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Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, N.

Samar COLLEGE OF NURSING

Requirement in Psychiatric Nursing


(PROCESS RECORDING)
Prepared by:

GIRAY, GENCRIS M. CAPILLAS, NEOMI B. ADRIATICO, JENELYN P.


BSN 3a

Presented to:

MRS. JEANETTE J. ROJO, RN, MAN


Clinical Instructor

I. DEMOGRAPHIC PROFILE
Name: Luisa Age: Unknown Sex: Female Address: Leyte Civil Status: Unknown Religion: Roman Catholic Date of Interview: December 17, 2011 Time of Interview: 2:00 PM

II. GOAL OF INTERVIEW:


1.To establish therapeutic communication and a trusting relationship with the client.

2.To gain experience in dealing client with mental illness in order to master therapeutic

communication for psychiatric patients.

3.To identify clients behavior, emotions and thoughts and to help the client express these emotions and thoughts.

III. CONTEXT OF INTERACTION:


It was a cloudy afternoon around 2:00 pm in Catarman N. Samar outside the Vicencio Pawnshop when we had our interview with our client. The client is wearing a black blouse and a striped skirt with a handkerchief in her head and her jacket tied around her neck. She is bringing with her a shoulder bag, two plastic bags and a plastic container with water and a rug soaked in it. The client lacks personal care/hygiene. Her nails are untrimmed and dirty. She smells unpleasant. She has a brown complexion. The client is semi-bald, wearing a green eye shadow and an eyeglass. She is wearing a pair of slippers with cellophane tied on her great toe. We saw her first at a burger stand arguing with some policemen who were convincing her to leave. We followed her to a pawnshop just a few blocks from the burger stand.

Nurse Magandang hapon po. Pwede ka po ba namin mainterview?

Interpretation Giving recognition by greeting the client and asking permission implies respect and helps gain the clients trust.

Client Magandang hapon din naman.(Node s her head).

Interpretation A positive response from the client means she is willing to start with the conversation . A response indicating the clients acceptance of the information and the conversation as well.

Mga estudyante po kami galing ng UEP. Ako po si Gencris Giray. Ako naman po si Neomi Capillas. At ako naman si Jenelyn Adriatico. Ano po ba ang pangalan ninyo?

Giving Okay. information eliminates clients fear or doubt. It also builds trust from the client to the nurse.

Analysis The student nurse greets the client in a lively manner to show respect and to gain her trust. The clients response is a positive feedback. Giving information builds a trusting relationship which allows the conversation to be effectively flowing. The client somehow wants to show that she is able to write and that she can understand us. The communication has been effective since the student nurse recognized the presence of a perceived problem.

Seeking information to have background knowledge about the client. The student nurse makes an observation about what the client wrote. Delving further about her identity will help recognize the presence of a problem.

Akin na papel at ballpen mo at isusulat ko.

Shows willingness in giving information about her.

(After 30 seconds.) Tila buong pamilya mo yata ang sinulat mo dito. Ano po ba tunay ninyong pangalan?

Mga kapatid ko yan. Kasi marami ang gumagaya ng pangalan ko. Wag kang maingay Luisa pangalan ko. Baka gayahin nila. Sssh.

The client shows fear because she perceives us, from knowing her identity, as threats.

Talaga po? Voicing doubt E, ilang taon expresses the na po ba student kayo? nurses uncertainty about the clients perceptions. Exploring more about the clients identity.

Parang hindi naman po kapanipaniwala ang sinasabi ninyo. Ano po ba ang ibig ninyong sabihin?

The student nurse is voicing his doubt from the clients statement. He is also exploring the meaning of the clients statement.

Aah, talaga po? E, may pamilya po ba kayo?

Voicing doubt and politely asking for more information.

Ako? Dinaya lang ang edad ko. Inilagay kasi ako sa incubator. Plus 32, singkwenta minus 32. Ilan na ba iyon? Maraming beses na rin akong namatay. Kasi ilang beses ko ng nakita ang langit. Pinakain lang ako ng balot kaya yun nabuhay ako. Nakita ko si San Pedro pero pinabalik niya ako. Hindi ko pa daw oras. Pumasok ako sa ibang katawan. Hindi ko naman ito katawan e. Ang totoo bata pa ako. Oo.

The client is denying or hiding her real age. Her statement does not directly answer what was originally asked.

The client has inability to have a goal-directed association of thoughts. She is showing tangentiality of thought. She is also possessing denial. The client is showing flight of ideas where she talks rapidly and continuously causing a constant shift from one idea to another.

The client has rapid and continuous verbalizatio ns of her thoughts too far from reality.

The patient answered the question directly.

Voicing doubt and asking the client for information in a polite manner implies respect.

Nasaan po The student sila ngayon? nurse is delving further into the topic.

My mother is ipinanganak sa Baguio and may lolo is in Bacolod.

The patient gave little information about her family.

Sige po magkwento pa po kayo tungkol sa pamilya niyo. Tungkol sa asawa mo.

General leads encourage the client to continue what she is talking about.

Ang asawa ko? Patay na. Magaling iyon magluto. Masipag.

The patient responded well with the question.

May mga anak Exploring po kayo? deeper about the clients family background.

Sinabi mo po na ipinaampon ang mga anak mo ng doctor mo at binigyan kayo ng pera. Alam niyo po ba kung nasaan

Summarization seeks to bring out the important points of the discussion and to increase the awareness and

Oo. Sampung babae at sampung lalaki. Kinuha sa akin ng doktor ko at pinaampon. Binigyan ako tresi mil kasi siya daw nagpalaki sa anak ko. Nandun sa Saudi. Si Dr. Yruma may clinic doon yung doctor ko. Yung nagchecheckup sa akin

The clients answer seemed to be unrealistic but there should be something behind it.

Exploring also examines the clients thought processes. She somehow did not respond well from the question. General leads indicate that the student nurse is listening and following what the client is saying without taking away the initiative for the interaction. The client is somewhat exaggerating the truth. Exploring helps examine the issue more fully.

The client is demonstratin g an inability to arrive from desired point to desired

Tangentiality is a disturbed form of thinking where the client never gets from desired point

sila ngayon?

understanding of both participants. The nurse is again exploring the clients thoughts. The student nurse is putting into words what the client has implied to make the discussion less obscure. Asking the client her present location assesses her orientation to place. Informing the client increases her knowledge and corrects her false beliefs. It also builds trust with the client.

nung buntis ako. Palagi nag akong pumupunta dun sa clinic niya. Alam mo ba yun?

Ahh... Ibig niyo pong sabihin hindi mo alam kung nasaan ang mga anak mo ngayon? Alam niyo po ba kung nasaan kayo ngayon?

goal. She is to desired having a goal. She flight of also ideas. demonstrates a rapid and continuous verbalization of thoughts/flig ht of ideas. Sa Sugod sa From the Verbalizing Bacolod clients the implied City. Diba statement, is voicing siyudad to? the student what the nurse can client has conclude hinted at or that the suggested. client is Assessing not oriented clients to the orientation place. She to place is currently reflects her in Catarman. thinking ability. Yung lolo ko 1900. Hindi ko alam. Hindi pa ako pinapadalhan . The clients statement denotes rejection of the fact made available by the student nurse. Giving information makes available the facts that the client needs. Refusal of the client to accept it indicates denial. Clients The student reaction nurse from the recognized question that the implies her client is interest for hungry. food.

Aayy wala po kayo sa Sugod o sa Bacolod. Nasa Catarman po kayo ngayon.

Kumain na po Looking into ba kayo? the clients nutritional state can help explore the issue more fully.

Kagabi mani lang. Yun lang. Hindi pa ako kumakain mula kaninang umaga.

(After 1 minute) Nay, ito po o. Tinapay at saka softdrink. Kumain po muna kayo. Hihintayin ka po naming matapos.

Offering/shari Salamat ng to the ha. client just a (Smiling) little of what you have other than interest and desire to understand is important. It breaks the wall between the nurse and the client.

The client appreciates what the student nurse did.

It is important that offering oneself is unconditional ; that is, the client does not have to respond verbally to get the nurses attention.

Nay, pwede po ba kaming magpa picture kasama kayo? Para lang po sa documentation namin. Salamat po.(Silence for 10 seconds.)

The student nurse is asking for permission to the client. Asking permission shows respect. Silence conveys interest but the student nurse continues to maintain eye contact. Giving information to the client is making available the facts she needs. It increases her knowledge about a topic and lets her know what to expect.

Sige.

A response The student indicating nurse asks consent. for approval from the client to demonstrate respect. The client breaks the silence and perceives the student nurse is a dentist or a doctor. The clients statement has no relevance with the student nurses statement. This means that the client do not accept the information given by the From the clients statement, the student nurses identified that she is in pain. The client said that she has had taken thorazine before. A proof of having a psychotic disorder or schizophrenia .

Dentista ka ba? Ibili mo naman ako ng pampamanhid. Iturok mo naman dito (pointing her teeth). (The client appeared dismayed) Doon sa mental hospital nakakulong si Sylvia, kapatid kong panganay. Private yun. Umiinom ako ng thorazine pero hindi na ngayon.

Hindi po ako dentista o doktor. Estudyante po ako. At tsaka hindi po kami pwedeng bumili o magturok ng gamot kapag walang resita ng isang doctor. Masakit po ba ngipin niyo?

student nurse. Bakit po kayo umiinom ng thorazine dati? Asking the client for information regarding the use of such drug will help define the presence of a problem. Pampamanhid . Nakakatulog din ako. Pero di na ako umiinom nun matagal na. Pumapangit ako kasi nakakaaddict . Giving (Nodding but information does not will increase agree with the clients her facial understanding expression.) about the drug. The client states something about thorazine but is not able to recognize its indication. Does not totally accept the statement the student nurse made. The client had been taking the drug before for several periods of time which is used only by psychiatric patients. The client is somehow giving an incongruent message wherein her nodding and her facial expression do not agree.

Ang thorazine po ay hindi pampamanhid o anesthesia. Isa po itong gamot para sa sakit sa pagiisip tulad po ng psychosis at schizophrenia . Ano po ba The student ang relihiyon nurse is mo? trying to start another topic to eliminate the tension brought by the previous question. Nag-aral po Exploring into ba kayo another dati? subject may help alleviate tension.

Siyempre! Katoliko. Naniniwala sa Diyos Ama, Anak, at Espirito.

The client answers directly but in a sarcastic way.

Commerce marketing graduate ako. Sa elementary at high school sa public school kaya may

Answering in a sarcastic manner indicates that the tension brought by the previous question has not been terminated yet. The client Exploring answers into another correctly in subject is an indirect effective manner. since the patient showed an agreeable expression.

Ano po ba Discovering ang laman ng what is inside bag ninyo? the clients bag may help the student nurse to obtain more information about the client.

allowance ako. Make-up lang at mga picture ko at ng pamilya ko. Gusto mo bang makita picture ko nung mahaba pa ang buhok ko? (Gets something inside her bag.

The client demonstrates interest in showing us more information about her.

The clients response give you an idea that trust between the student nurse and the client is established.

Okay po.

sige Accepting the clients offer indicates the nurse has heard what the client said.

Kani-kanina lang po sinabi mo na 10 babae at 10 lalaki ang anak mo. Pero sa mga pictures na ito, isang babae lang po ang anak ninyo. Ilang taon na po ba siya? Aahh, sige The student Passbook ko po. Ano po ba nurse is to. (Client yan? (Student trying to allowed us

Isa lang anak ko. Ito anak ko. Andun sa kapatid ko. Ako nag alaga sa kapatid ko. Tabi kami sa kuna. Yang anak ko ayaw maging babae. Gusto niya maging lalaki. Summarization Isa lang seeks to bring anak ko. out the Sampu na important siya. points of the discussion and to increase the awareness and understanding of the student nurse and the client.

The client wholehearted ly told the student nurses about the pictures (photos in photocopy).

It means that the client is eager to show and tell us about the photos of her family.

The client denies her statement earlier about the number of her children.

Through summarization , the student nurse omits the irrelevant and organizes the pertinent aspects of the interaction.

The client The client showed has a willingness delusion that

nurse is referring to the passbook inside the clients bag.)

gather more information from the client.

to scan her passbook). Wag mong basahin ng malakas, sa isip lang. (Then she took it away from us). Aalis na ako. Pupunta na ako ng burger (Jann Burger) kasi matutulog na ako.

in sharing her belongings to us but immediately grabs it back for she considers us as threats. The client is trying to terminate the conversation .

Okay po.

sige An accepting response indicates the nurse has heard and followed the train of thought. Okay sige An accepting po. May klase response also pa rin po indicates kasi kami. respect of the Maraming student nurse salamat po sa to the panahon clients ninyo. decision. Sa school po The student namin. nurse is giving the client information to let her know what to expect.

Saan kayo The client pupunta? is somehow trying to make the conversation be back on track again. Wag kayo dun kasi maraming bulate dun. (And then the client left) The client tries to scare the student nurse.

somebody will imitate her name and she is considering the student nurses, after knowing her identity, as threats. The clients attempt to terminate the conversation should be respected by the student nurse. The student nurse respects and understands the clients choice.

The client left but she is not upset. The student nurses followed her to Jann Burger outlet near Jajas and then she waved and said goodbye to us.

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