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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.
3à #&|#|$|9

ëccording 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. ës 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. ënd from this case, the client tend to blame her mother for the
development of the condition.
3à |"#

) 2

 2  48 y/o

!

2 February 17, 1961

!

 : Marikina City

! : 98 Malaya Street, Malanday Marikina City

  !: Female

0 "

: Married


 
%: Filipino

|  : Jehovas Witness


  

)
: College Graduate


 ) : July 11, 2001

#)  ) : 2:40 PM

)

 % 2

  )

: ëccording 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.

)

  : Undifferentiated Schizophrenia, Chronic and Unstable

  2 Undifferentiated Schizophrenia, Manageable

 %: National Center for Mental Health, Mandaluyong City

3à &$#

ëccording 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.

3à &"#|(|"#""

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.

3à "#$&"#|(

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. ëccording 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. ët
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.
3à "#|"&"#|(

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.

&3à "#$&"#|(

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. ëccording 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.

3à "#"&"#|(

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.

3à &("$#""""$#
3à ||

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.

3à |&|##(

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.

3à |##

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.

3à #$

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.

3à #&&#|""##

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.

3à $$|( |"#|$#

 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.

3à 5$#

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.

&3à "&#

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.

3à ##

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.

53à $&"$"

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.

93à "$&"$

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. ënd 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.

3à "(&#&&("(

3à "(&($"

ëccording 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. ë 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. ës 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. ët 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. ënd
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.

%  
 ) 

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. BëTESON (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. BëTESON used the term double bind to
explain these ideas of contradictory messages.

)
   0! )

 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. ëlternatively, 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.

 
0  


ëlso, 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.


 8"
! $ 

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

:$ $ 2

   

 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

!  )
!%

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. ëlso, 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.

3à |""|###|"

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. ës 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.

3à "(&#&(

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.à DRUG STUDY

|
 |
|"#(31

|: ""# $&"$ #|8 "; |" #

|  # |" $8
$ # # #
Haloperidol/ ëntipsychotic ë butyrophenone Hypersensitivity CNS: severe - Monitor
Haldol that probably to drug and extra pyramidal patient for
exerts those with reactions, tardive
antipsychotic Parkinsonism, dyskinesia, dyskinesia
effects by coma or CNS seizures, which may
blocking post depression lethargy occur after
synaptic CV: prolong use.
dopamine hypotension, - Watch for
receptors in the tachycardia signs and
brain. GI: anorexia, symptoms of
constipation, extra
dry mouth pyramidal
effects
" # #&|# |#
- Tell client to
#"
relieve dry
5 mg tablet Psychotic Disorders Exerts Use cautiously mouth with
once a day antipsychotic in elderly sugarless
effects to the clients, those candy
client with history of
seizures, CV
disorders and
those using
lithium.
 |
 |
|"#(3+

|: ""# $&"$ #|8 "; |" #

|  # |" $8
$ # # #
Chlorpromazine ëntipsychotic ë piperidone Hypersensitivity CNS: severe -Monitor
phenothiazine to drug and extra blood pressure
that may block those with pyramidal regularly.
post synaptic Parkinsonism, reactions, - Watch for
dopamine coma or CNS dyskinesia, orthostatic
receptors in the depression dizziness, hypotension
brain. drowsiness -Monitor for
CV: tardice
tachycardia dyskinesia
GI: nausea -Watch for
constipation, signs and
dry mouth symptoms of
neurolyptic
" # #&|# |#
malignant
#"
syndrome
100 mg capsule Psychotic Disorders Exerts Use cautiously -ëdvise client
once a day antipsychotic in elderly not to chew
effects to the clients, those extended
client with history of release capsule
seizures, CV before
disorders and swallowing
respiratory
disorders
3à |"###|#

3à |""||

|##&".5(,6 +,,7/

5#"2

þà to establish rapport and trust and cooperation

þà to establish roles and purposes of the meeting

þà to identify client¶s problems and clarify expectations

""""$#2

þà Wears pink dress with a face towel at her back

þà Well groomed with good personal hygiene with good posture and gait

þà Has good eye contact during interaction, good mood and appropriate affect

þà Well oriented on time, place and identity

þà Well nourished with fair skin

þà Spontaneous speech and with relevant answers

þà ëble to recall past experiences and relate to the present situation and reality

þà ëlert and had good judgment and reality

 |##&".5%< +,,7=12,,)/

|" # #&|# |#

$$#
Magandang Hapon po, Okay naman ako, Giving recognition Greeting the
kumusta po kayo? magandang hapon client indicates
din. the she is
acknowledge
and recognize as
a person.
ëko po si Roderick Ganun ba? Giving Information This gives the
ëncheta, and magiging client an
student Nurse ninyo. overview what
Tawagin mo naang po were the reasons
akong Rhod. Galing po why you were
ako Sa Divine Word there and make
College of Bangued. her aware what
Simula po sa araw na ito, are the
July 7, 2009 makakasama boundaries of
niyo po ako at the interaction,
makakausap hanggang sa the purposes,
susunod na Linggo, July the time and
16, 2009. Magsisimula po place and who
tayo ng alas otso ng were to be
umaga hanggang alas tres involved
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.
Tapos na po akong ëko si Charito Providing General It encourages
magpakilala, pwede po Laureano, naktira Leads the client to
bang kayo naman po ang sa Marikina City. continue what
magpakilala? she is saying
and that the
nurse is active
in listening.
Ilang taon nap o ba kayo? 48 years old na Seeking information Helps the client
ako. facilitate
thoughts,
feelings and
ideas clearly.
Matagal na po ba kayo Fourteen years na Seeking Information Helps the client
rito? ako rito pero facilitate
yung 6 years, thoughts,
pabalik-balik ako feelings and
at yong walong ideas clearly.
taon diretso
hanggang ngayon.
Maari po ba ninyong Ipinasok ako ng Exploring Helps them both
ilahad kung ano po ang tatay ko ditto the client and
dahilan kung pano po tsaka gusto ko na the nurse to
kayo napasok ditto? ding magpahinga examine the
at magrelax. issue more
fully.
ëno po sa palagay ninyo Di ko na maalala. Seeking Information
ang dahilan kung bakit Basta ipinasaok
kayo ipinasok na tatay nlang nila ako
niyo rito? rito.
ëno po ba ang trabaho Bale tinutulungan Seeking Information
ninyo dati at nasabi po ko lang yong
ninyong pagod na kayo? tatay ko sa
pagtitinda?
ëno po ung mga itinitinda Mga pare parts ng Seeking Information
ninyo? mga sasakyan
ëno pong kurso ang Business Seeking Information
tinapos ninyo, maari kop o Management ako
bang malaman? sa University of
the East.
May mga gusto pa po ba Wala na Rhod. Offering self Making oneself
kayong sabihin sakin? available and
showing interest
and concern to
the client let
them feel more
comfortable and
will develop
further trust.
Cge po Nanay Charito, Sige, maraming Giving Recognition Greeting the
bukas po ulit ha. salamat. Paalam client indicates
Magsisimula nap o tayo the she is
ng alsa otso ng umaga. acknowledge
Mag-isip po kayo ng mga and recognize as
ikukwento ninyo sa akin a person.
ha.
 |9&".5%,> +,,7/

5#"2

þà To identify issues and concerns causing problems

þà To guide client to examine feelings and responses

þà To develop coping skills and more positive self image

þà To examine consistency of thoughts and ideas

""""$#2

þà Well dressed with pink dress

þà Well groomed with pink hair band

þà With good eye contact during interaction and oriented on date, time, place and
identity

þà With euthymic mood and appropriate affect

þà With hand tremors on both hands

þà Spontaneous speech, consistent answers to questions asked

þà Has good communication skills, insight and judgment

þà ëlert, able ti think abstractly and make generalizations

 |9&".(1=5%> +,,7/

|" # #&|# |#

$$#
Magandang Hapon po, Magandang Giving recognition Greeting the
Nanay Charito. umaga din Rhod. client indicates
the she is
acknowledge
and recognize as
a person.
Napansin ko po, bagong Maaga kasi akong Making observations To make them
ligo na kayo, kumusta po nagising kaya aware what are
ang araw ninyo. naligo na ako. their actions and
Masaya ako dahil what the client
andito ka na feels.
naman.
Maaari niyo po bang Nagpakilala tayo Summarizing This seeks to
ilahad kung ano yung sa isa¶t isa at bring out the
ginawa natin kahapon? pinag-usapan important points
natin kung bakit of the
ako andito? discussion and
increase
awareness to the
client
ëno po uli yung dahilan Gusto ko lang Seeking information
kung bakit po kayo magrelax at
andito? magpahinga
Ganun po ba. Kapag wala Kumakanta Seeking information
po tayong activity ano po lamang ako.
ung kadalasan ninyong
gingawa?
ëno po ung paborito Kahit anong Seeking Information
ninyong kanta? religious song
ëno naman po ung mga Gumagaan Encouraging Encouraging the
nasa isip at nararamdaman pakiramdam ko expression client to make
ninyo kapag kayo ay dahil di ako her own
kumakanta ng religious pinababayaan ng appraisal rather
song? Diyos. than to accept
opinions from
others.
Sa activity po natin kanina Masaya at medyo Encouraging
na Music and arts therapy, malungkot? expression
ano po ang nararamdaman
ninyo habang ginagawa
ang activity?
ëno pong dahilan at Naalala ko kasi Seeking information
nasabi po ninyong yong mga anak
malungkot? ko at pamilya ko.
ëng ibig niyo po bang Oo, gusto ko nang Translating into This technique
sabihin ay gusto nap o umuwi. feelings is to verbalize
ninyong umuwi at clients feeling
maksama ang pamilya of what she said
ninyo? indirectly
ëno naman po yung mga Magpapakabuti Exploring Helps them both
naiisip ninyong paraan o ako ditto at the client and
solusyon para makauwi na sinusunod ko the nurse to
kayo? yunmg mga examine the
sinasabi ng mga issue more
nurses at doctor. fully.
ëno naman po ang una Magsisimba ako Seeking information
niyong gagawin kapag para
nakalabas na kayo ditto? magpasalamat sa
Diyos at
mamamasyal
kaming buong
pamilya
Maari niyo po bang May tatlo akong Seeking information
ibahagi sa akin tungkol sa anak, dalawang
inyong pamilya? lalaki at isang
babae.
Nasaan po sila ngayon? Nag-aaral sila Seeking information
Sino po ang nag-aalaga sa Yung tatay at Seeking information
kanila? asawa ko.
ëno po ba ang pangalan Fernando yung Seeking information
ng asawa at Tatay Ninyo? asawa ko at yung
tatay ko eh
clarito.
ëno po yung trabaho nila? Wla nasa bahay Seeking information
lang yung asawa
ko, ung tatay ko
naman ay nasa
shop.
Sinabi po ninyo kahapon Pagod na kasi ako Seeking information
na gusto niyo ppong eh, kaya gusto ko
magpahinga at magrelax. nang magpahinga.
Iyon lang po ba ang
dahilan?
Sa palagay niyo po ba Oo, kasi konti Seeking information
makakapgpahinga po kayo lang yung mga
rito kung andito po kayo? ginagawa.
May gusto pa po ba Wala na Rho. Offering Self
kayong ibahagi sa akin?
Sige bukas ulitCharito. Salamat, Paalam Giving Recognition


(+.5%7 +,,7/

|" # #&|# |#

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

(?.5%1, +,,7/

|" # #&|# |#

$$#
Magandang umaga po. Magandang Giving recognition Greeting the
umaga din client indicates
the she is
acknowledge
and recognize as
a person.
Kumusta naman kayo Mabuti naman at Seeking information
ditto? nakakatulog din
Napansin kop o kanina Naiisip ko lang Making Observations To make them
nung nag-eexercise po yung mga anak aware and to
tayom parang matamlay ko. Parang know what
po kayo, maaari niyo po nakikita ko sila really the client
bang sabihin sa akin ang kapag andito ka. feels
dahilan?
ëno po bang pangalan ng Yung panganay, Seeking information
mga anak ninyo? si Clarence, 19
taon na siya,
tapos si
Frederick, 18
naman at tsaka si
Ruth, magteten
years old na siya.
Saan po nag-aaral yung Si Clarence, sa Seeking information
mga anak ninyo? UST. Nursing din
siya kagaya mo.
Si Frederick ay sa
UE, civil
engineering at si
Ruth sa POLë.
 ëng gagaling pala ng mga Salamat Giving Recognition Greeting the
anak ninyo Nanay client indicates
Charito. the she is
acknowledge
and recognize as
a person.
Habang pinag-uusapan po Namimiss ko na Making Observations To make them
natin sila, parang naluluha kasi sila at aware what are
po kayo, ano po ang naaawa ako sa their actions and
dahilan? kanila kasi di ko what the client
sila maalagaan feels.
dahil andito ako
sa Mental
Sige po, ipagpatuloy niyo Lalo na ksi yung Giving general leads
lang. bunso, di ko siya
naalagaan at
nagyon malaki na
siya at pasalamat
ako di siya
pinabayaan ng
Diyos.
Kahapon sa activity natin, Opo Giving recognition Greeting the
ang saya-saya po ninyo. client indicates
the she is
acknowledge
and recognize as
a person.
Nanalo nga rin po kayo sa Masay, kahit Encouraging Encouraging the
mga games, ano po ang papano expression client to make
nararamdaman ninyo? nakakalimutan ko her own
yung mga appraisal rather
problema ko at than to accept
para rin sa mga opinions from
anak ko yun, others.
inspirasyon ko
kasi sila.
ëno pa po? Miss ko na sila, Giving general leads
gusto ko nang
umuwi.
Sige po Nanay Charito, Sige (client Giving recognition Greeting the
hanggang sa susunod ulit. smiled) client indicates
May gagawin po tayo the she is
nagyon, puntahan nap o acknowledge
natin yung mga kasama and recognize as
natin. a person.

 (-.5%1? +,,7/

|" # #&|# |#

$$#
Hello po Nanay Charito, Magandang Giving recognition Greeting the
magandang umaga. umaga din client indicates
ëndito na naman po ako. the she is
acknowledge
and recognize as
a person.
ëno po ang Masay kasi may Seeking information
nararamdaman ninyo? makakausap na Giving recognition
naman ako.
Pwede niyo po bang Marami. Summarizing. This seeks to
sabihin sa akin yung mga Nagmusic and bring out the
napag-usapan natin noong arts tayo, tapos important points
nakaraang lingo? may palaro at of the
tsaka yung discussion and
bugtungan na increase
bingyan natin ng awareness to the
mga importansiya client
yung mga sagot.
ëno po ang naaalala Di ko sigurado Clarifying Clarifies further
ninyong bugtong? yung tanong, pero knowledge and
yung sagot ay understanding
yung gatas ng on what is
ina? verbalized
Napansin ko po nung Unaware naman Making observations To make them
Makita ninyo yung ako dun sa aware what are
larawan, napahawak po nagawa ko. their actions and
kayo sa inyong dibdib, Naalala ko lang what the client
ano po yung naalala yung mga anaqk feels.
ninyo? ko lalo na yung
bunso.
ëno po yung mga naalala Lahat kasi sila Seeking informations
ninyo tungkol sa inyong nagbote lang, di
mga anak? ko sila napasuso.
Maganda pala ang
gatas ng ina.
Iyon lang po ba ang Oo Seeking information
dahilan?
May mga gusto pa po ba Wala na. Seeking information
kayong sabihin?
Sige nanay Charito, Sige Giving recognition.
pumunta nap o tayo sa
mga kasamahan natin.
 (@.5%1@ +,,7/

|" # #&|# |#

$$#
Magandang umaga nanay Magandang Giving recognition Greeting the
Charito. umaga din Rhod. client indicates
the she is
acknowledge
and recognize as
a person.
Kumusta po ang tulog Mabuti naman. Seeking information
ninyo?
Kumain nap o ba kayo? Oo, inom na rin Seeking information
ng gamut.
ëno pong petsa ngaun ang July 14 ay nagyon Seeking information
anong araw? ay Miyeskules.
Magaling. Tama po. (client Smiled) Giving recognition
Sa tuwing nag-uusap po Mga anak ko, Seeking information
tayo, ano po yung mga miss na miss ko
naaalala ninyo? na kasi sila at
yung mga lugar
na parati naming
pinupuntahan.
Saan po yung mga lugar Sa Batangas, Seeking information
na parati ninyong Palawan, tapos sa
pinupuntahan? Thailang nung
nagtour kami.
ëno po yung ginagawa Nagsuswimming Seeking information.
niyo dun kapag kami,
pumupunta po kayo? namamasyal at
kumakain.
Kung sakali po, Sa Batangas, Exploring Helps them both
makakalabas kayo ditto, magsuswimming the client and
saan po yung lugar na kami. Tapos the nurse to
pupuntahan ninyo at ano punta kami sa examine the
yung mga gagawin ninyo? Mall. Bibili kami issue more
ng maraming fully.
pagkain,
mamamasyal
kahit saan kasama
ang mga anak ko.
May gusto pa po ba Wala na. Offering self
kayong sabihin sa akin?
Sige po, puntahan na natin Sige. Salamat Giving recognition.
yung mga kasama natin, (Client smiled
may activity po tayo ulit. and followed)
 #|$#&".5%1@ +,,7/

|" # #&|# |#

$$#
Magandang umaga po Ganu din sayo Giving recognition Greeting the
Nanay Charito. (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, Ganun ba, sige. Giving Information
bale ito nap o yung huli
nating pagsasama¶t pag-
uusap. May kunti po
tayong programa at
maaasahan kop o ba ang
kooperasyon ninyo?
ëFTER THE PROGRëM
Nag-enjoy po ba kayo? Nag-enjoy naman Seeking information
Sige po, hanggang ditto Maraming salamat Giving recognition
nalang po an gating pag- din. Paalam
uusap Nanay Charito. (client shoke
Maraming salamat pos a hands with me)
inyong kooperasyon at
tiyaga sa pakikinig sa
amin.
 3à "#|"""./

" |""" 5"##

"5#2 Disturbed sensory perception Disturbed sensory perception
related to loneliness and should be given first priority
isolation as evidenced by for the client may manifest
5#2 talking to self frequently, untoward behavior towards
>talks to self frequently leaves suddenly without self and other clients due to
> leaves area suddenly explanations, poor misinterpretation of stimuli
without explanation concentration and has
>poor concentrations difficulty in maintaining
>Has difficulty conversations.
maintaining
conversations

"5#2 ënxiety related to prolong ënxiety level of the client

>Gusto ko nang umuwi, rehabilitation as evidenced by should be given importance
miss ko na mga anak ko. grimacing, poor eye contact at for it will also lead the client
times, hand tremors and to danger if uncontrolled.
restlessness. Therefore, it should monitored
5#2 and managed for the client¶s
>poor eye contact at safety
times
> grimacing
> hand tremors
> restless
"5#2 Social Isolation related to Social isolation would be the
>Malungkot ditto kapag sadness, poor eye contact at last for it requires least
walang student nurse. times, absent of significant nursing interventions but it
others and isolation of self in should also be given
5#2 room most of the time. importance for the benefit and
>sadness success of the clients
> poor eye contact at rehabilitation. The client will
times be able to develop social skills
>absent of significant and social acceptance if it is
others properly given appropriate
>isolates self in room nursing interventions.
most of the time
 |
 |
! !  1
" 9| ##" 5#  |"#"
9 |$ #|#" |#
SUBJECTIVE: The client Disturbed sensory ëfter Nursing >Establish a therapeutic relationship.
experience perception related interventions, the _To gain client¶s trust
disturbed sensory to loneliness and client will
perception which is isolation as demonstrate ability >Orient the client continuously to actual
incongruent with evidenced by to hold conversation environment, events and activities.
actual stimuli. In talking to self without hallucinating _Frequent orientation helps to present
OBJECTIVE: this case, the client frequently, leaves and ceases to talk to reality to the client
>talks to self misinterpreted and suddenly without self.
frequently acts contrary to explanations, >Call the client by name.
> leaves area what is real. poor _Using correct names reinforce reality are
suddenly without concentration and reducing hallucinations.
explanation has difficulty in
>poor maintaining >State your reality about the client¶s
concentrations conversations. hallucinating experience.
>Has difficulty _The client is helped to distinguish the
maintaining actual voices which promote reality.
conversations
>Use clear and distinctive voice
_To avoid misinterpretations

>Encouraged the client to engaged in

activities
_ëctivities are alternatives and distractions
to hallucinations

>ëccept and support feelings of the client

_This convey empathy and understanding
which reduces fear or anxiety.
 |
 |
! !  +
" 9| ##" 5#  |"#"
9 |$ #|#" |#
SUBJECTIVE: Uneasy feeling of ënxiety related to ëfter Nursing >Provide therapeutic Environment
>Gusto ko nang discomfort prolong interventions, the _To gain client¶s trust
umuwi, miss ko accompanied by rehabilitation as client¶s leve; of
na mga anak ko. autonomic evidenced by anxiety will be >Be available to client at all times
response. The client grimacing, poor lessened. _to make the client¶s feel valued and has
experiences anxiety eye contact at importance.
for she thought that times, hand
she¶ll be discharged tremors and >Stay at the clients and provide a
OBJECTIVE: and be restlessness. comfortable environment.
>poor eye contact accompanied by her _To make client¶s feel valued and relieves
at times family. the level of anxiety and releases tension
> grimacing
> hand tremors >Encourage client to engage self in
> restless activities
_ëctivities 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.


 |
 |
! !  ?
" 9| ##" 5#  |"#"
9 |$ #|#" |#
SUBJECTIVE: ëloneness Social Isolation ëfter nursing >Provide therapeutic Environment
>Malungkot ditto experienced by the related to sadness, interventions, the _To gain client¶s trust
kapag walang individual are poor eye contact client will be able to
student nurse. perceived as at times, absent of engage self in all > Provide a positive reinforcement when
imposed by others significant others social activities client makes moves towards others.
and as a negative or and isolation of actively and _It encourages continuation of efforts.
OBJECTIVE: threatening state. self in room most verbalize willingness
>sadness of the time. to social interactions. >Promote participation in activities.
> poor eye _This facilitates socialization
contact at times
>absent of >Engage other client to interact with the
significant others client
>isolates self in _this promotes social skills in a safe
room most of the setting.
time
>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.
 3à #&|"

13à ##"( - ën 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

A 
0 2

1.à To promote and improve personal hygiene and grooming

2.à To promote self-independence
3.à To encourage participation
4.à Evaluation through return demonstration
5.à To develop awareness on home management and community
development
6.à To develop interpersonal relationship

+3à (:||##&|( - ë 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

A 
0 2

1.à To help patient interact with other patients in a slightly competitive but
thoroughly enjoyable level, manner.
2.à The client will be able to express themselves through acceptance and
enjoyable mans.
3.à To promote diversion from usual routinely experienced by the client in
favor of a more dynamic activities.
4.à To promote cooperation and sportsmanship
5.à ëllow 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 ³Kumusta 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 ³Hep 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
³lean forward, and lean backward´. The song was sung the student nurses
together with the client. Each client will be sitting and follow the action. ë 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.

 #||##(""2

With this therapy, the client showed interest and became a winner at one
game, the ³Hep 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.

?3à $"  |# #&|( - Is the opportunity for socialization and self
expression and sometimes realization affected by certain musical activities. ërt
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

A 
0 2

1.à To know as a diagnostic tool, collecting signs and symptoms to supply

psychiatric and to give correct diagnosis.
2.à To release past trauma in life unconsciously.
3.à To interpret psychological drawing
4.à To discuss emotional problem and to give reasons and ideas regarding
such problems
5.à 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.
 #||##(""2

My client had drawn a grain which she said symbolizes as the main source
of food. ënd 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.

-3à 8#&|( - 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

A 
0 2

1.à To stimulate the psychological, sociological and aesthetic values from

books into human character, personality and behavior
2.à To provide stimulus for the memory to compare events with their own
interpersonal and intra psychic experience.
3.à To increase level of understanding with information from the reading
materials.

In this therapy, we used ³Bugtungan´. 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. ëfter 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.

@3à ##&|( - ëny 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
 A 
0 2

1.à To improve general performance

2.à To obtain essential skills of living
3.à To assist in symptom reduction
4.à To increase the sense of accomplishment, satisfaction and control
over one¶s own life
5.à To increase social responses
6.à To increase self-esteem

63à |$###&B - 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.à To stimulate client to think about something and talk about himself
2.à To develop ability to communicate and share idea and experience with
others
3.à To develop feeling of acceptance and recognition.
3à "|$$#"

ës a result of the study and interaction of the client, the following conclusion are
being gathered and seen:

þà There is a great influence of the family and significant others in the

development and progression of the illness.

þà Severe religiosity can cause a disorder when really obsessed to the religious
affiliation itself.

þà Schizophrenia can be manageable with the aid of the family as the main
source of strength and hope of the client.

þà Clients who develop this kind of disorder have a connection to their

development task which were unmet that makes them vulnerable to stress.

þà 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.

þà 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:

þà Constant visitation should be done to the client in order for them to feel
valued and cared by the family.

þà 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.

þà 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.
3à ||#||#

5%,6 +,,7

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 PëGëSë 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. ës 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. ëfter 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.
ënd from the endeavor we had that day I can say that I learned a lot!

5%,< +,,7

It was the second day of our duty at the National Center for Mental Health. This
day, we had our Self-ëwareness. 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. ët 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.
 5%,> +,,7

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.
ës 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. ëfter the activity, we
had a follow up sharing about the activity and went out from the area.

ët exactly 1:00 PM, we entered the area together with our instructor and
interacted with our clients. ëfter 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.

5%,7 +,,7

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. ëfter 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. ënd 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.

5%1, +,,7

It was our last day or the first week of our duty at National Center for Mental
Health. ënd 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.

ëfter 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. ës 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.

5%1? +,,7

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. ës 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. ës 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.

5%1- +,,7

ë 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. ënd 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.
 5%1@ +,,7

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. ës 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. ëfter 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.

5%16 +,,7

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.

ënd 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.