WORKING PHASE

Description:
The working phase is the time where the nurse helps the client identifies
problems caused by a particular issue. It also the time wherein the nurse guides the
client to formulate better coping mechanisms by allowing him to explore and examine
his feelings.

Objectives:
The following are the objectives of the working phase:
1. To provide positive self-concept to the client.
2. To have realistic goal setting.
3. To allow verbalization of clients feelings.
4. To develop positive self-concept.
5. To plan for better coping mechanisms.

Date/Time/Venue:
January 7, 2016 / 09:30 AM / NCMH Pavilion 1

RATIONALE OF
NURSES
NURSE-PATIENT INTERACTION
COMMUNICATION
TECHNIQUE
Nurse: Good morning Akiles, how Giving
are you?
Recognition
Patient: I am fine. I am happy
Greeting the patient
by name indicates
recognition of the
individual as a
person

ANALYSIS OF THE
PATIENTS RESPONSE
General Appearance:
The
patient
is
appropriately
dressed
and well groomed, body
odor is noted. He has
normal facial expression
with an upright posture.
The patient can keep
eyes contact.

Nurse: Are you still remember my

name?
Patient: Yes, I Still remember, your
name is Anam.
Nurse: How was your last night?
Patient: Not so good, I was
difficulty sleep.

General Leads
Encourages
the
individual
to
continue
in
the Cognition:
direction
of Patient is coherent and
alert, oriented to date,
conversation
time and place.
already begun.

Nurse: What makes you difficulty

sleep?
Patient: You know that all patient
from ward 6 were moved into ward
7. Inside the ward are very
crowded. I feel uncomfortable. They
are very noisy so I cannot sleep.

Seeking
Information
This
allows
continuance of
conversation as
patient
do
readily engage

Attitude:
patient
the The
the cooperative.
the
not
in

is

Nurse: Are you the one who cannot the conversation.

sleep last night?
Patient: Not only me, they are
some patient also cannot sleep. I
can sleep when the nurse giving me
medication for inducing sleep.
Nurse: how many hours did you
sleep last night?
Patient: I dont know how many
hours I slept last night.
Nurse: how about in the morning
when you wake up, do you feel
better or maybe you experience
dizziness?
Patient: In the morning I woke up
as usual, I felt better and I did not
feel dizziness.
Nurse: Did you have breakfast?
What is your breakfast?
Patient: Yes, I have my breakfast
with slice of breads.

Speech:
The patient speaks in
English,
spontaneous,
loud, and rapid manner.

Psychoanalytic
Theory:
According
to
Jean
Piaget, in the formal
operations stage, the
structures
of
development
become
the abstract, logically
organized system of
adult intelligence. When
faced with a complex
problem, the adolescent
speculates about all
possible solutions before
trying them out in the
real world.

Nurse: Do you have any complain

that would like to share with me?
Patient: No I dont have, I know I
am stay here for my medication and
my rehabilitation.

Broad Openings
Encouraging
the
patient to take the
least in introducing Cognition:
the topic does not Patient is alert and can
restrict
the recall past histories
conversation to a
specific subject.

Nurse: By the way, do you know

what is NCMH?
Patient: Yes, I know, NCMH is
National Center for Mental Health.
This place is used to threating
patient with mental problem. In this
case, I am patient with drug abuse
and alcoholic abuse, I just need for
rehabilitation. I am not supposed to
be here together with mental illness
patients. Stay inside the ward with
them is not comfortable for me.
Nurse: Do you know the reason of
you being admitted in this NCMH?
Patient: Before I admitted at
Medical City by my wife. I stayed
there
for
two
weeks
for
detoxification drug abuse, but
because of the payment is very
expensive so I transfer to this place.
You know for two weeks in Medical
City my wife should pay for 124.000
peso.
Nurse: what is the reason of you
being admitted at the hospital?
Patient: Because I am drinking

Exploring
Its helps in getting
the
needed
information about a
specific
subject
without
misinterpreting any
of
the
given
information.

alcohol and use shabu, so I

admitted to the hospital.
Nurse: Are your family and your
wife accept your behaviors?
Patient: Before my wife was accept
my behavior. But eventually my wife
told me to stop all my bad
behaviors, include drinking alcohol,
drug abuse, and also Casino. Of
course I can follow the rules of my
wife but only for several months and
after that I do drinking alcohol, use
shabu, and playing Casino. I like to
drink, use drugs, and play Casino
when I have a lot of money. I always
went to Casino for drinking maybe
three or fourth times a week. I am
happy if I won in playing Casino.
Usually I go there with my friend
works from Startek Call Center
Makati.
Nurse: What is the reaction of your
wife when she knows that you
started again for drinking alcohol,
drug abuse, and play Casino?
Patient: She got mad to me and
decide to leave me. She didnt
accept me because I am drunk
alcohol, use drugs, and play
Casino.
Nurse: Is that situation makes you
sad or angry?
Patient: Yes, I sad because
separate with my wife and my two
son. But when I want to drink, use
drug, or play Casino no one in this
world can stop me.
Nurse: So that is the reason of you
being admitted?
Patient: Yes, because of alcoholic
and drug abuse. So I should admit
in NCMH in rehabilitation by my
wife.
Nurse: Do you still remember, when
did you come to this NCMH?
Patient: I was transfer from Medical
City to this NCMH on November 24,
2015.
Nurse: are your family ever visit to
this NCMH?
Patient: Not yet, my wife and my
family never visit me. Do you want
to check my Facebook account?
Nurse: You mean that I should Seeking
check your Facebook account?
clarification
Patient: Yes, you have to see my It is an attempt to

Facebook account. From my

Facebook you see and understand
how I am as father, how I am as
alcoholic abuse, you also can see
the two of my kids and my wife.
When I have free days, sometimes I
spend my time to stay I house and
play with my kids.

make clear
which
is
meaningful
understood

Nurse: Do you miss your family?

Patient: I miss my family, but I
know I should join rehabilitation
therapy in this NCMH. When my
rehabilitation is done I will stop to
drinking alcohol, use drug, and play
Casino. I would like comeback to
my family and comeback to work as
call center

Encouraging
expression
of
Feelings
Allows the patient to
verbalize
his
emotions in order to
relieve him of his
anxieties.

Nurse: By the way how was your

job before as call center, can you
explain to me?
Patient: I work as call center in
Startek, I usually handle client if
other call center cannot handle
his/her problem.

Seeking
Information
This
allows
the
continuance of the
conversation as the
patient
do
not
readily engage in
the conversation.

Nurse: You mean that you always

handle the problem that cannot
handle by other?
Patient: Yes, that is my job. Can
you open my Facebook please?
From my Facebook you can see
how I am and you will understand
my life story. There is my picture
with my family and my friends.
Nurse: you mean I should check
your Facebook to know more about
yourself?
Patient: Yes, if you didnt check my
Facebook I cannot tell more to you
about my life. This is my email
akilesibanez@yahoo.com. That will
be your assignment before we meet
next week.

Seeking
clarification
It is an attempt to
make clear that
which
is
not
meaningful
or
understood

Nurse: Are Filipino always use

Facebook?
Patient: Yes, almost all people use
Facebook.
Nurse: I am sorry, because in
Indonesia we are not too familiar to
use Facebook.
Patient: It is ok. You can ask to
Filipino friends just to see my
Facebook account.

that
not
or

Nurse: By the way, what are your

feeling after our play therapy a while
ago.
Patient: I am very happy and I think
that therapy very fulfillment for us.
Nurse: What things that makes you
happy?
Patient: I am happy because I can
play together with the patients and
nursing students nurse. We play as
a team. Very lucky that my team
became a winner.
Nurse: Is this the first time for you
to play this game?
Patient: Yes, this is the first time, I
got new experience this morning.
Do you have some snack for me?

General Leads
Encourages
the
individual
to
continue
in
the
direction
of
conversation
already begun.

Nurse: Yes, we have, we will give to

you after this session, and then
after that we will have music and art
therapy.
Patient: So after this we will have
music and art therapy?
Nurse:
Yes,
do
you
have
experience with music and art
therapy?
Patient: I have before, we will draw
while listening music.
Nurse: You will be given paper and
crayon to draw. After finished, you
will be given a chance to describe
your drawing.
Patient: We will discuss one by
one?
Nurse: Yes, so we can understand
about your drawing.
Patient: Ok, I understand.
Nurse: By the way, I would like to
remind you. For next week on
Wednesday, Thursday, and Friday
we will have continue our activity.
Finally, on Friday we will have
socialization.
Patient: Ok. I understood.

Giving Information
Involves
making
available to the
patient facts that he
needs. Keeping the
patient informed and
answering questions
helps to build trust.

Nurse: I think our session for this

time is enough. Thank you very
much for your attention and being
cooperate with me.
Patient: Ok. You are welcome. No
problem.

Restating
contract
This reminds
patient
of
contract
relationship
between patient
nurse

the
the
the
and
and