psychiatric nursing iii

Republic of the Philippines

BATAAN PENINSULA STATE UNIVERSITYBalanga Campus

Balanga City, Bataan

COLLEGE OF NURSING AND MIDWIFERY

Mariveles Mental Hospital

Process Recording and Mental Status Assessment

MTW Group 6

Submitted to:

Mrs. Leonora Llandilar R.N

Clinical Instructress

Submitted by:

Lindon Enriquez Cruz (process recording)Lorryleen Galicia (MSA)

Alma Joy Bumagat Lupido (psychotherapy)

Process Recording and Theme Identificatio

n

I. PERSONAL DATA

Name: Mr. G.M Address: Duliman Pangasinan Age: 69 years old Gender: Male Date of Birth: Oct. 15, 1941 Place of Birth: Malaysia Religion: Iglesia ni Cristo

Last 15 years of Patient’s Life:During the conversation with our client he mentioned that he’s living

Duliman Pangasinan, supervising their mango farm as ordered by his father and sometimes after that he also worked at the military. Even up to now Mr. G.M believes that he is still working as a Military Spy at MMH and that his fellow clients are NPA’s.

II. OBJECTIVES:

A. Client-Centered Objective To reorient the client to reality by gradually setting his mind apart

from the world he is recognizing at present which is distant to reality.

To entertain clients and provides a means of enjoyment through series of therapeutic activities that we’re prepared in order to uplift and improved their social wellness and well being.

To encourage the client to verbalized and express his thoughts and feelings in order to provide a feeling of comfort and freedom as well from hidden fears and anxities.

B. Nurse-Centered Objective To encourage and explore the clients feeling and condition in order

to understand his situation. To gain client trust and cooperation throughout the therapeutic

activities. To maintain the therapeutic relationship with the clients through

series of therapeutic communication in order to assess the client’s feeling and behaviors.

III. DESCRIPTION OF SETTING

A. Describe the environment:It was a warm yet windy afternoon when we received our client aroung 2 in the afternoon we held our conversation in the tennis court of MMH under the shade of the mango tree which help us gain a comportable area

and eases our conversation. The surrounding was fairly clean except from pieces of dried fallen leaves. It was a silent area ideal for conversation.

B. Describe the nature, behavior, affect and mood of the client.

During the conversation the facial expression was normally serious and often stares at his feet but as we go on the conversation the he would respond and start making eye contact. And would occasionally smile when answering our questions.

IV. PROCESS RECORDING

Nurse-Client Conversation Therapeutic Communication Technique Used

Analysis and Interpretation based on Theories

SN: Magandang umaga po! Kami po ang student nurse nyo ngayong hapon Mang G.M. Ako po si Lorryleen at ako naman po si Lindon. Makakasama nyo po kami ng apat na linggo. Dalawang Linggo po kaming makakasama sa hapon mula 2:00pm hanggang 4:30pm at sa susunod na dalawang linggo po ay umaga naman po tayo magkikita sa oras na 9:00am to 11:00am.

SN: Kamusta naman po kayo Mang G.M?

C: Ok naman ako

SN: Ilan taon na po kayo Mang G.M?

C: 69 yrs old

(naglalakad papuntang grooming area)

Asking broad open-enfded question

The nurse should ask neutral question that encourage the client to express her concerns. It is essential for us to assess the client moods and behavior and feelings through means of asking broad open-ended questions that allow us to understand the client condition and thus be able to apply appropriate therapeutic techniques of communication with the client.

SN: Mang G.M taga san po kayo?

C: Malaysia

SN: Sa malaysia din po ba kayo pinanganak Mang G.M?

C: Oo,dun ako pinanganak.

SN: Mang G.M ano po ba ang relihiyon nyo?

C: Iglesia ni Cristo

SN: Mang G.M alam nyo po ba kung nasaan kayo?

C: Oo, nasa Mariveles, Mental Hospital

SN: Mang G.M alam nyo po ba kung bakit kayo nasa mental hospital?

C: Oo, kasi ako ay isang impormatiko

SN: impormatiko? Ano po ba ang ibig nyong sabihin sa impormatiko?

C: impormatiko, nagmamasid sa mga NPA.SN: NPA po Mang G.M? Ano po ang ibig nyong sabihin?

C: mga NPA kasi ang kasama ko dito.

SN: Ganon po ba Mang G.M. kamusta naman po ang mga kasama nyo dito sa mental?

Clarifying

Clarifying

The nurse helps the client to put unclear thought and ideas into words. This will avoid misunderstanding and misinterpretations that will facilitate a good flow of conversation between the nurse and the client.

C: di ko naman sila kinakausap dahil baog daw ako.

SN: sila?sino pang sila Mang G.M?

SN: ah Mang G.M may pamilya pa po ba kayo?

C: Oo meron pa.

SN: Kilala nyo pa po ba ang mga magulang nyo Mang G.M?

C: Oo, ang nanay ko si Cremia at ang aking ama ay si Juan Crisostomo

SN: Mang G.M asan po ba sila?

C: Di ko alam

SN: Mang G.M may asawa po ba kayo?

C: Meron

SN: Ano po ang pangalan ng asawa nyo?

C: Lianne

SN: May mga anak po ba kayo ni Aling Lianne?

C: Meron mga siyam.

SN: Mang G.M kilala nyo ba silang lahat?

C: si jelly, steve at at limot ko na ang iba.

Clarifying

Clarifying

Using silence

Placing event into time and sequence.

The nurse helps the client to put unclear thought and ideas into words. This will avoid misunderstanding and misinterpretations that will facilitate a good flow of conversation between the nurse and the client.

Silence often encourage the client to verbalized, provided that is interested and expectant.

SN: Nasan na po sila Mang G.M?

C: Nasa underground

SN: Underground? Ano po ang ibig nyong sabihin?

C: Nagtratraining ang mga anak ko sa underground para maging Militar.

SN: eh si aling Lianne po nasaan?

C: Nandun sa DulimanSN: Duliman?san po yun Mang G.M?

C: Sa pangasinan, nandun siya sa may calabawan pinaparusahan at ginagahasa ng madaming lalaki.

SN: (natahimik)

SN: Mang G.M may mga kapatid pa po ba kayo?

C: Oo, 3 kaming magkakapatid.

SN: Kilala nyo parin po ba sila Mang G.M?

C: Si Nine ang panganay, si Anita ang pangalawa at ako ang bunso.

SN: Dinadalaw po ba nila kayo dito?

C: Oo, dinadalaw pa nila ko.

SN: Kelan po yung huling

Giving information.

Clarifying

Using silence

It is necessary for the nurse to give and share information to the client that is relevant to her health care and well being. Therapeutic activities are prepared in order to enchance the client skills, creativity, as well as cognitive ability in order to facilitate the process.

Giving the procedure of the activity is important to create a productive working environment

The nurse helps the client to put unclear thought and ideas into words, this will avoid misunderstanding and misinterpretation that will facilitate good flow of conversation between the nurse and client.

Silence often encourages the client to verbalized, provided that it is

dalaw nila?

C: matagal na di ko na maalala.

SN: ganoon po ba Mang G.M sino po ba ang mas madalas dumalaw sa inyo Mang G.M?

C: Si Anita, sa kanya din binibigay yung mga dukomento na binibigay ng doktor at mga papeles na bibilin nya.

SN: ah, Riseta po ang tawag dun.

SN: may mga pinapainum po ba sa inyong gamot Mang G.M?

C: Oo at sa tuwing pinapainum ako ng gamot na yon lumiliit ako.

SN: Lumiliit po Mang G.M?ano po ang ibig mong sabihin Mang G.M?

C: Lumiliit ako sa tuwing pinapainum ako ng gamot na yun. Pero bumabalik din ako sa dati kapag kumakain.

SN:Sino po ang nagbibigay ng tableta sa inyo Mang G.M?

C: mga nakaputing damit. Minsan pinagtutulungan nila kong lahat at iniinjectionan.

SN: mga nakaputi po ba Mang G.M?sila po ang mga nurse nyo na nagbibigay ng

Summarizing

interested and expectant.

Point out the highlights of the important content in the communication. By this nurse could emphasized the important aspect that the client should know about the activity. It could also enhance the client memory and cognitive ability by incorporating important and relevant ideas through summarizing. And base from Henderson’s 14 fundamental needs theory, learning is one of the needs of an individual in order to grow and mature.

mga gamot nyo.

SN: Mang G.M ano po ba ang trabaho nyo?

C: militar ako at binabantayan ko ang mga NPA dito.

SN: San po ba kayo naka-base dati?

C: madami, sa Germany, U.S.A, Valenzuela, Zambales, Subic.

C: kaya nga ang dami kong asawa hindi ko mabilang. Nung nagtratrabaho ko sa parola sa subic nakita ko si Kris Aquino, Rosa Rosal, Korina Sanchez.

SN: Mang G.M may ano po ba sa Parola sa Subic bakit nyo nakita sila Kris Aquino, Rosa Rosal at Korina Sanchez?

C: wala, pinaasawa sakin si Kris Aquino, Korina Sanchez at Rosa Rosal.

SN: (natahimik)

C: Nagkaanak pa ko kay Kris Aquino at Rosa Rosal 31 anak kay Kris Aquino at 2 kay Rosa Rosal (smiling)SN: Ganon po ba Mang G.M?

SN: Mang G.M kilala nyo po ba ang presidente ng Pilipinas ngayon?

Direct question

Direct question

Direct question

Using silence The nurse allows periodic pauses to give nurse and client to reflect

C: ako!

C: ako yung presidente ngayon paiba-iba lang ako ng pangalan.

C: dati tinatawag nila akong Gloria, Erap at Cory. Tsaka ako din si Rizal pero hindi ako yung namatay na Rizal. Ako yung Rizal na pinatatayuan ng Monumento.SN: Mang G.M alam nyo po ba ang mga napag-usapan natin kanina?

C: ang naaalala ko ay napag-usapan natin ang pamilya ko at ang underground si Lianne ang asawa ko at si Anita ang kapatid ko.

V. THEME IDENTIFICATION

Content Theme

The conversation were mostly about the family of our client. His activities during his last 15 years of his life, his working experiencing, the places he’d been to, the personalities he’d met and the rest was about his basic personal information.

Interaction Theme

During the interaction with our client. Mr. G.M was cooperative and answered most of our question. He willingly narrate his life to us and told us things about himself.

Mood Theme

During the conversation our client was serious and has no facial expression, he would only answer our question and when asked how he feel he

only said “ayos lang” but as our conversation lengthen he would occasionally smile at us while talking.

VI. Nursing Diagnosis

Impaired memory r/t psychological disturbances as manifested by forgetting his past experiences such as place, time and event.

VII. Nursing Intervention

Implement appropriate memory retraining techniques such as keeping calendars, writing list, memory we games, mnemonic devices and so forth. Provides for importance of pacing learning activities and having appropriate rest to avoid fatigue.

VII. SUMMARY AND EVALUATION

All in all the interaction between us and our client had ended without any unwanted events. We had met our objective which is to gather the personal data and asses the mental status of Mr.G.M as well as to establish rapport and gain our client’s trust as evidenced by his expression of feelings and willing narration of his own life. Mr.G.M tried to answer all the questions that we asked and we utilized our therapeutic communication technique during the course of our whole conversation.

VIII. REFERENCE

Nursing Pocket Guide 10th Edition

I.Personal Data A. Name Mr. G.MB. Address PangasinanC. Age 41 years oldD. Gende MaleE. Date/Place of Birth December 12, 1966, PangasinanF. Religion Roman CatholicG. Place where the patient spent the last 15 years of life:

The client Mang G.M was previously well ang living a normal life as a farmer until 2002 he started exhibiting odd behaviors. His father Mang A.M brought the client to the faithealer in their Area and seek medical advice for four months. However, when after four months had past and the client condition still did not improve. His family decided to consult in NCMH where in Mang G.M was admitted confined at ACIS for 15 days until he was taken home with prescribed medication.

Until returning home, the client resumed farming and started neglecting his medication until he discontinued taking it when client was still symptomatic. During that time the client would sometimes exhibit oddities but was tolerated. Aside from his occasional manifestation of oddities the client and his family didn’t encounter anymore problem.

That was until 2008, when the clients brother started to building a house in the land that the client believed was all his. 4 days after the house was build, the client broke the jalousy of his brother new house thus the client family decided to seek medical attention at Mariveles Mental Hospital.

Source: Client Chart

II. OBJECTIVES

A. Client-Centered Objectives

To reorient the client to reality by gradually setting his mind apart from the world he is recognizing at present which is distant to reality.



B. Nurse-Centered Objectives

To Encourage and explore the clients feeling and condition in order to understand his situation.

To gain client trust and cooperation throughout the therapeutic activities.

To maintain the therapeutic relationship with the clients through series of therapeutic communication in order to assess the client’s feeling and behaviors.

III. Description of Setting

A. Describe the set-up/environment

It was a cloudy afternoon when we received our client at already 2:00pm he smiled at us even before we get our personal contact. Some clients inside the ward were just staring at us while the other client were saying some things which are not clear. The weather is cool even without the contact blowing across the atmosphere. The trees were standing still and there were only few leaves falling from the trees unlike last week. We moved chair to avoid interruption while he is reading the comics. The environment is quite and peaceful except for the bit noise produced by the other client inside the ward.

B. Describe the nature, behavior, affect and mood of the client

Just before we received our client, Mang G.M was already smiling at us from his ward. He seemed to be more happy and lively than last week, although we saw the same facial expression from him. Serious face.

IV. Process Recording

Nurse-Client Conversation

Therapeutic Communication Technique Used

Analysis and Interpretation Based on Theories

SN: Magandang umaga po, kamusta na po kayo Mang G.M?

C: ok lang ako.

SN: Mang G.M naaalala nyo pa rin po ba kami?

Asking broad-open ended questions.

Asking broad-open ended questions.

The nurse should ask neutral questions that encourage the client to express concerns. It is essential for us to know the client mood, behavior, and feelings through means of asking

C: Hmmm.. nalimutan ko na e.

SN: Mang G.M ipapakilala po ulet namin ang aming pangalan. Ako po si Leen at ako po si Lindon.

C: naaalala ko lang kasi yung mukha nyo pero ang pangalan hindi.

SN: oh dapat Mang G.M wag nyo pong kalimutan ang pangalan ng mga student nurse nyo.

C: (smile)

SN: Mang G.M pupunta muna tayo sa grooming area. Para po makapag-ayos kayo at malinis ang katawan nyo at mapreskohan po kayo.

C: (tumatango lang)

SN: (after maglinis)

SN: Kamusta naman po ang pagkaen nyo ng tanghalian?

C: Mabuti naman, nabusog naman ako.

SN: ah masarap naman po ba ang mga pagkaen nyo?

C: Masarap naman ang pagkaen.

Giving information

Giving information.

broad open-ended questions in order to understand the client’s conditions and be able to apply appropriate therapeutic communication with the client. In relation to the theory of Peplau: Interpersonal theory, in order to come up to a therapeutic relationship, one of the 4 phases we should undergo is the 1st phase.


Giving the procedure of the activity is important to create a productive working environment.

It is necessary fo the nurse to give and share information to the client that is relevant to her health care and well being therapeutic activities are prepared in

SN: Mang G.M ano po ang nararamdaman nyo kapag nakakalabas po kayo ng ward?

C: ah masaya presko

SN: tara po Mang G.M doon po tayo mauupo.(under the mango trees)

SN: Mang G.M ngayon po ay magkakaroon tayo ng dalawang therapy. Ang unang therapy po ay ang comics reading mayamaya po ay bibigyan namin kayo ng comics at babasahin nyo poi to. Kapag po natapos kayo sa pagbabasa tatanungin po naming kayo kung ano po ang aral na natutunan yo sa binasa nyo.

C: (tumango)

SN: Mang G.M alam nyo po ba ang comics?

C: Oo, alam ko ang comics

SN: Mang G.M alam nyo po ba ang comics?

C: Oo alam ko ang comics

SN: ano po ba ang ibig sabihin ng comics?

C: mga cartoons sa papel

SN: Mang G.M marunong

Clarifying

Direct Question

Asking broad open-ended question.

Direct question

order to enhance the client’s skill, creativity as well as cognitive ability in order to facilitate the process.

The nurse helps the client to put unclear thoughts and ideas into words, this will avoid misunderstanding and misinterpretations that will facilitate a good flow of conversation between the nurse and the client.

The nurse should ask neutral questions that encourage the client to express concerns. It is essential for us to know the client mood, behavior and feeling through means of asking broad open-ended question in order to understand that client’s condition and be able to apply appropriate therapeutic therapy.

po ba kayong magbasa?

C: Oo, marunong akong magbasa.

SN: Mang G.M ito na po yung comics at basahin nyo na po.

C: Kinuha ang comics at nagbasa.

SN: Mang G.M tapos na po ba kayong magbasa ng comics?

C: Oo tapus ko na basahin.

SN: Amina po ang comics Mang G.M at tatanungin ko po kayo about sa nabasa nyong comics.Mang G.M ano po ang pamagat ng binasa nyong comics?

C: Si Tesang Chismosa

SN: tama po. Sino naman po ang main character ng kwento?

C: Si Tesa yung madaldal (client laugh)

SN: Ano naman po yung natutunan nyong magandang aral sa nabasa nyo?

C: wag po mangboboso (smiling)

SN: Hindi po,ang aral po

Focusing The nurse ask goals directed question to help the client focus on a specific area of concern. This will also help the nurse to further understand the topic that is introduced.

ay wag po makialam sa buhay ng may buhay at wag pag-usapan ang kapitbahay.

(Photo Language Therapy)SN: Mang G.M ang gagawin po natin ngayon ay photo language therapy. Ito po yung therapy nating pangalawa. Mamimili lang po kayo ng dalawang picture. Yung pinakafavorite nyo po. Pag nakapili na po kayo, tatanungin po naming kayo kung bakit ayun yung napili nyong picture.

SN: Mang G.M tara na ho. At mamili na kayo ng picture.

(namili ng picture si Mang G.M)

C: Eto na yung picture na napili ko.

SN: ah ang napili nyo pong litrato ay isang manok at isang babae. Mang G.M sa dinamidami ng litrato na pinakita namin ito pong dalawang picture nato ang nagustuhan nyo?simulan po natin sa manok.

C: kasi dati nag-aalaga kami ng manok sa bahay tas bibinibigyan ko din ng

Accepting

Clarifying

Encouraging Comparison

Focusing

An accepting response indicate the nurse has and followed train or though.

The nurse helps the client to put unclear thoughts and ideas into words; this will avoid misunderstanding and misinterpretation.

Comparing ideas, experiences or relationship bring out many recurring themes.

The nurse asks goal directed questions to help the client focus on a specific area of concern. This will also help the nurse to further understand the topic that is introduced to the client.

manok ang mga kapitbahay.SN: Mang G.M ano po ang dahilan bakit binibigyan ng manok ang mga kapitbahay nyo?

C: para dumami at mangitlog tas ibabalik nila sakin ulit yung manok.

SN: ah ganon po ba Mang G.M.

C: Marami akong manok dati sa Monsalud.

SN: Monsalud, san po yun?

C: dun sa Duliman.

C: kasama ko si Jelly at Steve nangunguha ng itlog

SN: e Mang G.M yung isang larawan naman po. Bakit babae yung kinuha nyo?

C: Maganda kasi

SN: May naaalala po ba kayo sa picture na yan?

C: Oo, asawa ko siya e. (smiling)

SN: ano po ba ang pangalan nya?

C: Si Bibie Ranny

SN: Bibie Ranny?Sino po

Summarizing

Giving recognition

Seeking clarification

The nurse summarizes a given activity or intervention by reviewing the main point discussion and making appropriate conclusion. With this, we can gather all the activities rendered into a simple thought that will provide the client an understanding of what activities has been done.

Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect. The nurse is functioning as a resource person giving information also builds trust with the client.

The nurse helps the

siya ulit?

C: Siya ang asawa ko.

SN: Mang G.M hindi po siya ang asawa nyo. Ang nasa larawan po ay isang artista/singer.

SN: Mang G.M ano naman po ang pinagkaiba ng dalawang litrato?

C: yung manok may tuka, palong,feather (L.O.L) yung tao o wala non.

SN: bukod pa po doon Mang G.M?

C: ang tao nakakapagsalita ang manok hindi.

SN: e ano naman po ang pinagkaparehas ng dalawang picture?

C: parehas kumakain kaso ang sa tao foods ang sa manok palay/feeds (laughing) at ang manok kinakain ng tao. At ang tao din kinakain kapag nakahubad. (L.O.L)

SN: Mang G.M natatandaan nyo pa po ba ang mga ginawa natin ngayong araw?

C: Pinagbasa nyo ko ng comics tungkol kay tesang chismosa.

Direct question

General leads

client to put unclear thoughts and ideas into words; this will avoid misunderstanding and misinterpretation.

Encouraging continuation; using neutral expressions to encourage client to continue talking

SN: ano nga daw po ulit ang aral sa kwento ngayon?

C: wag maging chismoso.

SN: Mang G.M mabuti po ba o masama ang pagtsitsismis?

C: Masama

SN: tama po. Pagkatapos nating magbasa ng comics anong therapy pa po ang ginawa natin?

C: Photo Language theory

SN: tama po ulit. Ano po ulit ang ginawa natin sa photo language therapy?

C: ano.. pinapili ako sa madaming picture at pinapili ng dalawa.

SN: Mang G.M naaalala nyo pa po ba kung ano ang picture na napili nyo?

C: Oo, yung manok at yung magandang babae.

summarization

Asking direct question

summarizing



V. Theme Identification

Content Theme

During our interview with our client, the content of our conversation and interaction revolved around the outcome of our therapeutic activities (comic reading and photo language therapy) on what they’ve learned from it, on what ideas they can share regarding the activity and what they feel after doing the therapeutic activities.

Mood Theme

When we received our client, his mood appears to be happy and peaceful as well as during the whole process of therapeutic activities as manifested by his serious and calm facial expression and verbalization of his feelings “Masaya” he claimed with a smile. We’ve also noticed that during our comic and photo language therapy, his facial expression turned a bit excitement.

Interaction Theme

Our client participate and cooperated well during the entire therapeutic activities we’ve prepared.


Knowledge deficit r/t cognitive limitation as manifested by inaccurate follow through of instruction.

Vll. Nursing Intervention

We should prepare therapeutic activities that will enhance the learning and cognitive ability of the client. Base on the theory of Virginia Henderson: Learning is one of the 14 fundamental needs of a human being. It is need for an individual to grow and mature and what he has learned will help him survive in the world outside his place at present. His learning will help him to cope up with different processes and obstacles in life such as searching for a job. We should provide therapeutic activities that provide step by step approach from a simple to a complicated one that will provide an enhancement on his capabilities to analyze things and put this into perspective. We should also provide activities that will provide that will create a means of entertainment and enjoyment to provide relaxation that will refresh the mind of the client.

VIII. Summary and interpretation.XI. references: Lippincott Williams & wilkins : handbook of nursing

I. Personal Data A. Name Mr. G.MB. Address PangasinanC. Age 41 years oldD. Gende MaleE. Date/Place of Birth December 12, 1966, PangasinanF. Religion Roman CatholicG. Place where the patient spent the last 15 years of life:




Source: Client chart

II. Objectives:


To reorient the client to reality by gradually setting his mind apart from the world he is recognizing at present which is distant to reality.



C. Nurse-Centered Objectives

To encourage and explore the clients feeling and condition in order to understand his situation.



II. Description of Setting

A. Describe the set-up/environment

It’s a bright sunny afternoon when we received our patient at already 2:00pm the sun was high and the heat is on. Some of the client in the dorm were quite silent and our client’s face is serious at first but after a while it became bright and calm. The weather get humid. As we headed to the yard outside the BPSU student center, the place. Seemed to be messy due to the leaf that had fallen across the ground due to the sudden rain earlier. Though the environment seemed to be distracting,still, the air was calm with on and off soft blowing of wind that keeps the atmosphere cozy and relaxing. The environment was peaceful and quite.


As we received our client, Mang G.M seems to have a bright mood that reflects upon his face that look so calm. He smiled at us whenever we smiled and greeted him. The clients seems to be familiar to the daily routine of grooming care as we observes on his iniative in grooming his own. He automatically went to the sink and wash his face and arms then brushes his teeth without or due assistant. Our client is also happy as manifested by his facial expressions and verbalization of “ok naman” and “Masaya” he claimed.


Nurse-Client Conversation



SN: Magandang hapon po, kamusta kayo Mang G.M?

C: mabuti

Asking Broad Open-Ended questions


The nurse should ask neutral question that encourage the client to express concerns. It is essential for us to know

SN: Ano po ba ang nararamdaman nyo ngayon?

C: masaya(client smile)

SN: ah eh kamusta naman po ang tanghalian nyo?

C: mabuti, nabusog naman ako.

SN: ah ano naman po ba ang nararamdaman nyo kapag nakakalabas kayo ng dorm at nakakalakad dito sa paligid.

C: masaya, presko

(at the BPSU student center ground)

SN: Mang G.M, ngayon po ay magkakaroon tayo ng dalawang therapy. Ang unang therapy po ay ang puzzle therapy. Bibigyan po kayo ng dalawang puzzle na magkaiba. Isang simple puzzle at isang complex.

(SN: show the actual puzzle)

Ito po ang bubuuin nyong puzzle Mang G.M guguluhin po natin ang puzzle at ibabalik nyo po sa dati.

C: (client nods)(after the explanation of


Giving information

Assesing Relationship

the client’s mood, behavior, and feelings through means of asking questions in order to understand the client conditions and be able to apply appropriate therapeutic communication with the client.


Giving the procedure of the activity is important to create a productive working environment. Based on the theory of Virginia Henderson, learning is included as one of the 14 fundamental needs of human being and by giving information, we are assisting them to have learning.

Assesing relationship will aid the nurse in exploring relation with the other person affect the mood, feeling and behavior of

the procedure, we proceeded to the conduct of puzzle therapy and facilitates a group dynamics)

(after doing the puzzle therapy, we proceeded to our one on one interview with our client)

SN: napansin po naming na natagalan po kayong buuin ang complex puzzle.

C: Oo, madami kc at mahirap buuin.

SN: Alin po pra sa inyo ang madaling buuin? Yung simple o yung complex?

C: Yung complex ay yung simple pala kasi naaalala ko ang puno sa tabi ng bahay namin.

SN: Mang G.M ang susunod naman pong therapy ay ang play therapy. Dito po ay maglalaro po tayo ng pasahan ng bola at maglalaro ng baraha.

C: (Client smile,nods)(after the explanation of the procedure, we proceeded to the conduct of play therapy and facilities group dynamics.)

(after doing the play

Making Observation

Accepting

Direct question

the client.

Verbalized what the nurse sees on the client’s appearance and behaviors as well as action. This will provide an access for the nurse in assessing the client’s moods thought and feelings through non-verbal cues.

therapy, we proceeded to our one on one interview with our client)

SN: Mang G.M napansin po namin na ang saya nyo habang naglalaro kanina na ng pasahang bola.

C: Naalala ko kasi na nilalaro ko ‘to kasama ang dalawang anak ko na si Steve at Jelly.

SN:San nyo naman po nilalaro yung pasahan ng bola Mang G.M?

C: doon,samin sa Sta.Cruz

SN: ah ganon po ba Mang G.M

SN: Masaya naman po ba kayo Mang G.M kapag nakakalaro kayo ng anak nyo?

C: Oo, masaya ako

SN: nag-enjoy naman po ba kayo sa ginawa nating therapy Mang G.M?

C: Oo Masaya at natutuwa ako at enjoy (client smile)


Content Theme

The content of our interaction with our client revolves around the learning that have retained from his mind based on the series of therapeutic activities that we’ve conducted last week and a few moments ago as well as his mood feelings white doing the activities.

Mood Theme

When we received our client this afternoon, his mood seemed to be serious at first but on the latter part, his bright and calm facial expressions as well as his cheerful eyes appeared again and he verbalized a feeling if happiness such as “Masaya” and nag-enjoy ako” he claimed. Interaction Theme

During our therapeutic activities, our client participated and cooperated well on our prepared activities. He often answered to the facilitator’s question; he even tried to fixed the complex puzzle (puzzle therapy) even if he find some difficulties.



VII. Nursing Interventions

We prepared therapeutic activities that will enhance the learning and cognitive ability of the client. Base on the theory of Virginia Henderson: Learning is one of the 14 fundamentals needs of a human being. It is a need for an individual to grow and mature and what he learned will help him to survive in the world outside his place at present. His learning will help him to cope up with different processes and obstacles in life such as searching for a joy. We should also provide an active environment that is conducive for therapeutic activities that will further facilitate a productive outcome. Based on nightingale theory, environment affects the health of a person, thus any alteration in the factor: fresh air, pure water, efficient drainage, cleanliness and direct sunlight will cause health deficiency not only physically, but emotionally and mentally as well. We should also provide therapeutic conversation with the client in order to encourage him to verbalized his feeling, thoughts, mood as well as fears and activities. Based on the interpersonal theory of Peplau, to attain therapeutic relationship, the nurse must undergo the 4 phases: orientation, identification and resolution through the series of therapeutic communication.

VIII. Summary and Interpretation

During the whole interaction, our client participates and cooperates well to our prepared therapeutic activities. He always responds to our questions and tried to reach out even if he find some difficulties in answering our questions. He occasionally smiles. Sometimes, he just stares at us and keep quite for a while. The client seems to be happy and possesses a peaceful mood. He enjoyed our therapy especially the play therapy with our observations and manifestations from the client. He seems to have a great time with his co-client. Though sometimes that he smiles while telling sad events, then sometimes he has no reaction while stating wonderful events.

XI.: References Lippincott Williams & wilkins: handbook of nursing

I.Personal Data

A. Name Mr. G.MB. Address PangasinanC. Age 41 years oldD. Gende MaleE. Date/Place of Birth December 12, 1966, PangasinanF. Religion Roman CatholicG. Place where the patient spent the last 15 years of life:





II. Objectives:

B. Client-Centered Objectives To reorient the client to reality by gradually setting his mind apart

from the world he is recognizing at present which is distant to reality.


To encourage the client to verbalized and express his thoughts and feelings in order to provide a feeling of comfort and freedom as well from hidden fears and anxieties.

C. Nurse-Centered Objectives

To encourage and explore the clients feeling and condition in order to understand his situation.



III. Description of setting

A. Describe the set-up environment.It’s a bright sunny morning when we received our client at

already 10am the sun was high and heat is on some of the client in the dorm were quite silent and still our client face is quite serious. As we headed to the BPSU student center, the place seemed to be cool because of the on and off blowing of the wind that keeps the atmosphere relaxing and the environment was peaceful and quiet.

B. Describe the nature, behavior, affect and mood of the client.As we received our client this morning, Mang G.M seemed to be

serious. But as we proceeded to the grooming station, our client facial expressing changes he’s smiling though his eyes seemed to be different. We’ve waited for a few minutes in the grooming station because other client, were also using the sink. Our client just sit patiently until Mang G.M turn to groom. But as we headed to the BPSU student center the seemed to be serious and in the mood. But as we asked him how is he, Mang G.M replied “mabuti” with a smile. His facial expression was not so bright as before.


Nursing-Client Conversation Therapeutic Communication Technique Used


SN: Magandang Umaga Po!Kamusta po kayo?

Asking broad open-ended question

C:OK naman

SN: Napapansin po naming na mukhang malalim ang iniisip nyo? Ano po ba ang nararamdaman nyo?

Direct Question Asking direct question to the client will merely assess the clients capability to think, rationalize and give answer to a specific question.

C: Wala

SN:Wala?e ang seryoso po ng mukha nyo.

C: Wala (laugh)

SN: Kamusta po ba ang tulog nyo?

C: Ok naman, nakatulog naman ng maayos.

SN: Natatandaan nyo pa po ba kami Mang G.M?

C: Oo, Leen at Lindon

SN: Mabuti naman po at naaalala nyo pa po kami.

Giving recognition Giving recognition uplifts the self esteem of an individual through means of complementing and performance thus making him feels important and valuable as well.

(At the BPSU student center)

SN: Mang G.M ngayon po ay magkakaroon tayo ng panibagong therapy at ang theraphy po na ito ay ang Bibliotherapy. Ang bibliotherapy po ay nasasagawa po kami ng isang maikling dula-dulaan na ang istorya ay hango sa bibliya. Ang mga karakter po ay ginagampanan ng mga ginawa naming puppets na makikita nyo po sa loob ng ginawa naming telebisyon. Ang gagawin nyo lang po ay manood, makinig at intindihin ang istorya dahil po mamaya magtatanong po kami sa mapapanood nyo kung may

Giving information It is necessary for the nurse to give and share information to the client that is relevant to her health care and well being. Therapeutic activities are prepared in order to enchance the client skills, creativity, as well as cognitive ability in order to facilitate the process.

Giving the procedure of the activity is important to create a productive working environment.

natutunan po kayong aral.C: (client nods) Based on the theory of

Virgina Henderson, learning is included as one of the 14 needs of human being and by giving information: we are assisting them to have learning.

(after the explanation fo the procedure we proceeded to the conduct of bibliotherapy and facilitates a grou[p dynamics.)

(after doing the bibliotherapy, we proceeded to our one on one interview with the client)SN: Ano po ang pamagat ng dula-dulaan naming ipinalabas kanina?

C: ah.. Noeh at ang Baha

SN: Sino po ang bida sa dula-dulaan?

Focusing The nurse asks goal directed questions to help the client focus on a specific area of concern this will also help the nurse to further understand the topic that is introduced to the client.

C: Si Abraham at Noeh

SN: Hindi po Mang G.M ang bida po sa ating dula-dulaan ay si Noeh. Hindi po kasali sa kwento si Abraham.

Seeking Clarification The nurse helps the client to put unclear thoughts and ideas into words, this will avoid understanding that will facilitate a good flow of conversation between the nurse and the client.

C: (client nods)

SN: Anong hayop naman po ang kasama ni Noeh ng

kausapin siya ng Diyos sa burol?

C: ah yung cornel

SN: hindi po Mang G.M hindi po cornel yun. Ang hayop na kasama ni Noeh ay camel.

Seeking clarification It is necessary for the nurse to

SN: e san naman po galing ang malaking baha Mang G.M?

C: sa depmacho! (soft laugh)

SN: Depmacho? Ano po yung ibig nyong sabihin don?

C: Doon galing ang tubig.

SN: Mang G.M sa ulan po galling ang tubig kaya nagkakabaha at hindi po depmacho.

C: (client serious)

SN: Mang G.M nararanasan nyo po bang sumakay sa Daong?

C: Oo, nakasakay na ng Daong ako ang nagpapaandar ng Daong (client laugh)

SN: ah kayo po ang nagpapaandar ng daong?pano nyong napapaandar?

C: Dahil sa exploimaker.SN: exploimaker?ano pong ibig nyong sabihin Mang G.M?C: nagpapaangat sa barko yung exploimaker may elisiSN:ah ganon po ba? Accepting Indicating that the nurse

has heard and is willing to

hear the client wants to say and will facilitate the flow of conversation as well as verbalization of feelings.

SN: Mang G.M, Mang G.M, Mang G.M Nakikinig po ba kayo?

Direct Question

C: Oo (stairing his feet)

SN: Naintindihan nyo po ba ang kwento Mang G.M?(client is not responding)

SN: Mang G.M! Mang G.M! Mang G.M! Ano po ba yang hawak nyo?

C: Eto?kahoy ng dahon

SN: San nyo naman po nakuha yan?

C: Wala hawak ko na ‘to kanina pa!

SN: Mang G.M! Mang G.M! Mang G.M! (client is turnig his head left to right and his hand is making a fist)

C: May bumubulong sakin!(eyeball rolling from left to right)

SN: Bumubulong? Sino po Mang G.M?

C: hindi ko kilala pero tumatawa sya!(client look irritable)

SN: Mang G.M ok lang po ba

kayo?(client is not answering)

SN: Mang G.M gusto nyo na po bang magpahinga?(still the client not responding)

SN: Siguro po Mang G.M kailangan nyo na pong magpahinga.(client brought back to the dorm)(when the client is entering the gate of the dorm he says)

C: Madami ding akong aklat na ganyan at kaya ko ding magdrawing at magkulay ng ganyan.


Content Theme

The content of our interaction with our client revolves around the Bibliotherapy that we conducted. About what he thinks, feels and imagines as he watched the show. What does he learned and gain from the therapy as well as his impression about the said activity.

Mood Theme

The mood of the client seemed to be serious at first based on the latter part, he turned more serious and unattentive whenever we asked him questions. But he still replies “ok lang” whenever we asked him about what he feels and accompanies with smile on his face.

Interaction Theme

During our therapeutic activities, our client participated and cooperated on our activities even though we’ve noticed that he had some difficulties explaining what he saw in the bibliotherapy. He also not responds to our questions during the interview and when we asked him a question about the sotry of “Noe at Malaking Baha” he finds it hard to answer, he thinks first and tell us his idea about the story.

VII. Nursing Diagnosis

Impaired memory r/t Psychological disturbances as manifested by forgetting his past experiences such as place, time and event.

Vll. Nursing Intervention

We should prepare therapeutic activities that will enhance the learning and cognitive ability of the client. Base on the theory of Virginia Henderson: Learning is one of the 14 fundamental needs of a human being. It is need for an individual to grow and mature and what he has learned will help him survive in the world outside his place at present. His learning will help him to cope up with different processes and obstacles in life such as searching for a job. We should provide therapeutic activities that provide step by step approach from a simple to a complicated one that will provide an enhancement on his capabilities to analyze things and put this into perspective. We should also provide activities that will provide that will create a means of entertainment and enjoyment to provide relaxation that will refresh the mind of the client.

VIII. SUMMARY AND INTERPRETATION

Xl. ReferencesLippincott Williams and Wilkins: Handbook of Nursing

I. Personal Data

A. Name Mr. G.MB. Address PangasinanC. Age 41 years oldD. Gende MaleE. Date/Place of Birth December 12, 1966, PangasinanF. Religion Roman CatholicG. Place where the patient spent the last 15 years of life:





II. Objectives:



To educate the client about the therapeutic activities and assist the client to review the information that he had learned and transfer the learningsto her relationship with other.

To enhance the client skill and creativity through series of therapeutic activities that will provide her an active mind.


To learn and explore the client’s feelings and conditions in order to understand his situation so as to apply the appropriate therapeutic communication and activities for the client.

To enhance our skills and creativity through the series of therapeutic activities that we’ve prepared.

To expand our knowledge in every therapeutic communications that we’ve conducted through the theories that we use to co-relate with our client conversation.

III. Description of Setting

A. Desribe the set-up/environment

It was sunny morning when we received our client at already 9:00am he smiled at us even before we got our personal contact. Some client inside the word were just staring at us while the other clients were saying somethings which are not clear. The weather is cool even without even the constant wind blowing across the atmosphere. The trees were standing still and there were only few leaves falling from the trees unlike yesterday.


Just before we received our client Mang G.M was already smiling at us from his door. He seemed to be happy and lively than yesterday, although we saw the same facial expression from his: a serious face like what he used to do during our grooming care session. He automatically went to the sink and wet his face, when we offered him a toothbrush and toothpaste brushes his teeth without our due assistance. He used all the stuff that we’ve offered him without any hesitancy thus we easily done our grooming sessions. Our client seemed to be fine and happy. Based on facialy expression and his verbalization of “Masaya” and “Mabuti” with a smile. Though are some instances that we found our client having a blank stare. We also notice that our client seemed to be more interested in our prepared therapeutic activities today rather than yesterday.

IV. Process Recording Nurse-Client Conversation



SN: magandang umaga po, kamusta na po kayo?

C: mabuti

SN: ano po ang nararamdaman nyo ngayon?

C: Masaya (client smiles)

SN: ah e kamusta naman po ang pagtulog nyo?

C: mabuti nakatulog naman akong maayos.

SN: ah ano naman po ang almusal nyo ngayon?

C: champorado

SN: ang sarap naman po!

C: oo, masarap nga

SN: marunong po ba kayong magluto nun?

C: hindi eh pero kanin lang yon at may kasamang shabu.

SN: po?shabu po?ano pong ibig nyong sabihin Mang G.M?

C: yung shabu nilalagay sa kanin para di ako makatulog.


Asking open-ended question


Seeking Clarification

The nurse should ask neutral questions that encourage the client to express concerns. It is essential for us to know the client’s mood, behavior, and feelings through mean of asking broad open-ended question in order to understand the client conditions and be able to apply appropriate therapeutic communication with the client. In relation to the theory of Peplau: interpersonal theory, in order to come up to a therapeutic relationship one of the 4 phases we should undergo is the 1st phase which is orientation.

The nurse helps the client to put unclear thoughts and ideas into words, this will avoid misunderstanding and misinterpretations that will facilitate a good flow of conversationbetween

SN: gumagamit po ba kayo ng shabu Mang G.M?

C: oo hinihithit nga namin yun

SN: namin?may mga kasama po kayong gumagawa noon?

C: oo mga katrabaho ko dati

SN: ah san nyo naman po nakukuha yung shabu?

C: binibili namin yun

SN: ah ganun po ba?

SN: Mang G.M ngayon po ay magkakaroon tayo ng dalawang therapy. Ang unang therapy po ay expressive therapy. Ang expressive therapy po ay expressive art therapy ay gagamit tayo ng papel, posporo at pandikit. Ang gagawin nyo lang po ay iayos ang posporo sa kung ano po ang naiisip nyo. Pwede pong, bahay, puno or tanawin. Mamaya po ay bibigyan namin kayo ng papel, pandikit at posporo.

(SN:shows the actual paper)Dito po ilalagay ninyo ang disenyo na naiisip nyo.

Accepting

Giving information

the nurse and client.

Indicating that the nurse has heard and is willing to hear what the client wants to say and will facilitate the flow of conversation.

It is necessary for the nurse to give and share information to the client that is relevant to her health care and well being. Therapeutic activities are prepared in order to enchance the client skills, creativity, as well as cognitive ability in order to facilitate the process.Giving information regarding the procedure of the activity is important to create a productive working environment. Based on the theory of Virginia Henderson,

C: (client nods)(after the explanation of the procedure, we proceeded to the conduct of expressive art therapy a group dynamics.)

(after doing the expressive art therapy, we proceeded to our one on one interview.)

SN: Mang G.M napansin po naming na ang ginawa nyong expressive art ay letters or alphabet? Ano pong ibig sabihin ng tatlong A at isang O?

C: yung 3 A Art,Active, Activity

SN: ano po ang ibig nyong sabihin sa tatlong yan Mang G.M?

C: nakalimutan ko na eh..

SN: eh yung O po?

C: around yan at tsaka yan ang butas ng mga babae.

SN: butas? Ano pong ibig nyong sabihing butas ng mga babae?

C: yun “kiki” (client laugh)

SN: ganon po ba Mang G.M?

SN: group dynamics, ang pangalawa po nating therapy ay ang song

Encouraging elaboration

Seeking clarification

Giving information

Giving information

learning is included as one of the 14 fundamental needs of human being and by giving information, we are assisting them to have learning.

The nurse help the client describe more fully the concerns of even problem under the discussion with the technique, the client will have the opportunity to express more of his ideas in mind without hesitancy.

The nurse helps the client to put unclear thoughts and ideas into words, this will avoid misunderstanding and misinterpretation that will facilitate a good flow of conversation between the nurse and client.

It is necessary for the nurse to share information to the client that is relevant to his health care and well being. Therapeutic activities were planned and prepared in order to enhance the client’s skills creativity as well as cognitive ability.It is necessary for the

therapy. Lahat po ba ang marunong kumanta?

C: oo, ako sa videoke ako kumakanta

SN: yung kakantahin po natin ngayon ito yung kakantahin natin sa grand socialization.

SN: kaya po dapat makabisa po natin ang kanta dahil ito po yung kakantahin natin sabay-sabay at ito na rin po ang ating huling therapy. Dahil ito na po yung huli nating pagsasama. Pero magkikita pa rin po tayo sa isang linggo. Sa January na po ulit yung susunod na mga bagong student nurses.

(at the BPSU student center ground)(after the explanation of the procedure and explain to the client the termination phase are proceeded to the conduct of song therapy and facilities a group dynamics)(after doing the song therapy, we proceeded to our one on one interview with our client while there are eating)

SN: napansin po naming na ang seryoso nyo kanina habang sumasayaw.

Making observation

nurse to give and share information to the client that is relevant to her health care and well being. Therapeutic activities prepared in order to enhance the client skills, creativity, as well as cognitive ability in order to facilitate the process. Giving information regarding the procedure of the activity is important to create productive working environment.

Verbalized what the nurse sees on the client appearance and behaviors as well as actions. This will provide an access to the nurse in

C: di ko kasi alam yung kanta.

SN: pero po nakakasunod kayo sa step di po ba?

C: oo pero nahihirapan ako e.

SN: wala po ba kayong naaalala kapag kumakanta kayo?

C: ang mag-videoke

SN: nag-enjoy po ba kayo Mang G.M

C: oo masaya.

assessing the client moods, thoughts and feelings through non verbal cues.

V. Theme identification

Content Theme

During our interview with our client, the content of our conversation and interaction revolves the outcome of our therapeutic activities (expressive art and song therapy) on what they’ve learned from it, on what ideas they can share regarding the topic and what they feel after doing the therapeutic activities.

Mood Theme

When we received our client, his mood appears to be happy and peaceful as well as during the whole process of therapeutic activities as manifested by his bright and sometimes a serious expressions and verbalization of his feelings “Masaya” he claimed with a smile. We’ve also noticed that during our song therapy, his facial expression turned a bit serious like he’s definitely concentrating on his every moves while singing during the song therapy.

Interaction Theme

Our client participated and cooperated well during the entire therapeutic activities we’ve prepared. Even though we’ve noticed that he had some difficulties following the flow of the song but still he tried to reach out and follow the step the whole practice. He also respond to our question during the interview

and when we asked him a question he think first tell something which is not related to the question.



VII. Nursing Intervention

We should prepare therapeutic activities that will enhance the leaving and cognitive ability of the client. Base on the theory of Virginia Henderson: Learning is one of the 14 fundamentals need of human being. It is a need for an individual to grow and mature and what he has learned will help him survive in the world outside his place at present. His learning will help him to cope up with different processes and obstacles in life such as searching for a job. We should provide therapeutic activities that provide a step by step approach from a simple to a complicated one that will provide an enhancement on his capabilities to analyze things and put this into perspective. We should also provide activities that will provide that create means of entertainment and enjoyment to provide relaxation that will refresh the mind of the client.

VIII. Summary and Interpretation

During the whole interaction, our client participate and cooperates well to our prepared therapeutic activities. He tried to compensate on our song activity by trying to follow the steps of the song although he finds some difficulties in following the song. He still participates on the practice as well as responds to our questions during the conversation. During our expressive art therapy, even though he had some difficulties doing the art, we’ve noticed her determination to continue and watched closely as we demonstrates him how to do the art. All in all, he showed interest on our therapeutic activities.

References:Lipponcott Williams and Wilkins: Handbook of Nursing

I. Personal Data

A. Name Mr. G.MB. Address PangasinanC. Age 41 years oldD. Gender MaleE. Date/Place of Birth December 12, 1966, PangasinanF. Religion Roman CatholicG. Place where the patient spent the last 15 years of life:





II. Objectives:



To educate the client about the therapeutic activities and assist the client to review the information that he had learned and transfer the learningsto her relationship with other.

To enhance the client skill and creativity through series of therapeutic activities that will provide her an active mind.


To learn and explore the client’s feelings and conditions in order to understand his situation so as to apply the appropriate therapeutic communication and activities for the client.

To enhance our skills and creativity through the series of therapeutic activities that we’ve prepared.

To expand our knowledge in every therapeutic communications that we’ve conducted through the theories that we use to co-relate with our client conversation.

III. Description of settings

A. Describe the environment: It was sunny morning when we received our client at already 9:30am he smiled at us even before we got our personal contact. Some client inside the word were just staring at us while the other clients were saying somethings which are not clear. The weather is cool even without even the constant wind blowing across the atmosphere. The trees were standing still and there were only few leaves falling from the trees.

B. Describe the nature, behavior, affect and mood of the client: During the conversation the facial expression was normally serious and often stares at his feet but as we go on the conversation the he would respond and start making eye contact. And would occasionally smile when answering our questions.


Nurses – client Conversation

Therapeutic communication Technique used

Analysis and interpretation based on theories

SN: Magandang umaga po Mang G.M. kamusta po ang tulog nyo?

C: ok naman ako at maayos ang tulog ko.

SN: mabuti naman po kung ganun Mang G.M.Nakapag almusal po ba kayo?

Asking open – ended question

The nurse should ask neutral question that encourage the client to express concerns. It is essential for us to know the client’s mood, behavior, and feelings through means of asking questions in order to understand the client conditions and be able to apply appropriate

C: oo, sardinas nga ang almusal naming ngayon.

SN: nabusog naman po ba kayo Mang G.M?

C: ( clients nodes)

SN: Mang G.M. naaalala nyo pa po ba yung kantang pinag aralan natin nung nakaraang linggo?

C:oo, yung star ng pasko!

SN: ang galing nyo naman po at naaalala nyo pa po yung tinuro namin senyo. Ngayon po kasi natin kakantahin yung tinuro namin senyo.

C: (client smile)

SN: Mang G.M. ngayon na po ang huling araw na magkikita tayo. Diba po nung isang linggo sinabi na po namin senyo na sa susunod na linggo ang huling pagkikita natin.?

C: oo, naaalala ko pa yun.

SN: ngayon po ay magkakaroon tayo ng grand socialization. Kung saan po magkakaroon tayo ng maliit na programa. At kainan mga palaro Bilang pasasalamat. Kaya dapat Mang G.M. sasali po kayo sa mga palarung

Direct question

Giving recognition

Giving information

Giving information

therapeutic communication with the client.

Giving information regarding the procedure of the activity is important to create a productive working environment. Based on the theory of Virginia Henderson, learning is included as one of the 14 fundamental needs of human being and by giving information, we are assisting them to have learning.

inihanda po namin.

C: (client nodes)

(after the explanation of the procedure and explain to the client the termination phase, we proceed to the conduct of grand socialization)

(while in the middle of the ceremony) ( the speaker called Mang G.M name to participate in the game.)

SN: Mang G.M. tinatawag po ang pangalan nyo. Pinapasali po kayo sa laro.

C: ayoko maglaro.

SN: ano po ba ang dahilan kung bakit ayaw nyo maglaro?

C: alam ko na lahat nag larong yan! Nalaro mo na lahat yan!

SN: hindi nyo po ba nagustuhan ang larong sinasagawa ngaun?

C: alam ko na kasing lahat yan. Dati kasi sumasali ako sa larong pambasa.

SN; ano pong ibig nyong sabihin sa larong pambansa?

C: mga laro

Asking broad open – ended question

Seeking clarrification

The nurse should ask neutral question that encourage the client to express concerns. It is essential for us to know the client’s mood, behavior, and feelings through means of asking questions in order to understand the client conditions and be able to apply appropriate therapeutic communication with the client.

The nurse helps the client to put unclear thoughts and ideas into words, this will avoid misunderstanding and

yun..madaming laro at ako ang champion sa lahat ng laro sa palarong pambansa.( client laugh)

SN: marami na pala kayong nalarong mga laro..ayaw nyo po ba talagang maglaro? Tignan nyo sila ang saya nila at halos nakikilaro din sila sa mga palarong hinanda namin.

C: ayokong maglaro. May nakaitim na nakatingin sakin kaya ayoko maglaro.

SN: naka itim? Wala pong naka itim dito Mang G.M. lahat po kami ay nakaputing damit.

C: hindi may nakaitim at tinitignan nya ko.

SN: wala pong nakaitim.

C: ayun sya sa gilid at tinitignan nya ko.kaya ayokong maglaro.

SN: Mang G.M hindi po yon tao. Trash bag po yon. Lalagyan ng basura.

C: (staring his feet)

SN: Mang G.M. ayaw nyo po ba talagang sumali sa laro.? Tignan nyo oh, ang saya saya nila.

C: ayoko.

Confronting

misinterpretation that will facilitate a good flow of conversation between the nurse and client.

Giving a realistic explanation of what the client sees or hears without arguing with the client

SN: ano po ba ang nararamdaman nyo? Pagod na po ba kayo?

C: ok lng ako (Client smile)

SN: pag katapos po ng mga laro. Kakantahin na po natin yung kantang tinuro namin sa inyo nung nakaraang linggo.

(after the song was conducted)

SN: galing nyo po kanina kumanta. Napapa indak pa po kayo Mang G.M.

C: maganda kasi yung kanta.

SN: mabuti naman po at nagustuhan nyo. Eto nga po pala ang pagkaen nyo Mang G.M.

SN: Mang G.M naaalala nyo pa po ba kung ano po ang ginawa natin ngayong araw?

C: nanood ako ng mga naglalaro at kumantat’ sumayaw.kasama ang mga SN.

SN: ano po ang nararamdaman nyo na ngayon ang ang huling pag kikita ntin?

C: malungkot, kasi wala ng SN. Pero sabi nyo naman may mga papalit

Giving recognition

summarizing The nurse summarizes a given activity or intervention by reviewing the main point discussion and making appropriate conclusion. With this, we can gather all the activities rendered into a simple thought that will provide the client an understanding of what activities has been done.

senyong SN sa January. Hihintayin ko na lang sila.

V. Theme identification

Content Theme

During our interview with our client, the content of our conversation and interaction revolves the outcome of our termination phase (grand socialization) on what they’ve learned from on our previous therapies, on what ideas they can share regarding the topics and what they feel after doing the grand socialization.

Mood theme

During the conversation our client was serious and has no facial expression, he would only answer our question and when asked how he feel he only said “ok lang” but as our conversation lengthen he would occasionally smile at us while talking.

Interaction Theme

During our Grand socialization, our client participated and cooperated on our song number even though we’ve noticed that he had some difficulties in following the steps. But our client is not participate in our games.

VI. Nursing diagnosis

Knowledge deficit r/t cognitive limitation as manifested by inaccurate follow through of instruction.

VII. Nursing Interventions

We should prepare therapeutic activities that will enhance the leaving and cognitive ability of the client. Base on the theory of Virginia Henderson: Learning is one of the 14 fundamentals need of human being. It is a need for an individual to grow and mature and what he has learned will help him survive in the world outside his place at present. His learning will help him to cope up with different processes and obstacles in life such as searching for a job. We should provide therapeutic activities that provide a step by step approach from a simple to a complicated one that will provide an enhancement on his capabilities to

analyze things and put this into perspective. We should also provide activities that will provide that create means of entertainment and enjoyment to provide relaxation that will refresh the mind of the client.

VIII. Summary and EvaluationXI. References: Lippicott Williams & wilkins: handbook of nursing

Mental Status

Assessment

ORIENTATIONDAY 1 2 3 4 5 6 7 8 9 10 11 12

Person

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Date / / / X / xTime / / / / / /Situation X X X X X x

ANALYSIS AND INTERPRETATION

Day 1: ORIENTATION

Day2: SELF-AWARENESS

Day3: It was day 3 when we had our first conversation with our client. The conversation

with Mr. G.M. includes the collection of the names of the members of the family,

answers where he is, what the date was, what kind of weather that day have,

which he was able to answer all of it correctly. But when he asked what he is

doing to MMH the client said that he was working. One of the roles of the nurse

according to Hildegard E. Peplau was the “role of the stranger”. As a stranger to

the client the nurse must treat the client with courtesy and should not be prejudice

and accept the client as a “person”.

Day4: During the conversation with Mr. G.M. he was able to tell us the name of his

father, children and also was able to recall our names. He also knew that he was

residing at Mariveles Mental Ward but he thought that he was there for work.

When asked, Mr. G.M. was able to tell us that today was Nov. 15, 2010 and was

able to describe the environment and time.

Day5: Mr. G.M. was oriented to person, he was able to remember our names and the

names of his student nurse in the morning shift. He was able to tell us the current

date as well as describe the afternoon environment. When ask he knew that he

was at Mariveles Mental Hospital but was not aware that he was there because of

mental illness instead he thought he was there for work.

Day6: HOLIDAY

Day7: upon interaction our client Mr. G.m. was able to recall and identify us, his student

nurses. He was able to describe the day saying “ maaraw, pero hindi naman

mainit” when he was asked to described it. He told us that he didn’t know the date

today so we’ve told him the date and asked him repeat it. When asked if he knew

where he was, Mr. G.M. said he was in his hometown atD.I.P., and even after

we’ve made an attempt to correct him he insisted that he was in D.I.P.

Day8: During the interaction with the client, Mr. G.M. was able to remember us his

student nurses, was able to tell us the date and was able to describe the time by

saying “mainit ngayon, ma araw…” And when asked where he was, he said

“Mariveles Hospital” but according ti him it’s a hospital that treats’ injured

soldier.

Day9: SCHOOL

Day10: HOLIDAY

Day11: Mr. G.M. was not oriented to date and said that he’s at MMH because of

his work as a soldier.

Day12: SCHOOL

DEFENSE MECHANISMS

DAY 1 2 3 4 5 6 7 8 9 10 11 12Repression

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Suppression X X X X X XRegression X X X X X XFixation X X X X X XDenial / / X X / /Displacement X X X X X XConversion X X X X X XIdentification X X X X X XIntellectualization X X X X X XIntrojections X X X X X XProjection X X X X X XRationalization X X X X X XSublimation X X X X X XSubstitution X X X X X XSymbolism X X X X X XUndoing X X X X X XReaction Formation

X X X X X X

Fantasy / / / / / X


Day 1: ORIENTATION


Day3: During our conversation with Mr. G.M. that day he said that he was in “MMH”

because he is currently working as a ”military spy”, (“informatiko ako”) and that

his fellow clients NPA’s providing that our client is still in the state of denial.

Fantasy: during the course of our conversation, our client mentioned that he had

met well-known personalities including; Kris Aquino, Rosa Rosal, and Carina

Sanchezand have had sexual intercourse with them.

According to Hildegard E. Peplau’s four psychobiological experience which

includes; 1. Needs; 2. Frustrations; 3. Wants; 4. An anxiety, these experiences are

somehow transformed into some form of action that leads to destructive responses

from patients.

Day4: during the interaction with Mr. G.M. we’ve noticed that repression is present

whenever Mr. G.M. was asked where and when he study at school he would say

that he can’t recall it. Also Mr. G.M. manifest denial about his situation, he said

he was at MMH for work and would also manifest fantasizing that he met and had

sexual intercourse with well-known personalities such as Corina Sanchez.

Day5: Denial: during the conversation Mr. G.M> said that he was at MMH only because

he was working. Even though he knew it was a hospital but a hospital for persons

with liver problems, he insisted that he was there for military works despite our

questions of what might he be doing at a hospital.

Fantasy: Mr. G.M. said that he owned the “earth globe” and that he had traveled

and studied at different countries of the world.

Day6: HOLIDAY

Day7: during the conversation the patient was telling us that he had been there when the

Noah’s ark was built and when the great storm passed he said that he experienced

it with Noah.

Day8: Mr. G.M said that the reason he was at MMH was only because it’s a hospital for

injured soldier like him. During the conversation Mr. G.M said that his mother,

Mrs. R.M was actually his first wife and that it’s a saint that uses “agimat” to fly.

Day9: SCHOOL

Day10: HOLIDAY

Day11: Mr. G. M said that he was at MMH because he’s working there as a

military spy.

Day12: SCHOOL

EXTRAPYRAMIDAL SYMPTOMDAY 1 2 3 4 5 6 7 8 9 10 11 12

Pseudoparkinsonism

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1. Mask-like Face X X X X X X2. No Swining of

ArmsX X X X X

X3. Hesitancy of Speech

X X X X X X

4. Decrease Muscle Strenght

/ / / X X X

5. Shuffling Gait X X X X X X6. Drooling X X X X X X7. Fine Intention Tremors

X X X X X X

Acute Dystonic Reaction1. Muscle spasm of jaw,tongue, neck, eyes.

X X X X X X

2. Laryngeal Spasm X X X X X XAkathisia X1. Restlessness X X X X X X2. Tenseness X X X X X X3. Inability to Sit Still X X X X X X4. Rocking back and forth on feet

X X X X X X

5. Crossing Leg Frequently

X X X X X X

6. Inability to Relax X X X X X XTardive Dyskinesia1. Involuntary movements of mouth, tongue, face, may extend to fingers, arms and trunk.

X X X X X X


Day 1: ORIENTATION


Day3: during our interaction with Mr. G.M., we’ve noticed that he’s weak in appearance

and when asked what activities he normally does, he said that he just usually sit in

one corner of the ward and look at the other client the whole day because

according to him he is “observing” them. The lack of activities may also be the

reason for the decrease muscle strength.

According to Faye Glenn Abdellah’s 21 nursing problem, To promote optimal

activity, exercise and sleep that should exist in a balance is one of the needs the

client should meet in assistance by a nurse.

Day4: for extrapyramidal symptoms we only noticed that our client Mr. G.M. is weak in

appearance and walks and moves slowly. And when asked what activity he

normally does for a day to day basis Mr. G.M. said that he spend his days sitting

in the corner of the ward and observing other client there.

Day5: During the day’s activity we’ve noticed that Mr. G.M. was not smiling and when

asked Mr. G.M. said that he was tired from the previous activity even though

we’ve just started our therapy. During the previous encounter Mr. G.M. told us

that only sit in the corner of the ward everyday and would only walk whenever

there’s activity/ therapy.

According to Abdellah’s 21 Nursing problem, promotion of optimal activity,

exercise and sleep should be in equilibrium and must be met by nurse’ assistance.

Day6: HOLIDAY

Day7: none of the above extrapyramidal symptoms were manifested by our client.

Day8: None of the above extrapyramidal symptoms was manifested by our client.

Day9: SCHOOL

Day10: HOLIDAY

Day11: None of the above extrapyramidal symptoms was manifested by our

client.

Day12: SCHOOL

THINKING AND COMMUNICATION

DAY 1 2 3 4 5 6 7 8 9 10 11 12Looseness of Association

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1. Neologism X / X / / X2. Word

SaladX / / / / /

3. Echolalia X X X X X X4. Echopraxia X X X X X X5. Clang

Association

X X X X X X

6. Illogical thinking

X X X / / /

Alogia X X X X X XConcrete Thinking

X X X X X X

Lack of Insight

X X X / X X

Aphasia X X X X X XApraxia X X X X X XAgnosia X X X X X XFlight of Ideas

X X X / / /


Day 1: ORIENTATION


Day3: none of the above communication and thinking above had been manifested by our

client.

Day4: During the second day of interaction with our client the topic of our conversation

revolves around the therapies we’ve facilitate today. While we were discussing

the story in the comics we’ve ask Mr. G.M. some questions including what course

did he take school and Mr. G.M. answered “spanlile” and when we proceed to

clarify the meaning the word our client said “ anu yun… lotus… in the water…

dun sa creek”. Aside from neologism, the conversation reveals that Mr. G.M.

sometimes got words mix and even after analyzing it… it held no meaning or

nonsense at all.

Day5: during the conversation with Mr. G.M. he would say words or phrases that do not

make any sense, considering our conversation. He manifested verbalization of

word salads when the topic of the conversation goes to his father and his job.

Day6: HOLIDAY

Day7: during the conversation the client verbalized a few neologisms while answering

our questions some of those are: “Lebroy”-super intendent; “demacho”-“yung

source ng tubig”, “cornel”-yung isang klase ng camel. Marami yan iba-iba”;

“exploimaker”-“nagpapaangat ng barko”.

While we are trying to discuss the story of Noah’s ark Mr. G.M. would mention

quite a few words that does not make sense at all. He would sometimes answer us

with his own story and would try to evade our questions by changing the topic of

our conversation. He would introduce other character such as Adam and Eve as

well as Abraham and at the end he seemed to be confused, and would refuse to

answer at all.

Day8: During the conversation with our client he mentioned “lorten” and when asked

what that means he said “yung samit sa paggawa ng bahay” The client says

something that we didn’t understand and some ideas are not related to the topic

being discussed. And he would also bring a lot of topics different from our

current conversation. While we were talking about his finished product in

expressive arts he suddenly said that his mother was a saint, and that he had many

wives.

Day9: SCHOOL

Day10: HOLIDAY

Day11: During the conversation when we are trying to go back to all the

activities and therapies that we’ve done and ask our client to tell us what he could

remember he would answer us with words that does not makes any sense and

some ideas that was not related to the topic.

Day12: SCHOOL

PERCEIVING AND INTERPRETINGDAY 1 2 3 4 5 6 7 8 9 10 11 12

Delusions

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1. Reference X X X X X X2. Persecution X X X X X X3. External

InfluenceX X X X X X

4. Somatic X X X X X X5. Grandiose / / / / / /

Hallucinations / / / / X XIllusions / / X X X /Attending to irrelevant Stimuli

X X X / X X

Poor Reality testing X X / / / /ANALYSIS AND INTERPRETATION

Day 1: ORIENTATION


Day3: Grandiose: Mr. G.M. said that he is the president of the Philippine Island and that

he bought and owned it. He also claimed that he is Jose P. Rizal and George W.

Bush when he was younger.

Hallucinations: during the conversation Mr. G.M. said that there is an

underground in the MMH and that his son and daughter is training there to be a

military personnel.

According to Hildegard E. Peplau’s nursing Role as the “resource person” the

nurse should provide specific answer to questions that that arises from the context

of a large problems and determines what response is appropriate for the sake of

learning and orienting either giving straight forward factual answer or providing

counselling.

According to Merie Mishel uncertainty is the inability to determine illness related

events that occurs when the client is unable to assign definite value to events,

objects and persons.

Day4: delusion of grandiose is evidently present during our conversation with Mr. G.M.

He said that he had been to different countries including Tokyo, Japan; United

States of America; Malaysia and that he’s the president of the Philippines as well

as its owner. Hallucination was still present; Mr. G.M. mentioned the existence of

the underground in MMH where his children kept today as well. As for Illusions,

today he mentioned that his children ( Steeve and Jelly) turned to a kid after

taking the tablets that could turn a man to a child, according to him it was the

same tablet that was given to him in MMH.

Day5: Grandoise. According to Mr. G.M. he have had dramatic affairs with Rosa Rosal

and Kris Aquino and they both bear his child.

Hallucination. During the conversation with Mr. G.M. yet again mentioned the

underground that exist in the MMH despite our correction on our part. According

to Hildegard Peplau’s Nursing Role, the nurse can assume the role of the

“resource person” the nurse provides the specific answer to questions that arises

from the context of a larger problem and determine what response is appropriate

for the sake of learning.

Illusion: according to Mr. G.M. there is a tablet that was given to his children, the

same tablet that was given to him by a person in a white dress, when asked if he

knew the person he said he didn’t, we presume that the tablets are his medicine

and that the person in white is either a doctor or a nurse.

Day6: HOLIDAY

Day7: During the conversation Mr. G.M. claimed that he owned the whole Philippines

he said he bought it, but when asked from who, or when he said he already forgot

it.

Hallucinations: at the later part of our interaction with Mr. G.M. suddenly whisper

something to his right side, and when we asked him who he was talking to he said

he could hear voices laughing at him.

Attending to different stimuli. While we were discussing the story Mr. G.M.

would sometimes refuse to answer and would simply sit there and play with the

piece of twigs in hi hands. We’ve tried to gain his attention and interest but to not

avail.

Poor reality testing. Mr. G.M. said that; he could hear voices; that he experienced

Noah’s ark and the great storm when it happened and that he own the Philippines,

Day8: while we were in the middle of our conversation about the client’s house in

Olongapo, he suddenly said that he was the owner of the whole city and the

president of the Philippines because he said the people there likes him and thus

voted him for the position.

Day9: SCHOOL

Day10: HOLIDAY

Day11: during the grand socialization day when our client was asked to participate

in games he said “ayaw ko” and when asked for the reason, he first said that he

didn’t need to participate because he’s the champion of ‘Palarong Pambansa’.

And when asked again he said that there were people in black standing at the ruin

building and watching him so he didn’t want to play.

Day12: SCHOOL

FEELING AND AFFECT

DAY 1 2 3 4 5 6 7 8 9 10 11 12Flat

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Blunted X X X X X X

Inappropriate / X X X X /

Lability X / X X X X


Day 1: ORIENTATION


Day3: During the conversation with Mr. G.M. we observed that he had inappropriate

feelings while saying that his wife Lianne was sexually abused by many men. Mr.

G.M. was smiling while he was narrating that to us.

Day4: during the conversation Mr. G.M. was serious. He does not smile even after

we’ve greeted him “magandang hapon po” he would simply reply “ ayus lang”.

During the therapy he also assumed a serious mood. But as we go on our

conversation when we we’re discussing the picture he picked in photo therapy

Mr. G.M. suddenly change his mood, he would smile and laugh when the topic

goes on how he could differentiate a woman from a chicken.

Day5: none of the above feeling and affect was manifested by our client.


Day6: HOLIDAY


Day8: The feeling and affect is normal and congruent.

Day9: SCHOOL

Day10: HOLIDAY

Day11: During the interaction when Mr. G.M was asked how he feels he said

“Masaya” without smiling and keeping a serious expression. The clients feeling

and affect is incongruent.

Day12: SCHOOL

BEHAVING AND INTERACTING

DAY 1 2 3 4 5 6 7 8 9 10 11 12Withdrawal

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Motor Hyperactivity

X X X X X X

Motor Hypoactivity

X X X X X X

Ambivalence X X X X X XAnhedonia X X X X X XAbolition X X X X X XPoor Personal Hygiene

X X X X X X

Impulsive X X X X X XParanoia X X X X / /


Day 1: ORIENTATION


Day3: none of the above characteristics was manifested by our client.

Day4: During the conversation with Mr. G.M. he said that he ha no friends and never

talk to his fellow client. As for motor hypoactivity, we’ve observed that Mr. G.M.

moves slowly, always sit still and are weak in appearance. Paranoia as previously

explained he thinks that his entire fellow clients are his enemy that’s why he

never talks to them.


Day6: HOLIDAY


Day8: During the interaction today, our client seemed restless and when we asked, he

said he didn’t sleep well last night. When we asked for the reason he said it’s

because of the food that he ate. When we asked him to elaborate it, he said

someone might have slipped some ‘shabu’ in his food because he couldn’t sleep

at all.

Day9: SCHOOL

Day10: HOLIDAY

Day11: Our client refuse to participate in games because he said there was people

watching his moves.

Day12: SCHOOL

NEGATIVE COGNITION

DAY 1 2 3 4 5 6 7 8 9 10 11 12Overgeneralization

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All-or-Nothing Thinking

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Should Statements X X X X X X

Labeling X X X X X X

Mind Reading X X X X X X

Fortune Telling X X X X X X


Day 1: ORIENTATION


Day3: none of the above negative conditions are manifested by our client.



Day6: HOLIDAY


Day8: Our client didn’t display any manifestation under negative cognition skills.

Day9: SCHOOL

Day10: HOLIDAY

Day11: No manifestation seen on the client.

Day12: SCHOOL

OTHERS

DAY 1 2 3 4 5 6 7 8 9 10 11 12Amnesia

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Fugue X X X X X XDepersonalization X X X X X XPhobias X X X X X XMemory

1. Remote / / / / / /2. Recent / X / / / /3. Recent part / X / / / /4. Immediate

memory/ X / / / /

5. Immediate recall

/ X / / / /


Day 1: ORIENTATION


Day3: during the later part of our conversation, Mr. G.M. was able to recall for us, the

memories of his life and many other memories of recent duration.

Day4: Mr. G.M. was able to tell us what he was doing last week, what his last meal was,

his previous activity/therapy with the morning shift, was able to summarize the

comic therapy but was not able to recall in details his childhood memory.

Day5: Mr. G.M. was able to answer questions that would determine his ability to

remember. During the conversation Mr. G.M. was able to tell us his morning

activity with the morning shift. He was able to tell us what his last meal was and

what it tastes like as well as the previous activity we’ve had. When Mr. G.M. was

asked about things regarding his past, such as his previous task/jobs he was able

to tell it to us but can’t remember the exact date.

Day6: HOLIDAY

Day7: during our conversation with our client he was able to recall his last meal, the

name of his new student nurse and answer our other question.

Day8: During the interaction the client was able to tell us and describe the taste of his

last meal, as well as to recall our recent activities and conversations.

Day9: SCHOOL

Day10: HOLIDAY

Day11: The client had difficulty recalling some of our activities in the past 4

weeks but he managed to recall the few he’d missed with our help.

Day12: SCHOOL

Psychotherapy

COMIC READING THERAPY

DEFINITION

Comic reading therapy helps the client to assess how their reading skills work in terms of

reading a comic. How they relate scripted words in their everyday life, this is used to test

how they can read comprehensively and make their mind work.

GOALS

1. To let the client understand and verbalize words.

2. To develop their comprehensive ability.

3. To promote thorough process.

4. To understand the level of ability in terms of reading.

PROCEDURES

1. The facilitator orients the client about the therapy and how it should be done.

2. The client allows reading.

3. After reading, they were asked a few questions about the content by their student

nurse.

4. All the clients were asking to state their thought regarding the therapy.

ANALYSIS & INTERPRETATION

Once were started the therapy, our client started reading it silently for several

min. After reading it for 20 min., he said that he’s finished so we’ve proceed with

discussing the story of the comic “tesang tsismosa”. When we asked our client what are

the parts of the story that he could remember, he hesitantly said he can’t remember it. He

was only able to tell us the Title and the lead character “tesa”. So we took the comics

from him and retell the story for him. All in all Mr. G.M participated in the therapy

without any complaints though he has difficulties remembering the whole story, he was

able to tell us what he has learned from it. But when asked to relate it to his life or if there

is a similar story or situation that has happened to him, he simply said that he didn’t know

and stays silent. He would smile occasionally to us when he didn’t know the answer to

our question.

We relate Mr.G.M’s passive behaviors and answer to his state of denial to his situation.

PHOTO LANGUAGE THERAPY

DEFINITION

Photo Language Therapy helps the client to verbalized and state the level of their

thinking by formulating an idea on the photos they picked, this is used to test thinking

skills of the client and make their mind work.

GOALS

1. To let the client to verbalized his/her insights, thoughts and feelings about the

picture.

2. To develop client’s cooperation.

3. To promote thought process and verbalization of the client.

4. To let the client participate and socialize in a group discussion.

PROCEDURE

1. The facilitator orients the clients about the therapy and give instructors.

2. The client was asking to pick two photos they like.

3. After a minute of looking of the photos, they were asked to speak out the idea

they made about the photo and asked why did they picked that pictures

4. All the clients were asking to state their thought regarding the photos.


Once we have started the therapy, we noticed that MR. G.M had high enthusiasm

on choosing an image for the therapy. He took some time choosing the two pictures and

seemed hesitant to let go of the third photo he’s having difficulty choosing from. He had

decided to the picture of a chicken and a woman. He said that he used to keep a lot of

chicken ion his former house. He said he keep them for the eggs and their meat. And the

other picture reminds him of his wife. When the topic became his wife we’ve noticed that

our client became uncomfortable and when asked he simply said he’s fine. When asked

what other things he remember he said he cant remember it anymore, and started saying

word salads. We’ve also encourage him to compare the pictures for their similarities and

differences. He was able to give us correct answers, so we’ve proceed with summarizing

the conversation.

PLAY THERAPY

DEFINITION

Play therapy refers to social recreation activity that requires strategies & physical

strength. There 2 kinds of play therapy, first is the indoor games, which are played inside

the house example of this are snake & ladders, chess, damath, etc. ; the other one is

outdoor games, this are played outside the house examples are basketball, volleyball,

badminton & etc.

This therapy is used to help to interact & for socialization purposes and, to

encourage them to be competitive in any type of game. It is a tool to encourage client to

have their exercise them forget their boredom.

GOALS

1. To help the client to socialize & other people.

2. To help the client to be competitive & to trust their planned strategies.

3. To encourage their client to conceptualized ideas on how to win.

4. To give client new information outside the hospital.

PROCEDURE

1. The facilitator commences the assigned activity of that day, explaining its nature,

description and how it will be done.

2. Prepare the necessary equipment needed for indoor games (chess, cards,snakes, &

ladders, puzzles) outdoor (Badminton, Basketball, Volleyball).

3. Stretching

4. Game process

5. Summarization and discussion of therapy.


At the beginning of the therapy our client’s mood was serious, but it lightens a

little when we start with the games and stretching, though he only seldom smiles. We

first star the outdoor game “pass ball” we participated at firs and joined the circle, but as

the games goes on we’ve made it so that the client are the only one’s playing. After

several minutes the playing goes down to three, including our client so we declared them

all winners. Our client said the game tires him so he refuses to play badminton when

offered, but participated in the indoor games and willingly plays the card. We’ve played

it 3 times. And he seemed to be happy winning the games. He smiled a lot. After the

games we’ve had a brief discussion of the therapy Mr.G.M said he like the games and

that he enjoyed it.

BIBLIO THERAPY

DEFINITION

It cultivates & enhances the client’s memory capacities as well as reasoning & learning

ability in recalling the title. The character & the values regarding the story play which is

based from the Bible. It also served as a means of instruments in recognizing good

manners & values since the story was based from the bible.

GOALS

1. To enhance the client’s intellectual & memory capacity in recalling the important facts &

details to the therapeutic activities and retain this to his mind in order to use it for

future goals.

2. To provide a means of the entertainment & enjoyment in order to provide a lively &

active working environment to the client.

3. To enhance the client thought about good manners & values and be able to apply it to

his relationship with others.

4. To assess the client feelings and thoughts regarding his view about the story and its

relationship to her experiences in life in order to explore the feelings of the client even

more.

5. To enhance the clients understanding & reminding regarding the thought of the topic &

be able to express the opinion.

PROCEDURE

1. Prepare all the necessary equipment/ materials.

2. Make a television image the put curtains around it.

3. Present the improvised television together with the puppets handled by the student

nurses behind the blanket.

4. Allow the clients to watch the whole play & ask them if they recall the important details

regarding the story on a group dynamics as wells as one on one interview with the

client.


Our client seemed to be attentive. During the play he was quiet and was looking at

the stage with serious expressions. During the discussion our conversation centered at

the parts of the story that he could remember. But when asked Mr.G.M have

difficulty answering us. He can’t even remember the title of the play. He would try to

avoid the questions by saying irrelevant things and by introducing new topic. But

when we refocus the conversation, he would no longer answer and stays silent. We

tried to reestablish the conversation by starting in a lighter topic, but to no avail. At

the end of the therapy we noticed that Mr.G.M’s mood change, he seemed to be

angry, and started talking to himself. And when asked he claimed that he could hear

voices that are laughing at him. After clearing to him that we’re the only person there

and no one else is, we’ve decide to return him to the ward to rest.

PUZZLE THERAPY

DEFINITION

A puzzle is a problem or enigma that tests the ingenuity of the solver. Puzzle

therapy is purposely to evaluate the client’s cognitive and problem-solving ability. Puzzle

was created to advance development this instilling aptness on the part of the client.

GOALS

1. To access the client’s memory, cognition and problem-solving ability.

2. To augment their thinking abilities and independence.

3. To imbibe self-esteem and fulfillment on the client.

PROCEDURE

1. The facilitator commences the assigned activity of that day, explaining its nature,

description and how it will be done.

2. Give the necessary materials for the activity, 2 simple and 2 complex puzzles.

3. Let the client choose 1 simple and 1 complex.

4. Start with the simple puzzle. Give sufficient amount of time for the client to scan and

see what the puzzle look like.

5. Record the duration of the first puzzle building.

6. Present the next puzzle, the complex. Again, give sufficient amount of time for the client

to scan and see what the puzzle look like.

7. Record the duration of the second puzzle building.

8. Evaluate the outcomes of the activity with the client.


We primed two pictures of simple and puzzle and one picture of a complex puzzle. Mang

G.M selected the tree, As a simple puzzle. First, we give the simple puzzle which is

composed of six pieces. He was able to form the simple puzzle at one minute and ten

seconds. Then we give the complex puzzel which is composed of 12 pieces, a picture of

a mountain and river. He was able to form the complex puzzle at 4 minutes and 50

seconds. Evidently, Mang G.M. took longer time in forming the complex puzzle. he had a

hard time in distinguishing the picture he was forming. Verbalized that he find it difficult

in forming the complex puzzle. Mang G.M. initial reaction after finishing the two puzzle

is a smile of fulfillment.

EXPRESSIVE ARTS THERAPY

DEFINITION

Expressive arts therapy is the use of the creative arts as a form of therapy. It is predicted

on the assumption that a client can heal through use of imagination and the various forms

of creative expression. It is also about reclaiming innate capacity as human beings for

creative expression of an individual and collective human experience its artistic form.

GOALS

1. To express his ideas and feelings.

2. To lessen the anxiety felt by the client in terms of entertainment.

3. To help the client to express his thoughts.

4. To assess the clients working attitudes.

5. To assess clients creativeness.

PROCEDURE

1. The facilitator commences the assigned activity of the day, explaining its nature,

description and how it is done.

2. Prepare the necessary materials needed (A4 paper, glue, and matches w/o the head

part).

3. Instruct the client to make us of the matchsticks by creating images/ figures that comes

into their mind and stick then with glue.

4. Allow their to finish their work and then interpret what image they create.


During the expressive art therapy Mang G.M. mood was quit serious but he still willingly

participate in the activity.After the brief discussion of the activity and the instruction for

the therapy Mr. G.M took the materials, the matches and the glue and stay silent for three

mins. Only looking at the bond paper in front of him. After that he took pieces of matches

in the match box and started forming shapes. He first formed three triangles placed side

by side with one another across the bond paper then he silently glued it and told us its d

one. When we’ve asked him what the symbol means he told us that it’s a letter,”3

A’s” he said”A,A,A yan”. Then we’ve asked him to think of other things and to add

another symbol in the paper after quite a while he put a square shape below the three

letter A’s and when asked what that is he said it’s a letter O.We’ve discuss the meaning

of the letters that he formed he said that “yung A para sa arts ibig sabihin arte, yung isa

pang A,active gawa un gawa, at yung isa pang A ibig sabihin gamit”. We’ve asked for

the meaning of letter O and he said “around yun” dun sa loob pinag usapan naming

yun…matagal na di ko na matandaan..pagod yun around sa hapon”.When we asked to

elaborate what he was sayinghe said Yung ano yan ng mga babae…yung kuwan

nila…iyon.”Then for a few mins. The client would refuse to answer to our questions and

would simply nod when wew would call his name.

SONG THERAPY

A. DefinitionSong therapy will motivate client to enhance their memory by memorizing lyrics

of song as well as the steps or interpretation of it. It will also develop their interpretation about the meaning of the song on w/c they will easily understand the message of the song. They will also have their to energize their physical strength.

B.Goals1.) To encourage client to express feelings by singing a song that is appropriate with their

emotions.2.) To enhance their memory by singing the song repetitively.3.) To enhance their physical strength by having exercised while dancing so that they can

use their strength in more progressive way.4.) To develop their talents about singing & dancing where in client will regain their self-

esteem.5.) To assess client capacity to follow instruction by copying steps from the steps from

the students nurses.6.) To enhance client social relationship w/ others by dancing & singing all together.C.Procedure1.) Find & select an aspiring song that is appropriate for the community song.2.) Get the lyrics of the song. Download the song.3.) Write the lyrics in the Manila paper.4.) Practice the song until memorized.5.) Create steps threat will match the sentences from every stanzas.6.) Practice together with the patient. Teach them the song & steps.7.) Sing a loud & clear & play the steps. Gracefully.

D.Analysis & InterpretationDuring the therapeutic activity (Song Therapy), our client participate and cooperate well on ourprepared therapy. He followed the steps and listened to the tone of the song, Mang G.M. find it hard to follow the steps and even the lyrics, he didn’t memorized the song but he remember some of the stanza.

Bro Ikaw ang Star ng Pasko Lyrics

Kung kailan pinakamadilimAng mga tala ay mas nagniningning

Gaano man kakapal ang ulapSa likod nito ay may liwanag

Ang liwanag na itoNasa ‘ting lahat

Mas sinag ang bawat pusong bukasSa init ng mga yakap

Maghihilom ang lahat ng sugat

Ang nagsindi nitong ilawWalang iba kundi ikawSalamat sa liwanag mo

Muling magkakakulay ang paskoSalamat sa liwanag mo

Muling magkakakulay ang pasko

Tayo ang ilaw sa madilim na daanPagkakapit bisig ngayon higpitanDumaan man sa malakas na alon

Lahat tayo’s makakaahon

Ang liwanag na itoNasa ‘ting lahat

Mas sinag ang bawat pusong bukasSa init ng mga yakap

Maghihilom ang lahat ng sugat



Salamat sa liwanag moMuling magkakakulay ang pasko

Kikislap ang pag-asaKahit kanino man

Dahil ikaw Bro, dahil ikaw BroDahil ikaw Bro

Ang star ng pasko









Dahil ikaw Bro, dahil ikaw BroDahil ikaw Bro

Ang star ng pasko!

Past Medical History

The client Mr. G.M was previously well and leading a normal life as a

farmer until 2002 when he started exhibiting odditres. His father Mr. A.M brought

the client to faith healers in their area to seek medical/health advise from them.

But when 4 months had past and the client’s condition still did not improved his

family decided to consult in NCMH wherein Mr. G.M was admitted and confined

at ACIS for 15days until he was taken home with prescribed medications. After

returning home the client resumed farming and discontinued taking the medical

cation while he was still symptomathic.

During that time the client would sometimes exhibit odd behavior. The client and

his family did not encounter anymore problems aside from the occasional

manifestation of odd behavior that was tolerable of brief duration.

That was until 2008, when the clients brother started building a house in the land

that the client believe was all his. Four days after the house was built, the client

broke the jalousie of his brother’s new house. Thus, the client’s family decided to

seek medical attention at Mariveles Mental Hospital on May 5, 2008.

Mr. G.M was admitted dad in blue sando, dark shorts, barefooted and on

handcuffs with a chief complaints of “Nagsusunog ng bahay”, “nagbabasag ng

salamin”, interrupted sleep and irrelevant speech”.

Upon the admission the client was behaved, responsive to questions but briefly

and with a tendency to became evasive and irrelevant. Mr. G.M denied the

presenting complaints. He was admitted with a diagnosis of a paranoid

schizopherema and was transferred to the ward at July 26, 2008.

Present Medical History

Mr. G.M currently resides at Marivelse Mental Hospital, Dorm A. He is always

silent whenever he is inside the dorm. He doesn’t talk to anybody and would

normally sit in one corner of the room. During his stay in the dorm he was taking

the following medication: Akineton, Thorazine Haldol and flu pentixol.

Mr. G.M shows only a few of the presenting complaints, such as: interrupted

sleep and irrelevant speech. As of now, Mr. G.M was manageable and shows

little manifestation during daily interaction. Mr.G.M would participate in therapies

and other activities.

Family History

According to our client he’s living in Infanta Pangasinan together with his sister.

He is the second eldest son of Mr. A.M and Mrs. R.M he had 5 other siblings. His

parents sources of income was from farming, and even though our client lived

separately from his parents his first source of income is also farming, then he

was hired to do bromite mining. He was also not in good terms with his father

Mr.A.M, during the interaction the client mentioned that he bears ill emotions

towards his father. Because his father gave their land to his older brother without

his knowledge. Our client Mr. G.M had a wife and two children but he is living

separately from them.

psychiatric nursing iii

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