tao na masama ako. Nagagalit na ako kasi hindi nila nirerespect yung rights ko. Inaabuso na nila ako kasi alam nila na may sakit ako. Theyre manipulating me and the people around me. They will do anything to make other people think that Im bad. I-m mad because they dont respect my rights. They were abusing me because they know that Im sick.

6) NURSE: Ahh. Manipulating you and other people? Paano at ano mga ginagawa nila? Ahh. Manipulating you and other people? How and what do they do? (Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual understanding between nurse and patient.)

CLIENT: Basta parang ganoon parin sa dati, gusto nila iprove sa mga tao na masama ako. Lahat ng kilos ko alam nila. Gusto nila na nakikita akong malungkot. Its just like before, they want to prove to everyone that Im bad. They know all my actions. They want to see me sad.

7) NURSE: Silence.. Paano mo nalaman na ginagawa nila yung mga bagay na yan para maging malungkot ka? Silence.. How did you know that theyre doing those things just to see you sad? (Silence: Gives the patient time to collect thoughts or think through a point.)

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

CLIENT: Basta alam ko. Sinasabi din nila minsan. Pag malungkot ako hindi sila nakikialam. Kaya kung anu-ano iniisip ng mga tao tungkol sakin I just know. They sometimes tell me. When Im sad, they dont usually care. Thats why people think of different things about me

8) NURSE: Ahh..Sino yung mga kung anu-ano ang iniisip sayo? Ano mga iniisip nila? Ahh..Who are those people who think of different things about you? What do they think of?

(Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

CLIENT: Basta. Yung mga tao, lahat sila! Iniisip nila kung ano yung iniisip nga mga NBI, minanipulate nga kasi yung mga yun. Wag nalang natin sila pag-usapan People, all of them! They think just like the NBI, because theyre manipulated by them. Lets just not talk about them.

9) NURSE: Okay. Kung yun yung gusto mo, okay lang sakin. Okay ka lang? Okay, if thats what you want, thats fine with me. Are you okay?

(Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

CLIENT: Smiles. Oo, okay lang ako. Sorry medyo nagagalit lang talaga ako. Thank you. Smiles. Im okay. Sorry Im just really mad. Thank you. 10) NURSE: Meron ka ba gusto gawin o pag-usapan? Do you want to do anything or anything you want to talk about? (Giving broad openings - this clarifies that the lead is to be taken by the client. However, the nurse discourages pleasantries and small talk) CLIENT: Pwede mag-drawing nalang muna ako? Tapos dito ka nalang din muna? Can I just draw first? Then just stay here.

III. ALTERNATIVES

1) In the nurse-client exchange # 1, I should have used Giving Broad Openings so she could lead the conversation. I should have allowed her to lead the conversation like asking her Where would you like to begin or what do you want to talk about?. 2) In the nurse-client exchange # 2, even though its therapeutic, I should have explored her feelings even more. It might be difficult for her to accept that were not going to see each other that much and that we have only few meetings.

3) In the nurse-client exchange # 3, I should have used Exploring, this way the patient could fully elaborate the details of her feelings and thoughts.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

4) In the nurse-client exchange # 3, I could also use Encouraging Comparison, so the patient can bring out recurring themes in her experiences. Maybe she could compare this experience with her past student nurses.

5) In the nurse-client exchange # 4, I could have used Seeking Onsensual Validation, so I could clarify my understanding of what she said.

6) In the nurse-client exchange # 4, I could have also used Focusing, so she could have concentrated on a single point.

7) In the nurse-client exchange # 5, I could have also used Exporing, so she could further explain to me her ideas and thought most especially about the actions of the NBI.

8) In the nurse-client exchange # 6, I could have also used Encouraging Evaluation, so I could have asked her about her feelings regarding the incident.

9) In the nurse-client exchange # 7, I could have also used Exploring, so she could further explain her ideas and experiences.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

10) In the nurse-client exchange # 9, I could have also used Encouraging of Perceptions, so she could talk about her feelings and that could lessen the need to act them out inappropriately.

EXCHANGES DAY 2 Feb. 10, 2012 INTERATION #2: During our second day, the client showed also interest in the conversation. She seemed glad to see me again. She shared more things about her life and experiences. This time I noticed that shes more sociable with other patients and nurses as well! 1) NURSE: Good morning, Irene! Kamusta ka naman? Nandito na ulit, diba sabi ko kahapon babalik ako ngayon. Dito ulit ako para makapag-usap ulit tayo. Good morning, Irene! How are you? Remember I told you yesterday that Ill be back today. Im here again so we can talk again.

(Offering self: This is a way of expressing a desire to understand and collaborate with the client. I also made boundaries during this phase of our conversation.) (Giving Information makes available facts the patient needs. Supplies knowledge from which decisions can be made or conclusions drawn. I used this technique to introduce myself to my patient and for her to know my purpose of being there.)

CLIENT: Good morning! Buti nakabalik ka. Masaya ako kasi nandito ulit kayo. Okay lang nmn ako. Medyo nahirapan lang makatulog kagabi. Good morning! Im glad youre back. Im glad youre guys are here again. Im fine. I just had difficulty falling asleep last night.?

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

2) NURSE: Nahirapan ka makatulog? Ano sa palagay mo dahilan kung bakit hindi ka makatulog? You had difficulty falling asleep? What do you think is the reason for that?

(Restating: Repeats the main idea expressed. Gives the client an idea of what have been communicated. I used this so I could clarify my understanding.) (Reflecting: Directs questions, feelings, and ideas back to the client. Encourages the client to accept her own ideas and feelings.)

CLIENT: Madami pa rin ako iniisip. Tas ganun parin sa dati. Sinusundan parin ako nung mga.. I was thinking of many things. Just like before... I was still followed by the..

3) NURSE: Nung mga? by the?

(Exploring: Examines certain ideas, experiences, or relationships more fully. I used this so she would expound more about her thoughts)

CLIENT: Mga NBI.. Nanjan parin sila. Nanggugulo na naman. the NBI.. theyre still there. Theyre bothering me again

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

4) NURSE: ah. Ano mga ginagawa nila kagabi? Ah. What were they doing last night? (Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

(Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual understanding between nurse and patient.)

CLIENT: Yung mga NBI kasi, lagi parin nila ako ginugulo. Tapos lagi pa nila ako binabantayan. Tapos parang hindi sila napapagod The NBI keeps on bothering me. They always look after me. And it seems like theyre not getting tired of it.

5) NURSE: Ano mga ginagawa ng mga NBI sayo? What do they do to you?

(Exploring: Examines certain ideas, experiences, or relationships more fully.)

CLIENT: Kung anu-ano ginagawa. Gusto nila ako i-distruct! Kung anu-ano sinasabi nila Theyre doing random things. They want to distruct me! They keep on saying different things

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

6) NURSE: Ano sa tingin mo dahilan kung bakit ka nila gusting idistruct? What do you think is the reason to why they want to distruct you? (Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual understanding between nurse and patient..)

CLIENT: Ayaw kasi nila malaman ng tao na mali na yung ginagawa nila sakin. Inaabuso na nila yung karapatan ko. Hindi sila nakikinig! They dont want others to know that theyre already doing the wrong thing. Theyre abusing my rights. Theyre not listening!

7) NURSE: Silence.. Nakikinig saan? Silence.. Listen to what? (Silence: Gives the person time to collect thoughts or think through a point.)

CLIENT: Nakikinig sa akin. Ayaw nila maniwala na ako yung biktima dito. Parang ako pa kasi yung masama sa mga tao. They dont want to listen to me. They wont believe that Im the victim here. It seems like other people think that Im bad

8) NURSE: ahh.Ano yung reason mo kung bakit mo nasabi na masama ang tingin sayo ng mga tao? ahh.What made you think that other people think youre bad?

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

(Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

CLIENT: Naririnig ko sila. Pinag-uusapan nila ako. Akala nila ako yung gumagawa ng masama. I heard them talking about me. They think that I was doing all those bad things.

9) NURSE: okay. Ano daw yung sinasabi nila na mga bagay daw na ginagawa mong masama ? okay. What were the bad things according to them that you did?

(Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

CLIENT: Basta. Nahihirapan ako sabihin at iexplain. Wag nalang natin pag-usapan. Im having a hard time explaining that to you. Lets not just talk about it.

10) NURSE: Sige. Okay ka lang? Sige. Are you okay??

(Accepting: Indicates that the person has been understood. The statement does not necessarily indicate agreement but is non-judgemental.)

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

CLIENT: Smiles. Oo. Smiles. Yes.

III. ALTERNATIVES

1) In the nurse-client exchange # 1, I should have used Giving Broad Openings so she could lead the conversation. I should have allowed her to lead the conversation like asking her Where would you like to begin or what do you want to talk about now? 2) In the nurse-client exchange # 2, I should have explored her feelings even more. Maybe I asked her to explain more her thoughts and the things that are bothering her. 3) In the nurse-client exchange # 3, I should have used Exploring, this way the patient could fully elaborate the details of her feelings and thoughts and whats going on her mind that time.

4) In the nurse-client exchange # 3, I could also use Encouraging Comparison, so the patient can bring out recurring themes in her experiences. She might be able to tell me if this happened already in the past or if this was the first time.

5) In the nurse-client exchange # 4, I could have used Seeking Onsensual Validation, so I could clarify my understanding of what she said.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

6) In the nurse-client exchange # 4, I could have also used Exploring. I shouldve asked about the people behind those things. And she might tell me more about the incident.

7) In the nurse-client exchange # 6, I could have also used Exporing, so she could further explain to me her ideas and thought most especially the distructions she was telling me. I should have asked what kind of distructions these NBI were doing.

8) In the nurse-client exchange # 6, I could have also used Encouraging Evaluation, so I could have asked her about her feelings regarding the incident.

9) In the nurse-client exchange # 7, I could have also used Exploring, so she could further explain her ideas and experiences.

10) In the nurse-client exchange # 9, I could have also used Encouraging of Perceptions, so she could talk about her feelings and that could lessen the need to act them out inappropriately.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

III. THEORY Patient, C.I. was still my patient. Just like the first time we met, she still manifests the same thing. At first, when I approached her she seemed not in the mood to talk. She said that shes not okay for us to talk and that I cant talk to her. But when our C.I. talked to her, she agreed to talk to me. She was very cooperative and was calm and was totally different from the first time I approached her. As we go along with our conversation, she said that she waited for me for so long. She said that she was sad when were not visiting them. Then she again opened up the topic about these NBI that according to her are sent by her enemy, she started to have difficulty explaining or verbalizing her thoughts. This was not the first time she said it. During our first meeting, she already told me stories about those NBIs. She would always say that shes sorry that she couldnt everything well because she feels anxious and mad about it. When I asked her about the NBI, she looked at her back and then looked at her surrounding and said that theyre always there to make her feel as if its her fault that shes in that facility. She frequently stops and pause for some time to think for the appropriate words to describe her feelings. She said that those NBIs are secretly investigating her since 2004 and her enemy is the master mind. Whenever I asked her about the enemy that shes saying, she would just avoid it and will say that Basta, kakilala ko noon at kaaway ko na siya ngayon (I know him before hes already my enemy now. She also told me how bad that guy was to her. At that point, she repeatedly verbalized that she was anxious and feel uncomfortable with it so she would ask me to change topic just like before and to talk about something that is happy. But even if were talking about happy things like comedy movies that she likes, she would always talk about those NBIs out of nowhere. She would always mention that the people around her would think negative things about her even her family and would also emphasize the word malicious. The way she emphasized it was so obvious to the point of raising the tone of her voice. In the middle of our

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

conversation, she had mumbling episodes as if shes saying something, but I could hardly understand it. I asked her to repeat it but she said she didnt say anything. I also noticed that she keeps on looking at her back and very sensitive about her surroundings and even told me that she gets distracted easily especially when there are a lot of people around her. And we started to talk about her family, she said they often visit her and she doesnt care because according to her even though shes telling her parents all her problems, they wont believe her. She said that, maybe her enemy is manipulating everybody even her family. During the entire time that were talking, I can see that shes willing to share her stories but not everything. She refused to tell me the cause of her scars on her forearm. She said shes not yet ready to share it with me and some other time maybe. Shes trying to avoid sensitive issues and will always say that shes mad and anxious and not yet time to talk about it. She also told me that her anger is still there and will always be there for the rest of her life. She also shared to me the reason behind her scars at her forearm. She refused to tell me about it during our first meeting. She said, she didnt know how to express her emotions and all she could do is to hurt herself so she wont feeling anything. She even told me of things to expect when you cut your forearm. She said, she has been doing that for like a year before until she was admitted in the facility. She admitted that she has difficulty coping with her problems because of her experiences. She refused to tell me about those experiences but promised to share it some other time. Irene has Post Traumatic Stress Disorder and considering Psychosis NOS r/o Delusional Disorder. PTSD is a disorder wherein the person has experienced, witnessed, or been confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. The persons response involved intense fear, helplessness or horror. The traumatic event is re-experienced in the mind, and there is an avoidance of stimuli associated with the trauma and the numbing of general responsiveness. On the other hand, Delusional

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

Disorder involves non-bizarre delusions of at least 1 months duration. The persons ability to function is not markedly impaired nor is the persons behaviour obviously odd or bizarre. Based on her chart, it was written there that she is physically and verbally assaultive, easily gets irritable, (+) mumbling episodes, and insomnia for 4 days one week prior to her admission. Her sister stated that, Mas grabe na yung mga ginagawa niya. Nagmumura tapos naninira ng gamit tapos madalas na nagsasalita mag-isa. It is also written on her chart that months prior to this duty, shes shouting spells to the other patients and was trying to stab the nurse using a ballpen. She still has mumbling episodes and always stays in the corridor alone. According to our lecture about psychiatric patients, they could decrease or prevent symptoms by complying with the medications and with her since she has PTSS, she needs counselling and use of therapeutic communication. They also need someone to talk to for them to vent their feelings and for them to feel that theyre taken care of and supported, participating regularly in any other forms of treatment such as Milieu Therapy and other group activities, discussing the troubling side effects of medications with the health care personnel, avoiding the use of alcohol and other prohibited drugs, and maintaining physical health by following a healthy diet, regular exercise and have adequate rest and sleep. The clients current medications include: Epival 250mg BID - an anticonvulsant and Thorazine 100mg after breakfast and 50mg after dinner - antipsychotic. She has not been taking medications for weeks now because her family is not anymore giving her supply. Based on Erik Eriksons Developmental Theory, Irene is under Intimacy vs Isolation Stage. According to her she was being talked about by the people around her. Theyre saying negative things about her that arent true according to her. Shes not married but she had a living partner before for 10 years. Her partner was abusing her physically that resulted in her condition now. According to Erikson, she was supposed to have her own family and establishing intimate

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

bonds of love and friendship. But because of her situation, shes now in the isolation stage where shes moving away from people. She thought that its the right thing to do since shes hearing a lot of issues and negative things against her. For Maslows Hierarchy of needs, the patient is currently under physiologic needs. Proper hygiene is one of human basic needs. As I observed and also verbalized by the patient, she has poor hygiene. She said shes not comfortable taking a bath and she doesnt want to fix herself because theres no need for it. She also said that the NBI are also there and shes not comfortable with it. And also, according to her, when people forced her to do things she doesnt want, like eating or drinking, she would usually do the opposite. So interventions should still focus on attending her physiologic needs. My priority Nursing Diagnosis for this client is Ineffective Coping related to low selfesteem, inadequate support system and inability to trust as evidenced by inability to meet basic needs. The patient has problems with her self esteem after her traumatic experience with her partner. She also has difficulty trusting people because she thinks that they will just judge and misinterpret and hurt her. Her basic needs are also altered. She has difficulty coping with her problems and has negative insights about life. She also thinks that her family is not there for her because her enemy is manipulating them. These factors are the reasons why the patient is having a hard time coping with her stressors.

IV.SELF-EVALUATION

During the start of the rotation, I was really scared. After seeing her reaction when I approached her, I really dont know what to do or even say. Her aura threatened me. But when

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

we started talking, it suddenly changed. When she explained to me the reason about her attitude, I realized that I should be more understanding and patient with her. She doesnt want to be like that its just that her condition played a big role with the way she reacts with stimuli and even people. Her experiences also contributed a lot with her character now. I was able to explore her feelings and thoughts and I think thats something that I have to be proud of. Patients like Irene have difficulty trusting people and I was able to make her feel comfortable. I would say, I was able to do my role as a nurse and I guess I was able to give her needs at that time. Therapeutic communications also played a major role in dealing with patients like Irene. Since she thinks that people will always judge her, I should be careful with the words Im saying. That may help her or might further induce stress and guilt. I was happy that at the end, she told me that shes thankful for me and that her anxiety decreases and she feels better. Im so proud of myself that I was able to help her and that she appreciates it and that means a lot to me!

A. PROS I was scared and nervous at the start of the duty but I didnt let those feelings affect my way of thinking and of course my role. I was able to communicate with my patient effectively. Though I was not comfortable at first, I was also able to use my therapeutic techniques during the entire conversation. Because of that, she was able to express her feelings and thoughts with me. She was also able to share her stories and opened up some delicate issues about her life. When she opened up that shes sad that I cant stay longer, I made my bounderies. I shouldnt be attached to her, and Im there as a nurse so emotions shouldnt be affecting me. I also was able to recognize

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

her strengths and weaknesses. I also accept and respect her for who she is and not judge her emotions and actions. B. CONS I wasnt able to explore more on some of her thoughts because she was hesitant and not comfortable about it. She didnt want to share some informations to me because she said shes not ready yet. I wasnt able to think of any appropriate words to use so I could explore it. I really have a hard time to think of words to say so I wont be offending or judging her.

V. FEELINGS AND PERSONAL INSIGHT (MYERS-BRIGGS KIERSEY TYPE ANALYSIS)

Based on Myers Briggs Kiersey Type Analysis, I found out that I am an INFP. It means that I am a perceiver and a judger and adapt to change well and I am able to adjust on a different situation that would eventually come into my life.

As a judger, it was stated there that I live in such a way that everything is organized and planned in an organized manner. As an introvert person, I tend to keep things hidden. I am more comfortable of working alone than in groups. I also solve conflicts in my own way and I can also be independent whenever I want to.

Since Im an introvert, I was able to relate to my patient. She preferred to keep some important things to herself. But even though she wants to be independent, she has difficulty solving her own problem.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

As an NF or intuitive feeler, they say that I need encouragement and recognition to do things better. And I am also sympathetic and love to establish close relationships with people.

VI. STEDFAST

SELF ASSESS: Okay Ninay! Mindfully breathe... This is your 2nd rotation here.. so are you ready?? Are you ready for all the things that youll be experiencing now?? How about your emotions? Mindfully breathe.. Are you willing to open up your mind and even yourself with your patient? She needs you now.. Are you equipped with therapeutic communication? Mindfully breathe.. you can do this! Remember to always focus on your patients feelings, not yours! Be yourself and try not to impose your beliefs and opinions. Okay? Mindfully breathe! Good luck!..

THERAPEUTIC ROLE: Ninay, try to focus with your goals. You are here as a nurse and you are trained to be one, right? Mindfully breathe..Your patient needs you now and you might help her with her problems. You studied this on your class so youre equipped with knowledge about dealing with these patients! Listen carefully to her and always talk to her using therapeutic communication. Mindfully breathe.. Always understand her and accept her for who she is. Her actions are part of her illness.. Mindfully breathe.. You can do it! Be the best nurse you can be!

EMPATHY: That must be so hard for her.. I was also sad when she told about her feelings and experiences in life.. and I think if Ill be in her position, I wont be able to make it, I

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

swear! She must be in a very difficult situation right now. Mindfully breathe.. How could I be firm with my role and not be affected by her actions and stories? Mindfully breathe!

DETACHED REFLECTION: Mindfully breathe, Ninay.. Yes, you feel for her but thats it. You have your own thoughts and she has hers. Her feelings are hers and you have yours.. Mindfully breathe.. You have to respect it and try to understand.. She needs you now and you have to keep that in mind!.. She NEEDS YOU now!

FACILITATED DEBRIEFING: Mindfully breathe.. I think I need someone to talk to about my feelings.. Its gonna be hard if Ill just keep it to myself.. Our C.I. said that we have to accept our patients whoever they are. Mindfully breathe.. We have different ways of thinking and thats what I have to understand and take in consideration! We are different beings and I also have to accept that! Mindfully breathe..

ALERT EMPATHY: Waiitttt... I dont think its still okay.. Yes, I empathize her but thats it! I am here to help them and be their nurse.. If Ill be sad like her, that wont help.. her feelings are hers and I have mine. Shes sad and mad, and Im not! So dont let her feelings affect you.. Mindfully breathe.. Focus on your goal! Remember your bounderies!

SELF-AWARE MINDFULNESS: Ive learned a lot today. Though I cant help myself from being affected by my patients feeling, I still managed to be firm with my role and goal. I was able to use therapeutic communication most of the time but sometimes, I couldnt help but be non- therapeutic! Im sometimes running out of appropriate words to say! Mindfully breathe..

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

Its just a matter of time and you have to learn from your experience and mistakes! Youll be fine! Mindfully breathe....

THERAPEUTIC USE OF SELF: I offered myself to Irene today.. I am glad that shes thankful for me and that I was able to decreased her anxiety level. Looking forward to our next rotation so I could be able to help them again in the best way I can..

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

NURSING CARE PLAN1 Nursing Diagnosis: Ineffective Coping related to low self-esteem, inadequate support systems and inability to trust as evidenced by inability to meet basic needs ASSESSMENT Subjective Data: I dont take a bath or fix myself because theres no need for that I dont want to talk to other people, they often judge me PLANNING INTERVENTION & EVALUATION RATIONALE If possible, make sure that the patient will be having just 1 nurse or caregiver. To promote trusting relationship with the caregiver. Avoid laughing, giggling, and whispering where the patient can see but cant hear. They may think that youre talking about them Be honest and avoid promises when youre not sure if youll be able to comply with it. To develop trust with the caregiver Provide noncompetitive activities that promote one-toone relationship with the nurse. Competitive activities are very threatening to suspicious clients. After the 8 hour shift: Client developed trust with her primary caregiver. She shared her stories and thoughts during the course of duty. Client was able to share and vent her feelings and thoughts

After the 8 hour shift: Client will develop trust in staffs even just with their primary caregiver Client will be able to share and vent her feelings and thoughts

Objective Data: (+) mumbling episodes labile affect reaction formation Poor eye contact Decreased productivity

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

Encourage client to verbalize feelings and thoughts. Verbalization of feelings in a nonthreatening environment may help the client come to terms with long unresolved issues.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

NURSING CARE PLAN2 Nursing Diagnosis: Anxiety related to situational crisis and stress as manifested by verbalization of fear, poor eye contact, (+) mumbling episodes, diminished productivity, difficulty concentrating, flight of ideas ASSESSMENT Subjective Data: Sorry medyo anxious na naman ako. Nawawala kasi ako sa sinasabi ko Objective Data: (+) mumbling episodes poor eye contact diminished productivity difficulty concentrating flight of ideas easy irritability forgetfulness impaired attention PLANNING INTERVENTION & EVALUATION RATIONALE If possible, make sure that the patient will be having just 1 nurse or caregiver. To promote trusting relationship with the caregiver. Avoid laughing, giggling, and whispering where the patient can see but cant hear. They may think that youre talking about them Provide noncompetitive activities that promote one-toone relationship with the nurse. Competitive activities are very threatening to suspicious clients. Observe clients behaviour. This may indicates clients level of anxiety Take not of defense mechanisms that After the 8 hour shift: Client was relaxed and clam during the entire shift Client reported that her anxiety is reduced after the duty Salamat, nakatulong ka talaga. Medyo konti nalang yung mga naiisip ko at yung anxiety ko din Client was able to share and vent her feelings and thoughts Client acknowledged and verbalized understanding about the teaching plan

After the 8 hour shift: Client will be relax and clam during the shift Client will report that her anxiety is reduced Client will be able to share and vent her feelings and thoughts Learn effective and healthy ways deal with anxiety

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

the patient is using. This may interfere with the clients ability to deal with her stress and problem Establish a therapeutic relationship all the time. This prevents misinterpretation Listen attentively to the patient. This assists patient to vent their feelings Encourage client to express her feelings and thoughts. This may lessen the anxiety level of the patient Provide feedbacks and checking meaning with the client. Clarify clients meaning of feelings and actions. Be truthful and provide physical contact if possible. To soothe fears and provides assurance. Accept the patient as it is. This provide self worth for the client and boosts her selfesteem Allow the patient to vent her feelings and emotions. Avoid giving personal

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

advices and responses. This prevents client from escalating Provide nonthreatening environment and minimize stimuli. Lessen effects of transmission of feelings Teach client about healthy ways to deal with her anxiety (diversional activities-drawing, watching tv, reading) Encourage patient to have an exercise program. This may help in reducing anxiety Encourage client to verbalize feelings and thoughts. Verbalization of feelings in a nonthreatening environment may help the client come to terms with long unresolved issues.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368- Acute Psychosocial Nursing

References: Carson, V., Shoemaker, N., Varcarolis, E. (2006): The Clinical Interview and Communications Skills, Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 5th Edition, (pp. 171-194), Missouri: Saunders Elsevier. Townsend, M.C., (2008): Nursing Diagnoses in Psychiatric Nursing 7th ed., F.A.Davis Company. Stuart, G.W., Laraia, M.T., (2005): Principles and Practice of Psychiatric Nursing, 8th Edition, (pp. 273), Missouri: Mosby Elsevier. Nursing 386, Acute Psychosocial Nursing Syllabus.