Cebu Normal University

College of Nursing
LEARNING FEEDBACK DIARY GUIDE IN
PSYCHIATRY AS A NURSING SPECIALTY
Name of Student: Renee Camille L. Laguda
Yr and Section: BSN - 3
Date: 3/24/14
Time: 10AM 2PM
Objectives for the day:
Re-orientation/Working Phase
o Re-establish rapport and trust, strengthen nurse-patient relationship
o Reinforce therapeutic contract (renewal)
o Continue mental assessment and history interview
o Discuss issues of termination
Feelings: I felt really excited since I was able to see patients again after a week. Im
glad to know that my patient is not placed in restraints anymore, and that she is able to
mingle with other patients and participate in various ward activities as well. We had to
re-acquaint ourselves with our patients since they tend to have forgotten some of us,
that is why it was a bit hard on my part because my patient seemed to have a hard time
recalling our therapeutic contract two weeks ago.
Expectations: I expect that this duty week would still be meaningful and exciting for all of
us. After all, even though this is our second week and we are now familiar with the ward
set-up, I am sure that there is still so much to learn and so many things to see and
experience. Aside from that, I am expecting that this week would be hectic for all of us,
since we are about to take on a case presentation on Friday, and that is adding up to
our workload. Still, we are positive that we can achieve a lot as a group.
Evaluation: Seeing my patient, I could say that she is doing far better than she was the
last time I saw her. She is definitely more calm and easy-going, and that makes it easier
for me to assess and interact with her. I am happy that she is taking initiative in being
involved in her own care, and that she is having a positive outlook in spite of her
situation. With regards to ward management, there are still a lot of points to improve,
especially when it comes to hygiene and sanitation of the vicinity.

Recommendations: I recommend that more ward activities (especially individual

therapy) would be enforced by the student nurses, not only from our schoolmates, but
also from co-affiliates from other schools as well. That is to ensure individualized care
and to see more positive changes in the patients.

Cebu Normal University

College of Nursing
NURSING CARE PLAN IN
PSYCHIATRY AS A NURSING SPECIALTY
Name of student: Renee Camille L Laguda
Yr & Section: BSN -III
Client Initials: M.M.
Diagnosis: Schizophrenia Affective Type
Doctor: Dr. Milan Ratunil

Date of Exposure: 3/24-28/14

Area of Exposure: VSMMC WARD XII
Date of submission: 3/24/2014

PHASE OF NURSE-CLIENT RELATIONSHIP: Re-orientation/Working Phase

PROBLEM/CUES:
SUBJECTIVE:
Student Nurse: Pila man mo kabuok mag-igsuon, Maam?
Client: Tulo
Student Nurse: Unsa man ang pangalan sa imong mga igsuon, Maam?
Client: si Maricel, Maricel ug si Maricelha-ha-ha, as verbalized by client.
OBJECTIVE: Received client sitting on bed, awake, calm and afebrile, with vital signs
as follows: T-36.1, PR-82, RR-21, BP-110/80. Client demonstrates neologisms, word salad,
thought blocking, thought insertion, and occasional thought withdrawal. There are evident
inappropriate reactions to others communication, behavior and to environmental events
(laughing in response to serious or despondent queries/content).
NURSING DIAGNOSIS: Disturbed Thought Processes related to impaired ability to
process/synthesize internal and external stimuli.
THEORETICAL BASIS: Schizophrenia is composed of a broad collection of symptoms from all
domains of mental function. The term schizophrenia literally means split mind it is often
confused with a split or multiple personality. Individuals affected with such syndrome may show
a wide range of disruption sin their ability to see, hear and process information from the world
around them. They may also experience disruption in their normal thought processes, as well
as their emotions and behaviors. (http://rnspeak.com/nursing-care-plan/schizophreniancpnursing-care-plan-disturbed-thought-processes/)
OUTCOME CRITERIA
SHORT TERM GOAL:
After 4 hours of client interaction, the client is expected to:
Be oriented to time, date and place
Exhibit some realistic insights about her situation (share ideas,
interact enthusiastically with student nurse)
Be oriented and know that there are certain boundaries between self
and others, and self and environment.
LONG TERM GOAL:
After 1 month of nursing interventions and interaction, the client is expected to:
Demonstrate reality based thinking in verbal and non-verbal behavior
Demonstrate total/partial absence of incoherent, illogical speech,
magical thinking, ideas of reference, thought blocking/insertion and
broadcasting.
Demonstrate ability to abstract, conceptualize, reason and calculate
consistently with developmental stage
Be able to make decisions about care and verbalize these decisions
with the nurse.

NURSING STRATEGIES
10 INDEPENDENT NURSING FUNCTIONS:
Avoid physical contact.

RATIONALE
Suspicious clients may perceive touch as a
threatening gesture. (Townsend, 2003)

Competitive activities are very threatening

Activities should never include anything
to suspicious clients. (Townsend, 2003)
competitive. Activities that encourage a one- to-one
relationship with the nurse or therapist are best.
Maintain safety of client and others in environment
from possible harmful effects of clients thought
disorder

Encourage client to verbalize true feelings. The

Verbalization of feelings in a nonthreatening

nurse should avoid becoming defensive when angry

feelings are directed at him or her.
Distract client from the delusion by engaging the
client in a less-threatening, more comforting topic
or activity at the first sign of anxiety/discomfort
Appraise the clients non-verbal behavior, such as
gestures, facial expression and posture.
Use simple, declarative statements when talking to
client who demonstrates fragmented, disconnected,
incoherent, or tangential speech patterns reflecting
loose associations
Listen attentively for key themes and realityoriented phrases/thoughts in clients communication
with staff and other clients
Respond to clients delusions with calm, realistic
statements.

The nurses first priority is to protect the client and others

if the clients delusion or thought disorder contains
paranoid content that may result in harm/injury (Fortinash
& Holoday-Worret, 2007)

environment may help client come to terms

with long-unresolved issues. (Townsend, 2003)

Dealing on delusional content may increase clients

Identify patients religious and spiritual needs

and practices and encourage her to talk about it.

anxiety, aggression or other dysfunctional

behaviors. (Fortinash & Holoday-Worret, 2007)
Appraisal of nonverbal behavior may help meet
clients needs that he cannot convey through speech
Simple statements tend to enhance meaning of
message, which is important for a client struggling
to interpret and access reality(Fortinash & HolodayWorret, 2007)
Keen listening helps elicit problem areas, promotes
clients willingness to relate to another person, and
helps meet clients needs (Fortinash & HolodayWorret, 2007)
Delusions of persecution represent clients fears or
threats to self-system in an environment she
perceives as hostile. (Fortinash & Holoday-Worret,
2007)
Spirituality is integral in a persons life, allowing
client to vent about her feelings and concerns may
help nurse understand clients belief system, thus
better interaction follows (Videbeck, 2008)

1 DEPENDENT NURSING FUNCTION

Administer anti-psychotic medications as per
doctors order.

Helps alleviate manifestation of symptoms,

thus, balance in neurotransmitter production is
established. (Videbeck, 2008)

1 COLLABORATIVE NURSING FUNCTION

Employ various therapies as adjunct to patient
treatment

Play/socialization/music/dance, etc.
therapies can encourage positive feelings of
patient towards present condition
(Doenges, et al 2011)

EVALUATION:
(see table attachment)
BIBLIOGRAPHY:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2011) Nursing care plans: Guidelines for
individualizing patient care. Philadelphia: F.A. Davis.
Fortinash, K. M., & Holoday-Worret, P. A. (2007). Psychiatric nursing care plans. St. Louis, Mo:
Mosby/Elsevier.
Townsend, M. C. (2006). Psychiatric mental health nursing: Concepts of care in evidence-based practice.
Philadelphia: F.A. Davis Co.

Videbeck, S. L. (2008). Psychiatric-mental health nursing. Philadelphia, PA: Lippincott Williams &
Wilkins.
http://nurseslabs.com/schizophrenia-case-study-types-diagnosis-interventions-treatment/
http://www.schizophrenia.sk.ca/what-are-the-facts-about-schizophrenia/what-is-schizophrenia/symptoms/