56796742-Schizophrenia-NCMH-Case-Study.docx

Republic of the Philippines
DIVINE WORD COLLEGE OF BANGUED
Bangued, Abra
NURSING DEPARTMENT
A case study on
SCHIZOPHRENIA,
UNDIFFERENTIATED TYPE
In Partial Fulfillment of the Requirements in NCM 204 (RLE)
Leading to the Degree Bachelor of Science in Nursing
National Center for Mental Health
Mandaluyong, City
Pavilion 10
Submitted to:
Myra P. Locquiao, R.N., R.M., MAN.
Clinical Instructor
Submitted by:
Roderick C. Ancheta
July 26, 2009
SY 2009-2010
BATCH 2010

I. BACKGROUND OF THE STUDY
A. INTRODUCTION
Schizophrenia is a group of psychotic reactions that affect multiple areas of an
individual’s functioning including thinking and communication, perceiving and
interpreting reality, feeling and demonstrating emotions and behaving in a socially
accepted manner. This condition causes distortion and bizarre behavior, thoughts,
movements, emotions and perceptions. This condition is usually diagnosed in late
adolescence or early adulthood and rarely manifest in childhood.
The symptoms of schizophrenia are divided into two major categories; the
positive and negative symptoms. The positive symptoms include delusions and its types,
hallucinations, loose associations and bizarre or disorganized behavior while the negative
symptoms includes restricted emotions, anhedonia, avolition, alogia, catatonia and social
withdrawal. Most clients with schizophrenia have a mixture of both types of symptoms.
The diagnosis of this condition usually is made when the person begins to display more
actively positive symptoms of delusions, hallucinations and disordered thinking. Onset
may be abrupt but most clients slowly and gradually develop signs and symptoms such as
social withdrawal, unusual behavior, loss of interest and neglected hygiene.
Schizophrenia is also classified into five types and diagnosed according to the
client’s predominant symptoms. Paranoid type is characterized by persecutory or
grandiose delusions, hallucinations and occasionally excessive religiosity hostility and
aggressive behavior. Disorganized type is characterized by inappropriate or flat affect,
disorganized speech and disorganized behavior. The catatonic is characterized by marked
psychomotor disturbance, either motionless or excessive motor activity. Motor
immobility may be manifested by waxy flexibility or stupor. Excessive motor activity is
apparently purposeless and not influenced by external stimuli. Other features include
extreme negativism, echolalia, echopraxia or even mutism. Undifferentiated type is
characterized by mixed schizophrenic symptoms of other types along with disturbances
of affect and behavior. The last type which is residual is characterized by the absence of
prominent delusions, hallucinations, disorganized speech and grossly disorganized or
catatonic behavior.
Our client was classified and diagnosed as schizophrenia, undifferentiated type.
Which means, that she demonstrated mixed schizophrenic symptoms of others but not
enough of them to define its particular type.

B. THEORETICAL FRAMEWORK
According to Learning Theory, the irrational ways of handling situations, the
distorted thinking and the deficient communication patterns of person with schizophrenia
are a result of poor parental models in early childhood. Children learn what they are
exposed to on daily basis, from parents who have their own significant emotional
problems. Thus, the child does not develop skill forming good interpersonal relationships
which she possesses when she grows up. If this was not to be resolve, it will lead to some
emotional distortions.
Sullivan was the principal proponent of learning theory, believing that the
developing individual was shaped by social interactions. Therefore, the complex feelings,
thoughts and behavioral expressions grew out of the individual’s experiences with those
closest to her or him. For example, if the child’s father was mean and dictatorial, the
perception may have generalized to other men in positions with authority. Or if the
child’s mother coped problems by projecting blame onto others, the child learn this
pattern of behavior and alienated others by putting it into practice. As what the child seen
at early stage of life, that was the things she will be doing when she grow up to cope
problems and save her or his ego identity.
This theory I think was indicated to my client who have difficulty in coping when
she was still at normal state of life. Later, she developed untoward behaviors when
triggers the development of her condition and was diagnosed to have schizophrenia,
undifferentiated type. This is in relationship with the relationship of the client with the
other members of the family especially her parents who were to be the model of the
young minds. She grew up with a mean father and mother which she never inculcated
during the interactions. And from this case, the client tend to blame her mother for the
development of the condition.

C. PERSONAL DATA
Name:
Age: 48 y/o
Birth date: February 17, 1961
Birthplace: Marikina City
Address: 98 Malaya Street, Malanday Marikina City
Gender: Female
Civil Status: Married
Nationality: Filipino
Religion: Jehovas Witness
Educatonal Attaiment: College Graduate
Date of Admission: July 11, 2001
Time of Admission: 2:40 PM
Admitting Physician:
Chief Complaints: According to the Father, the client was hostile and showing
untoward behaviors. She was claiming that she was a prophet and speaks most often
about satan. The informant also added that the client often says that she was not accepted
by their church because of her mother who sold herself to satan when they went to a tour
around the world.
Admitting Diagnosis: Undifferentiated Schizophrenia, Chronic and Unstable
Final Diagnosis: Undifferentiated Schizophrenia, Manageable
Agency: National Center for Mental Health, Mandaluyong City

D. CHIEF COMPLAINT
According to the Father, the client was hostile and showing untoward behaviors.
She was claiming that she was a prophet and speaks most often about satan. The
informant also added that the client often says that she was not accepted by their church
because of her mother who sold herself to satan when they went to a tour around the
world.
E. HISTORY OF PRESENT ILLNESS
The present condition of the client started when she was 34 years old. Due to
some circumstances, the client become hostile and showed untoward behaviors and even
hurting her own self. She was readmitted on July 11, 2001 with a diagnosis of
Schizophrenia undifferentiated type, Chronic and unstable. She has a regular check up
and taking the medications religiously but her condition worsened when she was not
accepted to their church.
The client’s condition now was already stable and manageable, but sometimes she
still manifests some symptoms like hallucinations and tends to mumble to herself.
F. PAST MEDICAL HISTORY
The client has a regular medical check up when she was still at normal state.
She’s been taking antihypertensive drugs due to the rise and fall of her blood pressure.
The client was first admitted at the National Center for Mental Health at the year
1995 because of hostility, untoward behaviors and social withdrawal. She was then
diagnosed to have Schizophrenia, undifferentiated type. According to the client herself,
she always heard voices and even saw things which were vague for her. Meaning, she
was experiencing visual and auditory hallucinations. That was why her father brought her
at the center. She was been manageable and was in and out at the center for 6 years. At
the year 2001, at 2:40 in the afternoon of July 11, she was readmitted accompanied by her
father for she experienced again symptoms like hallucinations and delusions. The client
then denied the presence of auditory and visual hallucinations and claimed to have a good
sleep. She also added that she was been admitted at the center before and taking up
medications like Haloperidol.
The client was been at the National Center for Mental Health for about 14 years
but sometimes in and out due to the progressive state of her condition.

G. PAST PERSONAL HISTORY
The client was a graduate of College Degree at the University of the East. She
was married and has three children. She’s been affiliated religiously at their church as a
member and she was been active to their church activities. She spends most of her time
on her affiliation and has a normal state dealing with her colleagues.
H. PAST FAMILIAL HISTORY
The client belongs to a well to do family. They were five siblings in their family
and have already their own families respectively and she was the only one who has the
condition. Her father was businessman and so with her husband. The client has three
children and they were studying at a prestigious school in Metro Manila. According to
her, their family fond of going into different places in the country and also abroad. On
both paternal and maternal side, they do not have a history of schizophrenia and she was
the first to have the condition. The client has a mean father and she never speak to much
about her mother.
I. PAST SOCIAL HISTORY
The client was an active member of her Religious affiliation. She was dedicated
and goes along with her colleagues religiously and acts accordingly. She’s fond of
dealing with her co-members. The client always remembers that she was singing at their
church with other group members. The client’s social atmosphere changed when one day
she was not already a member of their church. She always claimed that she was rejected
due to the wrong doing of her mother. She became socially withdrawn, suspicious and
later became hostile and has disorganized behavior.
II. PHYSICAL AND MENTAL ASSESSMENT

A. GENERAL APPEARANCE
The client appears stated with her age of 48 years old, wearing a pink dress with a
face towel at her back, well groomed and with good personal hygiene. She’s taking a bath
everyday with a good daily routine. The client has a good posture, gait and coordination.
During interaction, she has a good eye to eye contact and an appropriate affect or facial
expression with regards to a certain situation. She was well nourished and has a fair skin
as evidenced by her good body built and has no sleeping difficulties by the absence of
dark circles under her eyes. She was well oriented with time, place, date and reality. The
client considered the interview the interview as a normal thing and she was guided
accordingly with no harsh or offending questions thrown to her during the interview. She
was cooperative with consistency of speech and behavior.
B. GENERAL BEHAVIOR AND ACTIVITY
The client sometimes lethargic and catatonic stupor during interactions. There are
also times that she was restless where she can’t remain still. She has also hand tremors
which were involuntary, purposeless rhythmic movements.
C. ORIENTATION
The client was well oriented on date, time, place and reality. She can relate to past
experiences and able to organized ideas and thoughts related to her present condition. She
know and aware that she was at the National Center for Mental Health.
D. AFFECT AND MOOD
The client show appropriate affect with regards to a certain situation. But
sometimes, she suddenly change in expression of mood and this makes hard to identify
whether she was on stated condition and willing to cooperate and interested with the
interaction. Sometimes, there was an alteration of the affective state of the client which
was inappropriate and contrary to her feelings and emotions.
E. THOUGHT PROCESS AND CONTENT
Even the client was at the center, she has a normal and logical thought process.
What she uttered was meaningful and with sense. She didn’t use confabulation nor
circumstantial. She can easily catch up what the interviewee mean and answer relevant to
the questions.
F. MEMORY, PRESENT AND REMOTE

The client good memory but sometimes she had lapses. She can recall and
remember her past experiences and important events and people in her life. What were
discussed in the previous days were recalled which were integrated on the present
scenario on the interaction.
G. JUDGMENT
The condition of the client only started when she was on her early adulthood.
Therefore, it doesn’t mean that she can not make decisions on its own for she was at the
center. She can formulate and think of other alternatives which later beneficial for solving
her own problems.
H. INSIGHT
The client was knowledgeable and aware of her condition that she was at the
national center for mental health. She knows the state of her illness being manageable
and how was the progression with regards to her rehabilitation and in response to
medication regimen and psychotherapies. She was able to respond of what was going on
and can comprehend appropriately.
I. INTELLECT
She has a good sense of reasoning but it was limited. She was able to pinpoint and
defend her answers but if asked for the main reason why she was at the center, she can’t
answer directly.
J. COPING MECHANISMS
The client has good pattern in handling stressors that arises in her life. Since she
was able to formulate ideas and alternatives in order to divert her attention her problems,
she just did her responsibilities at the center and just enjoyed the therapies especially
during plays for her not to think or not be bothered by her problems even in a short period
of time.
K. DEFENSE MECHANISM
In the case of my client, she used denial as a defense mechanism. In the reason
why she was at the center, she elaborated that she only wanted to rest because she was
already tired and exhausted, but in fact, she’s been hostile and doing unacceptable
manner. In some of the activities that were done, the client never excels in such, but
became a winner in the play therapies; therefore she was compensating on her actions
that was not succeeded on her part. And one thing also that I noticed was that, she tend
and often said that her attitude of mumbling and rattling of speech was due to limited

visitation by her family. She’s blaming and concluding that her physical handicap was
due to that event and it was a defense mechanism called conversion.
III. PSYCHOPATHOPHYSIOLOGY
A. PSYCHODYNAMICS
According to Freud, schizophrenia is a form of regression, back to the oral stage of
development. The oral stage is the first stage of psychosexual development. A baby is born
a bundle of id; ID is self-indulgent and concerned only with a satisfaction of his/her needs.
There is a need to gratify these impulses but their experiences in the real world result in
conflict. People with schizophrenia are overwhelmed by anxiety because their egos are not
strong enough to cope with id impulses. In schizophrenia, this can lead to self-indulgent
symptoms such as delusions of grandeur, Jesus Christ. As the patient is still living in the real
world, this may result in further DELUSIONS such as hearing voices which may have an
ultimate authority such as God.
This explanation suggests that schizophrenia has a psychosomatic cause the origin is
solely in the mind. At best it could only be a partial explanation of some symptoms, e.g.
delusions. In reality, Freud is denying the very experience of patients with schizophrenia. It
is unscientific and extremely difficult to test. Concepts such as repression are difficult to
observe and measure, although this difficulty does not invalidate the theory. The theory is
based on unrepresentative samples, case studies, from which it is difficult to generalize. And
it involves poor methodology. The theory fails to account for gender differences - the onset
for males is around 20 years, and for females 30 years. Nor does the theory explain why,
prior to diagnosis, their behavior has appeared normal. Further more, it excludes a
consideration of the environment.
Dysfunctional Families
This explanation suggests that schizophrenia is the result of dysfunctional families. In
contrast to the biological or medical approach which may be regarded as more humane,
attaching no blame to the individual, this model by implication is attaching blame to the
family. BATESON (1956) claimed that parents predispose their children to schizophrenia by
communicating in double binds. Double binds are a no-win situation for the child, e.g. a
parent might complain about a child, lack of affection, but when the child does give
affection, s/he is told that s/he is too old for that. BATESON used the term double bind to
explain these ideas of contradictory messages.
Emotions and Environments

Support for this view comes from the work of BROWN (1966) who examined the
progress of patients with schizophrenia discharged from hospital. BROWN found that those
patients who came from families characterized by high expressed emotion (high conflict,
constant interference) were more likely to return to hospital in a shorter period of time. 58%
of patients returned to high EE families experienced a relapse compared with 10% returning
to low EE families. The implications of this research are that the environment has a
significant role to play in the course of the development of schizophrenia. However, the
direction of causation is unclear, it may be that living with a person with schizophrenia is
causing hostility and high expressed emotion within the family. Alternatively, it may be the
family that is causing the relapse. The effects of stress on the immune system and on the
incidence of disease and illness are well-known. If stress has a role in physical illness, it may
well have a role in mental illness.
Cognitive Deficits
Also, it may be noted that schizophrenia is characterized by cognitive deficits,
disorganized speech, hallucinations, delusions, and a cognitive model focuses more tightly on
these deficits. Deficits in information processing may leave people vulnerable to the
behaviors typically seen as symptoms of schizophrenia. The cognitive approach tends to be
descriptive rather than explanatory and tend to use the biological model to explain the origin
of schizophrenia. Research does suggest that people with cognitive deficits are highly
susceptible to stress.
Diathesis-Stress Model
The diathesis-stress model combines biological and genetic factors with levels of
stress. Diathesis refers to a predisposition (innate) and the stress is environmental (nurture).
This model suggests that mental disorders are the result of an interaction between nature and
nurture. Finnish study revealed that none of the adopted children raised in healthy families
developed schizophrenia, but 11% in severely disturbed families went on to do so. The bio-
psycho-social approach is a more eclectic approach to studying and understanding
schizophrenia.
The idea that schizophrenia is the result of schizophrenogenic families is based on
retrospective studies and may be unhelpful and highly destructive. Today, high expressed
emotion families which are hostile, critical, and over-involved, are seen as maintaining
schizophrenia rather than causing it. However, it should be noted that many patients with
schizophrenia are estranged from their families. It does seem as if there is a role for
attributions of relatives. Weisman (1998) found that relatives who tend to attribute positive
symptoms and delusions to a person mental illness do not hold them accountable. Relatives
attributing negative symptoms tend to become angry and critical. There are higher relapse
rates in families with highly critical attributions
Biological/Medical Model: Genetic Influences

This model suggests that schizophrenia is rooted in our physiology and is treated as a
disease or illness. The model operates at the level of genes, brain structure, brain chemistry,
hormones, and disease/illness. Schizophrenia has a tendency to run in families. First degree
relatives are 18 times more at risk.
However, family studies are conducted using interview techniques. Interviews are
retrospective involve looking back at the past and our memories are often inaccurate.
Interviews are also subjective based on opinions and interviewees do not have the benefit of
diagnostic criteria. Furthermore, family history studies fail to separate genes and
environment.
This suggests that genes do play a significant role in schizophrenia. However, the
concordance rate is not 100%. There remains the problem that Tienaris study is ongoing and
the critical period for the onset for females has only just been reached. These figures are
likely to be underestimates as the figures fail to include information about the biological
father. Genes do not operate in isolation and are linked to brain chemistry
Brain Chemistry
This level of explanation would suggest an imbalance of neurotransmitters or
chemical messengers in the brain. The dopamine hypothesis suggests that schizophrenia is a
result of excess levels of dopamine in the brain.
The evidence for this hypothesis lies in the fact that phenothiazines reduce symptoms
of schizophrenia. They inhibit levels of dopamine activity. L-Dopa is a synthetic dopamine
releasing drug which induces the symptoms of schizophrenia. Also, Parkinsons disease,
shaking of limbs are common side effects associated with the effects of anti-psychotic
medication. Parkinsons disease is associated with low levels of dopamine. Further support
for the dopamine hypothesis comes from studies of amphetamines. These release dopamine
at the central synapses. They worsen the symptoms of schizophrenia.
B. PREDISPOSING AND PRECIPITATING FACTORS
The relationship between members of the family has a big relationship in the
development of the condition. Parenting in the early stage of life which the child seen during
those years, she may manifest and carried until shed grow up. As to the blaming of others for
problems and maybe a problem with authority figures. In this case, the person may be able to
be withdrawn and may not develop interpersonal or social relationships, she may also
vulnerable to stress as she never know what were the alternatives for the coping of her
problems.
Nature of work also predispose the development of the condition, if the person is
always ridiculed even she thinks that she did her best and her work is good but it has no
effect on his boss, feeling of guilt a and inadequacy and inferiority begins. That’s why, the
person maybe have fascinating effects that someday her boss would be please on what she
had done or maybe think of hostility against her boss.

Low Frustration Tolerance also a factor that triggers the development of the illness.
Like on the nature of work, she may not be able to cope up with the problems she may
encounter that makes her think of something that were not appropriate to reality and acts
contrary.
Severe Religiosity was also included as a part of the past social history of the client.
She was very active to her religion and she did anything for that her faith in god and to their
church may not be ruined. But one that predisposed was the wrong act of her mother that the
latter cause her to be rejected to their church. In this case, the client become hostile and
shows untoward behaviors towards other and towards self.
Since the client has well to do family, socio economic status has a lesser effect on the
development of her condition, but the main thing connected to it was the attitude of family
members like her father which is very mean and strict to them.
Other factors include the acquisition of influenza virus by the mother during the
second trimester of pregnancy. The virus may create maternal antibodies. In the fetus, there
become auto antibodies which an external source of developmental change. In this case, this
is a great factor in the development of adult schizophrenia. Others include trauma like head
injuries or diseases during childhood and substance abuse.
C. PSYCHOPATHOLOGY
Schizophrenia is a group of psychotic reactions that affect multiple areas of an
individual’s functioning including thinking and communication, perceiving and interpreting
reality, feeling and demonstrating emotions and behaving in a socially accepted manner. This
condition causes distortion and bizarre behavior, thoughts, movements, emotions and
perceptions. This condition is usually diagnosed in late adolescence or early adulthood and
rarely manifest in childhood.
In relation to the predisposing and precipitating factors, the client’s cause of illness is
severe religiosity, parenting (family relationships and attitudes towards other), low frustration
tolerance and the nature of work.
The onset of the symptoms usually occurs in the adolescence or early adulthood and
the onset can be gradual or sudden. Course of schizophrenia is variable and remissions may
occur. Some clients may recover completely. Some have chronic, unremitting disorder.
Schizophrenic clients have difficulty in perceiving reality and disturbances on ego. These
individuals have poor sense of identity as well as lowered self esteem.
The signs and symptoms which manifested by the client when admitted were
delusions (grandiose, jealous, persecution and reference), hallucinations (auditory and

visual), hostility, loose associations, disorganized behavior, social withdrawal and restricted
emotions.

D. DRUG STUDY
BANGUED, ABRA
DRUG STUDY NO.1
GENERIC/
BRAND
NAME
CLASSIFICATION MECHANISM
OF
ACTION
CONTRAIN-
DICATION
SIDE &
ADVERSE
EFFECT
NURSING
IMPLI-
CATION
EVALUATION
Haloperidol/
Haldol
Antipsychotic A butyrophenone
that probably
exerts
antipsychotic
effects by
blocking post
synaptic
dopamine
receptors in the
brain.
Hypersensitivity
to drug and
those with
Parkinsonism,
coma or CNS
depression
CNS: severe
extra pyramidal
reactions,
dyskinesia,
seizures,
lethargy
CV:
hypotension,
tachycardia
GI: anorexia,
constipation,
dry mouth
- Monitor
patient for
tardive
dyskinesia
which may
occur after
prolong use.
- Watch for
signs and
symptoms of
extra
pyramidal
effects
- Tell client to
relieve dry
mouth with
sugarless
candy
DOSAGE INDICATION THERAPEUTIC
EFFECTS
PRECAUTION
5 mg tablet
once a day
Psychotic Disorders Exerts
antipsychotic
effects to the
client
Use cautiously
in elderly
clients, those
with history of
seizures, CV
disorders and
those using
lithium.

BANGUED, ABRA
DRUG STUDY NO.2
GENERIC/
BRAND
NAME
CLASSIFICATION MECHANISM
OF
ACTION
CONTRAIN-
DICATION
SIDE &
ADVERSE
EFFECT
NURSING
IMPLI-
CATION
EVALUATION
Chlorpromazine Antipsychotic A piperidone
phenothiazine
that may block
post synaptic
dopamine
receptors in the
brain.
Hypersensitivity
to drug and
those with
Parkinsonism,
coma or CNS
depression
CNS: severe
extra
pyramidal
reactions,
dyskinesia,
dizziness,
drowsiness
CV:
tachycardia
GI: nausea
constipation,
dry mouth
-Monitor
blood pressure
regularly.
- Watch for
orthostatic
hypotension
-Monitor for
tardice
dyskinesia
-Watch for
signs and
symptoms of
neurolyptic
malignant
syndrome
-Advise client
not to chew
extended
release capsule
before
swallowing
DOSAGE INDICATION THERAPEUTIC
EFFECTS
PRECAUTION
100 mg capsule
once a day
Psychotic Disorders Exerts
antipsychotic
effects to the
client
Use cautiously
in elderly
clients, those
with history of
seizures, CV
disorders and
respiratory
disorders

IV. NURSE PATIENT INTERACTION
A. PROCESS RECORDING
ORIENTATION PHASE (JULY 06, 2009)
OBJECTIVES:
 to establish rapport and trust and cooperation
 to establish roles and purposes of the meeting
 to identify client’s problems and clarify expectations
ASSESSMENT:
 Wears pink dress with a face towel at her back
 Well groomed with good personal hygiene with good posture and gait
 Has good eye contact during interaction, good mood and appropriate affect
 Well oriented on time, place and identity
 Well nourished with fair skin
 Spontaneous speech and with relevant answers
 Able to recall past experiences and relate to the present situation and reality
 Alert and had good judgment and reality

ORIENTATION PHASE (July 7, 2009 – 1:00 Pm)
NURSE CLIENT THERAPEUTIC
COMMUNICATION
RATIONALE
Magandang Hapon po,
kumusta po kayo?
Okay naman ako,
magandang hapon
din.
Giving recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Ako po si Roderick
Ancheta, and magiging
student Nurse ninyo.
Tawagin mo naang po
akong Rhod. Galing po
ako Sa Divine Word
College of Bangued.
Simula po sa araw na ito,
July 7, 2009 makakasama
niyo po ako at
makakausap hanggang sa
susunod na Linggo, July
16, 2009. Magsisimula po
tayo ng alas otso ng
umaga hanggang alas tres
ng hapon. Pag-uusapan po
natin ang inyong mga
karanasan at mga dahilan
kung paano po kayo
napunta ditto. Lahat po
ang pag-uusapan natin ay
mananatiling sikreto at
tayo lamang pong dalawa
ang nakakaalam.
Ganun ba? Giving Information This gives the
client an
overview what
were the reasons
why you were
there and make
her aware what
are the
boundaries of
the interaction,
the purposes,
the time and
place and who
were to be
involved
Tapos na po akong
magpakilala, pwede po
bang kayo naman po ang
magpakilala?
Ako si Charito
Laureano, naktira
sa Marikina City.
Providing General
Leads
It encourages
the client to
continue what
she is saying
and that the
nurse is active
in listening.
Ilang taon nap o ba kayo? 48 years old na
ako.
Seeking information Helps the client
facilitate
thoughts,
feelings and
ideas clearly.

Matagal na po ba kayo
rito?
Fourteen years na
ako rito pero
yung 6 years,
pabalik-balik ako
at yong walong
taon diretso
hanggang ngayon.
Seeking Information Helps the client
facilitate
thoughts,
feelings and
ideas clearly.
Maari po ba ninyong
ilahad kung ano po ang
dahilan kung pano po
kayo napasok ditto?
Ipinasok ako ng
tatay ko ditto
tsaka gusto ko na
ding magpahinga
at magrelax.
Exploring Helps them both
the client and
the nurse to
examine the
issue more
fully.
Ano po sa palagay ninyo
ang dahilan kung bakit
kayo ipinasok na tatay
niyo rito?
Di ko na maalala.
Basta ipinasaok
nlang nila ako
rito.
Seeking Information
Ano po ba ang trabaho
ninyo dati at nasabi po
ninyong pagod na kayo?
Bale tinutulungan
ko lang yong
tatay ko sa
pagtitinda?
Seeking Information
Ano po ung mga itinitinda
ninyo?
Mga pare parts ng
mga sasakyan
Seeking Information
Ano pong kurso ang
tinapos ninyo, maari kop o
bang malaman?
Business
Management ako
sa University of
the East.
Seeking Information
May mga gusto pa po ba
kayong sabihin sakin?
Wala na Rhod. Offering self Making oneself
available and
showing interest
and concern to
the client let
them feel more
comfortable and
will develop
further trust.
Cge po Nanay Charito,
bukas po ulit ha.
Magsisimula nap o tayo
ng alsa otso ng umaga.
Mag-isip po kayo ng mga
ikukwento ninyo sa akin
ha.
Sige, maraming
salamat. Paalam
Giving Recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.

WORKING PHASE (July 08, 2009)
OBJECTIVES:
 To identify issues and concerns causing problems
 To guide client to examine feelings and responses
 To develop coping skills and more positive self image
 To examine consistency of thoughts and ideas
ASSESSMENT:
 Well dressed with pink dress
 Well groomed with pink hair band
 With good eye contact during interaction and oriented on date, time, place and
identity
 With euthymic mood and appropriate affect
 With hand tremors on both hands
 Spontaneous speech, consistent answers to questions asked
 Has good communication skills, insight and judgment
 Alert, able ti think abstractly and make generalizations

WORKING PHASE (DAY 1 – July 8, 2009)
COMMUNICATION
RATIONALE
Magandang Hapon po,
Nanay Charito.
Magandang
umaga din Rhod.
client indicates
the she is
acknowledge
and recognize as
a person.
Napansin ko po, bagong
ligo na kayo, kumusta po
ang araw ninyo.
Maaga kasi akong
nagising kaya
naligo na ako.
Masaya ako dahil
andito ka na
naman.
Making observations To make them
aware what are
their actions and
what the client
feels.
Maaari niyo po bang
ilahad kung ano yung
ginawa natin kahapon?
Nagpakilala tayo
sa isa’t isa at
pinag-usapan
natin kung bakit
ako andito?
Summarizing This seeks to
bring out the
important points
of the
discussion and
increase
awareness to the
client
Ano po uli yung dahilan
kung bakit po kayo
andito?
Gusto ko lang
magrelax at
magpahinga
Seeking information
Ganun po ba. Kapag wala
po tayong activity ano po
ung kadalasan ninyong
gingawa?
Kumakanta
lamang ako.
Seeking information
Ano po ung paborito
ninyong kanta?
Kahit anong
religious song
Seeking Information
Ano naman po ung mga
nasa isip at nararamdaman
ninyo kapag kayo ay
kumakanta ng religious
song?
Gumagaan
pakiramdam ko
dahil di ako
pinababayaan ng
Diyos.
Encouraging
expression
Encouraging the
client to make
her own
appraisal rather
than to accept
opinions from
others.
Sa activity po natin kanina
na Music and arts therapy,
ano po ang nararamdaman
ninyo habang ginagawa
ang activity?
Masaya at medyo
malungkot?
Encouraging
expression
Ano pong dahilan at Naalala ko kasi Seeking information

nasabi po ninyong
malungkot?
yong mga anak
ko at pamilya ko.
Ang ibig niyo po bang
sabihin ay gusto nap o
ninyong umuwi at
maksama ang pamilya
ninyo?
Oo, gusto ko nang
umuwi.
Translating into
feelings
This technique
is to verbalize
clients feeling
of what she said
indirectly
Ano naman po yung mga
naiisip ninyong paraan o
solusyon para makauwi na
kayo?
Magpapakabuti
ako ditto at
sinusunod ko
yunmg mga
sinasabi ng mga
nurses at doctor.
the client and
the nurse to
examine the
issue more
fully.
Ano naman po ang una
niyong gagawin kapag
nakalabas na kayo ditto?
Magsisimba ako
para
magpasalamat sa
Diyos at
mamamasyal
kaming buong
pamilya
Seeking information
Maari niyo po bang
ibahagi sa akin tungkol sa
inyong pamilya?
May tatlo akong
anak, dalawang
lalaki at isang
babae.
Seeking information
Nasaan po sila ngayon? Nag-aaral sila Seeking information
Sino po ang nag-aalaga sa
kanila?
Yung tatay at
asawa ko.
Seeking information
Ano po ba ang pangalan
ng asawa at Tatay Ninyo?
Fernando yung
asawa ko at yung
tatay ko eh
clarito.
Seeking information
Ano po yung trabaho nila? Wla nasa bahay
lang yung asawa
ko, ung tatay ko
naman ay nasa
shop.
Seeking information
Sinabi po ninyo kahapon
na gusto niyo ppong
magpahinga at magrelax.
Iyon lang po ba ang
dahilan?
Pagod na kasi ako
eh, kaya gusto ko
nang magpahinga.
Seeking information
Sa palagay niyo po ba
makakapgpahinga po kayo
rito kung andito po kayo?
Oo, kasi konti
lang yung mga
ginagawa.
Seeking information
May gusto pa po ba
kayong ibahagi sa akin?
Wala na Rho. Offering Self

Sige bukas ulitCharito. Salamat, Paalam Giving Recognition
DAY 2 (July 9, 2009)
COMMUNICATION
RATIONALE
Magandang umaga po
Nanay Charito, andito na
naman ako para kausapin
kayo.
(Client smiled)
Magandang
Umaga din
Giving recognition
Offering self
Kumusta po ang tulog
niyo?
Mabuti naman Seeking information
Kumain nap o ba kayo? Katatapos lang at
uminom nari ako
ng gamut.
Seeking information
Mabuti po kung ganun.
Sige po magsimula na
tayo
(Client smiled) General leads
Tungkol pos a napag-
usapan natin na paborito
niyo pong kanta, ano ulit
ang mga yun?
Mga religious
songs. Gusdto mo
kumanta ako.
(Client sung)
Clarifying Clarifies further
knowledge and
understanding
on what is
verbalized
Wow, ang galling pop ala
ninyong kumanta.
Salamat Giving recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Saan po ninyo natutunan
yun?
Sa simbahan
naming, active
kasi ako doon.
Seeking information
Ano naman po ang
pangalan ng simbahan
ninyo?
Jehovas Witness Seeking information
Ano naman po ung mga
naaalala ninyo sa
simbahan ninyo?
Masaya (Client
become silent)
Seeking information
Maari po ba ninyong
sabihin sa akin?
(Client become
silent)
Silence Making silence
let the client
formulate and
organize ideas
and makes feel
the client that
she is

understood and
with
companion.
May sasabihin pa po ba
kayo sa akin?
Wala na. Seeking Information
Sige po Nanay Charito,
bukas po ulit. Punta na po
tayo dun sa mga
kasamahan natin at may
gagawin po tayong
activity.
(Client smiled
and just followed)
Giving Recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
DAY 3 (July 10, 2009)
COMMUNICATION
RATIONALE
Magandang umaga po. Magandang
umaga din
client indicates
the she is
acknowledge
and recognize as
a person.
Kumusta naman kayo
ditto?
Mabuti naman at
nakakatulog din
Seeking information
Napansin kop o kanina
nung nag-eexercise po
tayom parang matamlay
po kayo, maaari niyo po
bang sabihin sa akin ang
dahilan?
Naiisip ko lang
yung mga anak
ko. Parang
nakikita ko sila
kapag andito ka.
Making Observations To make them
aware and to
know what
really the client
feels
Ano po bang pangalan ng
mga anak ninyo?
Yung panganay,
si Clarence, 19
taon na siya,
tapos si
Frederick, 18
naman at tsaka si
Ruth, magteten
years old na siya.
Seeking information
Saan po nag-aaral yung
mga anak ninyo?
Si Clarence, sa
UST. Nursing din
siya kagaya mo.
Si Frederick ay sa
UE, civil
engineering at si
Ruth sa POLA.
Seeking information

Ang gagaling pala ng mga
anak ninyo Nanay
Charito.
Salamat Giving Recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Habang pinag-uusapan po
natin sila, parang naluluha
po kayo, ano po ang
dahilan?
Namimiss ko na
kasi sila at
naaawa ako sa
kanila kasi di ko
sila maalagaan
dahil andito ako
sa Mental
Making Observations To make them
aware what are
their actions and
what the client
feels.
Sige po, ipagpatuloy niyo
lang.
Lalo na ksi yung
bunso, di ko siya
naalagaan at
nagyon malaki na
siya at pasalamat
ako di siya
pinabayaan ng
Diyos.
Giving general leads
Kahapon sa activity natin,
ang saya-saya po ninyo.
Opo Giving recognition Greeting the
client indicates
the she is
acknowledge
and recognize as
a person.
Nanalo nga rin po kayo sa
mga games, ano po ang
nararamdaman ninyo?
Masay, kahit
papano
nakakalimutan ko
yung mga
problema ko at
para rin sa mga
anak ko yun,
inspirasyon ko
kasi sila.
Encouraging
expression
Encouraging the
client to make
her own
appraisal rather
than to accept
opinions from
others.
Ano pa po? Miss ko na sila,
gusto ko nang
umuwi.
Giving general leads
Sige po Nanay Charito,
hanggang sa susunod ulit.
May gagawin po tayo
nagyon, puntahan nap o
natin yung mga kasama
natin.
Sige (client
smiled)
client indicates
the she is
acknowledge
and recognize as
a person.

DAY 4 (July 13, 2009)
COMMUNICATION
RATIONALE
Hello po Nanay Charito,
magandang umaga.
Andito na naman po ako.
Magandang
umaga din
client indicates
the she is
acknowledge
and recognize as
a person.
Ano po ang
nararamdaman ninyo?
Masay kasi may
makakausap na
naman ako.
Seeking information
Giving recognition
Pwede niyo po bang
sabihin sa akin yung mga
napag-usapan natin noong
nakaraang lingo?
Marami.
Nagmusic and
arts tayo, tapos
may palaro at
tsaka yung
bugtungan na
bingyan natin ng
mga importansiya
yung mga sagot.
Summarizing. This seeks to
bring out the
important points
of the
discussion and
increase
awareness to the
client
Ano po ang naaalala
ninyong bugtong?
Di ko sigurado
yung tanong, pero
yung sagot ay
yung gatas ng
ina?
Clarifying Clarifies further
knowledge and
understanding
on what is
verbalized
Napansin ko po nung
Makita ninyo yung
larawan, napahawak po
kayo sa inyong dibdib,
ano po yung naalala
ninyo?
Unaware naman
ako dun sa
nagawa ko.
Naalala ko lang
yung mga anaqk
ko lalo na yung
bunso.
Making observations To make them
aware what are
their actions and
what the client
feels.
Ano po yung mga naalala
ninyo tungkol sa inyong
mga anak?
Lahat kasi sila
nagbote lang, di
ko sila napasuso.
Maganda pala ang
gatas ng ina.
Seeking informations
Iyon lang po ba ang
dahilan?
Oo Seeking information
May mga gusto pa po ba
kayong sabihin?
Wala na. Seeking information
Sige nanay Charito,
pumunta nap o tayo sa
mga kasamahan natin.
Sige Giving recognition.

DAY 5 (July 15, 2009)
COMMUNICATION
RATIONALE
Magandang umaga nanay
Charito.
Magandang
umaga din Rhod.
client indicates
the she is
acknowledge
and recognize as
a person.
Kumusta po ang tulog
ninyo?
Mabuti naman. Seeking information
Kumain nap o ba kayo? Oo, inom na rin
ng gamut.
Seeking information
Ano pong petsa ngaun ang
anong araw?
July 14 ay nagyon
ay Miyeskules.
Seeking information
Magaling. Tama po. (client Smiled) Giving recognition
Sa tuwing nag-uusap po
tayo, ano po yung mga
naaalala ninyo?
Mga anak ko,
miss na miss ko
na kasi sila at
yung mga lugar
na parati naming
pinupuntahan.
Seeking information
Saan po yung mga lugar
na parati ninyong
pinupuntahan?
Sa Batangas,
Palawan, tapos sa
Thailang nung
nagtour kami.
Seeking information
Ano po yung ginagawa
niyo dun kapag
pumupunta po kayo?
Nagsuswimming
kami,
namamasyal at
kumakain.
Seeking information.
Kung sakali po,
makakalabas kayo ditto,
saan po yung lugar na
pupuntahan ninyo at ano
yung mga gagawin ninyo?
Sa Batangas,
magsuswimming
kami. Tapos
punta kami sa
Mall. Bibili kami
ng maraming
pagkain,
mamamasyal
kahit saan kasama
ang mga anak ko.
the client and
the nurse to
examine the
issue more
fully.
May gusto pa po ba
kayong sabihin sa akin?
Wala na. Offering self
Sige po, puntahan na natin
yung mga kasama natin,
may activity po tayo ulit.
Sige. Salamat
(Client smiled
and followed)
Giving recognition.

TERMINATION PHASE (July 15, 2009)
COMMUNICATION
RATIONALE
Magandang umaga po
Nanay Charito.
Ganu din sayo
(Client smiled)
client indicates
the she is
acknowledge
and recognize as
a person.
Kumusta po kayo? Mabuti naman Seeking information
Ngayon pong araw na ito,
bale ito nap o yung huli
nating pagsasama’t pag-
uusap. May kunti po
tayong programa at
maaasahan kop o ba ang
kooperasyon ninyo?
Ganun ba, sige. Giving Information
AFTER THE PROGRAM
Nag-enjoy po ba kayo? Nag-enjoy naman Seeking information
Sige po, hanggang ditto
nalang po an gating pag-
uusap Nanay Charito.
Maraming salamat pos a
inyong kooperasyon at
tiyaga sa pakikinig sa
amin.
Maraming salamat
din. Paalam
(client shoke
hands with me)
Giving recognition

B. LIST OF NURSING DIAGNOSIS (NANDA)
CUES NURSING DIAGNOSIS JUSTIFICATION
SUBJECTIVE:
OBJECTIVE:
>talks to self frequently
> leaves area suddenly
without explanation
>poor concentrations
>Has difficulty
maintaining
conversations
Disturbed sensory perception
related to loneliness and
isolation as evidenced by
talking to self frequently,
leaves suddenly without
explanations, poor
concentration and has
difficulty in maintaining
conversations.
Disturbed sensory perception
should be given first priority
for the client may manifest
untoward behavior towards
self and other clients due to
misinterpretation of stimuli
SUBJECTIVE:
>Gusto ko nang umuwi,
miss ko na mga anak ko.
OBJECTIVE:
>poor eye contact at
times
> grimacing
> hand tremors
> restless
Anxiety related to prolong
rehabilitation as evidenced by
grimacing, poor eye contact at
times, hand tremors and
restlessness.
Anxiety level of the client
should be given importance
for it will also lead the client
to danger if uncontrolled.
Therefore, it should monitored
and managed for the client’s
safety
SUBJECTIVE:
>Malungkot ditto kapag
walang student nurse.
OBJECTIVE:
>sadness
> poor eye contact at
times
>absent of significant
others
>isolates self in room
most of the time
Social Isolation related to
sadness, poor eye contact at
times, absent of significant
others and isolation of self in
room most of the time.
Social isolation would be the
last for it requires least
nursing interventions but it
should also be given
importance for the benefit and
success of the clients
rehabilitation. The client will
be able to develop social skills
and social acceptance if it is
properly given appropriate
nursing interventions.

BANGUED, ABRA
Nursing Care Plan 1
CUES BACKGROUND
KNOWLEDGE
PATIENTS
PROBLEM
OBJECTIVE OF
INTERVENTIONS
NURSING ACTIONS AND
RATIONALE
SUBJECTIVE:
OBJECTIVE:
>talks to self
frequently
> leaves area
suddenly without
explanation
>poor
concentrations
>Has difficulty
maintaining
conversations
The client
experience
disturbed sensory
perception which is
incongruent with
actual stimuli. In
this case, the client
misinterpreted and
acts contrary to
what is real.
Disturbed sensory
perception related
to loneliness and
isolation as
evidenced by
talking to self
frequently, leaves
suddenly without
explanations,
poor
concentration and
has difficulty in
maintaining
conversations.
After Nursing
interventions, the
client will
demonstrate ability
to hold conversation
without hallucinating
and ceases to talk to
self.
>Establish a therapeutic relationship.
_To gain client’s trust
>Orient the client continuously to actual
environment, events and activities.
_Frequent orientation helps to present
reality to the client
>Call the client by name.
_Using correct names reinforce reality are
reducing hallucinations.
>State your reality about the client’s
hallucinating experience.
_The client is helped to distinguish the
actual voices which promote reality.
>Use clear and distinctive voice
_To avoid misinterpretations
>Encouraged the client to engaged in
activities
_Activities are alternatives and distractions
to hallucinations
>Accept and support feelings of the client
_This convey empathy and understanding
which reduces fear or anxiety.

BANGUED, ABRA
Nursing Care Plan 2
CUES BACKGROUND
KNOWLEDGE
PATIENTS
PROBLEM
OBJECTIVE OF
INTERVENTIONS
NURSING ACTIONS AND
RATIONALE
SUBJECTIVE:
>Gusto ko nang
umuwi, miss ko
na mga anak ko.
OBJECTIVE:
>poor eye contact
at times
> grimacing
> hand tremors
> restless
Uneasy feeling of
discomfort
accompanied by
autonomic
response. The client
experiences anxiety
for she thought that
she’ll be discharged
and be
accompanied by her
family.
Anxiety related to
prolong
rehabilitation as
evidenced by
grimacing, poor
eye contact at
times, hand
tremors and
restlessness.
After Nursing
interventions, the
client’s leve; of
anxiety will be
lessened.
>Provide therapeutic Environment
>Be available to client at all times
_to make the client’s feel valued and has
importance.
>Stay at the clients and provide a
comfortable environment.
_To make client’s feel valued and relieves
the level of anxiety and releases tension
>Encourage client to engage self in
activities
_Activities helps the client divert attention
from anxiety and from undesirable
behaviors.
>Encourage client to acknowledge and
express feelings
_To explore the cause of feeling of
apprehension.

BANGUED, ABRA
Nursing Care Plan 3
CUES BACKGROUND
KNOWLEDGE
PATIENTS
PROBLEM
OBJECTIVE OF
INTERVENTIONS
NURSING ACTIONS AND
RATIONALE
SUBJECTIVE:
>Malungkot ditto
kapag walang
student nurse.
OBJECTIVE:
>sadness
> poor eye
contact at times
>absent of
significant others
>isolates self in
room most of the
time
Aloneness
experienced by the
individual are
perceived as
imposed by others
and as a negative or
threatening state.
Social Isolation
related to sadness,
poor eye contact
at times, absent of
significant others
and isolation of
self in room most
of the time.
After nursing
interventions, the
client will be able to
engage self in all
social activities
actively and
verbalize willingness
to social interactions.
>Provide therapeutic Environment
> Provide a positive reinforcement when
client makes moves towards others.
_It encourages continuation of efforts.
>Promote participation in activities.
_This facilitates socialization
>Engage other client to interact with the
client
_this promotes social skills in a safe
setting.
>Help the client seek out clients to
socialize with who have similar interest.
_Shared common interest promote more
enjoyable socialization which may be
repeated.
>Praise the client for attempts to seek out
others for activities and interactions
_Praises promotes repeated positive social
behavior.

V. THERAPIES
1. ACTIVITIES OF DAILY LIVING - An activity done by an individual which is
necessary for the promotion of good personal hygiene which can be done with or
without assistance/ supervision to an individual
Objectives:
1. To promote and improve personal hygiene and grooming
2. To promote self-independence
3. To encourage participation
4. Evaluation through return demonstration
5. To develop awareness on home management and community
development
6. To develop interpersonal relationship
2. PLAY/RECREATIONAL THERAPY - A technique that makes it possible for the
patient to express himself. Free play enables the individual a unique opportunity to
discharge strong motion n a secure atmosphere. It is also a form of Psychotherapy for
regressed psychotics to an extent of making its impossible to communicate with them
through verbal channels
Objectives:
1. To help patient interact with other patients in a slightly competitive but
thoroughly enjoyable level, manner.
2. The client will be able to express themselves through acceptance and
enjoyable mans.
3. To promote diversion from usual routinely experienced by the client in
favor of a more dynamic activities.
4. To promote cooperation and sportsmanship
5. Allow free expression of feelings and thoughts.
The first activity was not actually a game but we made it as a part of
getting to know each other, it was an action song “Kumusta Ka”. First, the
facilitator explains the mechanics of the game. That first, we will sing the song
and then turn to the other client until the student nurse will be able to reach her/his
partner. Then, the student nurses will kept their name tags and each client will
name five of them, the client who will be able to name five will be given a price.
The second game was “Hep Hep Hurray”, as a general rule, the client who
will not be able to follow the direction will be out, and only one client will be the
winner and have a grand prize while each client was given a consolation prize.

The third game was also an exercise which we made it as a game, the
“lean forward, and lean backward”. The song was sung the student nurses
together with the client. Each client will be sitting and follow the action. A client
who will not be able to follow will be out of the game. The song was sung faster
and faster until only one will be left and never committed a mistake, she will be
declared as the winner.
INTERPRETATION AND ANALYSIS:
With this therapy, the client showed interest and became a winner at one
game, the “Hep Hep, Hurray”. She showed competitiveness and very active. This
time, she said that this activity we’ve done was a good diversional activity for her
to forget her problems.
3. MUSIC AND ART THERAPY - Is the opportunity for socialization and self
expression and sometimes realization affected by certain musical activities. Art
therapy is the process by letting the patient expresses his feelings and thoughts
through various artistic means particularly sketching and drawing. One type of
therapy with purposeful use of music and arts as a participative or listening
experienced in the treatment of the patient to improve and motivate their mental and
emotional state
Objectives:
1. To know as a diagnostic tool, collecting signs and symptoms to supply
psychiatric and to give correct diagnosis.
2. To release past trauma in life unconsciously.
3. To interpret psychological drawing
4. To discuss emotional problem and to give reasons and ideas regarding
such problems
5. To develop interpersonal relationship
During this activity, we gave each client one bond paper and a set of
crayons. Then, we played a happy and fast music. We let them draw what they
feel and later they interpreted it. Secondly, with the set of crayons and another
bond paper, we played a sad and slow music and we let them also draw what they
really feel. Since my client has hand tremors, she was not able to finish her
activity until the song had finished, so we played again the song until all of them
were finish doing the activity.

INTERPRETATION AND ANALYSIS:
My client had drawn a grain which she said symbolizes as the main source
of food. And she also added that she misses her grandfather who was a farmer
before. During the sad music, she had drawn a mango and papaya fruit which she
explained that she miss to eat those fruits, because of long rehabilitation she was
not able to have and eat those favorite fruits of her.
4. BIBLIO-THERAPY - Use of literature, film or feature on creative writing with
group discussion to promote self-acknowledgement and inter action of thoughts and
feelings. Enhances patient’s awareness regarding an article of material s well as it
increase with the information and content of such reading materials. It stimulates the
inner self by expressing their feelings regarding with given story
Objectives:
1. To stimulate the psychological, sociological and aesthetic values from
books into human character, personality and behavior
2. To provide stimulus for the memory to compare events with their own
interpersonal and intra psychic experience.
3. To increase level of understanding with information from the reading
materials.
In this therapy, we used “Bugtungan”. We made ten riddles written in a
cartolina and each answer corresponding to each riddle was drawn in a bond
paper. One by one, each client read the riddle and picked the picture of the
answer. After they all answered, we gave importance each answer and we ask also
what they know about the picture. Each client was very willing to answer and the
activity was done smoothly.
5. OCCUPATIONAL THERAPY - Any activity mental and physical guided to an
individual to recover from a handicap.There is an increasing awareness that process
and not the product of the process is the greatest importance. Manual recreational and
creative technique to facilitate personal experiences and increase social responses and
self esteem

Objectives:
1. To improve general performance
2. To obtain essential skills of living
3. To assist in symptom reduction
4. To increase the sense of accomplishment, satisfaction and control
over one’s own life
5. To increase social responses
6. To increase self-esteem
6. REMOTIVATION TECHNIIQUE - Is a technique of every simple group therapy
of an objective nature used in an effort to reach the wounded areas of the patient’s
personality and get them moving in the direction of reality
Objectives:
1. To stimulate client to think about something and talk about himself
2. To develop ability to communicate and share idea and experience with
others
3. To develop feeling of acceptance and recognition.

VI. CONCLUSION AND RECOMMENDATIONS
As a result of the study and interaction of the client, the following conclusion are
being gathered and seen:
 There is a great influence of the family and significant others in the
development and progression of the illness.
 Severe religiosity can cause a disorder when really obsessed to the religious
affiliation itself.
 Schizophrenia can be manageable with the aid of the family as the main
source of strength and hope of the client.
 Clients who develop this kind of disorder have a connection to their
development task which were unmet that makes them vulnerable to stress.
 In relation to their treatment, psychotherapies were used for the rehabilitation
and will prepare the clients for their recovery and readiness to face challenges
when they go outside the center.
 In relation to the management and interventions, close monitoring and
guidance were important for the safety of the client especially for the
recurrence of the signs and symptoms of the illness.
The following are the recommendations:
 Constant visitation should be done to the client in order for them to feel
valued and cared by the family.
 Close monitoring should be done to client in order not to develop the
recurrence of symptoms which are harmful to them and to other clients.
 Therapeutic communication should always be used and observed for clients
not to be offended for they were already at the rehabilitation area, they have
absolutely feelings to be hurt and may feel rejection.

VII. NARRATIVE REPORT
July 06, 2009
It was the first day of our duty at the National Center for Mental Health. To be
honest, I was so nervous. The time when our service van entered the gate of NCMH, my
heart beated so fast and I begun trembling because it was the very first times I entered in
a mental hospital and soon dealing with clients with different type of disorders.
We waited in front of PAGASA Hall when we arrived. We waited for the
orientation program to start as a part of the routine before starting our exposure at the
institution. We saw lots of students from different schools that will also have their
affiliation in the said institution. As we finally entered the hall, the anxiety I felt lessened
because of the accommodating speakers like Mrs. Lucila o. Espinoza, the chief nurse.
She was so good in speaking. She did talk about therapeutic techniques and therapeutic
communications. The second speaker talked about the history of NCMH and the
orientation was done smoothly. After the orientation, we went to our designated Pavilion
together with our clinical instructor, Mrs. Myra P. Locquiao. She was good and very
vocal. We were assigned to Pavilion 10 at the Rehabilitation area and I think we were so
lucky because we had already a good teacher, and at the same time we had a good
ambiance. We didn’t yet get inside the ward but we’d already seen the place were we are
assigned. The day and the time had gone fast and we went home after a very exciting day.
And from the endeavor we had that day I can say that I learned a lot!
July 07, 2009
It was the second day of our duty at the National Center for Mental Health. This
day, we had our Self-Awareness. One by one, we shared our experiences in life, our
weaknesses and strengths, our limitations and our goals in life. Most of us cried because
we were able to recall some of our painfull experiences in the past. We finished the self-
awareness with a half day session, just in time for us to have our break for lunch.
In the afternoon, our Clinical Instructor gave us some briefing before we entered
our assigned pavilion. At first, I was not at ease during our first time to enter, but as time
passed by, my anxiety was relieved. Finally I met my client. Her name was Charito.
She’s nice and friendly. We had our orientation for a short period of time because our
stay inside was limited during that time. Since we were assigned at a rehabilitation area,
it was easy with us to mingle with our clients because they are already manageable. The
notion I had that the clients are harmful was changed because of the way the clients
accepted us. We ended our interaction and we went home with smiles on our faces.

July 08, 2009
It was a pleasant Wednesday morning. The day came to spend our whole day stay
at the Pavilion 10 where we were assigned. It was a busy day for us and to our clients.
As I observed during the activities inside the area, all clients were so active and
participative with the activities. Later on, we watched and observed for remotivation
therapy, what to be done and what to be discussed. It was demonstrated by a staff and it
went so good because of the willingness and active participation of the group. The
discussion was all about vegetables, what they get from them and how to make different
things out from vegetables to make them beneficial to our healthy living. It was exciting
and remembering because of the very bright ideas the clients have. After the activity, we
had a follow up sharing about the activity and went out from the area.
At exactly 1:00 PM, we entered the area together with our instructor and
interacted with our clients. After a while, we gathered and went as a group at the pantry
for our next activity. We started with an exercise in order to boast up their energy and
motivate them. Our activity was music and arts. I, together with Delmar facilitated the
activity and as a warm up, we asked them what they know about music and arts therapy
and I couldn’t believed that everybody wanted to answer. First, we played a fast music
and we let them draw what they felt while listening to the fast music and afterwards, one
by one explained their works. Secondly, we also played a soft and sad music and we let
them also draw what they feel and think when they heard a sad music and later on, we let
them also explained individually. We ended up the activity with their snacks and the
activity gone smoothly and also we enjoyed it and I learned a lot including the mechanics
and what to do consider in order for the activity to be interesting and memorable to our
clients.
July 09, 2009
It was already our fourth day of duty at the Pavilion 10. We joined their flag
ceremony and exercises and had a short interaction with our clients. I was so happy
because my client had a good mood for the day, she evenly sung a song for me and in
return, I did it too. I observed to my client that she always singing a religious song
whenever I talked to her about singing and music. In the afternoon, I was shocked how
my client turned to have an untoward action for she said that she will be discharged. She
dressed up and ready to go home. After a few minutes, and maybe realizing that she will
not be discharged, we changed her dress with their usual dress at the Pavilion joined our
activity, and this time, the activity we had was play therapy. We played the Hep Hep
Hurray, Kamusta Ka, and Lean Forward. It was so funny because I didn’t expect that all
of them were competitive even the other clients who were very silent and rare to talk.

They were willing to get the prize and declared to be winners. And one more thing was,
when we played the lean forward, we even tend to give up because as we sung the song
and became faster and faster, our three competitors were very good and no one ever to be
a loser, so that’s why we declared the three of them to be winners after a very long rally.
It was an overwhelming experience and I was happy again because of what had happened
even we’re a little bit tired, at least, we had given them happiness and we gave our best
for them feel that they were also people who were longing for happiness.
July 10, 2009
It was our last day or the first week of our duty at National Center for Mental
Health. And it was an interesting day for me for I will be given a chance again to
discover more about the reason why my client was brought to the center. In the early
morning, we joined them on their flag ceremony and their exercises. I was little bit
embarrassed because sometimes I was not able to follow their steps for I admit that I was
not a good dancer, but even just like that, I enjoyed and I hope that it would be beneficial
for me to enhanced my dancing skills.
After our clients had finished the necessary things they were doing everyday, I
had my interaction again with my client and a little while, we’d went to the pantry for our
next activity. This day, the activity we’ve done was one of the forms of bibliotherapy, it
was Bugtung-bugtungan. We prepared ten questions and all the answers were drawn and
they only picked the answers. Each answer of the corresponding riddles were given
importance by asking the clients what they think about and from this activity, I learned
that this form of therapy will give the clients to explore more and express their own
feelings as we dig more about their lives. We ended up with snacks and gave them
rewards for their active participation.
In the afternoon, we did not enter at the area for we had our discussions and
evaluated the activity we had in the morning. As we all know that evaluation was very
important in order for us to know our weaknesses and what to be improved for the
betterment of the succeeding activities to be done. We’d go home with good smiles on
our faces as we remember our clients.
July 13, 2009
It was not a good Monday morning for it was raining very early. The journey to
Pavilion 10 continued as we go to our duty. As we waited for the flag ceremony, we
cutted out the necessary materials needed for our first activity this morning, art therapy.

For this activity, we prepared cut outs for them to form and this would enhance their hand
coordination for their roper manipulation and placement of every cutted parts for the
activity.
Since the rain stopped pouring for a while, we entered our designated area and
interacted with our clients and joined them on their routine activities like the flag
ceremony and their daily exercise and after, we proceeded to the pantry for their activity.
Since it was an art therapy, it was simple and meaningful even we have our companion
school at the pantry, we ended our activity successfully and the output od each client was
a butterfly and a flower. As a summary and generalization of what they have done, we
asked them their interpretation of the activity and what they felt while doing the activity.
They shared their ideas and expressed their feelings. I had the chance also to interact with
my client and followed up our activity and she told me that it was her first time to do that
activity and cited that she was happy because she had her name and the corresponding
student nurse in the activity and she misses to see butterflies especially during her
childhood years. I learned that doing this kind of activity, we were given the chance to
explore more about our clients and give them the chance to recall their happy moments in
life.
July 14, 2009
A good and pleasant Tuesday morning. It was the time we observed socialization
activity from other schools but before that, I had an interaction with my client. This gave
me the chance to know more about my client and had a follow up on the things she had
done and I had noticed especially her attitude upon seeing the breastfeeding mother
during our activity with riddles. And out from this, she stated that she was unconscious
on what she had done and remembering her children because she didn’t have the chance
to breastfed her children during their childhood years.
In the afternoon, we had our chart reading. Here, I had seen the true condition of
my client. On the things she had stated during our interaction, almost all of them were
correct but she didn’t elaborate much of the true reasons why she had been on the center
for several years. I also discovered that she was religiously disturbed because of the cues
she uttered during her stay at the center and during the onset of her condition and this was
maybe the reason why she was at the center right now. She was been to the center for
fourteen years but not consecutively. She was able to go out and be together with her
family but later on go back to the center again. I ended the day with having so many
questions on my mind why there are people having those kinds of problems and how
their own family surpass and cope up with the situation.

July 15, 2009
Its Wednesday again, and only two days left for our stay at the National Center
for mental Health. This day, we had our music therapy. We sung the song together and
one by one, we asked them what the meaning of the song they had sung was. As a part of
it, we gave the time for our clients to show their talents, they sung after the other and so
with the student nurses. After all, we gave them their prizes as we promise for their active
participation during the art and bibliotherapy.
In the afternoon, we had our reporting by two’s. We presented our reports and our
clinical instructor had her questions and the necessary supplementations. We ended the
day with bright ideas as she explained more and shared what she had.
July 16, 2009
The grand socialization day came. The day to say goodbye to our clients. The
time to share our remaining times we were together with different schools here in Metro
Manila. Since, it was already our last day at the institution, I learned a lot from here and
we hope that we had done our parts. Even though we had only short period staying and
dealing with our clients we had already developed trust between us student nurses ad so
with our clients. From this socialization, we hope still gave them happiness by means of
the presentations and games we prepared for them.
And this day I thought would be the most remarkable and embarrassing moment
during my stay at the national Center for Mental Health because of unfortunate things
that was happened before and during the socialization and not to elaborate further. This
time, we saw also our clinical instructors from different schools showing their singing
talents, and of course our clinical instructor also did her part. During my stay at the
National Center for Mental Health, I learned a lot, even though its hard to say goodbye,
but it’s a must. Before we went out form the area where we had our two weeks duty, we
gave out token for our patients as a sign of thanksgiving for their active participation and
cooperation and also to the warm welcome they had given to us.

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