Professional Documents
Culture Documents
Presented to
In Partial Fulfillment
Of the Requirements for the Degree
MASTER in NURSING major in
NURSING MANAGEMENT AND ADMINISTRATION
By
ACKNOWLEDGEMENT
This clinical research paper would not be accomplished
without the assistant and encouragement, support and guidance of
several people whom I am forever indebted with.
First I would like to thank God for bestowing me the
blessings and a beautiful mind even if at times it might be such
a wonderful mess. Without such Omnipotent Grace, none of these
are possible.
To my ever-loving family, friends and dear mentors for
their unyielding support upon my venture in finishing this paper
I salute your ever steadfast confidence you have given me
despite of my frailties and shortcomings upon accomplishing this
task.
My deepest gratitude to the Negros Occidental Drug
Rehabilitation Foundation, Inc. (NODRFI) staff especially to Dr.
Ernesto A. Palanca and Ms. Juvy A. Pepello for allowing me to
discover the struggles and beauty, triumph and despair as well
as the magnificence of the human mind that had been the source
of hope and motivation of the restoration and inspire
rehabilitation. Thus, the essential existence of the
institution.
And lastly, I dedicate this paper as a tribute to the
patient and to those who are suffering the same ailment. May
this paper serve as a penchant of hope that all is not lost; an
affirmation that you have capabilities in determining the course
of your own destiny. Thank you for trusting me and sharing with
me the fragile yet intricate longings, beautiful yet forlorn
dreams and allowing me to impart and to take a glimpse in your
battles with loneliness and despair. May you find your inner
purpose that will motivate you to be a blessing in humankind and
accept your condition as a gift rather than a curse, making most
of lifes clashing ironies into magnificent symphony.
TABLE OF CONTENTS
Page
Title Page
Approval Sheet
Table of Contents
List of Tables
List of Figures
Chapter I
i
ii
iii
iv
v
Introduction
Background of the Study
Statement of the Problem
Significance of the Study
Chapter II
Chapter III
Findings
Conclusion
Recommendation
References
Appendices
1
3
4
22
26
26
- Appendix A: Letters
- Appendix B: Assessment Tool
- Appendix C. NCP
-
28
28
29
38
43
46
43
48
54
58
List of Tables
Table
Page
45
48
Monitoring Chart
49
56
56
List of Figures
Figures
Page
27
Evaluative Scale
46
46
47
57
57
CHAPTER I
INTRODUCTION
Moods are typically transient things that shift from moment
to moment or day to day. While people's moods rise and fall,
most of it never become that extreme or uncontrollable. As
depressed as an average person might get, it won't take too much
for them to recover and start feeling better. Similarly, happy
and excited moods are not easily sustainable either, and tend to
regress back to a sort of average mood.
At times, emotions could stir an artistic drive that
creates a marvelous passion. Yet, sometimes it is deeply rooted
on a more serious pathology. It generates a fire that
potentiates an individual to be motivated or it personifies a
force to led life to a deeper essence. However to certain
people, it is the same fire that burns.
be the
Future researchers.
CHAPTER II
REVIEW OF RELATED LITERATURE
In contrast to people who experience normal mood
fluctuations are people who have Bipolar Disorder. People with
bipolar disorder experience extreme and abnormal mood swings
that stick around for prolonged periods, cause severe
psychological distress, and interfere with normal functioning.
Most people can't stay too depressed or too happy for any
length of time. A study suggests that emotional pain lasts for
12 minutes, anything longer than that is considered to be selfinflicted as it shows people would rather inflict pain on
themselves than spend 15 minutes with their own thoughts
(Sheridan, 2014).
Bipolar Disorder (also known as Manic-Depression, or
sometimes Bipolar Affective Disorder), is a category of serious
mood disorder that causes people to swing between extreme,
severe and typically sustained mood states which deeply affect
their energy levels, attitudes, behavior and general ability to
function. Bipolar mood swings can damage relationships, impair
job or school performance, and even result in suicide. Family
and friends as well as affected people often become frustrated
and upset over the severity of bipolar mood swings.
Bipolar moods swing between 'up' states and 'down' states.
Bipolar 'up' states are called Mania, while bipolar 'down'
often they felt the way described on a four point scale that
ranged from never to often.
Hildegard Peplau (Forchuk,2014) a legendary nurse theorist,
introduced a theory of interpersonal relationships in nursing.
She argued that the purpose of the nurse-client relationship is
to provide effective nursing care leading to health promotion
and maintenance. Within the nurse-client relationship, the nurse
adopts one or more of six helping roles when providing care:
stranger, resource person, teacher, leader, surrogate, and
counselor. A seventh role, technical expert, was added later
(Stockman, 2012). Although the seventh role was not included in
Peplaus original theory, all the roles will be referred to as
Peplaus helping roles in this article as is customary in the
nursing literature.
The stranger role occurs when the nurse and the client
first meet and become acquainted. They begin the relationship as
strangers, each with preconceived expectations for the first
encounter. The goal of the nurse is to establish the
relationship and build trust with the client. Peplau (Rust,
2012) believed that compassionate verbal and nonverbal
communication, a respectful approach, and nonjudgmental behavior
are essential to this role. Successful implementation of the
stranger role is the foundation for development of a therapeutic
Orientation
2.
Identification
3.
Exploitation
4.
Resolution
I. Orientation phase
Conceptual Framework
Peplau (Rust, 2012) defines man as an organism that
strives in its own way to reduce tension generated by needs.
The client is an individual with a felt need. Healthcare
professionals are considered to be any individuals who provide
services to promote the physical and mental well-being of others
and to care for those who are ill or injured. Peplau (Rust,
2012) described nursing as "a significant, therapeutic,
interpersonal process. It functions co-operatively with other
human processes that make health possible for individuals in
communities. Nursing is an educative instrument, a maturing
force, that aims to promote forward movement of personality in
the direction of creative, constructive, productive, personal
and community living". Lack of growth, for whatever reason,
implies impaired health in the individual and basic human needs
must be met if a healthy state is to be achieved and maintained
(Forchuk,2014).
The relationship of nurse and patient is influential in the
outcome for the patient; People may assume a number of roles and
have the capacity for empathy in relationships (Rust, 2012);
People tend to behave in ways which have worked in the past when
faced with a crisis (Forchuk,2014); Anxiety and tension arise
from unmet or conflicting needs, and the energy which arises may
Assumption
Nurse and patient can interact. Peplau stresses that
both the patient and nurse mature as the result of the
therapeutic interaction. Communication and interviewing
skills remain fundamental nursing tools. Peplau believed
that nurses must clearly understand themselves to promote
their clients growth and to avoid limiting clients
choices to those that nurses value. It is assumed that the
nurse will utilize Hildegard Peplaus Interpersonal
Relations Theory in the care of the bipolar patient in
response to UCLA (University of California, Los Angeles)
Loneliness Scale,in determining patients level of tendency
towards loneliness.
Definition of Terms
Important terms in this study were defined conceptually and
operationally:
Bipolar. Formerly called manic depression, is a mental illness
that brings severe high and low moods and changes in sleep,
energy, thinking, and behavior.
Environment. Existing forces outside the organism and in the
context of culture
Health. A word symbol that implies forward movement of
personality and other ongoing human processes in the direction
PATIE
NT
Socially
Withdrawn
RESOLUTION PHASE
EXPLOITATION
PHASE
IDENTIFICATION
Severe
Tendency
Towards
Loneliness
PHASE
ORIENTATION
PHAS
E
Nurse
Patient
Relations
hip
WellRounded Person
with Restored
Socialization,
Nurse as
a:
v Stranger
v Teacher
v Resource
Person
v Counselor
v Surrogate
v Leader
Confidence, Self
Integrity and
Effective Coping
Mechanism.
PATIENT
A Schematic Diagram Depicting the Relationship of Utilizing the
Effectiveness of Peplaus Interpersonal
Relations Theory practicing the Nurses Roles throughout the phases towards the
success of patients Rehabilitation.
36
CHAPTER III
Application of the Nursing Theory
Client Profile
Name: P. U.
Age: 16 years old
Sex: Male
Birthday: July 7, 1998
Address: Esteban Subdivision, Pulupandan, Negros Occ.
Civil Status: Child
Educational Attainment: 4th year High School Student
Religion: Roman Catholic
History of the Present Illness
The patient had manifest first depression upon returning
home from school one day having ambivalent expression and had
his packed lunch untouched. Since then, he consecutively had
bouts of sudden crying of getting restless and mad for no
apparent reason. He had been skipping classes and found to be
with peers who are having recent substance abuse records. He
would escape their house at the middle of the night and suddenly
resort to being a loner and complain having insomnia.
The patient then had been under the care of Dr. Charibel
Escandelor on June 2012. He exacerbated again late last year
(2013) and is presently still very symptomatic showing both
psychosis band very manic symptoms. His folks have difficulty
keeping him at home and ensuring he takes his medicines. He
recently had a negative (-) drug test and has no known illness.
On March 24, 2014 he had been admitted at the Negros Occidental
Drug Rehabilitation Foundation, Inc. and and was discharged June
6, 2014 provided being still on strict medication and a monthly
ERIKSONs
PATIENT ANAMNESIS
A. Prenatal
v Mother is in good
condition
v Mother has no vices
and is not into drugs
v No illnesses during
pregnancy
B. Delivery
The Riverside
Hospital, Bacolod
delivery of baby
City
Infancy Period
Libido is
Trust V.
v Normal Delivery
v Mother is the most
significant person
v Father is a seaman
focused on the
Mistrust
and is absent at
mouth
Individual may
be frustrated
growing up
v Mother is always at
by having to
wait on
another
person, being
area
dependent on
v He has 5 siblings (2
another
person,
D. Anal Stage
Toddler Period
Autonomy Vs,
Shame and
Doubt
toilet
v Patient responded
positively with the
training
v Completed
immunization
v Patient did not
experience any
physical cruelty
v Patient was breastfed
until weaned during
2-3 years old while
transitioned with
bottle-feeding and
solid foods during 1
year old
E. Phallic Stage
Pre-School Period
(3-6 years
old)
Initiative Vs.
Guilt
F. Latent Stage
School Age
v Being active at
(6-12 years
old)
Industry Vs.
Inferiority
v Likes to play
football and enjoy
being with peers
G. Genital Stage
Adolescence
(12-18 years
old Above)
Intimacy Vs.
Isolation
v Started to try
smoking cigarettes
v Peer pressures
v Became a computer
addict
v Being hooked with RPG
games, had riot with
co-players and
experienced having
income solely on
bidding game
characters and items
via net
v Cellphone confiscated
once at school
because of pornviewing
v
Skipping school
hours and playing
games on computer
shops
v Always reprimanded
being leader of the
mischief in class
Good
Poor
Onset of Illness
A. Early 20 and above 40
B. Between 20 and 40
II.
Education Attainment
A. Highschool
B. College
III. Sex
A. Male
B. Female
IV.
A. Familial
B. None
V.
History of Admission
A. Chronic
B. Acute
VI.
Socio-Economic Status
A. Poor
B. Rich
VII. Family Support
A. With Family Support
Pre- Morbid
Personality
A. Introvert
B. Extrovert
C. Ambivert
IX.
Compliance to Medication
A. With Compliance
B. Without Compliance
Evaluation:
Patient overall has a good prognosis of his current
condition since the result of the evaluation shows 5 out of 9.
Having 4 negative or bad outcomes that can be wired easily in
patients good compliance to medication and treatment regimen so
there will be no exacerbation symptoms.
Patient
Inference
Smiles and
responds well
Smiles and
focuses more
on the
interaction.
Looks shyly
and slightly
withdrawn
Slightly
hesitant to
confide some
information
Open gesture
and lightly
respond to the
question
Silence
Remains
calm but
Encourage him to
quite
express feelings
distant
while proving him
time to organize
thoughts
Kadalum gid
(smiles
Encouraging expression
Somewhat
hesitant
sang
gently)..
To let him express
napanumdom ta
wala gid
emotions
sir aw?
man a.
Basi may
(smiles)
Suggesting collaboration Still
gusto ka
distant
To let the patient
ishare sir..
open up and
identify problems
while growing
emotionally with
others.
Sige sir a..
Dason lang
Translating into
Smiles and
indi ka pa
nurse a.
feelings
attentive
guro ready
Voicing what the
mag open up
patient has hinted
sharing..
Patient
Inference
Openly
responds
Falls silence
Responds
solemnly
Opens up
Reflects
deeply
Methodology
Assessment Tool
An adapted questionnaire the UCLA Loneliness Scale is used
as a measure of loneliness. Its name derives from its having
been developed at the University of California, Los Angeles
(UCLA). It was first published in 1978 by Russell, D., Peplau,
L.A., and Ferguson, M.L., and was revised in 1980 and 1996. The
internal consistency of the scale was high and the reported
correlations with measures of emotional loneliness, social
loneliness, self-esteem, depression, and personality traits,
supported the convergent and discriminant validity of the scale.
The scale consists of 20 items (11 positive and 9
negative), describing subjective feelings of loneliness, none of
which refers specifically to loneliness. A 20-item scale
designed to measure ones subjective feelings of loneliness as
well as feelings of social isolation. Participants rate each
item as either O (I often feel this way), S (I sometimes feel
this way), R (I rarely feel this way), N (I never feel this
way). The 20 items are rated on a 4- point Likert scale in
accordance with the rate of frequency, the following
corresponding weights were assigned to every response. Scores on
the scale range from 20 to 80 with higher scores reflecting
greater loneliness.
Using data from prior studies of college students, nurses,
teachers, and the elderly, analyses of the reliability,
validity, and factor structure of this new version of the UCLA
Loneliness Scale were conducted. Results indicated that the
measure was highly reliable, both in terms of internal
consistency (coefficient alpha ranging from .89 to .94) and
test-retest reliability over a 1-year period (r = .73).
Summation of MEAN
Frequency in
each
Scale
0
0
0
0
1
2
Never
Rarely
3
4
Sometimes 11
Always
9
Total/ Overall
Average
Mean Score
20
UCL
A
Scor
e
71
0.55
0.45
1
Summation MEAN
of
Frequenc
y in each
Scale B
3.55
80
0.89
UCLA Scoring:
Scale of Means
Description
4 (61-80)
3 (41-60)
2 (21-40)
1 (1-20)
UCL
A
Scor
e
Interpretation
of the Score
Scale of Means
Description
3.05 4.00
2.05 - 3.00
1.05 2.00
0.00 1.00
Relatively
Severe
Tendencyto
Loneliness
Relatively
Average
Tendency to
Loneliness
Incompletely
Answered
Questionnaire
Relatively
High Tendency
to Loneliness
During Initial
47
57
Planning Phase
Table 2. Nursing
Care Plan
ASSESSMENT
Subjective
Data:
v Nasubuan na ko di..
v Indi ko kisa mayo ka
tulog
gid.
v Wala pa sila ka bisita sa
akon
bi.
v Kadugay pa ko
makapuli
guru ni. Takan na ko
di.
v Subo e. La daan
kalingawan
gid.
Objective
Data
v Lack of goaldirected
behavior
v Use of forms of coping
that impede adaptive
behavior (including
inappropriate use
of defense mechanisms,
verbal
manipulation)
v Inability to meet role
expectation (no exercise,
poor concentration)
v Behavioral changes:
Impatience
Frustration
Irritability
Discouragement
NURSIN
G
DIAGNOSI
Ineffective
Coping
related to
depression
and
feelings of
hopelessn
es s as
evidenced
by
verbalizati
o n of
loneliness,
decreased
use of
social
support,
poor
concentrat
i on,
impatience
,
irritability,
insomnia,
lack of
energy,
non
participati
o n at
times, low
self
esteem
and a
score of
71 in
UCLA
which
indicate a
person
experienci
n g severe
loneliness
OBJECTIVES OF CARE
Within 14 days of nursing
intervention at NEGROS OCCIDENTAL
DRUG REHABILITATION CENTER the
patient will be able to:
1. Improve or increase
collaboration with the
rehabilitation nurse/staff.
2. Assess coping abilities and
skills.
3. Assist client to deal with
current situation:
a. Encourage communication
with staff/S.O.
b. Provide continuity of care
with the same personnel
taking care
of the client as often as
possible. c. Schedule
activities so periods of
rest alternate with nursing
care while increasing
activities slowly.
d. Assess client in use of
diversion, recreation,
relaxation techniques.
e. Encourage client to try
new coping behaviors while
confront when behavior is
inappropriate, pointing out
difference between words
and actions while providing
external locus of control,
enhancing safety.
4. Provide meeting
psychological needs.
5. Promote wellness.
a. Provide and encourage an
Table 3. Monitoring
Chart
Nursing
Intervention/
Rational
e
Independent:
1. Visit Mr. PU in
NEGROS
OCCIDENTAL DRUG
REHABILITATION
CENTER. Discuss the
purpose of the study
and interview will be
conducted. Establish
rapport with Mr. Pu.
[Establishing rapport
will increase patient
participation and
ease in date
gathering.]
2. Gather pertinent
data about Mr. PU
from
the NODRC
records and
staff.
[Baseline data will
serve as the basis
for comparison of
any significant
changes or
alteration.]
3. Observe Mr. PUs
self management
towards his illness
or towards the
signs and
symptoms of the
disease (Bipolar).
[Observation of his
reaction towards
illness will provide
significant data
and concrete
confirmation of his
Implementation Days
1 2 3 4 5 6 7 8 9 1 1 1 1 1
0 1 2 3 4
Evaluation/Outcom
es
After 14 days of
continuous
nursing
intervention,
effective illness
management of the
patient was
attained as
evidenced by:
1.
Increase
collaboration with
healthcare
providers.
2. Participate in his
plan
of care.
3. Exhibit self
esteem and
motivation.
4. Continuous
takes his
medication while
demonstrating
improvement in
rehabilitation.
5. Alleviate
sense of
despair, social
isolation and
loneliness.
Initiate Nurse
Patient Interaction
(NPI) with Mr. PU.
[Provide care
for clients in
need of
psychosocial
intervention.]
6.
Provide a
safe
environment
for the client.
[Physical
safety of the
client is a
priority.]
Allow client to
express
opinions,
perceptions,
emotions in
appropriate
and safe
manner while
providing
privacy if he
desires and it
is safe to do
so. [Client may
not feel
comfortable in
expressing
7.
or privacy.
8.
9.
Encourage
client to
ventilate
feelings in
whatever way
is comfortable
verbal and
nonverbal. Let
the client
know you will
listen and
accept what is
being
expressed.
[Expressing
feelings may
help relieve
despair,
hopelessness
and so forth.
Feelings are
not
inherently
good or bad.
You must
remain
nonjudgmental
about the
clients
feelings and
express this to
the client.]
Teach the
client about
problem
solving
process:
explore
possible
options
examine the
consequences,
of each
alternative,
select and
implement an
alternative,
and evaluate
problemsolving
process
facilitates the
clients
confidence in
the use of
coping skills.]
10. Provide
positive
feedback at
each step of
the process. If
the client is not
satisfied with
the chosen
alternative,
assist the
client to
select another
alternative.
[Positive
feedback at
each step will
give the client
many
opportunities
for success.
Encourage him
to persist in
problem
solving, and
enhance
confidence. The
client can also
learn to
survive
making a
mistake.
Dependent Nursing
Action:
11. Monitor intake
of daily
medication
(Olanzapine,
Haloperidol,
Valpros)
[Assures
adherence to
should be
followed.]
Collaborative
Nursing
Action:
12. Collaborate
with the
Rehabilitation
nurse in the
provision of
daily
medication.
[Continuum of
care.]
13. Review
endorsement
procedure and
referral
processes
followed in
NODRC
14. Coordinate
with the
psychiatrist,
Administrator,
nurse and
authorized
persons
regarding
every
interaction
and results or
progress with
the
intervention
taken on
the client.
15. Assist in
patients
taking of
assessment
tools and
follow up
results to be
Implementation Phase
The progress of Mr. PU on his coping up patterns were monitored and recorded for a
period of
14 days from November 24, 2014 to December 7, 2014. Reflected on the table
below are the changes of his behavioral pattern while the nursing interventions
were implemented throughout the 14day period.
Nursing
Diagnosis
Day 1
(November 24,
2014)
Day 2
(November 25,
2014)
Ineffective
Coping
related to
depression
and
feelings of
hopelessne
ss as
evidenced
by
verbalizatio
n of
loneliness,
decreased
use of social
support,
poor
concentratio
n
,
impatience,
irritability,
insomnia,
lack of
energy,
non
participatio
n at times,
low self
esteem
and a score
of
45 in UCLA
Difficulty in
socializing
with others
noted.
Looks
Busy doing
shyly and
slightly
withdrawn.
Slightly
hesitant
to confide
some
informatio
n.
UCLA
Loneliness
Scale
Questionna
ire had
been
answered
something
but openly
respond
when
approached.
Quite hesitant
but willing
to
participate
in
discussion.
Day 3
(November
26,
2014)
Remains
Day 4
Day 5
(November (November
27, 2014)
28,
2014)
Patient
Patient
takes
the
has been
calm but
Duilford
visited by
quite
Zimmer
friends.
distant
Responds
ma
n
Somewhat
solemnly
hesitant Tempera
m
ent
in deep
Slightly
Survey
in
reflection
drifting
the
Unattentiv
in
rehabilita
e
thought
ti
on.
Express
s
Quite
feelings
reflectiv
of
e
loneliness
Shares
and
missing a
a
cozy
bit of
atmospher
remorse.
e.
Reminisce
nce.
Day 6
(November 29,
2014)
Day 7
Day 8
(November 30, 2014) (December 1,
2014)
Present in the
Attended
activity but does
communio
not participate.
n.
Low energy
Participative and
Quite distant and
listens intently on
in deep thoughts
the homily.
Polite but
still
prefers to
be
undisturbed
.
Privacy given.
Nurse
and
patient
interactio
n
conducte
d.
Expresse
d feelings
of despair
and
loneliness
.
Delved
deeper
into cause
of
loneliness.
Patient
expressed
missing
past
activities
and
hobbies.
Patient
Day 9
Day 10
(December 2, (December 3
2014)
, 2014)
Patient is
ambivale
nt.
Joined in
the
activity
but lacks
enthusias
m
Patient
converse
with
other
patients
briefly.
Patient is
hesitant
at first in
interacti
ng with
the
activities
.
Patient
is
being
watchful
with
the
mechanics
of the
game.
Encourage
to
take part in
the game
and
cheered on
by both staff
and fellow
patients.
Day 11
(December 4
, 2014)
Day 12
(December 5
, 2014)
Day 13
(December 6
, 2014)
Patient is nostalgic
after viewing favorite
cartoons.
Patient is being
attentive in
discussion about the
cartoons.
Possible coping up
has been
established
especially in
motivating the
patient for planning
Patients
Attended
relatives
the
arrived.
Holy
Patient
Mass.
interacted in the Patient
living room with
interacte
the family.
d with
some
friends.
Answered
the UCLA
Loneliness
Scale
Patient
has
played
soccer
after school.
Patient eats
dinner
and
quite tiresome,
take
his
medicines, rest
for a bit while
watching his
favorite show
and finally get
to sleep.
Day 14
(December 7
, 2014)
Table 4. Final
Assessment Score
(final assessment phase)
Summation of
Frequency in
each Scale B
4
9
Mean Difference
MEAN
0.20
0.45
5
2
20
UCL
A
Scor
0.20
0.45
45
0.25
0.10
2.25
80
0.5
6
0.30
0.35
1.3
0
Scale
Value
1
2
Never
Rarely
3
4
Sometime 11
s
Always
9
Total/ Overall
Average
Mean Score
20
0.55
0.45
1
3.5
5
5
2
80
20
0.89
0.25
0.10
2.2
5
80
0.5
6
Mean
0.20
0.45
0.30
0.35
1.3
0
1.3
0
10.00%
0
Sometimes Always
3
Value Never
Always
Role
1
Count
Percent
Rarely Sometimes
2
0.00%
Evaluation Phase
The clients mean difference was extracted by subtracting
Mr. PUs initial assessment results of overall means from the
initial assessment results. Overall mean of 1.30 was observed
implying a significant improvement in clients tendency to
loneliness.
Findings
The overall mean score Mr. PU in the initial assessment is
3.55 that shows his relatively high tendency to loneliness.
After 14 days of nurse-patient interaction and provision of
nursing intervention, the clients overall mean score in the
final assessment decreased to 2.25. The mean difference from the
initial mean score is 1.30. This shows that there is improvement
from the clients tendency to severe loneliness to be relatively
tolerable while he keeps warding off from his loneliness
tendency.
Conclusion:
Through the statistical findings presented, it can be
concluded that by recognizing tendencies to loneliness of the
client is an essential assessment tool to be utilized in
Peplaus Nurse-Patient Interaction to further assist the patient
in his needs and to understanding condition thatcan be the key
to patients trust and further assistance to the restoration of
self-integrity and promotion of health. The 14 day trial is just
a short course and if the clients score keeps on improving in
moderating his inclination towards loneliness, self-esteem,
confidence, trust in others and successful rehabilitation would
be inversely attain.
Recommendation:
The utilization of UCLA Loneliness Scale Assessment
tool in resonance to Peplaus Interpersonal Relationship Theory
as a concrete measurement in determining the loneliness and the
gravity of emotional need and psychological support of the
patient is highly recommended. It is essential not only to the
psychologically challenged but also applicable to different
kinds of patients with regards to emotional stability of a
person.
References:
Bailey,
[PubMed]
2011;10:226230. [PubMed]
Gastmans C. Interpersonal relations in nursing: A
philosophical-ethical analysis of the work of
Hildegard E. Peplau. Journal of Advanced Nursing.
1998;28:13121319. [PubMed]
Howk, C (2012). Hildegard E. Peplau: Psychodynamic Nursing.
In A. Tomey & M. Alligood. Nursing Theorists and their
Work (7th ed., pp. 338). St. Louis, Mosby. Retrieved
from: http://en.wikipedia.org/wiki/Hildegard_Peplau
Lego S. The application of Peplaus theory to group
psychotherapy. Journal of Psychiatric and Mental
Health Nursing. 1998;5:193196. [PubMed]
National Institute on Drug Abuse. High school and youth
trends. 2011 Available at
http://drugabuse.gov/pdf/infofacts/HSYouthTrends.pdf.
Peplau, H.E. (1954). Utilizing themes in nursing
situations. American Journal of Nursing, 54, 325328.
doi:10.2307/3460657 [CrossRef]
Russell DW. UCLA Loneliness Scale (Version 3): Reliability,
validity, and factor structure. Journal of Personality
Assessment. 1996;66(1):2040. [PubMed]
Staff, Casa Palmera .Drug Abuse and Depression in Teens.
2010, Posted on Tuesday, January 5th, at 3:37 am.
Retrieved from
http://casapalmera.com/drug-abuse-and-
depression-in-teens/
Lippincott.
Appleton-Century-Crofts.
Zhou, S. X. (2012). Gratifications, loneliness, leisure
boredom and self-esteem as predictors of SNS-game
addiction and usage pattern among Chinese college
students. International Journal of Cyber Behavior,
Psychology and Learning, 2(4), 34-48. http://www.irmainternational.org
Weiss BM, Williams AR. The effects of sense of belonging,
social support, conflict, and loneliness on
depression. Nursing Research. 2011;48(4):215219.
[PubMed]
Noted:
Atty. JOSEPH GEDEONI C. VALENCIA RN, MN, Ph.D
CLINICAL PAPER ADVISER
Noted:
Letter to the
Patient
November 24, 2014
Mr. P.U.
Dear Sir,
The undersigned, a post graduate student of Northern Negros State College of
Science and
Technology, is currently undertaking a study of the patient with Bipolar
Diagnosis.
In connection with the above statement, I am humbly asking your
permission to allow me to conduct a study your case.
Your positive response on this matter is highly appreciated. It would be a
great privilege if you could shed light on this matter.
More power and God
bless! Respectfully
Yours,
Noted:
Appendix B
Assessment Tool
NEGROS OCCIDENTAL DRUG REHABILITATION
CENTER
Managed by:
NEGROS OCCIDENTAL DRUG REHABILITATION
FOUNDATION, INC.
Camp Gen. AnicetoLacson Compound, Victorias City, Neg. Occ.
PSYCHOLOGICAL ASSESSMENT
GUILFORDZIMMERMAN
TEMPERAMENT SURVEY
I. PATIENT INFORMATION
Patient: P.
U. Age: 16
y. o. Sex:
M
II. TEST RESULTS
RS
22
15
17
16
20
10
14
16
13
55
10
20
10
30
15
15
35
10
AA
VLA
BA
VLA
BA
VLA
BA
BA
BA
VLA
Results show that the patient displays a highly impulsive behavior. He tends
to act on the first thought that comes into his mind, without thinking about the
possible consequences his actions might bring. As a result of this behavior, he has
the tendency to get himself in trouble most of the time. It is also shown that his
energy level is higher compared to most people of his age and sex. This would mean
that he would enjoy doing activities at such a fast pace, as he does not get tired
quickly. He may get things done as fast as possible. There might be times where he
would get restless as well.
friends with him. Apart from his introversion, he is also shown to be too submissive,
meaning he is likely the one to follow rather than to lead. He is inclined to follow
whatever he is being told to do, even if he feels that he cannot handle the
responsibility given to him. It is also indicated that he has a hostile personality.
Because of this, people might find it hard to get along with him. He tends to have
an aggressive side which would come out when someone would provoke him. Also,
he seems to be fond of belittling and mocking others. Whenever one commits a
mistake, he is likely to make fun of that individual without being considerate of
his/her feelings.
Results also indicate that the patient may be suffering from a possible mood
disorder. His feelings tend to shift from time to time, without any reason. He seems
to be quite negative when it comes to himself. He may feel insecure most of the
time, especially when being watched and criticized by others. He does not appear to
take constructive criticisms lightly and would get affected easily. Also, he tends to be
emotionally expressive. He has no difficulty with showing his feelings to others.
Lastly, it is shown that he may have paranoia tendencies. He is usually suspicious of
those around him, and he may find it hard to trust people easily.
Prepared by:
Approved by:
Ms. Juvy
Pepello
Junior
Administrator
Psychologist
Appendix B
Assessment Tool
4321
4321
4321
4. I lack companionship
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
Scoring: Items 1, 5, 6, 9, 10, 15, 16, 19, 20 are all reverse scored.
Keep scoring continuous.
NCP |
81
Appendix C
Nursing Care
Plans NURSING
CARE PLAN # 1
ASSESSME
NT
Actual
Cues
NURSIN
G
DIAGNOS
Impair
ed
social
Subjective: interacti
on r/t
Self
The
patient
concept
verbalized
disturban
,
ce AEB
Discomfor
t in social
Kis indi
situations,
ko kabalo
receive a
panu
satisfying
ihambal
sense of
namean
social
ko na
engageme
maintindih
nt, family
an gid nila.
report of
Natayugan changes in
na sila
interaction,
dysfunction
kuno.
al
interaction
Wala ko
with
RATIONALE
Social
isolation is
the condition
of aloneness
expe rienced
by
the
individual
and
perceived as
imposed by
others and
as a
negative or
threatened
state;
impaired
social
interaction is
an insufficient
or excessive
quantity or
DESIR
ED
OUTCO
ShortTerm:
1. Verbalize
awareness
of factors
causing or
promoting
impaired
social
interactions
2. Identify
feelings that
lead to poor
social
interactions.
3. Express
desire to be
involved in
achieving
positive
changes in
NURSIN
G
INTERVENTI
Independent:
JUSTIFICATI
ON
EVALUATION
After 14 days
of Nurse
A. Assess
a. This may
Patient
causative/contr result
to
Interaction,
ibu ting factors. conforming or
the
rebellious
client will be able
pattern
/ behavior
to:
while
noting
Verbalize
prevalent
feeling that
interaction
lead to
B. Assist
pattern.
poor
patient/SO to
social
recognize/make
interactio
positive
n
b.
Once
changes in
GOAL
impaired social recognized,
MET
client
can
and
choose to
interpersonal
Involve in
change as he
interactions.
social
learns to listen
interaction.
and
GOAL
communicate
japon sa
trip
nila.
Objectiv
e:
v Discomfort
in social
situation
v Do not
ask
question
v Observed
lack
of
attention
during
activities
Insufficie
nt
or
excessive
quantity
or
ineffective
quality of
social
exchange.
interpersonal
relationships.
Long Term:
4.
Give self
positive
reinforceme
nt for
changes
that are
achieved.
5.
Develop
social
support
system; use
available
resources
appropriatel
y.
Source:
Nurses
Pocket
Guide
10th
Edition
by
Marilynn
E.
Doenges
,
Mary
Frances
Moorhou
se, Alice
C.
Mur
r
GOAL MET
C. Work with
client to
alleviate
underlying
negative self
concepts
Collaborative:
D. Promote
wellness by
seeking
community
programs for
client
involvement
that promote
positive
behaviors the
client
is striving to
c. Negative
self concept if
left
unresolved
often impede
positive social
interactions.
Attempts at
trying to
connect with
another can
become
devastating to
selfesteem
and emotional
well being.
D,There is a
direct
correlation
between the
musical
portion
of the brain
and the
language
area, and the
use of these
programs may
result
in
Assess for
environment
al withdraw
(time spent
in room
versus time
spent with
others).
GOAL MET
NURSING CARE
PLAN #2
ASSESSMEN
T
Actual
Cues
NURSING
DIAGNOSIS
Chronic Low
Self
Estee
Subjective:
m
r/t Feelings of
The
abandonment
patient
secondary to
verbalized
separation
,
from
significant
Nahuya na
other/s AEB
ko kis a kag
Longstanding
na guilty sa
self negating
napang himu
verbalizations,
ko,,
Expressions of
shame and
Wala ko
guilt, Poor body
pulos ya.. La
presentation
na ko
(eye contact,
putoro.
posture,
movements)
Objective:
Nonassertive/pass
ive
Emotionally
stressed.
Facial
Definition:
Longstanding
RATIONA
LE
Developme
nt of a
negative
perception
of self
worth in
response
to a current
situation.
Low self
esteem
disturbanc
e describe
as
negative
feelings
about
themselve
s,
including
the loss of
confidence
and self
esteem,
sense of
failure to
reach the
desire,
self
DESIR
ED
OUTCO
Short
Term:
1. Accept
support
through
the nurse
patient
relationsh
ip
2.
Identify
areas of
ineffecti
ve
coping
3.
Examine
the
current
efforts at
coping
4.
Identify
areas of
strength
5. Learn
new
NURSIN
JUSTIFICATI
G
ON
INTERVENTI
Independen
t:
a. When
areas of
A.
concern
Identify
are
current
verbalize
stresse
d by the
s in
patient,
PUs
he will
life
be able
includin
to focus
g
on one
bipolar
issue at
disorde
a time.
r
B. Assess
current
level of
depression
using UCLA
Loneliness
Scale.
b. If she
identifies
the
mental
disorder
as a
stressor,
he will
more
likely be
able to
develop
strategies
EVALUATION
Determin
e if he is
able to
realistical
ly
identify
problem
areas.
GOAL MET
Assess if
he can
identify
any
previous
successes
in her
life.
GOAL MET
Assess for
environme
ntal
withdraw
(time
spent in
Narrowed
focus
Feelings of
helplessness,
hopelessness,
or
powerlessnes
s
Confusion
about self,
purpose, or
direction of
life
Source:
Nurses
Pocket Guide
10th Edition
by Marilynn
E. Doenges,
Mary
Frances
Moorhouse,
Alice C. Murr
productivit
y,
which is
directed
destructive
to others,
feelings of
inadequacy
, irritable
and being
withdrawn
socially.
new
coping
skills.
7. Focus
on
strengths
C. Involve
PU in
treatment
and
socializati
on
activities.
Stress
importanc
e of
activity in
helping
recovery
from
depression
and that he
will have to
make a
conscious
effort to
fight
it.
c. By
focusing
on past
successe
s, he can
identify
strength
s and
build
on them
in the
future
d.
Severely
depressed
individual
s need
D. Assist
assistance
PU in
with
discussing, decision
selecting,
making,
and
Assess if
the
patient
follows
through
on
learning
new skills
and
learned a
lot about
his
medicatio
n and
committe
d in
complying
with his
medicatio
n
regimen.
GOAL
MET
Continue
to practice
new coping
skills as
stressful
situations
aris
e
GOAL MET
Collaborati
on: E.
Educate
regarding
the his
medicine
and
medical
regimen
such as his
therapy
and
session
with the
rehabilitati
on staff
with its
relationshi
p to
depression
F. Assist
patient in
e. By
keeping
individual
s who are
depressed
active,
social
withdraw
al is
prevented
.
f. Social
activity
helps the
client deal
with the
depression
. Patient
should
have a
thorough
knowledge
Nursing Care
Plan #3
ASSESSMENT
Actual Cues
NURSIN
G
DIAGNO
Ineffecti
ve
Subjective:
Individu
al
The
Coping
patient
r/t Altered
verbalized
mood
,
(depression)
caused by
changes
secondary to
body
Objective:
chemistry
(bipolar
disorder)
Decreased use
AEB
of social
Verbalization
support
in inability to
Destructive
cope or ask
for help
behavior
Reported
toward self
difficulty with
or others
life stressors
Difficulty
Inability to
asking for
problem
help
solve
Fatigue
Alteration in
Inability to
social
meet basic
RATIONAL
E
Ineffective
individual
coping may
be manifest
when a
person
verbalizes
an inability
to cope or
to ask for
help, is
unable to
meet basic
needs or
role
expectation
s, cannot
use
problem
solving
techniques,
has a high
rate of
illness or
accidents,
exhibits
destructive
behavior
DESIRE
D
OUTCO
Short
Term:
2. Accept
support
through
the nurse
patient
relationsh
ip
2.
Identify
areas of
ineffecti
ve
coping
3.
Examine
the
current
efforts at
coping
4. Identify
areas
of
strengt
h
NURSING JUSTIFICATI
INTERVENT ON
ION
A.
d. When
Identify
areas of
current
concern
stresses in
are
PUs life
verbalize
including
d by the
bipolar
patient,
disorder
he will
be able
to focus
on one
issue at
a time.
B. Assess
current
e. If she
level of
identifies
depression
the
using UCLA
mental
Loneliness
disorder
Scale.
as a
stressor,
he will
more
likely be
able to
develop
EVALUATION
Determin
e if he is
able to
realistical
ly
identify
problem
areas.
GOAL MET
Assess if
he can
identify
any
previous
successes
in her
life.
GOAL MET
Assess for
environme
ntal
withdraw
(time
spent in
room
needs and
role
expectations
Statements
indicating
inability to
cope
behavior
toward
self
Definition:
Inability to
form valid
appraisal of
the stressors,
inadequate
choices of
practiced
responses,
and/or
inability to
use available
resources.
Source:
Nurses
Pocket
Guide 10th
Edition by
Marilynn E.
Doenges,
Mary
Frances
Moorhouse,
Alice C.
Murr
(includin
g
excessive
eating,
drinking, or
other
illnesses
related to
emotional
tension, is a
chronic
worrier, or
exhibits
chronic
depression.
Long
Term:
6.
Practice
new
coping
skills.
7. Focus
on
strengths
C. Involve
PU in
treatment
and
socializati
on
activities.
Stress
importanc
e of
activity in
helping
recovery
from
depression
and that he
will have to
make a
conscious
effort to
fight
it.
D. Assist
PU in
discussing,
selecting,
and
f. By
focusing
on past
successe
s, he can
identify
strength
s
and build
on them
in the
future.
d.
Severel
y
depress
ed
individu
als need
assistance
with
Assess if
the
patient
follows
through
on
learning
new skills
and
learned a
lot about
his
medicatio
n and
committe
d in
complying
with his
medicatio
n
regimen.
GOAL MET
Continue to
practice
new coping
skills as
stressful
situations
aris
e
GOAL MET
E. Educate
regarding
the use of
alcohol
and its
relationshi
p to
depression
F. Assist
patient in
coping
with
bipolar
disorder,
beginning
with
education
about it
e. By
keeping
individual
s who are
depressed
active,
social
withdraw
al is
prevented
.
f. Social
activity
helps the
client deal
with the
depression.
Patient
should
have a