Nursing Case Study Paranaoid Schizophrenia


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Nursing Case Study Paranaoid Schizophrenia

  1. 1. PARANOID
  2. 2. TABLE OF CONTENTSChapter 1 …………………………………………………………….  Introduction  Theoretical Framework  Personal Data  History of present Illness  Past Personal History  Family HistoryChapter 2 ……………………………………………………………  General appearance  Motor behavior  Sensorium and Cognities  Perception  Attitude and Behavior  Defense Mechanism  Affective State  Speech  Thought Process and ContentChapter 3 …………………………………………………………….  Psychopathology  Related Literature and Studies  Drug StudyChapter 4 …………………………………………………………….  Process Recordings  Prioritized Psychiatric Nursing DiagnosesChapter 5 ……………………………………………………………  Psychotherapies Implemented
  3. 3. CHAPTER 1Introduction Paranoid schizophrenia is the most common type of schizophrenia in most partsof the world. The clinical picture is dominated by relatively stable, often paranoid,delusions, usually accompanied by hallucinations, particularly of the auditory variety,and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonicsymptoms, are not prominent. With paranoid schizophrenia, your ability to think and function in daily life maybe better than with other types of schizophrenia. You may not have as many problemswith memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious,lifelong condition that can lead to many complications, including suicidal behavior.( Patients who have paranoid schizophrenia that has thought disorder may beobvious in acute states, but if so it does not prevent the typical delusions or hallucinationsfrom being described clearly. Affect is usually less blunted than in other varieties ofschizophrenia, but a minor degree of incongruity is common, as are mood disturbancessuch as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms suchas blunting of affect and impaired volition are often present but do not dominate theclinical picture. The course of paranoid schizophrenia may be episodic, with partial or completeremissions, or chronic. In chronic cases, the florid symptoms persist over years and it isdifficult to distinguish discrete episodes. The onset tends to be later than in thehebephrenic and catatonic forms. ( According to the World Health Organization, It describes statistics about mentaldisorders of year (2008). Schizophrenia is a severe form of mental illness affecting about7 per thousand of the adult population, mostly in the age group 15-35 years. Though theincidence is low (3-10,000), the prevalence is high due to chronicity. According to the
  4. 4. facts it reveals Schizophrenia affects about 24 million people worldwide.Schizophrenia is a treatable disorder, treatment being more effective in its initial stages.More than 50% of persons with schizophrenia are not receiving appropriate care.90% ofpeople with untreated schizophrenia are in developing countries. Care of persons withschizophrenia can be provided at community level, with active family and communityinvolvement. Schizophrenia affects men and women with equal frequency. Schizophrenia oftenfirst appears in men in their late teens or early twenties. In contrast, women are generallyaffected in their twenties or early thirties. In the U.S., mental disorders are diagnosed based on the Diagnostic andStatistical Manual of Mental Disorders, fourth edition (DSM-IV).( In the Philippine setting, the disability survey done in 2000 by the NationalStatistics Office (NSO) found out that mental illness was the 3rd most common form ofdisability in the country. The prevalence rate of mental disorders was 88 cases per100,000 population and was highest among the elderly group. This finding was supportedby a more recent data from the Social Weather Station Survey commissioned by DOH in2004. It reveals that 0.7 percent of the total households have a family member afflictedwith mental disability. The Baseline Survey for the National Objectives for Health in2000 stated that the more frequently reported symptoms of an underlying mental healthproblem were sadness, confusion, forgetfulness, no control over the use of cigarettes andalcohol, and delusions. The most recent study on the prevalence of mental health problems wasconducted by the National Epidemiology Center (DOH-NEC) in 2006 which showedrevealing results though the target population was limited only to government employeesfrom the 20 national agencies in Metro Manila. Among 327 respondents, 32 percent were
  5. 5. found to have experienced a mental health problem at least once in their lifetime. Thethree most prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%),depression and schizophrenia (6%). Mental health problems were significantly associatedwith the following respondent characteristics: ages 20-29 years, those who have bigfamilies, and those who had low educational attainment. The prevalence rate generatedfrom the survey was much higher than those that were previously reported by 17 percent.( Currently, there is no method for preventing schizophrenia and there is no cure.Minimizing the impact of disease depends mainly on early diagnosis and, appropriatepharmacological and psycho-social treatments. Hospitalization may be required tostabilize ill persons during an acute episode. The need for hospitalization will depend onthe severity of the episode. Mild or moderate episodes may be appropriately addressed byintense outpatient treatment. A person with schizophrenia should leave the hospital oroutpatient facility with a treatment plan that will minimize symptoms and maximizequality of life. This introduced psychiatric case was chosen primarily because it is the mostinteresting amongst the cases that were encountered by the group members. It postsrelevant manifestations that are psychiatric in nature and the entire case is highly possibleto be studied comprehensively within the limited time available.Theoretical Framework Maslows hierarchy of needs is predetermined in order of importance. It is oftendepicted as a pyramid consisting of five levels: the first lower level is being associatedwith physiological needs, while the top levels are termed growth needs associated withpsychological needs. Deficiency needs must be met first. Once these are met, seeking tosatisfy growth needs drives personal growth. The higher needs in this hierarchy onlycome into focus when the lower needs in the pyramid are met. Once an individual hasmoved upwards to the next level, needs in the lower level will no longer be prioritized. If
  6. 6. a lower set of needs is no longer being met, the individual will temporarily re-prioritizethose needs by focusing attention on the unfulfilled needs, but will not permanentlyregress to the lower level. For instance, a businessman at the esteem level who isdiagnosed with cancer will spend a great deal of time concentrating on his health(physiological needs), but will continue to value his work performance (esteem needs)and will likely return to work during periods of remission. The lower four layers of the pyramid are what Maslow called "deficiency needs"or "D-needs": physiological, safety and security, love and belonging, and esteem. Withthe exception of the lowest (physiological) needs, if these "deficiency needs" are not met,the body gives no physical indication but the individual feels anxious and tense.(
  7. 7. Personal Data Name of the Patient: Mr. X Age: 40 years old Gender: Male Address: Nueva Ecija Civil Status: Single Nationality: Filipino Religion: Roman Catholic Birthday: Date admitted: January 31, 2009 (2:35 pm) Admitting Diagnosis: Paranoid SchizophreniaHistory of Present Illness Patient has previous admission at Mariveles Mental Hospital. He was dischargedfrom male ward on December, 2007. He had 1-2 consultations with Dra. Medina. Hisparents cannot afford to bring him in Cabanatuan. Upon discharge he resumed smoking and after few months he resumed alcoholintake and he became suspicious and verbally assaultive when not giving cigarettes. After few hours upon admission, he heard his female cousin and a neighbortalking to each other and felt rejuvenated. He went down the house and with carrying anice pick. He stabbed at his cousin who sustained several abrasions in the forearm and shegot a scar on the head and on her right lower quadrant of abdomen. The neighbor placedhim in restraints and informed his father who was out in the farm.History of Previous Illness The patient was first admitted on October 4, 200 at Mariveles Mental Hospitalwith chief complaints of poor appetite, cannot able to sleep and hears a female voice onhis ear. A year prior to admission, the patient used illegal drug such as shabu. After usingshabu, few months prior to admission he was engaged to abused substances like alcohol
  8. 8. and cigarettes. He started to become violent and shouts to his parents. Few hours uponadmission, he was saw laughing by him only, becomes aggressive and always shouting.His father took him to MMH hence the reason for his admission. His condition becomes better and he was discharged on August 19, 2001. But hewas then readmitted on November 15, 2002 for the reason of he took things from thestores and insisted that it was his property. On the nest seven succeeding years, he was inand out of MMH with an admitting diagnosis of Undifferentiated Schizophrenia. Butearly this year, January 9, 2009, he was again readmitted with a new diagnosis ofParanoid Schizophrenia.Family Health and Psychiatric History
  9. 9. Chapter 2MENTAL STATUS ASSESSMENTA. General Appearance Criteria Day 1 Day 2 Day 3 Day 4Good grooming ☺Appropriate facial expression ☺ ☺ ☺ ☺Appropriate posture ☺ ☺ ☺ ☺Maintains eye contact ☺ ☺ During nurse-patient interaction, the patient’s grooming was not good prior tomorning care but on the later part he improves and shows good grooming. Most of thetime, he exhibited appropriate facial expressions and posture during interactions. At first,he cannot display eye contact which may show lack of focused and interest on the topic.As days passes by student nurse established trust on the patient and he maintains goodeye contact.B. Motor Behavior Criteria Day 1 Day 2 Day 3 Day 4Automatism ☺ ☺ ☺ ☺HyperkinesthesiaWaxy FlexibilityCataplexyCatalepsyStereotypeCompulsionPsychomotor RetardationEchopraxiaCatatonic StuporCatatonic excitementTics and spasmsImpulsivenessChoreiform movements Automatism is defined as repeated purposeless behaviors often indicative ofanxiety, such as drumming of fingers, twisting of locks of hair or tapping of foot. All
  10. 10. through out the 4 day nurse-patient interaction, the patient presented automatism. Noother motor behaviors were noted.C. Sensorium and Cognitive Criteria Day 1 Day 2 Day 3 Day 4Orientation ☺ ☺ ☺ ☺ Time ☺ ☺ ☺ ☺ Place ☺ ☺ ☺ ☺ Person ☺ ☺ ☺ ☺Concentration ☺ ☺ ☺ ☺Memory ☺ ☺ ☺ ☺ Remote ☺ ☺ ☺ ☺ Recent ☺ ☺ ☺ ☺ Immediate retention ☺ ☺ ☺ ☺ Sensorium and cognities consist of the assessment of orientation, concentration,and memory. Orientation refers to the client’s recognition of person, place and time. Thatis, knowing who and where he or she is and the correct day, date and year. (Videbeck,Psychiatric Mental Health Nursing). Memory is an organisms mental ability to store,retain and recall information which is divided into recent and remote memory. Short-termmemory allows recall for a period of several seconds to a minute without rehearsal.Long-term memory can store much larger quantities of information for potentiallyunlimited duration (sometimes a whole life span). During the 4 day nurse-patient interaction, patient’s orientation and memory arestable. He can recall memories from the past and aware of the place, who is he, time, day,and year. Based from the above definition of memory, he has an intact recollection of thepast events in his life.D. Perception Criteria Day 1 Day 2 Day 3 Day 4Hallucination Visual Olfactory Auditory Tactile Gustatory Liliputian
  11. 11. IllusionsDelusions ☺ ☺ ☺ ☺ In the most recent Diagnostic and Statistical Manual of Mental Disorders, adelusion is defined as a false belief based on incorrect inference about external realitythat is firmly sustained despite what almost everybody else believes and despite whatconstitutes incontrovertible and obvious proof or evidence to the contrary. The belief isnot one ordinarily accepted by other members of the persons culture or subculture. From the 1st up to 4th day of nurse-patient interaction, the patient manifestpresence of delusions wherein he always claims that he was the husband of SherylCosim. Other perceptions were not noted.E. Attitudes and Behavior Criteria Day 1 Day 2 Day 3 Day 4Cooperation ☺ ☺ ☺ ☺Outgoing ☺ ☺ ☺ ☺WithdrawnEvasiveSarcasticAggressivePerplexedApprehensive ☺ ☺ ☺ ☺ArrogantDramaticSubmissiveFearfulSeductiveUncooperativeImpatientResistantImpulsive Attitude is a position of the body or manner of carrying oneself. It is a position orposture of the body appropriate to or expressive of an action, emotion The patient exhibited cooperation in the whole duration of duty and able toanswers all questions asked to him and participates in all activities. It was also observed
  12. 12. that he was outgoing with other patient and student nurse. He also showsapprehensiveness throughout the interaction.F. Defense Mechanism Criteria Day 1 Day 2 Day 3 Day 4Denial ☺ ☺RepressionSuppressionRationalization ☺ ☺Reaction FormationSublimationCompensationProjectionDisplacementIdentificationInterjectionConversionSymbolizationDissociationUndoingRegressionSubstitutionFantasy ☺ ☺ ☺ ☺ Defense mechanisms are psychological strategies brought into play by variousentities to cope with reality and to maintain self-image. Healthy persons normally usedifferent defenses throughout life. An ego defense mechanism becomes pathological onlywhen its persistent use leads to maladaptive behavior such that the physical and/or mentalhealth of the individual is adversely affected. The purpose of the Ego DefenseMechanisms is to protect the mind/self/ego from anxiety, social sanctions or to provide arefuge from a situation with which one cannot currently cope. The patient manifests fantasy from day 1 to day 4 and shows also denial andreaction formation on the later days of interaction.G. Affective State Criteria Day 1 Day 2 Day 3 Day 4Euphoria
  13. 13. Flat affect ☺ ☺BluntingElationExultationEcstasyAnxietyFearAmbivalenceDepersonalizationIrritabilityRageLabilityDepression Affect is a grouping of physic phenomena manifesting under the form ofemotions, feelings or passions, always followed by impressions of pleasure or pain,satisfaction or discontentment , liking or disliking, joy or sorrow.(/ Flat affect: A severe reduction in emotional expressiveness. People withdepression and schizophrenia often show flat affect. A person with schizophrenia maynot show the signs of normal emotion, perhaps may speak in a monotonous voice, havediminished facial expressions, and appear extremely apathetic. ( The patient sometimes shows flat affect during the whole interaction.H. Speech Criteria Day 1 Day 2 Day 3 Day 4VerbigerationRhymingPunningMutismAphasiaUnusual rates of speechUnusual Volume of speechUnusual IntonationUnusual Modulation Speech refers to the processes associated with the production and perception ofsounds used in spoken language.
  14. 14. During the interaction, the patient does not show any alteration in his speechpattern. He did not experience verbigeration, aphasia, other speech problems.I. Thought Process and Content Criteria Day 1 Day 2 Day 3 Day 4BlockingFlight of IdeasWord SaladPerserverationNeologismCircumstantialityEcholaliaCondensationDelusion ☺ ☺ ☺PhobiaObsession ☺ ☺ ☺ ☺Hypochondriac During the first part of our nurse-patient interaction, the patient shows delusion.He also manifested obsession wherein he keeps on insisting that his wife is Sheryl Cosimwho is a famous news anchor.
  15. 15. Chapter 3Psychopathology Book-Based
  16. 16. Client-Based
  17. 17. Related Literature and Studies
  18. 18. What is Schizophrenia? It is a mental illness which affects one person in every hundred. Schizophreniainterferes with the mental functioning of a person and, in the long term, may causechanges to a persons personality. First onset is usually in adolescence or early adulthood. It can develop in olderpeople, but this is not nearly as common. Some people may experience only one or morebrief episodes in their lives. For others, it may remain a recurrent or life-long condition. The onset of illness may be rapid, with acute symptoms developing over severalweeks, or it may be slow, developing over months or even years. During onset, theperson often withdraws from others, gets depressed and anxious and develops extremefears or obsessions. Although an exact definition of schizophrenia still evades medical researchers, theevidence indicates more and more strongly that schizophrenia is a severe disturbance ofthe brains functioning. In The Broken Brain: The Biological Revolution in Psychiatry,Dr. Nancy Andreasen states "The current evidence concerning the causes ofschizophrenia is a mosaic. It is quite clear that multiple factors are involved. These include changes in the chemistry of the brain, changes in the structure ofthe brain, and genetic factors. Viral infections and head injuries may also play arole....finally, schizophrenia is probably a group of related diseases, some of which arecaused by one factor and some by another." (p. 222). There are billions of nerve cells in the brain. Each nerve cell has branches thattransmit and receive messages from other nerve cells. The branches release chemicals,called neurotransmitters, which carry the messages from the end of one nerve branch tothe cell body of another. In the brain afflicted with schizophrenia, something goes wrongin this communication system. Sometimes schizophrenia has a rapid or sudden onset. Very dramatic changes inbehaviour occur over a few weeks or even a few days. Sudden onset usually leads fairly
  19. 19. quickly to an acute episode. Some people have very few such attacks in a lifetime; othershave more. Some people lead relatively normal lives between episodes. Others find thatthey are very listless. depressed, and unable to function well. In some, the illness may develop into what is known as chronic schizophrenia.This is a severe, long-lasting disability characterized by social withdrawal, lack ofmotivation, depression, and blunted feelings. In addition, moderate versions of acutesymptoms such as delusions and thought disorder may be present in the chronic disorder.What are the symptoms of schizophrenia?Major symptoms of schizophrenia include: • Delusions - false beliefs of persecution, guilt or grandeur or being under outside control. People with schizophrenia may describe plots against them or of think they have special powers and gifts. Sometimes they withdraw from people or hide to avoid imagined persecution. • Hallucinations - most commonly involving hearing voices. Other less common experiences can include seeing, feeling, tasting or smelling things which to the person are real but which are not actually there. • Thought disorder - where the speech may be difficult to follow; for example, jumping from one subject to another with no logical connection. Thoughts and speech may be jumbled and disjointed. The person may think someone is interfering with their mind.Other symptoms of schizophrenia include: • Loss of drive - where often the ability to engage in everyday activities such as washing and cooking is lost. This lack of drive, initiative or motivation is part of the illness and is not laziness. • Blunted expression of emotions -where the ability to express emotion is greatly reduced and is often accompanied by a lack of response or an inappropriate response to external events such as happy or sad occasions.
  20. 20. • Social withdrawal - this may be caused by a number of factors including the fear that someone is going to harm them, or a fear of interacting with others because of a loss of social skills. • Lack of insight or awareness of other conditions - because some experiences such as delusions and hallucinations are so real, it is common for people with schizophrenia to be unaware they are ill. For this and other reasons, such as medication side-effects, they may refuse to accept treatment which could be essential for their well-being. • Thinking difficulties - a persons concentration, memory, and ability to plan and organise may be affected, making it more difficult to reason, communicate, and complete daily tasks.What causes schizophrenia?No single cause has been identified, but several factors are believed to contribute to theonset of schizophrenia in some people:Genetic factorsA predisposition to schizophrenia can run in families. In the general population, only 1per cent of people develop it over their lifetime. If one parent suffers from schizophrenia,the children have a 10 per cent chance of developing the condition - and a 90 per centchance of not developing it.Biochemical factorsCertain biochemical substances in the brain are believed to be involved in this condition,especially a neurotransmitter called dopamine. One likely cause of this chemicalimbalance is the persons genetic predisposition to the illness.Family relationships
  21. 21. No evidence has been found to support the suggestion that family relationships cause theillness. However, some people with schizophrenia are sensitive to any family tensionwhich, for them, may be associated with relapses.EnvironmentIt is well recognised that stressful incidents often precede the onset of schizophrenia.They often act as precipitating events in vulnerable people. People with schizophreniaoften become anxious, irritable and unable to concentrate before any acute symptoms areevident. This can cause relationships to deteriorate, possibly leading to divorce orunemployment. Often these factors are then blamed for the onset of the illness when, infact, the illness itself has caused the crisis. It is not, therefore, always clear whether stressis a cause or a result of illness.Drug useThe use of some drugs, especially cannabis and LSD, is likely to cause a relapse inschizophrenia.Source: www.mental-health-matters.comParanoid Schizophrenia People with paranoid schizophrenia, the most common form of the disorder,mainly experience hallucinations. They tend to believe that others are poisoning,harassing, or plotting against them. They may also hear voices, which order them to dothings. Contrary to popular belief, people suffering from this type of schizophrenia areactually not prone to violence; in fact, they generally prefer to be left alone.Common Symptoms of Paranoid Schizophrenia For people with paranoid schizophrenia, the primary symptoms are delusions orauditory hallucinations. People with paranoid schizophrenia usually do not have thoughtdisorder, disorganized behavior, or affective flattening.
  22. 22. People with paranoid schizophrenia have grandiose delusions. For example, they maybelieve that others are deliberately: • Cheating them • Harassing them • Poisoning them • Spying on them • Plotting against them or the people they care about.Auditory hallucinations can include hearing "voices" that may: • Comment on the persons behavior • Order him or her to do things • Warn of impending danger • Talk to each other (usually about the affected person).Paranoid Schizophrenia and Violence People with paranoid schizophrenia are not especially prone to violence and oftenprefer to be left alone. Studies show that if people have no record of criminal violencebefore they develop schizophrenia and are not substance abusers, they are unlikely tocommit crimes after they become ill. Most violent crimes are not committed by peoplewith paranoid schizophrenia, and most people with schizophrenia do not commit violentcrimes. Substance abuse almost always increases violent behavior, whether or not theperson has schizophrenia. If someone with paranoid schizophrenia becomes violent, their violence is mostoften directed at family members and takes place at home.Source:
  23. 23. Drug Study Name of Date Route/ General Indication Client’s drug ordered/ Dosage/ action/mechanis / response to Date Frequency of m of action Purpose medicine with started/ administration actual s/e Date changedGeneric Date Route of Chemical For AdministratioName: Ordered: Administration: Effect: patients n of the drug January 31 Per Orem May act by with acute was notClonazepam 2009 facilitating manic actually Date Dosage and effects of episodes, observed Started: Frequency: inhibitory panic January 31 2mg HS neurotransmit disorders, 2009 ter or GABA. seizures. Date Therapeutic Ended: Effect: -------------- Prevents or -------- stops seizure activity.NURSING RESPONSIBILITIES:BEFORE: • Explain the importance and action of the drugs. • Tell the possible reaction or side effects of the drugs. • Monitor patient for any adverse reaction.DURING: • The client may sip small amount of water • Stay with the client for at least 15-30 minutes after giving the drug • Be alert for adverse reaction and drug interaction
  24. 24. Name of Date Route/ General Indication/ Client’s drug ordered/ Dosage/ action/mechanism Purpose response to Date Frequency of of action medicine with started/ administration actual s/e Date changedGeneric Date Route of Chemical Effect: This is AdministratioName: Ordered: Administration: May block given to n of the drug January Per Orem postsynaptic the patient was notHaloperidol 31, 2009 dopamine with actually Date Dosage and receptors in brain. chronically observed Started: Frequency: Therapeutic psychotic January 5mg tab tid Effect: disorder 31, 2009 Decreases who needs psychotic prolonged Date behaviors. therapy. Ended: ----------- ---------- NURSING RESPONSIBILITIES: BEFORE: • Explain the importance and action of the drugs. • Tell the possible reaction or side effects of the drugs. • Monitor patient for any adverse reaction. DURING: • Stay with the client for at least 15-30 minutes after giving the drug • Monitor patient for tardive dyskinesia, which may not appear until months or years later and may disappear spontaneously or persists for life despite stopping use of drug.
  25. 25. CHAPTER 5PSYCHOTHERAPIES IMPLEMENTEDPsychotherapy- treatment of mental disorders and behavioral disturbances using verbaland nonverbal communication, as opposed to agents such as drugs or electric shock, toalter maladaptive patterns of coping, relieve emotional disturbance, and encouragepersonality growth. Also called psychotherapeutics.Individual Psychotherapy- Through one-on-one conversations, this approach focuses onthe patients current life and relationships within the family, social, and work.Group Psychotherapy- Group psychotherapy is a special form of therapy in which asmall number of people meet together under the guidance of a professionally trainedtherapist to help themselves and one another. Group therapy helps people learn aboutthemselves and improve their interpersonal relationships. It addresses feelings ofisolation, depression or anxiety. And it helps people make significant changes so theyfeel better about the quality of their lives.REMOTIVATION THERAPYDefinition: A simple group therapy which aims to bridge the fantasy- world of thePsychotics to the real world. Is a technique of simple group therapy, objective in nature,used with a group of patients in an effort to reach the “unwounded” areas of eachpatient’s personality & to get them back into reality.
  26. 26. Title of the poem: Ang Bulaklak The short poem describes the importance of flower in our nature.Goals:  To stimulate patients to be fellow explore the real world.  To develop their ability to communicated and share ideas and experiences with the other people.  To develop feelings of acceptance.  To promote group harmony and identification.Role of the nurse:  To be a facilitator in the activity  To encourage clients feeling about the topic  To present the reality to the client about the poem.NEWSPAPER THERAPYDefinition: Newspaper therapy is giving information to the clients about events and whatis happening outsideNewspaper therapy is cutting clippings from newspaper and sharing this information tothe clients and knowing their feelings and ideas about the information given. Providingbasic information about places/events may motivate the clients to follow the medicalregimen to be well. The facilitator let the clients to read the topic, then ask themquestions.Title of the cut news: Boxing The news was all about boxing competition held in Araneta Coliseum & who wonfor that competition.
  27. 27. Goals:  To give information to the clients on what is happening outside and to give latest news today.  To encouraged emotions and reactions about the newsRole of the Nurse:  To introduce topics that will encourage clients participation/cooperation  To assess level of intelligence of the clients  To encourage the clients to express/verbalize feelings/ideas regarding to the topicPLAY THERAPYDefinition: A form of psychotherapy used to help them express or act out theirexperiences, feelings, and problems by playing with dolls, toys, and other play material.Name of the Play: Ball catchingProcedure:The clients are instructed to catch the ball with their respective partners.Goals:  To establish rapport since it is the first recreational activity of the client  To encourage release/ express clients emotions  To let the client learn on how to cooperate  To let the client play freely and activelyRole of the Nurse:  To be the facilitator of the game  To let and encourage the clients to participate on the play
  28. 28. DANCE THERAPYDefinition Dance is the most fundamental of the arts, involving direct expression throughthe body. Dance /movement therapy effects changes in feelings, cognition, physicalfunctioning, and behavior.Title of the dance song: Cha-Cha-Cha Facilitators are in the front, dancing different steps, in able for the client to followeasily the facilitators.Goals:  To encourage release/ express clients emotions  To let the client learn on how to dance in simple steps  To let the client dance freely and activelyRole of the Nurse:  To be the facilitator of the game  To let and encourage the clients to participate on the danceSONG THERAPYDefinition: A kind of recreational therapy under the music category, which connects uswith our creativity, innate wisdom and our vast inner resources for growth and well-being. It has a soothing and pleasing effect and provides for emotion and release.Title of the song: Tag-ulanProcedure:
  29. 29.  Using the visual aids that has the written lyrics, the patients read it first.  The nurse sings the song with the use of guitars.  Nurses, together with the patients, sing the song.  Lastly, let the patients sing to the tune of guitars.Goals:  Develop patient’s ability to read and reflect.  Develop patient’s listening skill.  To encourage them to participate and cooperate.  Patients will learn to express emotions and feelings.Role of the Nurse:  Explain the procedure to the patients.  To be a good facilitator.  To be an active participant too.  To promote trust.ART THERAPYDefinition: is the use of art materials for self-expression and reflection.Name: House-Tree-PersonProcedure:  Patients are provided with crayons and 3 pieces of paper as drawing materials.  They are then asked to draw a house, afterwards a tree, and lastly, a person on each of the papers with the use of crayons.  Series of questions constitute the post drawing interrogations.
  30. 30.  During post drawing phase, paients are given opportunity to define, describe, and interpret the objects drawn.Goals:  To obtain data concerning patient’s progress.  To aid in the establishment of rapport between the nurse and the patient.  Help the patients gain insight through interpretations.  Measure patient’s self perception and attitudes.Role of Nurses:  Explain the procedure of the activity.  Provide the means of the therapy (crayons, papers).  Interrogate patients during post drawing phase.  Assessing and interpreting answers based on Buck’s HTP interpretation.  Develop a deeper nurse-patient relationship through building of trust.OCCUPATIONAL THERAPYDefinition: Any activity, mental or physical, prescribed and guided to aid an individual’srecovery from diseases or injury. This activity excludes competition and pressure. Thereis opportunity for creativeness and produce something tangible out of patient’s ownthinking and imagination. Self confidence and personal achievements are alsoexperienced.Title: Designing Picture FrameProcedure: Designing Picture Frame Nurses play a great role in making this therapy successful.  Nurses give picture frame.
  31. 31.  Different shapes of cut cartolina & different styles of stickers are also given along with the glue.  Patients are asked to design their picture frame wherever they like.Goals:  Expose patients’ hidden abilities in designing and pasting.  Increase patients’ self confidence.  Assess patients’ motor and intellectual functioning.Role of Nurses:  To select the most useful activity.  To facilitate the activity successfully.  To assist the patients.  To promote positive personality growth
  32. 32. BIBLIOGRAPHYVidebeck, Psychiatric Mental Health Nursing, Third EditionShives, Isaacs, Basic Concepts of Psychiatric-Mental Health NursingRebraca et. al., Psychiatric Mental Health Nursing, 5th EditionNurses Dictionary, Second Edition7th Edition Nursing Diagnosis Handbook: A Guide to Planning Care by Betty J Auckley and GailB. Ladwig