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 didn’t even bother to look at me. She was wearing a pink blouse and leggings. I noticed that she hasn’t taken a bath yet. When she said that she’s not willing to talk, I asked the help of our C.I. I honestly don’t 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. She’s even said that she’s comfortable with me.

During our conversation, she’s 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 she’s 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? I’m Jeannine, the student nurse from Arellano University. How are you? I’m 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! I’m okay. Sorry about what happened a while ago. I’m 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.” “It’s okay. Are you okay now? I’m 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 you’re not coming back anymore. I’m happy because you’re here again. I was a lil bit sad when you didn’t 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. Didn’t I tell you that I’ll be back after few weeks? What did you do during the times that we’re not here?”

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

Tapos lagi pa nila ako binabantayan. Madami din kasi ako iniisip mga ilang araw na. Sabi ko nalang sa sarili ko na kailangan ko na magmove-on” “You told me but I guess it slipped my mind. or relationships more fully.” 5) NURSE: “Ano mga ginagawa ng mga NBI sayo?” “What do they do to you?” (Exploring: Examines certain ideas. I was also thinking about many things these past days. experiences.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368.) . Then when I realized that I was waiting for a long time already. I just told myself that I have to move-on. They always look after me. During the times that you’re not here. Pwede mo ba sabihin sakin yung tungkol sa mga bagay na yun?” “You said you were thinking about many things these past days. Syempre nung hindi pa kayo bumabalik nalungkot ako. I was sad. kala ko hindi ka na babalik. 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. Tapos parang hindi sila napapagod” “The NBI keeps on bothering me. And it seems like they’re not getting tired of it.Acute Psychosocial Nursing CLIENT: “Sinabi mo siguro pero nawala sa isip ko. lagi parin nila ako ginugulo. Tapos nung medyo matagal na akong naghihintay . I thought that you’d never come back.” 4) NURSE: “Sabi mo madami kang iniisip na mga bagay netong mga nakaraang araw.

gusto nila iprove sa mga tao na masama ako.) .Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. They want to see me sad.. Manipulating you and other people? Paano at ano mga ginagawa nila?” “Ahh. They will do anything to make other people think that I’m bad.. Lahat ng kilos ko alam nila. I-’m mad because they don’t respect my rights. They know all my actions.” 6) NURSE: “Ahh.” “It’s just like before. they want to prove to everyone that I’m bad. They were abusing me because they know that I’m sick. Nagagalit na ako kasi hindi nila nirerespect yung rights ko. Paano mo nalaman na ginagawa nila yung mga bagay na yan para maging malungkot ka?” “Silence. 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. Inaabuso na nila ako kasi alam nila na may sakit ako.” 7) NURSE: “Silence. They will do anything para isipin ng mga tao na masama ako. How did you know that they’re doing those things just to see you sad?” (Silence: Gives the patient time to collect thoughts or think through a point.Acute Psychosocial Nursing CLIENT: “Manipulating me and the people around me. Gusto nila na nakikita akong malungkot. “They’re manipulating me and the people around me.) CLIENT: “Basta parang ganoon parin sa dati.

all of them! They think just like the NBI. Sinasabi din nila minsan.” 9) NURSE: “Okay. Let’s just not talk about them. because they’re manipulated by them. Pag malungkot ako hindi sila nakikialam.Sino yung mga kung anu-ano ang iniisip sayo? Ano mga iniisip nila?” “Ahh. Are you okay?” (Accepting: Indicates that the person has been understood.) . That’s why people think of different things about me” 8) NURSE: “Ahh. They sometimes tell me.. Kaya kung anu-ano iniisip ng mga tao tungkol sakin” “I just know.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368.Who are those people who think of different things about you? What do they think of?” (Accepting: Indicates that the person has been understood.) CLIENT: “Basta. The statement does not necessarily indicate agreement but is non-judgemental. they don’t usually care. if that’s what you want. that’s fine with me. Kung yun yung gusto mo. Yung mga tao. The statement does not necessarily indicate agreement but is non-judgemental. okay lang sakin. lahat sila! Iniisip nila kung ano yung iniisip nga mga NBI. minanipulate nga kasi yung mga yun.Acute Psychosocial Nursing CLIENT: “Basta alam ko. Wag nalang natin sila pag-usapan” “People. Okay ka lang?” “Okay.. When I’m sad.

I should have used Exploring.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368.” III. Sorry medyo nagagalit lang talaga ako. Sorry I’m just really mad. 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?”.” “Smiles.” 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 . I should have explored her feelings even more. Oo. ALTERNATIVES 1) In the nurse-client exchange # 1. Thank you. I should have used Giving Broad Openings so she could lead the conversation. even though it’s therapeutic. this way the patient could fully elaborate the details of her feelings and thoughts. . Thank you.Acute Psychosocial Nursing CLIENT: “Smiles. okay lang ako. I’m okay. It might be difficult for her to accept that we’re not going to see each other that much and that we have only few meetings. 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. However. 3) In the nurse-client exchange # 3.this clarifies that the lead is to be taken by the client. 2) In the nurse-client exchange # 2.

so she could further explain to me her ideas and thought most especially about the actions of the NBI. so I could have asked her about her feelings regarding the incident. Maybe she could compare this experience with her past student nurses. 6) In the nurse-client exchange # 4.Acute Psychosocial Nursing 4) In the nurse-client exchange # 3. so the patient can bring out recurring themes in her experiences. 7) In the nurse-client exchange # 5. I could have also used Exploring. 8) In the nurse-client exchange # 6.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. so she could further explain her ideas and experiences. so I could clarify my understanding of what she said. 5) In the nurse-client exchange # 4. I could have also used Encouraging Evaluation. 9) In the nurse-client exchange # 7. so she could have concentrated on a single point. . I could also use Encouraging Comparison. I could have used Seeking Onsensual Validation. I could have also used Exporing. I could have also used Focusing.

” (Offering self: This is a way of expressing a desire to understand and collaborate with the client. She shared more things about her life and experiences.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. This time I noticed that she’s more sociable with other patients and nurses as well! 1) NURSE: “Good morning. so she could talk about her feelings and that could lessen the need to act them out inappropriately. EXCHANGES DAY 2 Feb. 2012 INTERATION #2: During our second day.) (Giving Information – makes available facts the patient needs.?” . I’m fine. Irene! Kamusta ka naman? Nandito na ulit. She seemed glad to see me again. I’m here again so we can talk again.” “Good morning. 10. I also made boundaries during this phase of our conversation. 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. Dito ulit ako para makapag-usap ulit tayo. Irene! How are you? Remember I told you yesterday that I’ll be back today. Medyo nahirapan lang makatulog kagabi.” “Good morning! I’m glad you’re back. I’m glad you’re guys are here again. diba sabi ko kahapon babalik ako ngayon. I could have also used Encouraging of Perceptions. Masaya ako kasi nandito ulit kayo. Okay lang nmn ako.Acute Psychosocial Nursing 10) In the nurse-client exchange # 9. the client showed also interest in the conversation. I just had difficulty falling asleep last night.

They’re bothering me again” . Just like before.” 3) NURSE: “Nung mga?” “by the?” (Exploring: Examines certain ideas. and ideas back to the client.. they’re still there.” “I was thinking of many things. Nanggugulo na naman. feelings.) CLIENT: “Madami pa rin ako iniisip. Gives the client an idea of what have been communicated..) (Reflecting: Directs questions. Tas ganun parin sa dati. Encourages the client to accept her own ideas and feelings. Sinusundan parin ako nung mga.. I used this so she would expound more about her thoughts) CLIENT: “Mga NBI. or relationships more fully. I was still followed by the.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...” “the NBI. I used this so I could clarify my understanding.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. Nanjan parin sila.. experiences.

They want to distruct me! They keep on saying different things” .) CLIENT: “Yung mga NBI kasi.” 5) NURSE: “Ano mga ginagawa ng mga NBI sayo?” “What do they do to you?” (Exploring: Examines certain ideas. experiences. Tapos lagi pa nila ako binabantayan.Acute Psychosocial Nursing 4) NURSE: “ah. Tapos parang hindi sila napapagod” “The NBI keeps on bothering me. They always look after me.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. What were they doing last night?” (Accepting: Indicates that the person has been understood. or relationships more fully. lagi parin nila ako ginugulo.) (Seeking Clarification: Helps client clarify their own thoughts and maximizes mutual understanding between nurse and patient. And it seems like they’re not getting tired of it.) CLIENT: “Kung anu-ano ginagawa. Ano mga ginagawa nila kagabi?” “Ah. Gusto nila ako i-distruct! Kung anu-ano sinasabi nila” “They’re doing random things. The statement does not necessarily indicate agreement but is non-judgemental.

Parang ako pa kasi yung masama sa mga tao. Hindi sila nakikinig!” “They don’t want others to know that they’re already doing the wrong thing.” “They don’t want to listen to me. It seems like other people think that I’m bad” 8) NURSE: “ahh.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. Listen to what?” (Silence: Gives the person time to collect thoughts or think through a point. They’re not listening!” 7) NURSE: “Silence.) CLIENT: “Ayaw kasi nila malaman ng tao na mali na yung ginagawa nila sakin.) CLIENT: “Nakikinig sa akin. They’re abusing my rights. Nakikinig saan?” “Silence..Arellano University-Alderson Broaddus College International Nursing Program Nursing 368...What made you think that other people think you’re bad?” . Ayaw nila maniwala na ako yung biktima dito.Ano yung reason mo kung bakit mo nasabi na masama ang tingin sayo ng mga tao?” “ahh. They won’t believe that I’m the victim here. Inaabuso na nila yung karapatan ko.

Pinag-uusapan nila ako. The statement does not necessarily indicate agreement but is non-judgemental. Akala nila ako yung gumagawa ng masama. Nahihirapan ako sabihin at iexplain. Are you okay??” (Accepting: Indicates that the person has been understood. Wag nalang natin pag-usapan.Acute Psychosocial Nursing (Accepting: Indicates that the person has been understood.) CLIENT: “Naririnig ko sila.) CLIENT: “Basta. The statement does not necessarily indicate agreement but is non-judgemental. What were the bad things according to them that you did?” (Accepting: Indicates that the person has been understood.” 10) NURSE: “Sige.” “I heard them talking about me. The statement does not necessarily indicate agreement but is non-judgemental. Ano daw yung sinasabi nila na mga bagay daw na ginagawa mong masama ?” “okay.” “I’m having a hard time explaining that to you.) . They think that I was doing all those bad things.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. Okay ka lang?” “Sige. Let’s not just talk about it.” 9) NURSE: “okay.

I should have explored her feelings even more. Maybe I asked her to explain more her thoughts and the things that are bothering her. . I should have used Giving Broad Openings so she could lead the conversation.” III. ALTERNATIVES 1) In the nurse-client exchange # 1. She might be able to tell me if this happened already in the past or if this was the first time. so the patient can bring out recurring themes in her experiences. I could also use Encouraging Comparison. 3) In the nurse-client exchange # 3. so I could clarify my understanding of what she said.Acute Psychosocial Nursing CLIENT: “Smiles. Yes. 5) In the nurse-client exchange # 4.” “Smiles. I could have used Seeking Onsensual Validation. I should have used Exploring. Oo. 4) In the nurse-client exchange # 3. this way the patient could fully elaborate the details of her feelings and thoughts and what’s going on her mind that time.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. 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 could have also used Encouraging of Perceptions. I could have also used Exploring. so she could further explain her ideas and experiences. I could have also used Exploring. so she could further explain to me her ideas and thought most especially the distructions she was telling me. 7) In the nurse-client exchange # 6. And she might tell me more about the incident.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. . I should have asked what kind of distructions these NBI were doing.Acute Psychosocial Nursing 6) In the nurse-client exchange # 4. 8) In the nurse-client exchange # 6. I could have also used Exporing. I could have also used Encouraging Evaluation. so she could talk about her feelings and that could lessen the need to act them out inappropriately. I should’ve asked about the people behind those things. 10) In the nurse-client exchange # 9. so I could have asked her about her feelings regarding the incident. 9) In the nurse-client exchange # 7.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. She would always say that she’s sorry that she couldn’t everything well because she feels anxious and mad about it. The way she emphasized it was so obvious to the point of raising the tone of her voice. she started to have difficulty explaining or verbalizing her thoughts. 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. was still my patient. 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”. Just like the first time we met. kakilala ko noon at kaaway ko na siya ngayon” (I know him before he’s already my enemy now”.Acute Psychosocial Nursing III.I. when I approached her she seemed not in the mood to talk. But when our C. At first. she still manifests the same thing. C. She also told me how bad that guy was to her. She said that those NBIs are secretly investigating her since 2004 and her “enemy” is the master mind. She said that she’s not okay for us to talk and that I can’t talk to her. This was not the first time she said it. She was very cooperative and was calm and was totally different from the first time I approached her. she said that she waited for me for so long. She frequently stops and pause for some time to think for the appropriate words to describe her feelings.I. But even if we’re talking about happy things like comedy movies that she likes. During our first meeting. talked to her. Then she again opened up the topic about these NBI that according to her are sent by her enemy. When I asked her about the NBI. As we go along with our conversation. She said that she was sad when we’re not visiting them. she looked at her back and then looked at her surrounding and said that they’re always there to make her feel as if it’s her fault that she’s in that facility. she already told me stories about those NBIs. Whenever I asked her about the “enemy” that she’s saying. In the middle of our . THEORY Patient. she would just avoid it and will say that “Basta. she agreed to talk to me. At that point.

She’s trying to avoid sensitive issues and will always say that she’s mad and anxious and not yet time to talk about it. but I could hardly understand it. maybe her enemy is manipulating everybody even her family. she had mumbling episodes as if she’s saying something. She even told me of things to expect when you cut your forearm. She also shared to me the reason behind her scars at her forearm. On the other hand. And we started to talk about her family. The person’s response involved intense fear. She said that. she has been doing that for like a year before until she was admitted in the facility. She said she’s not yet ready to share it with me and some other time maybe. or a threat to the physical integrity of oneself or others. During the entire time that we’re talking. Irene has Post Traumatic Stress Disorder and considering Psychosis NOS r/o Delusional Disorder. Delusional . she didn’t know how to express her emotions and all she could do is to hurt herself so she won’t feeling anything. She said. She refused to tell me about those experiences but promised to share it some other time. 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. I can see that she’s willing to share her stories but not everything. helplessness or horror. or been confronted with an event that involved actual or threatened death or serious injury. She admitted that she has difficulty coping with her problems because of her experiences. she said they often visit her and she doesn’t care because according to her even though she’s telling her parents all her problems. She also told me that her anger is still there and will always be there for the rest of her life. She said. She refused to tell me the cause of her scars on her forearm. witnessed. The traumatic event is re-experienced in the mind. She refused to tell me about it during our first meeting. and there is an avoidance of stimuli associated with the trauma and the numbing of general responsiveness. I asked her to repeat it but she said she didn’t say anything.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. PTSD is a disorder wherein the person has experienced.Acute Psychosocial Nursing conversation. they won’t believe her.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. The client’s current medications include: Epival 250mg BID . She’s not married but she had a living partner before for 10 years. discussing the troubling side effects of medications with the health care personnel. she was supposed to have her own family and establishing intimate . it was written there that she is physically and verbally assaultive. According to Erikson. she needs counselling and use of therapeutic communication. She still has mumbling episodes and always stays in the corridor alone. They’re saying negative things about her that aren’t true according to her. (+) mumbling episodes. avoiding the use of alcohol and other prohibited drugs. regular exercise and have adequate rest and sleep.” It is also written on her chart that months prior to this duty.antipsychotic. and insomnia for 4 days one week prior to her admission. “Mas grabe na yung mga ginagawa niya. and maintaining physical health by following a healthy diet. She has not been taking medications for weeks now because her family is not anymore giving her supply. Her sister stated that. According to our lecture about psychiatric patients. Nagmumura tapos naninira ng gamit tapos madalas na nagsasalita mag-isa. she’s shouting spells to the other patients and was trying to stab the nurse using a ballpen.an anticonvulsant and Thorazine 100mg after breakfast and 50mg after dinner . they could decrease or prevent symptoms by complying with the medications and with her since she has PTSS. They also need someone to talk to for them to vent their feelings and for them to feel that they’re taken care of and supported. Based on her chart. easily gets irritable. Irene is under Intimacy vs Isolation Stage. participating regularly in any other forms of treatment such as Milieu Therapy and other group activities. Based on Erik Erikson’s Developmental Theory. Her partner was abusing her physically that resulted in her condition now.Acute Psychosocial Nursing Disorder involves non-bizarre delusions of at least 1 month’s duration. The person’s ability to function is not markedly impaired nor is the person’s behaviour obviously odd or bizarre. According to her she was being talked about by the people around her.

But when . But because of her situation. So interventions should still focus on attending her physiologic needs. like eating or drinking. when people forced her to do things she doesn’t want. She thought that it’s the right thing to do since she’s hearing a lot of issues and negative things against her. she would usually do the opposite. She has difficulty coping with her problems and has negative insights about life.SELF-EVALUATION During the start of the rotation. She also thinks that her family is not there for her because her “enemy” is manipulating them.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. according to her. My priority Nursing Diagnosis for this client is Ineffective Coping related to low selfesteem. she’s now in the isolation stage where she’s moving away from people. IV. she has poor hygiene.Acute Psychosocial Nursing bonds of love and friendship. I was really scared. She also said that the NBI are also there and she’s not comfortable with it. inadequate support system and inability to trust as evidenced by inability to meet basic needs. For Maslow’s Hierarchy of needs. As I observed and also verbalized by the patient. Proper hygiene is one of human basic needs. And also. Her basic needs are also altered. Her aura threatened me. After seeing her reaction when I approached her. I really don’t know what to do or even say. She also has difficulty trusting people because she thinks that they will just judge and misinterpret and hurt her. The patient has problems with her self esteem after her traumatic experience with her partner. These factors are the reasons why the patient is having a hard time coping with her stressors. She said she’s not comfortable taking a bath and she doesn’t want to fix herself because there’s no need for it. the patient is currently under physiologic needs.

I made my bounderies. I was also able to use my therapeutic techniques during the entire conversation. and I’m there as a nurse so emotions shouldn’t be affecting me. When she explained to me the reason about her attitude. Therapeutic communications also played a major role in dealing with patients like Irene. I was able to communicate with my patient effectively. I should be careful with the words I’m saying. Patients like Irene have difficulty trusting people and I was able to make her feel comfortable.Acute Psychosocial Nursing we started talking. When she opened up that she’s sad that I can’t stay longer. I was able to explore her feelings and thoughts and I think that’s something that I have to be proud of. PROS I was scared and nervous at the start of the duty but I didn’t let those feelings affect my way of thinking and of course my role. She was also able to share her stories and opened up some delicate issues about her life. She doesn’t want to be like that it’s just that her condition played a big role with the way she reacts with stimuli and even people. Since she thinks that people will always judge her.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. it suddenly changed. I also was able to recognize . That may help her or might further induce stress and guilt. I was able to do my role as a nurse and I guess I was able to give her needs at that time. she told me that she’s thankful for me and that her anxiety decreases and she feels better. Because of that. she was able to express her feelings and thoughts with me. Though I was not comfortable at first. I’m so proud of myself that I was able to help her and that she appreciates it and that means a lot to me! A. I shouldn’t be attached to her. Her experiences also contributed a lot with her character now. I was happy that at the end. I realized that I should be more understanding and patient with her. I would say.

V. I tend to keep things hidden.Acute Psychosocial Nursing her strengths and weaknesses. I wasn’t able to think of any appropriate words to use so I could explore it. . As a judger. Since I’m an introvert.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. I also solve conflicts in my own way and I can also be independent whenever I want to. But even though she wants to be independent. I found out that I am an INFP. She preferred to keep some important things to herself. She didn’t want to share some informations to me because she said she’s not ready yet. B. I also accept and respect her for who she is and not judge her emotions and actions. 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 an introvert person. she has difficulty solving her own problem. it was stated there that I live in such a way that everything is organized and planned in an organized manner. CONS I wasn’t able to explore more on some of her thoughts because she was hesitant and not comfortable about it. I am more comfortable of working alone than in groups. FEELINGS AND PERSONAL INSIGHT (MYERS-BRIGGS KIERSEY TYPE ANALYSIS) Based on Myers Briggs Kiersey Type Analysis. I really have a hard time to think of words to say so I won’t be offending or judging her. I was able to relate to my patient.

Your patient needs you now and you might help her with her problems.. Always understand her and accept her for who she is. Are you equipped with therapeutic communication? Mindfully breathe. You are here as a nurse and you are trained to be one.. VI. I was also sad when she told about her feelings and experiences in life... Her actions are part of her illness.... Okay? Mindfully breathe! Good luck!. I .Arellano University-Alderson Broaddus College International Nursing Program Nursing 368.. STEDFAST SELF ASSESS: Okay Ninay! Mindfully breathe. This is your 2nd rotation here.. You studied this on your class so you’re equipped with knowledge about dealing with these patients! Listen carefully to her and always talk to her using therapeutic communication. And I am also sympathetic and love to establish close relationships with people. Mindfully breathe. they say that I need encouragement and recognition to do things better. right? Mindfully breathe. You can do it! Be the best nurse you can be! EMPATHY: That must be so hard for her... try to focus with your goals. not yours! Be yourself and try not to impose your beliefs and opinions. I won’t be able to make it. and I think if I’ll be in her position. so are you ready?? Are you ready for all the things that you’ll be experiencing now?? How about your emotions? Mindfully breathe.Acute Psychosocial Nursing As an “NF” or intuitive feeler. Mindfully breathe. Are you willing to open up your mind and even yourself with your patient? She needs you now... THERAPEUTIC ROLE: Ninay. you can do this! Remember to always focus on your patient’s feelings.

said that we have to accept our patients whoever they are. Yes. We have different ways of thinking and that’s what I have to understand and take in consideration! We are different beings and I also have to accept that! Mindfully breathe.... It’s gonna be hard if I’ll just keep it to myself..Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. Mindfully breathe. Ninay. her feelings are hers and I have mine. Yes. ALERT EMPATHY: Waiitttt..... You have your own thoughts and she has hers. Her feelings are hers and you have yours. She needs you now and you have to keep that in mind!... Mindfully breathe. you feel for her but that’s it.... Mindfully breathe. I think I need someone to talk to about my feelings.Acute Psychosocial Nursing swear! She must be in a very difficult situation right now... I was able to use therapeutic communication most of the time but sometimes. I couldn’t help but be non. . She NEEDS YOU now! FACILITATED DEBRIEFING: Mindfully breathe. She’s sad and mad. Focus on your goal! Remember your bounderies! SELF-AWARE MINDFULNESS: I’ve learned a lot today. Though I can’t help myself from being affected by my patient’s feeling. I still managed to be firm with my role and goal.. I empathize her but that’s it! I am here to help them and be their nurse. that won’t help.. You have to respect it and try to understand... and I’m not! So don’t let her feelings affect you. How could I be firm with my role and not be affected by her actions and stories? Mindfully breathe! DETACHED REFLECTION: Mindfully breathe. Our C.I. I don’t think it’s still okay. Mindfully breathe. If I’ll be sad like her.therapeutic! I’m sometimes running out of appropriate words to say! Mindfully breathe.

Acute Psychosocial Nursing It’s just a matter of time and you have to learn from your experience and mistakes! You’ll be fine! Mindfully breathe. ..... THERAPEUTIC USE OF SELF: I offered myself to Irene today.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. I am glad that she’s 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.

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   . and  whispering where the patient can see but can’t hear. Avoid laughing. They may think that you’re talking about them Be honest and avoid promises when you’re not sure if you’ll be able to comply with it.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. make sure that the patient will be having just 1  nurse or caregiver.Acute Psychosocial Nursing NURSING CARE PLAN1 Nursing Diagnosis: Ineffective Coping related to low self-esteem. To promote trusting relationship with the caregiver. After the 8 hour shift: Client developed trust with her primary caregiver. She shared her stories and thoughts during the course of duty. inadequate support systems and inability to trust as evidenced by inability to meet basic needs ASSESSMENT Subjective Data:  “I don’t take a bath or fix myself  because there’s no need for that” “I don’t want to talk to other people. 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. they often  judge me” PLANNING INTERVENTION & EVALUATION RATIONALE If possible. giggling.

Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. Verbalization of feelings in a nonthreatening environment may help the client come to terms with long unresolved issues. .Acute Psychosocial Nursing  Encourage client to verbalize feelings and thoughts.

This may indicates client’s 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. diminished productivity. They may think that you’re talking about them Provide noncompetitive activities that promote “one-toone relationship with the nurse. 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       . poor eye contact. nakatulong ka talaga. and whispering where the patient can see but can’t hear. Observe client’s behaviour.Acute Psychosocial Nursing NURSING CARE PLAN2 Nursing Diagnosis: Anxiety related to situational crisis and stress as manifested by verbalization of fear. difficulty concentrating. Competitive activities are very threatening to suspicious clients. make sure that the patient will be having just 1 nurse or caregiver.” “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. giggling. (+) mumbling episodes. Avoid laughing. flight of ideas ASSESSMENT Subjective Data:   “Sorry medyo anxious na naman  ako. To promote trusting relationship with the caregiver.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368.

This may lessen the anxiety level of the patient Provide feedbacks and checking meaning with the client. This prevents misinterpretation Listen attentively to the patient. Be truthful and provide physical contact if possible.Acute Psychosocial Nursing        the patient is using.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. This provide self worth for the client and boosts her selfesteem Allow the patient to vent her feelings and emotions. Clarify client’s meaning of feelings and actions. Avoid giving personal . To soothe fears and provides assurance. This may interfere with the client’s ability to deal with her stress and problem Establish a therapeutic relationship all the time. Accept the patient as it is. This assists patient to vent their feelings Encourage client to express her feelings and thoughts.

Verbalization of feelings in a nonthreatening environment may help the client come to terms with long unresolved issues.Acute Psychosocial Nursing     advices and responses. This prevents client from escalating Provide nonthreatening environment and minimize stimuli. This may help in reducing anxiety Encourage client to verbalize feelings and thoughts. reading) Encourage patient to have an exercise program. . watching tv.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. Lessen effects of transmission of feelings Teach client about healthy ways to deal with her anxiety (diversional activities-drawing.

Missouri: Mosby Elsevier. E. Townsend. 8th Edition.. . Stuart.. 171-194). (pp. Varcarolis. (2006): The Clinical Interview and Communications Skills. 273).. G.. 5th Edition.W.Davis Company. Acute Psychosocial Nursing Syllabus.Acute Psychosocial Nursing References: Carson. M. (2005): Principles and Practice of Psychiatric Nursing. N. Laraia. Missouri: Saunders Elsevier.C.T.. F. Foundations of Psychiatric Mental Health Nursing: A Clinical Approach.Arellano University-Alderson Broaddus College International Nursing Program Nursing 368. M.. (pp. V. (2008): Nursing Diagnoses in Psychiatric Nursing 7th ed. Nursing 386. Shoemaker.A.

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