MALADAPTIVE PATTERNS OF

BEHAVIOR
Assessment of client Remotivation Technique
Process Recording Socialization
Music, Art Therapy Self-awareness
Occupational therapy Milieu Therapy
Psychodrama Case Presentation
 Nursing Process

* Organize & scientific way of giving

care to clients (individual, family,
group, or community) at any stage of
development & in any setting.
* It involves assessment, diagnosis,
planning, intervention, & evaluation.
R. A. # 9173 – “Philippine Nursing Act
of 2002”
“An Act Providing for a More
Responsive Nursing Profession,
Repealing for the purpose R.A. # 7164,
or the Phil. Nsg. Act of 1991 & for
other purposes”.
Sec. 28. Scope of Nursing
Duties & responsibilities of a
nurse.
 Assessment

I. Gather Data
A. Interview
Follow the phases of NPI
Establish NPR
Utilize therapeutic communication technique
Demonstrate caring attitude
B. Observe
C. Read existing record
D. Read related literature
2. Analyze data
Compare data with the standard
* Anything that is not within the
standard is a cue to a problem

* Nursing Diagnosis
Psychiatric Interview
(important aspects)

A. Management of Time: 30 minutes – 1 hour.

B. Seating arrangement & position:

1. Both chairs should be of equal heights.
2. Place the chairs without any furniture
between the caregiver & the nurse.
3. Nurse & client should sit facing each
other with an arm-length or 2 ft.
distance.
 4. Nurse should be in a relax position,
leaning forward (not very relax, no crossing of
arms nor legs)
5. If the interview is done inside a room, the
door should be left open & sit closest to the
open door, with no obstruction from the
clinician to the door.
6. Clinician should sit with available space
at her back.
7. A 3rd person should always be available.
C. Interviewer’s attire:
D. Note taking:
E. Subsequent interviews:
 Psychiatric History
I. Chief complaint: (in the patient’s own word)
II. History of present illness:
1. Predisposing factors
2. Precipitating factors
III. Previous Illnesses:
1. Psychiatric
2. Alcohol & other substance history
IV. Personal History (Anamnesis)
* understand the patient’s past life & its
relationship to present emotional problem
A. Prenatal & perinatal
* was the pregnancy planned & wanted?
* any health problem during pregnancy?
* was the mother abusing alcohol & other substances
during pregnancy?
* were there problems with the mother’s pregnancy &
delivery?
* what was the mother’s emotional & physical state at
the time of the person’s birth?
* were there any evidence of defect or injury at birth?
B. Early childhood (through age 3)
* Feeding habits - breastfed or bottle-fed, eating problems
* Early development: language, motor & physical; maternal
deprivation, separation anxiety, stranger anxiety, other
caretakers in the home, signs of unmet needs.
 * Toilet training: Age, attitude of parents, feelings about
it.
* Symptoms of behavior problems: thumb sucking,
temper tantrums, head bumping, rocking, night terror, fears,
bedwetting, nail biting, excessive masturbation.
* Personality as a child: shy, restless, overactive,
withdrawn, persistent, outgoing, timid, athletic, friendly.
* Early or recurrent dreams or fantasies.
C. Middle Childhood (ages 3 – 11)
* gender identification
* punishment used in the home.
* who provided the discipline & influenced early
conscience formation?
* early school experiences & how separation from
mother was tolerated.
* earliest friendships & personal relationships.
 * social participation in group or gang activities.
* history of learning disabilities, their
management & their effects to the child.
* presence of nightmare, phobias, bedwetting,
fire setting, cruelty to animals, excessive
masturbation.
D. Late childhood (puberty through adolescence)
* Social relationship: attitude towards siblings &
playmates, number & closeness of friends,
leader or follower, social popularity,
participation in group activities, patterns
of aggression, passivity, anxiety, antisocial
behavior.
 * School history: adjustment to school, relationships
with teachers (teacher’s pet vs rebel), favorite studies or
interests, particular abilities or assets, extra-curricular
activities, sports, hobbies.
* Cognitive & motor development: intellectual &
motor skills, learning disabilities – their management &
effects on the child.
* Emotional & physical problems: running away,
delinquency, smoking, alcohol or substance abuse,
anorexia, bulimia, weight problems, feelings of
inferiority, depression, suicidal ideas & acts.
* Sexuality: acquisition of sexual knowledge,
attitude of parents toward sex, sexual abuse, feelings
about puberty, attitude towards opposite sex, sexual
orientation, sexual practices.
E. Adulthood
* Occupational history: number & duration of jobs,
choice of occupation, any work related conflicts, long-
term ambitions & goals.
* Marital & relationship history: story of the
marriage or evolution of the relationship, areas of
agreement & disagreement.
* Military history: general adjustment to the
military, nature of discharge, any disciplinary action
during the periods of service?, any referral for
psychiatric evaluation?
* Educational history: educational attainment,
highest grade, attitude toward academic achievement.
* Religion: does the patient have a strong religious
affiliation? What does his religion say about his illness?
 * Social activity: type of social, intellectual, &
physical interests shared with friends
* Current living situation: ask to patient to describe
where he lives in terms of the neighborhood and their
residence (include the # of rooms, # of people living in
the home, sleeping arrangement), sources of family
income, who cares for the children at home, who visits
the patient in the hospital & how frequent.
* Legal history: any history of assault or violence
(against whom?, using what?), any history of arrest & in
prison?
F. Psychosexual history:
Any sexual dysfunction or disorder, extramarital or
premarital relationship?, does he worry about having
STD or being HIV positive?
G. Family history
* Ask the patient to describe each family (whom does he
mention first?, whom does he leave out?)
* whom does he feel he is most like? Why?
* what is his attitude toward his parents? siblings?
* any history of psychiatric illness, substance abuse,
antisocial behavior within the family?
H. Dreams, fantasies & values
* any recent dream? Can he discuss its possible meaning?
* what are his fantasies or daydreams about the future? Are
they grounded in reality?
* if he could make any change in his life, what would it be?
* what are his system of values?
* what is his concept of right & wrong?
Process Recording
* a verbatim account of what has transpired between the
nurse & the patient during their encounter or NPI.
* both verbal & non-verbal communication of both nurse &
client are accounted, for analysis.
* It is seen in various format.
* Content:
Patient’s initial _____________
Age _______
Diagnosis _____________
Goal of interaction __________________
Date & Time of interaction ______________
Description of environment _______________
____________________________________
Description of patient ____________________
____________________________________

NPI Analysis/assumptions C.I.’s comment

Nurse: verbal & non-verbal What communication

communication technique was used? Why
was it used?

Patient: verbal & non-verbal What is the meaning of the

communication patients communication?

What technique was used?

Nurse: Why was it used?

What is the meaning of the

Patient patient’s communication?
Other format:
Student Patient C.I.’s comment

1.Student’s verbal & non-verbal 1. Patient’s verbal & non-

communication verbal communication or
response.

What communication Why did she give such

technique was used? Why? response or communication?

2. Student’s verbal & non-verbal 2. Patient’s verbal or non-

communication verbal communication or
response
What technique was used? Why such communication
Why such technique? or response?

3. Etc
3. etc
 Self awareness
– ability to experience genuine
feelings in relation to your
environment.
Importance of Self-awareness
(to be able to use self therapeutically)

Accdg. to Sigmund Freud;

* much behavior is determined by beliefs &
feelings that are beyond awareness.
* if one is to help others, one must have an in-
depth understanding of one’s own beliefs &
feelings so as not to interfere with the client’s
progress.
Beliefs – are thoughts held to be true but
not proved to be so.
Sources of beliefs:
* individual’s prior experiences;
* society’s cultural norms.
Feelings – are affective states or emotions.
Feelings often arise from beliefs, rather than
beliefs stemming from feelings.
Methods use to increase self-awareness:
1. Introspection
2. Discussion
3. Enlarging experience
4. Role playing
JOHARI WINDOW – a helpful Model for understanding
the nature of self-awareness.
- developed by Joseph Luft & Harry Lipton
- 4 windows are :
a. open or public self;
b. blind or semi-public;
c. private
d. closed or inner-self.
Goal of Self-awareness : to enlarge window a &
reduce the other windows
Milieu Therapy/ Therapeutic Environment/Therapeutic
Community
* The environment itself becomes a treatment modality.
* Goals & characteristics of a therapeutic environment in
an inpatient setting:
1. The client’s physical needs are met.
2. The client is respected as an individual with rights,
needs, & opinions and is encouraged to express this.
3. Decision-making authority is clearly defined &
distributed appropriately among clients & staff.
4. The client is protected from injury from self & others.
5. The client is afforded increasing opportunities for freedom
of choice, commensurate with abiltiy to make decisions.
6. All personnel, particularly nursing staff, remain constant.
7. The environment provides a testing ground for the
establishment of new patterns of behavior.
8. Emphasis is placed on social interaction between & among
clients and staff. The environment’s physical structure &
appearance facilitate this interaction.
9. Programming is structured but flexible.
Psychodrama
A method of psychotherapy in which
clients are encouraged to continue &
complete their actions through
dramatization, role playing & dramatic
self-presentation.
* Scenes enacted can be specific
happenings in the past, unfinished
situations, fantasies, dreams,
preparations for future risk-taking
situations.
Socialization
The process whereby a person learns to
get along with and to behave similarly
to other people in the group, largely
through imitation as well as group
pressure.
Enables members to interact with one
another and so pass on skills, values,
beliefs, knowledge, & modes of
behaviour.