i

Republic of the Philippines

NORTHERN NEGROS STATE COLLEGE OF SCIENCE & TECHNOLOGY

Old Sagay, Sagay City, Negros Occidental

(034)722-4120/www.nonescost.edu.ph

CERTIFICATENUMBER:AJA12.0653

HILDEGARD PEPLAUS INTERPERSONAL RELATIONS

THEORY IN ITS RELEVANCE IN
A BIPOLAR PATIENT

A CLINICAL RESEARCH PAPER

Presented to

The Faculty of the Graduate School

NORTHERN NEGROS STATE COLLEGE OF SCIENCE AND TECHNOLOGY
Old Sagay, Sagay City, Negros Occidental

In Partial Fulfillment
Of the Requirements for the Degree
MASTER in NURSING major in
NURSING MANAGEMENT AND ADMINISTRATION

By

TIFFANY ALTEZA C. UNTAL, R.N.

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

i
ii
iii
iv
v

Chapter I

Introduction

Background of the Study

Statement of the Problem
Significance of the Study

1
3
4

Chapter II

Review of Related Literature

Conceptual Framework
Assumption
Definition of Terms

22
26
26

Chapter III

Application of Nursing Process

Patients Profile
Clinical History
Patients Anamnesis
NPI
Methodology
Assessment Tool
Scoring and Interpretation
The Nursing Process
Assessment Phase
Planning Phase
Implementation Phase
Evaluation Phase

Findings

Conclusion

Recommendation

References

Appendices

- 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

Initial Assessment Score

45

Nursing Care Plan

48

Monitoring Chart

49

Final Assessment Score

56

Mean Difference Between

The Initial and Final Assessment

56

List of Figures

Figures

Page

Schematic Diagram of Peplaus

Interpersonal Relations Theory:
Conceptual Framework

27

Evaluative Scale

46

Initial Evaluative Scale of Mean

46

Final Evaluative Scale of Mean

47

Comparative Level of Loneliness Tendency

Between The Initial and Final Assessment
Result

57

Comparative Level of Initial and

Final Assessment in Chart

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.

Taming emotions takes a

bit of mastery; but for them, it is already a major life battle

wherein their sanity priced the cost.
We all have monsters inside our head; Although a few lived
by their own demons and can no longer control their own sense of
self-integrity. These fellows need more attention; their
eccentricities and outbursts already a call for help. They could
be a stranger, a passerby, a neighbor, a friend, a family, or it
might had already been you.

Society itself held the stigma and biases to this persons

instead of understanding and support. These individuals actually
scream for help within their own inner dilemma. And if these
submerged implosions and rage be not sufficed to induce violence
with themselves, it eventually explodes into a violence toward
others.
This clinical paper had been brought forth to determine the
effectiveness of Nurse-Patient interaction and Nursing
intervention utilizing Hildegard Peplaus Interpersonal
Relations Theory wherein significant roles of a nurs is being
acted in promotion if not for the full-recovery, at least the
rehabilitation or even just the alleviation of symptoms
characterized by these patients having mental illness as
characterized in the change of attitude and disease adaptation
by helping them recover self-integrity in the discernment that
they are more than just the symptoms of their illness.

Statement of the Problem

Is there a change in the level of loneliness tendency when

Peplaus Interpersonal Relations Theory is utilized together
with the nursing process in the management of Bipolar.

Significance of the Study

Patient. That he/she would gradually identify the root of

his/her own disorder and imbue learning while encourage
awareness and hope to recovery and progressively

be the

inspiration and becoming an advocate to the youth unto

which act as a guide not to led astray.
Family. That each member will cultivate awareness and

instead of blame, anger and despair nurture understanding,

patience, compassion instead and inner growth in
understanding the patient and serve as a strong support
system to the recovery of the patient.
Health Provider/Rehabilitation Staff. That it would instill

resonance of learning and progression in profession not

only as a mental health nurse but by applying the theory in

each patients that he/she would come across into promoting
health, imparting social deliverance and render baggage
unburdening towards the holistic recovery of patients. And
Health and Social Programs for children, youth and families
should take on a forward- thinking and holistic approach;
services and programs should be available.
Community. That the community would gradually understand and

have a grasp of knowledge concerning substance abuse and

drug addiction, perception of the mentally deranged as well

of those who had been rehabilitated. The study also strive

to reach out awareness to the cause, effect and prevention
of factors that would lead to rehabilitation and not just a
casual cultural clich that each member of the society
could partake in collaboration into the nurses different
role to further advance recovery of the patients and
gradually to the interaction of the patient post
rehabilitation.

Future researchers.

The results of this study will serve

as a reference material for those who would like to conduct

further study on similar topics.

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'

states are called Depression. Mania is characterized by a

euphoric (joyful, energetic) mood, hyper-activity, a positive,
expansive outlook on life, an inflated sense of self-esteem or
grandiosity (a hyper-inflated sense of self-esteem), and a sense
that most anything is possible.
Depression is, more or less, the opposite mood state from

mania. Depression is characterized by feelings of lethargy and

lack of energy, a negative outlook on life, low or non-existent
self-esteem and self-worth, and a sense that nothing is
possible. Depressed individuals tend to lose interest in things
that used to give them pleasure and enjoyment (such as sex, food

or the company of other people). They may sleep too much or too
little. Regardless of how much sleep they actually get, they
tend to complain about feeling constantly tired and fatigued.
Their mood tends to be dysphoric (e.g., distressed, negative,
unhappy), although they may experience dysphoria in different
ways. Such negative feeling states help depressed people lose
confidence in their abilities, become pessimistic about their
futures, and (sometimes) conclude that life is no longer worth
living.
Interpersonal theory and interventions are useful for
patients with a wide variety of diagnostic labels, including
schizophrenia, depression, mood disorders, borderline
personality disorders, and mild mental retardation. These

interventions are useful both in one-to-one therapeutic

relationships and milieu interventions. The theory and
interventions provide an effective adjunct for
psychopharmacology and psychiatric rehabilitation, particularly
with people who have complex behavioral problems refractory to
psychopharmacological intervention.
Cacioppo and Hawkley (2010) have hypothesized that lonely
people are hyper-vigilant to social threat linking this bias
specifically to threats of social rejection or social exclusion.
This could mean that lonely people in their everyday lives (1)
fail to make accurate appraisals of social events, such that
they misinterpret social events negatively, but also (2) that
they have visual attention biases, such that they are on the
lookout for negative social events so that they can avoid them
and protect themselves against psychological pain.
According to the Canadian Nurses Association, psychiatric

nurses must be knowledgeable in the areas of biological and

psychological theories of mental health and mental illness,
psychotherapy, substance abuse, care of populations at risk, the
community as a therapeutic milieu, cultural and spiritual
implications of nursing care, psychopharmacology and
documentation specific to the care of the mentally ill. Skill
competency stresses comprehensive bio-psychosocial assessment,
interdisciplinary collaboration, identification and coordination

of resources for offenders and families, the use of psychiatric

diagnostic classification systems, therapeutic communication,
establishing therapeutic relationships, therapeutic use of self,
psycho-education with clients and administering and monitoring
psychopharmacologic agents.
Recovery has been defined as a process of healing and

transformation that results in the ability to achieve full

potential in living a meaningful life (Substance Abuse and
Mental Health Services Administration [SAMHSA], 2013). It
includes healing processes such as self-direction,
individualized and person-centered care, empowerment, holistic
recovery, strengths-based care, mutuality, respect, and
responsibility (SAMHSA, 2013). Person (patient)-centeredness is
one of multiple processes that support recovery.
Psychiatric nursing practice is rooted in the healing power
of the interpersonal nurse-patient relationship, as described by
Hildegard Peplau (Howk, 2012), an early leader in the
development of modern psychiatric nursing. Nurses generally
agree that nursing practice should be patient centered in the
sense that effective working relationships are formed with
patients to provide nursing care that incorporates an
understanding of the patients perspective. Beyond patientcenteredness, psychiatric nurses view nursing care as helping
patients work through mental health concerns that are marked by

anxiety and non-adaptive coping behaviors, to achieve mental

health recovery.
Dr. Hildegard Peplau introduced an interpersonal relations
paradigm for the study and practice of nursing in the late 1940s
and early 1950s (Rust, 2012). Her theory is one of the early
Nursing theories, published in 1952. The paradigm evolved from
her work with H. Sullivan, E. Fromm, F. Fromm-Reichmann, other
eminent clinicians, and her experience working with seriously
mentally ill patients in public and private psychiatric
hospitals. Her Interpersonal Relations Theory has had particular
relevance and usefulness in understanding and intervening to
reduce symptoms, re-establish relatedness, restore a sense of
self-identity, improve function, and promote health.
Peplau's Interpersonal Relations Theory describes
psychiatric nursing roles in terms of the position which the
nurse assumes during the various phases of the nurse-client
relationship. The client is defined as an individual rather than
a community or group. Dr. Peplau's scope of influence goes far
beyond the field of psychiatric mental health nursing. She
advanced nursing professional, educational, and practice
standards and stressed the importance of professional selfregulation through credentialing. For her, the key question was:
What do nurses know and how do they use that knowledge to
benefit people? (Rust, 2012).

10

The nurse-patient relationship consists of four steps

(orientation, identification, development and conclusion). In
these steps nurse could have the role of foreign, reliable
person, teacher, guide in nursing care, substitute and
consultant. Nurse-patient relationship is influenced by
psychobiological experiences (needs, frustrations, conflicts and
anxiety) which need dynamism. Peplau thinks that Nursing care is
an important opportunity for nurse because she can help patient
to complete the infancy psychological tasks (learning to rely on
other people, learning to show satisfaction, self-identifying,
and developing ability in sharing) if these are not completed.
For these reasons Nursing, by Peplau, is a maturation strength
of civilization (Dussault, 2014).
As many as 5 million adolescents suffer from clinical
depression, but according to a 2009 study, an estimated 70
percent are undiagnosed and dont receive any form of treatment.
Without treatment, a depressed teen may turn to alcohol or drugs
to escape their feelings of helplessness or to help them feel
normal. Unfortunately, drug and alcohol use only worsens
depression symptoms (Drug Abuse and Depression in Teens, 2010).
Adolescence, by definition, is a time of risk takingbrain
imaging has shown us that teens are hard-wired to take more
chances as the parts of the brain that generate ideas and make

11

decisions continue to mature and grow. (Drug Abuse and

Depression in Teens, 2010).

Many aspects of this phase of brain development are

beneficial, allowing teens to be creative and flexible in their
thinking, and helping them to hone in on the pursuits they are
passionate about. On the flip side, this risk-taking phase of
development also makes teens vulnerable in ways that have the
potential for harm and long-term problems.
Interpersonal theory and interventions are useful for
patients with a wide variety of diagnostic labels, including
schizophrenia, depression, mood disorders, borderline
personality disorders, and mild mental retardation (Rust, 2012).
These interventions are useful both in one-to-one therapeutic
relationships and milieu interventions. The theory and
interventions provide an effective adjunct for
psychopharmacology and psychiatric rehabilitation, particularly

with people who have complex behavioral problems refractory to

psychopharmacological intervention.
Bipolar disorder, also known by its classic name "manic
depression," is a mental disorder that is characterized by
serious mood swings. A person with bipolar disorder experiences
alternating highs (what clinicians call mania) and lows
(also known as depression). Both the manic and depressive
periods can be brief, from just a few hours to a few days, or

12

longer, lasting up to several weeks or even months (Cacioppo, et

al.2013).
A manic episode is characterized by extreme happiness,
extreme irritability, hyperactivity, little need for sleep
and/or racing thoughts, which may lead to rapid speech. A
depressive episode is characterized by extreme sadness, a lack
of energy or interest in things, an inability to enjoy normally
pleasurable activities and feelings of helplessness and
hopelessness. On average, someone with bipolar disorder may have
up to three years of normal mood between episodes of mania or
depression.
Bipolar disorder changes the course of your life, but it
doesnt mean you cant do great things, said Holly Swartz, M.D.,
associate professor of psychiatry at the University of
Pittsburgh School of Medicine and Western Psychiatric Institute

and Clinic in Pittsburgh (Cornwell, 2010). With a combination of

medication, psychotherapy and self-management strategies,
individuals with bipolar disorder can lead productive,
successful lives. If left untreated, bipolar disorder can wreak
havoc on a persons life. It requires both medical treatment and
psychotherapy. Having a support system is critical in
successfully managing bipolar disorder.
Peplaus (Rust, 2012) theoretical model of the nurse-

patient relationship emphasized mutuality as an essential

13

process for an effective nurse-patient working relationship to

foster growth in constructive coping responses toward the goal
of recovery. Mutuality is characterized by both individuals
sharing information and collaborating to make decisions in
relation to jointly agreed-on goals. The concept of mutuality
has been reframed and extended in the concept of shared decision

making that involve decision making about therapeutic options.

One of the most common side effects of bipolar disorder is

an intense and inexplicable sense of loneliness. This mental
state causes severe physical and psychological consequences for
people who fail to take adequate precautions or interventions to
avoid ongoing complications.
Loneliness is a universal emotional and psychological
experience. Loneliness is also seen as a normal experience that
leads individual to achieve deeper self-awareness, a time to be
creative, and an opportunity to attain self-fulfilment and to
explore meaning of life. Loneliness is also a condition of human
life, an experience of humanizing which enables the person to
sustain, extend, and deepen his/her humanity. According to Weiss
(2011), loneliness is caused not by being alone but being
without some definite needed relationship or set of
relationships. Loneliness appears always to be a response to the
absence of some particular relational provision, such as

14

deficits in the relational provisions involved in social

support.
Researchers have indicated that adolescents experience more
loneliness than any other age groups. Late adolescence and early
adulthood (i.e., university age) are especially high risk for
experiencing loneliness. Lack of social and emotional support
may lead to the experience of social and emotional loneliness.

For the most part, loneliness research has tended to focus on

individual factors, that is, either on personality factors or
lack of social contacts.
The degree, frequency, and quality of a person's loneliness
will be a function, among other things, of the society in which
he or she lives. The UCLA Loneliness Scale is a commonly used
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.Developer

Daniel Russell has expressed concern that publication of the
scale could skew responses. The UCLA Loneliness Scale was
developed to assess subjective feelings of loneliness or social
isolation.

Items for the original version of the scale were

based on statements used by lonely individuals to describe

feelings of loneliness.

The questions were all worded in a

negative or lonely direction, with individuals indicating how

15

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

16

relationship and a necessary condition for the establishment of

the other roles.
In the resource person role, the nurse provides specific
factual health information in response to a clients questions
and interprets the clinical plan of care (Rust, 2012). Essential
to this role are expert professional knowledge, the ability to
deliver information in a sensitive manner, and critical thinking
skills needed to process the clients questions and offer a
therapeutic response.
Assisting the client to attain knowledge to improve health
is the primary goal of the teacher role (Forchuk et al., 2013).
This process may be formal, such as providing detailed
instructions for individuals or conducting training sessions for
groups to teach a health-related behavior, or the process may be
informal, such as modeling patterns of health and wellness in
the therapeutic relationship.

The leadership role involves collaboration between the

nurse and the client to meet desired treatment goals. The nurse
offers guidance, direction, and support to promote the clients
active participation in maintaining his or her health. The goal
of the nurse is to help the client accept increased
responsibility for the plan of care (Rust, 2012).
In the surrogate role, the nurse functions as an advocate

or a substitute for another human being who is well known to the

17

client, such as a parent, sibling, other relative, friend, or

teacher (Rust, 2012). Through this process a client may
unconsciously transfer behaviors or emotions that are connected
to a significant other onto the nurse. The nurse addresses this
reaction and assists clients to recognize the differences as
well as similarities between themselves and the other.
In the counselor role, the nurse encourages the client to
explore his or her current situation or presenting problem. The
nurse must be aware that such exploration often engenders
anxiety and, therefore, must facilitate an atmosphere that is
conducive for the client to safely express his or her concerns.
To successfully implement the counseling role, the nurse must
demonstrate active listening skills, apply therapeutic
communication techniques, provide guidance and support in the
process of self-discovery, and maintain professional boundaries
and self-awareness (Forchuk et al., 2013)
Although Peplau (Rust, 2012) did not include the technical
expert role in her original work, it is now considered to be one
of the primary helping roles of the nurse-client relationship.
As a technical expert, the nurse demonstrates technical skills
to perform nursing care. The technical expert role includes
physical assessment and interventions and the use of equipment,
such as intravenous pumps, blood pressure cuffs, and
ventilators.

18

The implementation of the helping roles (Rust, 2012) has

been described in a number of settings, including psychiatric
and mental health, surgical, and palliative care. Peplau
discusses major features of the theory of interpersonal
relations. She describes her theory as among the most useful to
apply during nursing practice in order to understand nursepatient interactive phenomena. Peplau addresses how she derived
constructs from clinical data and identified their congruence
with nursing practice. She further addresses the specific
concepts of her theory and their relations, and specific uses of
the theory in practice.
Peplau went on to form an interpersonal model emphasizing
the need for a partnership between nurse and client as opposed
to the client passively receiving treatment (and the nurse
passively acting out doctor's orders). The essence of Peplau's
theories is the creation of a shared experience thus building
mutuality on both part of the patient and the health provider.
Nurses, she thought, could facilitate this through observation,
description, formulation, interpretation, validation, and
intervention (Fowler, 2011).
Roles of nurse

Stranger: receives the client in the same way one meets a

stranger in other life situations provides an accepting
climate that builds trust.

19

Teacher: who imparts knowledge in reference to a need or

interest

Resource Person : one who provides a specific needed

information that aids in the understanding of a problem or

new situation

Counselors : helps to understand and integrate the meaning

of current life circumstances ,provides guidance and

encouragement to make changes

Surrogate: helps to clarify domains of dependence

interdependence and independence and acts on clients behalf

as an advocate.

Leader : helps client assume maximum responsibility for

meeting treatment goals in a mutually satisfying way

Additional Roles include: Technical expert, Consultant,

Health teacher, Tutor, Socializing agent, Safety agent,
Manager of environment, Mediator, Administrator, Recorder
observer, Researcher.

Phases of interpersonal relationship (Taylor, 2011)

Identified four sequential phases in the interpersonal

relationship:
1.

Orientation

2.

Identification

3.

Exploitation

4.

Resolution

20

I. Orientation phase

Problem defining phase

Starts when client meets nurse as stranger

Defining problem and deciding type of service needed

Client seeks assistance ,conveys needs ,asks questions,

shares preconceptions and expectations of past experiences

Nurse responds, explains roles to client, helps to identify

problems and to use available resources and services

II. Identification phase

Selection of appropriate professional assistance

Patient begins to have a feeling of belonging and a

capability of dealing with the problem which decreases the
feeling of helplessness and hopelessness

III. Exploitation phase

Use of professional assistance for problem solving

alternatives

Advantages of services are used is based on the needs and

interests of the patients

Individual feels as an integral part of the helping

environment

They may make minor requests or attention getting

techniques

21

The principles of interview techniques must be used in

order to explore, understand and adequately deal with the
underlying problem

Patient may fluctuates on independence

Nurse must be aware about the various phases of

communication

Nurse aids the patient in exploiting all avenues of help

and progress is made towards the final step

IV. Resolution phase

Termination of professional relationship

The patients needs have already been met by the

collaborative effect of patient and nurse

Now they need to terminate their therapeutic relationship

and dissolve the links between them.

Sometimes may be difficult for both as psychological

dependence persists

Patient drifts away and breaks bond with nurse and

healthier emotional balance is demonstrated and both
becomes mature individuals.

22

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

23

be harnessed into positive means for defining, understanding and

meeting the problem at hand.
In 1952, Peplau published her Theory of Interpersonal
Relations that was influenced by Henry Stack Sullivan, Percival
Symonds, Abraham Maslow, and Neal Elgar Miller (Rust, 2012).
Her theory emphasized the nurse-client relationship as the

foundation of nursing practice. It gave emphasis on the giveand-take of nurse-client relationships that was seen by many as
revolutionary. Peplau went on to form an interpersonal model
emphasizing the need for a partnership between nurse and client
as opposed to the client passively receiving treatment and the
nurse passively acting out doctors orders.
The four components of the theory are: person, which is a

developing organism that tries to reduce anxiety caused by

needs; environment, which consists of existing forces outside of

the person, and put in the context of culture; health, which is
a word symbol that implies forward movement of personality

and nursing, which is a significant therapeutic interpersonal

process that functions cooperatively with other human process
that make health possible for individuals in communities.
The nurse patient relationship is characterized by a number

of overlapping phases with a number of therapeutic tasks or

goals to be accomplished. During each phase the patient

24

expresses needs which find expression and require intervention

in unique ways.
Health is defined as a word symbol that implies forward

movement of personality and other ongoing human processes in the

direction of creative, constructive, productive, personal, and
community living (Rust, 2012)
Although Peplau does not directly address

society/environment, she does encourage the nurse to consider

the patients culture and mores when the patient adjusts to
hospital routine. Hildegard Peplau considers nursing to be a
significant, therapeutic, interpersonal process (Rust, 2012).
She defines it as a human relationship between an individual
who is sick, or in need of health services, and a nurse
specially educated to recognize and to respond to the need for
help.
Therapeutic nurse-client relationship. A professional and

planned relationship between client and nurse that focuses on

the clients needs, feelings, problems, and ideas.
Nursing involves interaction between two or more
individuals with a common goal. The attainment of this goal, or
any goal, is achieved through a series of steps following a
sequential pattern.
The nursing model identifies four sequential phases in the

interpersonal relationship: orientation, identification,

25

exploitation, and resolution.

Anxiety was defined as the initial response to a psychic threat.

The phases of the therapeutic nurse-client are highly

comparable to the nursing process making it vastly applicable.
Assessment coincides with the orientation phase; nursing
diagnosis and planning with the identification phase;
implementation as to the exploitation phase; and lastly,
evaluation with the resolution phase.
Four Phases of the therapeutic nurse-patient relationship:

1. The orientation phase is directed by the nurse and involves

engaging the client in treatment, providing explanations and
information, and answering questions.
2. The identification phase begins when the client works

interdependently with the nurse, expresses feelings, and begins

to feel stronger.
3. In the exploitation phase, the client makes full use of the

services offered.

4. In the resolution phase, the client no longer needs

professional services and gives up dependent behavior. The
relationship ends.

26

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

27

of creative, constructive, productive, personal and community

living.
Loneliness. A normal experience that leads individual to achieve

deeper self-awareness, a time to be creative, and an opportunity

to attain self-fulfilment and to explore meaning of life.
Nursing: A significant therapeutic interpersonal process. It
functions cooperatively with other human process that make
health possible for individuals in communities.

Person. A developing organism that tries to reduce anxiety

caused by needs.
UCLA Loneliness Scale. A commonly used measure of loneliness

derives from its having been developed at the University of

California, Los Angeles (UCLA) to assess subjective feelings of
loneliness or social isolation. It was first published in 1978
by Russell, D., Peplau, L.A., and Ferguson, M.L., and was
revised in 1980 and 1996. This 20-item measure has reported high

internal consistency and good evidence of construct, concurrent,

and discriminant validity (Hagerty et al., 1996; Russel et al.,
1980). Items were assessed on a four-point Likert scale ranging
from 1 (never) to 4 (always), with a higher score indicating a
greater degree of loneliness. The internal consistency of the
Loneliness scale was 0.86.

Figure 1. Conceptual Framework:

Interpersonal Relations Theory

RESOLUTIONPHASE

LowSelfEsteem

PATIENT

EXPLOITATIONPHASE

IDENTIFICATIONPHASE

SevereTendency
TowardsLoneliness

Nurseasa:

SociallyWithdrawn

ORIENTATION
PHASE

NursePatient
Relationship

Stranger
Teacher
Resource

Person
Counselor
Surrogate
Leader

WellRoundedPersonwith
RestoredSocialization,
Confidence,SelfIntegrityand
EffectiveCopingMechanism.

PATIENT

ASchematicDiagramDepictingtheRelationshipofUtilizingtheEffectivenessofPeplausInterpersonal
RelationsTheorypracticingtheNursesTolesthroughoutthephasestowardsthesuccessofpatients

Rehabilitation.

28

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

29

follow up consultation with Dr. Escandelor and the Psychiatrist

of the said institution to finish his last year on high school.

Patients Anamnesis

FREUDs

ERIKSONs

Once cell differentiation is

PATIENT ANAMNESIS

mostly complete, the embryo enters

A. Prenatal

the next stage and becomes a fetus.

The early body systems and structures

established in the embryonic stage

continue to develop. The neural tube

Pregnancy was planned

Mother had pre-natal
Mother is in good
condition
Mother has no vices

develops into brain and spinal cord

and neurons form. Sex organ begins to

and is not into drugs

appear during the third month of

No illnesses during

gestation. The fetus continues to

pregnancy

grow in both weight and length,

although the majority of the physical
growth occurs in the latter stages of
pregnancy.
Stage 1. Begins from the onset of

true labor lasts until the cervix is

B. Delivery

completely dilated in 10cm.

The child was born at

Stage 2. Continues after the cervix

The Riverside

has dilated to 10cm until the

Hospital, Bacolod

delivery of baby

City

Stage 3. Delivery of the placenta

C. Oral Stage

Infancy Period

Normal Delivery
Mother is the most

(0-1 year old)

(0-1 year old)

significant person

Libido is

Trust V.

Father is a seaman

30

focused on the

Mistrust

mouth

and is absent at
times since on board

Individual may

while the child is

growing up

be frustrated

Mother is always at

by having to
wait on

the patients side

another

Patient grew in rural

area

person, being

He has 5 siblings (2

dependent on
another

boys,3 girls) being

person,

the 4th child in the

family

D. Anal Stage

Toddler Period

Patient was toilet

Autonomy Vs,

trained by mother and

Shame and

sometimes yaya in the

Doubt

toilet
Patient responded
positively with the
training
Completed
immunization
Patient did not
experience any
physical cruelty
Patient was breastfed
until weaned during
2-3 years old while
transitioned with
bottle-feeding and
solid foods during 1

31

E. Phallic Stage

year old
Entered the school as

Pre-School Period

(3-6 years

(3-6 years old)

a sit in with older

old)

Initiative Vs.

brother since 3 years

Guilt

old and started

formal schooling the
next year
More close
relationship to the
mother since the
father is working
abroad
Patient is active at
school being a cub
scout and always
volunteering for
roles in every school
activities
Being active at

School Age

F. Latent Stage

(6-12 years

(6-12 years old)

school while joining

old)

Industry Vs.

the campus band

Likes to play

Inferiority

football and enjoy

being with peers
Started to try

Adolescence

G. Genital Stage

(12-18 years

(12-18 years old)

old Above)

Intimacy Vs.

smoking cigarettes
Peer pressures

Isolation

Became a computer
addict
Being hooked with RPG

games, had riot with

32

co-players and
experienced having
income solely on
bidding game
characters and items
via net
Cellphone confiscated

once at school
because of pornviewing

Skipping school
hours and playing
games on computer
shops

Always reprimanded
being leader of the
mischief in class

33

Summary of Patients Precipitating Factors:

Peer pressure
Insomnia
Low Self-Esteem
Being transferred to private school to be
disciplined
Almost always being pressured by the two older
brother when there are shortcomings or
misbehavior
Strong personality of the mother and quite
distant relationship in contrast to earlier
version of maternal image
No outlet at home nor in friends

Stress in school transition and academy workloads

Reports being bullied at school
Addiction in computer began

Health History

A. History of Present

Illness

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 follow up

34

consultation with Dr. Escandelor and the Psychiatrist

of the said institution to finish his last year on
high school.
B. Past Health History
a. Childhood Illness
The patient had no known childhood illness.
b. Past Hospitalization
The patient had once been admitted at The

Doctors Hospital on 2010 due to Dengue.

c. Serious Illness/Chronic Illness
So far the most serious illness that had

been diagnosed with the patient is having a bipolar

disorder diagnosed during 2012 which he had been
managed with medication to the present while having
monthly and now, adjusted to every 3 months visit to
the Psychiatrist.
d. Previous Surgery

The patient had only done circumcision procedure

during earlier years and no previous surgery done.
C. Family History

Both sides of the family had one or two distant

relatives having nervous breakdown.
D. MSE PROPER

1. General Appearance

The patient is well-groomed and sometimes being

too conscious of appearance. He likes to wear fit
but comfortable clothes and presently argue to
resist haircut that is too long for a school
prescribed haircut.
2. Characteristic of Speech

The patient talks in a well-modulated voice,

speaks spontaneously and can express self. Patient

35

sometimes stutters and stammers in prolonged

conversation and fast-paced discussions
3. Mood and Affect

Patients is always on ambivalent expression

except when watching favorite anime that transforms
him also into being animate and charged with
motivation and positive disposition.
4. Form of Thought

The patient has a history of auditory

hallucinations esp. during the time of insomnia at
the first phase of his emerging symptoms. He also
have illusions once being a part of a powerful force
and the delusion of grandeur being a special being,
all-knowing and all-seeing creature.

5. Sensorium Function

ORIENTATION

10 Khans Questions(When he was still

admitted):

a. What is the name of this institution?

>> Rehab.

b. Where is it located?

>> Victorias.

c. What day of the week is today?

>> My day.. judgment day.

d. What is the month now?

>> March eh!

e. What is the year now?

>> 2014..

f. How old are you?

36

>> 15 kabos la ko ka intra the Voice

Audition

g. When were you born?

>> July 7, 1998

h. Where were you born?

>> Hospital sa Bacolod.

i. Who is the president now?

>> ..si P-noy ah.

j. Who is the president before?

>> :.. si Gloria. GMA

Evaluation:

The patient is oriented to person,time,

place and situational orientation, though he had
answered sarcastically the day of the week. Patient
answered 9 out of 10 Khans question correctly, thus
patient has mild brain organic syndrome. He had a
sense regarding of his surroundings and congruence of
his response.

Prognosis

Factors
I.

Onset of Illness

Good

Poor

A. Early 20 and above 40

B. Between 20 and 40

II.

Education Attainment

A. Highschool

B. College
III. Sex

A. Male

37

IV.

B. Female

History of Present Illness

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

B. Without Family Support

VIII.

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.

38

Nurse-Patient Interaction (NPI)

Nurse-Patient Interaction (NPI)Day 1 11/24/2014

Nurse
Patient
Nurse Inference
Interaction
Interaction
Sir good
Good
Giving information
morning, ako
morning
To have formal
gali imo nurse man
introduction to the
subong.
patient
Kamusta man
Ok lang.
Encouraging description
matyag mo
To let him express
subong sir?
his emotions on
that certain time
Ano sir ang
Nag
Exploring
rason ngaa na
padungol
To know if he is
rehab ka man? abi mo. Tak
open and knows the
an sila
reason of his
sakun
admission to the
pasaway
institution
dan.
Ano nga
Ga mauy ko Focusing
padungol na
bi.. ga
Concentrating on a
sir?
panigarilyo
single point
kag kis a
tilaw2
man..
Ano man na
Marijuana
Probing
ang natilawan
pero kis-a
Persistent
nyo sir?
lang to ya.
questioning of the
Sigarilyo
client
pa gid kag
pahubog e.

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

39

Nurse-Patient Interaction (NPI)Day 2 11/25/2014

Nurse
Patient
Nurse Inference
Patient
Interaction
Interaction
Inference
Busy doing
Good
indi gid man
Broad Opening
something but
morning
a. na
Allowing the
openly respond
sir!Daw
testingan ko
client to take
busy subong lang liwat
when approached
initiative in
sir aw..
himu pispis
introducing the
topic
Ano na
Ahh activity Encouraging
Open gesture and
siya nahimo ni namon
description
demonstrate
mo sir? Daw kagina pi-ud2x
paper origami
To understand
ga
papel
making of a bird
what he is
concentrate origami.
doing
ka gid aw?
Baw..
Indi mangid
Giving recognition
Smiling
kasagad
a.
Happy
To give
gali sa imo
acknowledgement
sir bha..
and
appreciation
Nag enjoy
Huo. Indi gid Encouraging
Smiling and
expression
ka gid gali man gali
enjoying what he
ka gina sa
budlay.
is doing
To let him
activity
express
nyo sir?
emotions
Shows enthusiasm
Te anhon
I-display ni
Formulating a plan
mo na dayun kuno namon sa
of action
sir?
table didto
Asking the
karun huh, pa
client to
nami2 a.
consider what
plans he is
considering

40

Nurse-Patient Interaction (NPI)Day 3 11/26/2014

Nurse
Patient
Nurse Inference
Patient
Interaction
Interaction
Inference
Open
Good morning Pwede gid
Offering Self
gesture;
sir. Updan ta a.
Making oneself
Responds
lang ka di
available
well
anay sir
subong a.

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..

41

Nurse-Patient Interaction (NPI)Day 4 11/27/2014

Nurse
Patient
Nurse Inference
Patient
Interaction Interaction
Inference
Responds well
Hi sir.
Huo. Pa kwa
Broad Opening
Nagkwa ka
ko nila Ms.
Allowing the
gali test
Daphne
patient to take
bag o
initiative in
lang.
introducing the
topic
Te kamusta Hapos lang
Encouraging description Opens with
ang test
man a. Damu
of perceptions
the topic
sir?
galing
Asking client to
answeran.
verbalize what he
Kapoy.
perceives
Daw
Kapoy e. ga
Encourage Comparison
Answers
parehas
mischievously
liguy gani..
Asking that
lang nagkwa hehe
similarities
ka exam sa
anddifferences
skwelahan
benoted
gali.
Abaw,
Kis-a e. mga
General Leads
Reminiscing
storyahi ko barkada ko na
happily
Giving
na bi sang
classmate
encouragement to
liguy mo
hagaray di
let him continue
sir?
magsulod kag
the topic
bakasyon sa
computeran.
Sadja daw
Haha
Te sir,
Sadya gid eh. Reflecting
Somewhat
ano man
Ako dan ang
Directing thoughts guilty but
nabatyag
leader galling
still
and feelings back
radiates from
nyo after
na konsensiya
to him
the memory
naman gali
man ko mag
ya ka
abot sa
balay.
computer
session nyo
nag cut
kamo
classes?

42

Nurse-Patient Interaction (NPI)Day 5 11/28/2014

Nurse
Patient
Nurse Inference
Patient
Interaction
Interaction
Inference
Daw kasubo sa
Bag o lang di
Making Observations
Openly
aton sir aw?
halin bi mga
responds
Verbalizing what
bisita ko. Daw
the nurse perceives
nasubo an man
ta pag bye2x
nila bha..
Nahidlaw ka
Oo.
Consensual Validation
Falls silence
gid sa ila
Searching for
siguro?
mutual
understanding
Nahidlaw ka
Kasadja kung
Restating
Responds
solemnly
gid sa ila sir
ara sila pero
Repeating the main
aw?
mabatyagan ko
idea expressed
naman nga
kulang kung
wala naman
sila.
Storyahe ko bi Daw ka amo na
Exploring
Opens up
sir panu mo ma
e. kulang. Subo
Delving further
describe ang ka ka naman. Tapos
into the subject
kulang na
na ang party.
nabatyagan mo?
So, na mean mo Siguro.. daw
Summarizing
Reflects
sir daw ka
ka ako na lang
deeply
Organizing and
temporary lang
dayun bi isa.
summing up what
ang kalipay nyu
have he had
na mabatyagan.
expressed.
Maumpawan kamo
if ara friend
nyo pero
gakadula man
maglakat na
sila?

43

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).

44

Convergent validity for the scale was indicated by significant

correlations with other measures of loneliness. Construct
validity was supported by significant relations with measures of
the adequacy of the individual's interpersonal relationships,
and by correlations between loneliness and measures of health

and well-being. Confirmatory factor analyses indicated that a

model incorporating a global bipolar loneliness factor along
with two method factor reflecting direction of item wording
provided a very good fit to the data across samples.

The nurse utilized this tool by allowing the patient to

answer the questionnaire that best describes his responses. The
response will be tallied, computed, analyzed and interpreted.
The assessment tool was translated verbally according to
patients dialect in order to understand the items asked and
give accurate response.

Computation of Clients Score

The data treatment is at the ordinal level, where the MEAN

score of the client per category was computed and ranked to
determine the priority of the problem and the overall mean to
indicate the level of patients loneliness as the basis of
treatment to be applied throughout the entire Nurse Patient
Relationship in utilization of Peplaus Theory.

45

Formula for Mean

The mean is obtained by dividing the summation of scores in

all the questions in the assessment tool.

46

Scale

Table1.Initial Assessment Score

(initialassessment phase)

Value

MEAN
Summationof
Frequencyineach
Scale

1
2

Never
Rarely

0
0

0
0

3
4

Sometimes
Always

11
9

0.55
0.45

Summationof
Frequencyin
eachScaleB

UCLA
Score

71

3.55

Total/OverallAverage 20
MeanScore

(final assessmentphase)
MEAN
UCLA
Score

80
0.89

UCLA Scoring:

21-30: People within this range would indicate manageable

instances of loneliness and effective coping up.

31-40: People attaining this score-range are operating

comfortably and experience an average level of loneliness.

41-60: People within this range struggle a little with social

interactions, experiencing frequent loneliness.

61-80: Scores falling within this range would indicate a person

experiencing severe loneliness.

Scale of Means

Description

4 (61-80)

Relatively Severe Tendency to Loneliness

3 (41-60)

Relatively High Tendency to Loneliness

2 (21-40)

Relatively Average Tendency to Loneliness

1 (1-20)

Incompletely Answered Questionnaire

47

Interpretation
of the Score
Scale of Means

Description

3.05 4.00

Relatively Severe Tendency to Loneliness

2.05 - 3.00

Relatively High Tendency to Loneliness

1.05 2.00

Relatively Average Tendency to Loneliness

0.00 1.00

Incompletely Answered Questionnaire

Relatively
Severe
Tendencyto
Loneliness

Relatively
Average
Tendency to
Loneliness

Relatively
High Tendency
to Loneliness

Incompletely
Answered
Questionnaire

Figure 2. Evaluative Scale

Utilized

Figure 3. Evaluative Scale of Mean

Assessment

During Initial

Relatively Severe Tendency

to Loneliness

47

48

PlanningPhase

Table2.NursingCarePlan

ASSESSMENT

NURSING
DIAGNOSIS

Subjective Data:

Nasubuan na ko di..
Indi ko kisa mayo ka tulog
gid.

Wala pa sila ka bisita sa akon
bi.

Kadugay pa ko makapuli
guru ni. Takan na ko di.

Subo e. La daan kalingawan
gid.

Objective Data
Lack of goaldirected behavior
Use of forms of coping that
impede adaptive behavior
(including inappropriate use
of defense mechanisms, verbal
manipulation)
Inability to meet role
expectation (no exercise, poor
concentration)
Behavioral changes:
Impatience
Frustration
Irritability
Discouragement

Ineffective
Coping
related to
depression
and feelings
of
hopelessnes
s as
evidenced by
verbalizatio
n of
loneliness,
decreased
use of social
support,
poor
concentrati
on,
impatience,
irritability,
insomnia,
lack of
energy,
non
participatio
n at times,
low self
esteem and
a score of
71 in UCLA
which
indicate a
person
experiencin
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
atmosphere of realistic hope.
b. Give information and sideeffects
of medications/treatments.
c. Discuss ways to deal with
identified stressors.

49

Table3.MonitoringChart

Implementation Days
Evaluation/Outcomes
1 2 3 4 5 6 7 8 9 1 1 1 1 1
0 1 2 3 4

After14days of continuous
Independent:


nursingintervention,

effectiveillness
1.VisitMr.PUin

managementofthepatient
NEGROS OCCIDENTAL

wasattainedasevidenced
DRUG

by:

REHABILITATION
NursingIntervention/
Rationale

2.Gatherpertinentdata

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.]

aboutMr.PUfrom
theNODRCrecords

andstaff.
[Baselinedatawill
serveasthebasisfor
comparisonofany
significantchangesor
alteration.]

3.ObserveMr.PUsself
managementtowards
hisillnessortowards
thesignsand
symptomsofthe
disease(Bipolar).
[Observationofhis
reactiontowards
illnesswillprovide
significantdataand
concrete
confirmationofhis
loneliness
assessment.

1. Increasecollaboration
withhealthcare
providers.
2. Participateinhisplan
ofcare.
3. Exhibitselfesteem
andmotivation.
4. Continuoustakeshis
medicationwhile
demonstrating
improvementin
rehabilitation.
5. Alleviatesenseof
despair,social
isolationand
loneliness.

50

4.DetermineMr.PUs
healthbeliefs,
patternsofcoping
withillnessand
attitudetowards
rehabilitation.
[DeterminingMr.
PUshealthbelief
pattern,self
awareness,and
perspectiveofhis
conditiontohavea
concrete
understandingofthe
subjectivedata
gathered.]

5. InitiateNursePatient
Interaction (NPI) with
Mr.PU.
[Providecarefor
clientsinneedof
psychosocial
intervention.]

6. Provideasafe
environmentfor
theclient.
[Physicalsafety
oftheclientisa
priority.]

7. Allowclientto
expressopinions,
perceptions,
emotionsin
appropriateand
safemanner
whileproviding
privacyifhe
desiresanditis
safetodoso.
[Clientmaynot
feelcomfortable
inexpressing
feelingsandmay
need
encouragement

51

orprivacy.

8. Encourageclient
toventilate
feelingsin
whateverwayis
comfortable
verbaland
nonverbal.Let
theclientknow
youwilllisten
andacceptwhat
isbeing
expressed.
[Expressing
feelingsmayhelp
relievedespair,
hopelessnessand
soforth.Feelings
arenot
inherentlygood
orbad.Youmust
remain
nonjudgmental
abouttheclients
feelingsand
expressthisto
theclient.]

9. Teachtheclient
aboutproblem
solvingprocess:
explorepossible
optionsexamine
the
consequences,of
eachalternative,
selectand
implementan
alternative,and
evaluatethe
result.
[Theclientmay
beawareofa
systematic
methodfor
solvingproblems.
Successfuluseof

52

problemsolving
processfacilitates
theclients
confidenceinthe
useofcoping
skills.]

10. Providepositive
feedbackateach
stepofthe
process.Ifthe
clientisnot
satisfiedwiththe
chosen
alternative,assist
theclientto
selectanother
alternative.
[Positive
feedbackateach
stepwillgivethe
clientmany
opportunitiesfor
success.
Encouragehimto
persistinproblem
solving,and
enhance
confidence.The
clientcanalso
learntosurvive
makinga
mistake.

DependentNursing
Action:

11. Monitorintakeof
dailymedication
(Olanzapine,
Haloperidol,
Valpros)
[Assures
adherenceto
medication.
Observanceof10
rightsofgiving
medication

53

shouldbe
followed.]

CollaborativeNursing
Action:

12. Collaboratewith
theRehabilitation
nurseinthe
provisionofdaily
medication.
[Continuumof
care.]

13. Review
endorsement
procedureand
referralprocesses
followedin
NODRC
14. Coordinatewith
thepsychiatrist,
Administrator,
nurseand
authorized
persons
regardingevery
interactionand
resultsor
progresswiththe
intervention
taken on the
client.

15. Assistinpatients
takingof
assessmenttools
andfollowup
resultstobe
utilizedasatool
indetermining
nursepatient
interactionand
intervention.

54

ImplementationPhase

TheprogressofMr.PUonhiscopinguppatternsweremonitoredandrecordedforaperiodof
14daysfromNovember24,2014toDecember7,2014.Reflectedonthetablebelowarethechangesof
hisbehavioralpatternwhilethenursinginterventionswereimplementedthroughoutthe14dayperiod.

Nursing
Diagnosis

Ineffective
Coping
related to
depression
and feelings
of
hopelessness
as evidenced
by
verbalization
of loneliness,
decreased
use of social
support, poor
concentration
, impatience,
irritability,
insomnia,
lack of
energy, non
participation
at times, low
selfesteem
and a score of
45 in UCLA
which
indicate a
person
experiencing
severe
loneliness

Day 2
Day 3
(November25,2014) (November26,
2014)

Day1
(November24,
2014)

Difficultyin
socializingwith
othersnoted.
Looks

shyly and
slightly
withdrawn.
Slightly
hesitant
to confide
some
informatio
n.
UCLA
Loneliness
Scale
Questionna
ire had
been
answered

Day4
(November
27,2014)

Busy doing

something
but openly
respond
when
approached.
Quitehesitant
but willing to
participate in
discussion.

Patient
calm but takesthe
Duilford
quite
Zimmerma
distant
n
Somewhat
hesitant Temperam
entSurvey
Slightly
inthe
driftingin
rehabilitati
thoughts
on.
Quite
reflective
Sharesa
bitof
remorse.
Reminisce
nce.
Remains

Day 5
(November28,
2014)
Patient has
been visited
byfriends.
Responds
solemnlyin
deep
reflection
Unattentive
Express
feelingsof
loneliness
andmissing
acozy
atmosphere.

55

Day6
(November29,2014)

Day7
(November30,2014)

Day 8
Day 9
(December1,2014) (December2,
2014)

Presentinthe
Attended
activitybutdoesnot
communion.
Participativeand
participate.
Lowenergy
listensintentlyonthe
Quitedistantandin
homily.
deepthoughts
Politebutstill
preferstobe
undisturbed.
Privacygiven.

Nurseand
patient
interaction
conducted.
Expressed
feelingsof
despairand
loneliness.
Delveddeeper
intocauseof
loneliness.
Patient
expressed
missingpast
activitiesand
hobbies.
Patientreflects
rootof
loneliness

Patientis
ambivalent.
Joinedinthe
activitybut
lacks
enthusiasm
Patient
converse
withother
patients
briefly.

Day 10
(December3
,2014)

Patientis
hesitantat
firstin
interacting
withthe
activities.
Patientis
being
watchfulwith
the
mechanicsof
thegame.
Encourageto
takepartin
thegameand
cheeredon
bybothstaff
andfellow
patients.
Patient
expressed
tirednessbut
inopen
expression.

Day11
(December4
,2014)

Day12
(December5
,2014)

Patientisnostalgicafter
Patienthasplayed
viewingfavoritecartoons.
soccerafterschool.
Patientisbeingattentive Patienteatsdinner
indiscussionaboutthe
andquitetiresome,
cartoons.
takehismedicines,
restforabitwhile
Possiblecopinguphas
watchinghis
beenestablished
favoriteshowand
especiallyinmotivating
finallygettosleep.
thepatientforplanning
towhatcoursehewill
takeforcollege.

Day 13
(December6
,2014)

Day14
(December7
,2014)

Attendedthe
Patientsrelatives
HolyMass.
arrived.
Patientinteractedin Patient
interacted
the living room with
withsome
thefamily.
friends.
Answeredthe
UCLA
Loneliness
Scaleagain.

56

Table4.FinalAssessmentScore

(finalassessmentphase)

SummationofFrequencyin
eachScaleB

MeanDifference

MEAN
UCLA
Score

4
9

0.20
0.45

5
2

0.25
0.10

2.25

80
0.56

20

0.20
0.45

45

0.30
0.35

1.30

Table5.MeanDifferencebetweentheInitialandFinalAssessment

Scale

(initialassessment phase)

(final assessment phase)

Value

Summationof
Frequencyin
eachScale

Summation
of
Frequency
ineach
ScaleB

1
2

Never
Rarely

0
0

3
4

Sometimes 11
Always
9

MEAN
UCLA
Score

0
0
0.55
0.45

71

3.55

80
0.89

4
9

0.20
0.45

5
2

0.25
0.10

20

Mean
Difference

UCLA
Score

0.20
0.45

45

0.30
0.35

2.25

20

MEAN

Total/Overall
AverageMean
Score

80
0.56

1.30

57

Figure4.ComparativeLevelofLonelinessTendencyBetweentheInitialandFinalAssessment
ResultofMr.PU

1.30

Figure5.ComparativeLevelofInitialandFinalAssessmentinChart

12

60.00%

10

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%
Sometimes Always

Value

Never

Role

RarelySometimes Always

Count

Percent

58

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.

59

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.

60

References:
Bailey,

Alan. The effectiveness of Motivational

Interviewing for Young People Engaging in Problematic

Substance Use. 2012.
http://www.headspace.org.au/media/326688/motivational_
interviewing_for_young_people_engaging_in_problematic_
substance_use_headspace
Cacioppo JT, et al. Loneliness within a nomological net: An
evolutionary perspective. Journal of Research in
Personality. 2013;40(6):10541085. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/12137144
Cornwell EY, Waite LJ. Social disconnectedness, perceived
isolation, and health among older adults. Journal of
Health and Social Behavior. 2010;50:3148.

[PubMed]

Dussault, Marc, and ric Frenette. "Loneliness and Bullying

in the Workplace." American Journal of Applied
Psychology 2, no. 4 (2014): 94-98.
Forchuk C. The orientation phase of the nurse-client
relationship. Testing Peplaus theory. Journal of
Advanced Nursing. 2014:4;20:532537. [PubMed]
Forchuk C,

et. al. From hospital to community: Bridging

therapeutic relationships. Journal of Psychiatric and

Mental Health Nursing. 2013;5:197202. [PubMed]
Fowler J. Taking theory into practice: Using Peplaus model
in the care of a patient. Professional Nurse.

61

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/

62

Stockburger , Jillian. Force on Substance Abuse Youth

Voices on the Prevention and Intervention of Youth
Substance Abuse. 2014. Retrieved from
http://www.unbc.ca/assets/centreca/english/piysa.pdf
Stockman C. A literature review of the progress of the
psychiatric nurse-patient relationship as described by
Peplau. Issues in Mental Health Nursing. 2012;26:911
919. [PubMed]
Stuart, G.W. & Sundeen, S.J. (1987). Principles and
Practice of Psychiatric Nursing (3rd Ed). St. Louis,
USA: C.V. Mosby Co. Retrieved from
Substance Abuse and Mental Health Services Administration.
(2004). National consensus statement on mental health
recovery. Retrieved from
http://download.ncadi.samhsa.gov/ken/pdf/SMA054129/trifold.pdf.
Substance Abuse and Mental Health Services Administration.
(2013). SAMHSAs shared decision-making (SDM): Making
recovery real in mental health care project. Retrieved
from
http://download.ncadi.samhsa.gov/ken/msword/SDM_fact_s
heet_7-23-2013.doc.
Taylor Carol, (2011). The Art & Science Of Nursing Care 4th
ed. Philadelphia,

Lippincott.

Torres, G. (2012). Theoretical Foundations of Nursing. USA:

63

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]

64

Letter to Conduct the Study

November 24, 2014

Dr. Ernesto A. Palanca
Negros Occidental Drug Rehabilitation Foundation, Inc.
Camp Gen Aniceto Lacson Compound,
Victorias City, Negros Occidental

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 would like to request a permission from
your good office to allow me to conduct a study on one of your patient.

Your positive response on this matter is highly appreciated.

More power and God bless!


Respectfully Yours,



TIFFANY ALTEZA C. UNTAL, RN
MN STUDENT, NONESCOST



Noted:


Atty. JOSEPH GEDEONI C. VALENCIA RN, MN, Ph.D
CLINICAL PAPER ADVISER

65

Letter to Conduct the Study

November 24, 2014

MS. JUVY A. PEPELLO
Negros Occidental Drug Rehabilitation Foundation, Inc.
Camp Gen Aniceto Lacson Compound,
Victorias City, Negros Occidental

Dear Maam,

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 would like to request a permission from
your good office to allow me to conduct a study on one of your patient.

Your positive response on this matter is highly appreciated.

More power and God bless!


Respectfully Yours,



TIFFANY ALTEZA C. UNTAL, RN
MN STUDENT, NONESCOST






Noted:



Atty. JOSEPH GEDEONI C. VALENCIA RN, MN, Ph.D
CLINICAL PAPER ADVISER

66

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,



TIFFANY ALTEZA C. UNTAL, RN
MN STUDENT, NONESCOST






Noted:



Atty. JOSEPH GEDEONI C. VALENCIA RN, MN, Ph.D
CLINICAL PAPER ADVISER

67

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.

PSYCHOLOGICALASSESSMENT
GUILFORDZIMMERMANTEMPERAMENTSURVEY

I.PATIENTINFORMATION
Patient:P.U.
Age:16y.o.
Sex:M

II.TESTRESULTS

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

III.TESTINTERPRETATION

Resultsshowthatthepatientdisplaysahighlyimpulsivebehavior.Hetendstoactonthefirst

thoughtthatcomesintohismind,withoutthinkingaboutthepossibleconsequenceshisactionsmight
bring.Asaresultofthisbehavior,hehasthetendencytogethimselfintroublemostofthetime.Itisalso
shownthathisenergylevelishighercomparedtomostpeopleofhisageandsex.Thiswouldmeanthat
hewouldenjoydoingactivitiesatsuchafastpace,ashedoesnotgettiredquickly.Hemaygetthings
doneasfastaspossible.Theremightbetimeswherehewouldgetrestlessaswell.

In terms of sociability, the patient shows signs of introversion. He is most likely to stay in the

backgroundwhenattendingsocialevents.Heseemstobesociallywithdrawn.Hewouldusuallyisolate
himselffromcrowds,asheprefersspendingtimealone.Hedoesnotseemtomindhavingonlyafew

68

friendswithhim.Apartfromhisintroversion,heisalsoshowntobetoosubmissive,meaningheislikely
theonetofollowratherthantolead.Heisinclinedtofollowwhateverheisbeingtoldtodo,evenifhe
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
aggressivesidewhichwouldcomeoutwhensomeonewouldprovokehim.Also,heseemstobefondof
belittlingandmockingothers.Wheneveronecommitsamistake,heislikelytomakefunofthatindividual
withoutbeingconsiderateofhis/herfeelings.

Resultsalsoindicatethatthepatientmaybesufferingfromapossiblemooddisorder.Hisfeelings

tendtoshiftfromtimetotime,withoutanyreason.Heseemstobequitenegativewhenitcomesto
himself.Hemayfeelinsecuremostofthetime,especiallywhenbeingwatchedandcriticizedbyothers.
Hedoesnotappeartotakeconstructivecriticismslightlyandwouldgetaffectedeasily.Also,hetendsto
beemotionallyexpressive.Hehasnodifficultywithshowinghisfeelingstoothers.Lastly,itisshownthat
hemayhaveparanoiatendencies.Heisusuallysuspiciousofthosearoundhim,andhemayfindithard
totrustpeopleeasily.

Preparedby:

Approvedby:

DaphneElyseKeng

Ms.JuvyPepello

JuniorPsychologist

Administrator

69

Appendix B
Assessment Tool

UCLA LONELINESS SCALE

INSTRUCTIONS:
Indicate how often each of the statements below is descriptive of you.
4 indicates I often feel this way
3 indicates I sometimes feel this way
2 indicates I rarely feel this way
1 indicates I never feel this way
1. I am unhappy doing so many things alone

4321

2. I have nobody to talk to

4321

3. I cannot tolerate being so alone

4321

4. I lack companionship

4321

5. I feel as if nobody really understands me

4321

6. I find myself waiting for people to call or write

4321

7. There is no one I can turn to

4321

8. I am no longer close to anyone

4321

9. My interests and ideas are not shared by those around me

4321

10. I feel left out

4321

11. I feel completely alone

4321

12. I am unable to reach out and communicate with those around me

4321

13. My social relationships are superficial

4321

14. I feel starved for company

4321

15. No one really knows me well

4321

16. I feel isolated from others

4321

17. I am unhappy being so withdrawn

4321

18. It is difficult for me to make friends

4321

19. I feel shut out and excluded by others

4321

20. People are around me but not with me

4321

Scoring: Items 1, 5, 6, 9, 10, 15, 16, 19, 20 are all reverse scored.
Keep scoring continuous.

N C P |1

AppendixC
NursingCarePlans
NURSINGCAREPLAN#1

ASSESSMENT

NURSING
DIAGNOSIS

RATIONALE

DESIRED
OUTCOME

NURSING
INTERVENTION

JUSTIFICATION

EVALUATION

ActualCues

Subjective:

Thepatient
verbalized,

Kisindiko
kabalopanu
ihambal
nameanko
na
maintindihan
gidnila.
Natayuganna
silakuno.

Walakoga
upodkayma
OP(outof
place)man
langkoto

Impaired
social
interaction
r/t
Self
concept
disturbance
AEB
Discomfort
insocial
situations,
receivea
satisfying
senseof
social
engagement,
familyreport
ofchangesin
interaction,
dysfunctional
interaction
withothers.

Definition:

Socialisolation
isthecondition
ofalonenessexpe
riencedby
theindividual
andperceived
asimposedby
othersandasa
negativeor
threatened
state;impaired
socialinteraction
isaninsufficient
orexcessive
quantityor
ineffectivequality
of
socialexchange.

ShortTerm:
1. Verbalize
awarenessof
factorscausing
orpromoting
impairedsocial
interactions

2. Identifyfeelings
thatleadtopoor
social
interactions.

3. Expressdesire
tobeinvolved
inachieving
positive
changesin
social
behaviorsand

Independent:

A.Assess
causative/contribu
tingfactors.

B.Assist
patient/SOto
recognize/make
positivechangesin
impairedsocial
andinterpersonal
interactions.

a.Thismayresult
toconformingor
rebelliouspattern
/behaviorwhile
notingprevalent
interaction
pattern.

b.Once
recognized,client
canchooseto
changeashe
learnstolisten
andcommunicate
insocially
acceptableway.

After14daysof
NursePatient
Interaction,the
clientwillbeableto:

Verbalizefeeling
thatleadto
poorsocial
interaction
GOALMET

Involveinsocial
interaction.
GOALMET

Identifyself
positive
reinforcement
forthechanges
thatare
achieved.

N C P |2

japonsatrip
nila.

Objective:

Discomfort
insocial
situation

Donotask
question

Observed
lack
ofattention
during
activities

Insufficient
orexcessive
quantityor
ineffective
qualityof
social
exchange.

Source:

Nurses
Pocket
Guide10th
Editionby
MarilynnE.
Doenges,
Mary
Frances
Moorhouse,
AliceC.
Murr

C.Workwithclient
c.Negativeself

toalleviate
conceptifleft

underlying
unresolvedoften

negativeself
impedepositive
LongTerm:
concepts
social

interactions.
4. Giveself

Attemptsat
positive

tryingtoconnect
reinforcement
withanothercan
forchanges

become
thatare

devastatingto
achieved.

selfesteemand

emotionalwell
5. Developsocial
support
being.

system;use

Collaborative:
available

D,Thereisa
D.Promotewellness directcorrelation
resources
appropriately. byseeking
betweenthe
communityprograms musicalportion
forclient
ofthebrainand
involvementthat
thelanguage
promotepositive
area,andtheuse
behaviorstheclient ofthese
isstrivingtoachieve. programsmay

resultinbetter

communication

skills.

interpersonal
relationships.

GOALMET

Assessfor
environmental
withdraw(time
spentinroom
versustime
spentwith
others).
GOALMET

N C P |3

NURSINGCAREPLAN#2
ASSESSMENT

NURSING
RATIONALE
DIAGNOSIS

ActualCues
Development
ChronicLowSelf

ofanegative
Esteem
Subjective:
perceptionof
r/t

selfworthin
Feelingsof
Thepatient
responsetoa
abandonment
verbalized,
current
secondaryto

situation.
Nahuyanako
separationfrom

significantother/s
kisakagna
Lowself
AEB
guiltysa
esteem
Longstandingself
napanghimu
disturbance
describeas
ko,,
negating
negative

verbalizations,
feelings
Expressionsof
Walakopulos
about
shameandguilt,
ya..Lanako
themselves,
Poorbody
putoro.
includingthe

presentation(eye
lossof
Objective:
contact,posture,
confidence

movements)
andself
Emotionally Nonassertive/passive
esteem,
stressed.

senseof
Definition:

failureto

reachthe
Facial
Longstandingnegative
desire,self
grimace
selfevaluation/
criticism,

feelingsaboutselfor
selfcapabilities.

reduced

DESIRED
OUTCOME

ShortTerm:
1. Accept
support
throughthe
nurse
patient
relationship
2.Identify
areasof
ineffective
coping
3.Examine
thecurrent
effortsat
coping
4.Identify
areasof
strength
5.Learn
newcoping
skills

LongTerm:

6.Practice

NURSING
INTERVENTION
Independent:
A.Identify
current
stressesin
PUslife
including
bipolar
disorder

B.Assess
currentlevelof
depression
usingUCLA
Loneliness
Scale.

JUSTIFICATION

a. When
areasof
concernare
verbalized
bythe
patient,he
willbeable
tofocuson
oneissueat
atime.

b. Ifshe
identifiesthe
mental
disorderasa
stressor,he
willmore
likelybeable
todevelop
strategiesto
dealwithit.

EVALUATION

Determineif
heisableto
realistically
identify
problem
areas.
GOALMET

Assessifhe
canidentify
anyprevious
successesin
herlife.
GOALMET

Assessfor
environmental
withdraw
(timespentin
roomversus
timespent
withothers).
GOALMET

N C P |4

Narrowed
focus

Feelingsof
helplessness,
hopelessness,or
powerlessness

Confusion
aboutself,
purpose,or
directionoflife

productivity,
whichis
Source:
directed
destructiveto
NursesPocket
th
others,
Guide10 Edition
feelingsof
byMarilynnE.
inadequacy,
Doenges,Mary
FrancesMoorhouse, irritableand
being
AliceC.Murr
withdrawn

socially.

newcoping
skills.
7.Focuson
strengths

C.InvolvePU
intreatment
and
socialization
activities.
Stress
importanceof
activityin
helping
recoveryfrom
depressionand
thathewill
havetomakea
conscious
efforttofight
it.

D.AssistPUin
discussing,
selecting,and
practicing
positivecoping
skills(jogging,
yoga,thought
stopping

c. Byfocusing
onpast
successes,
hecan
identify
strengths
andbuild
onthemin
thefuture

d.Severely
depressed
individuals
need
assistance
withdecision
making,
groomingand
hygiene,and
nutrition

Assessifthe
patient
follows
throughon
learningnew
skills
andlearneda
lotabouthis
medication
and
committedin
complying
withhis
medication
regimen.
GOALMET
Continueto
practicenew
copingskillsas
stressful
situations
arise
GOALMET

N C P |5

Collaboration:

E.Educate
regardingthe
hismedicine
andmedical
regimensuch
ashistherapy
andsession
withthe
rehabilitation
staffwithits
relationshipto
depression

F.Assist
patientin
copingwith
bipolar
disorder,
beginningwith
education
aboutit.

e.Bykeeping
individuals
whoare
depressed
active,social
withdrawalis
prevented.

f.Social
activityhelps
theclientdeal
withthe
depression.
Patientshould
havea
thorough
knowledgeof
the
medication
andside
effects

N C P |6

NursingCarePlan#3
ASSESSMENT
ActualCues

Subjective:

Thepatient
verbalized,

Objective:

Decreased
use of social
support
Destructive
behavior
toward self
or others
Difficulty
asking for
help
Fatigue
Inability to
meet basic

NURSING
DIAGNOSIS

RATIONALE

Ineffective
Ineffective
Individual
individual
Coping
copingmaybe
r/t
manifest
Alteredmood
whena
(depression)
person
causedby
verbalizesan
changes
inabilityto
secondaryto
copeortoask
bodychemistry
forhelp,is
(bipolar
unableto
disorder)
meetbasic
AEB
needsorrole
Verbalizationin expectations,
inabilitytocope
cannotuse
oraskforhelp
problem
Reported
solving
difficultywith
techniques,
lifestressors
hasahighrate
Inabilityto
ofillnessor
problemsolve
accidents,
Alterationin
exhibits
social
destructive
participation
behavior
Destructive
towardselfor
others

DESIRED
OUTCOME

ShortTerm:
2. Accept
support
throughthe
nurse
patient
relationship
2.Identify
areasof
ineffective
coping
3.Examine
thecurrent
effortsat
coping
4.Identify
areasof
strength
5.Learn
newcoping
skills

NURSING
INTERVENTION

A.Identify
current
stressesinPUs
lifeincluding
bipolar
disorder

B.Assess
currentlevelof
depression
usingUCLA
Loneliness
Scale.

JUSTIFICATION

d. When
areasof
concernare
verbalized
bythe
patient,he
willbeable
tofocuson
oneissueat
atime.

e. Ifshe
identifiesthe
mental
disorderasa
stressor,he
willmore
likelybeable
todevelop
strategiesto
dealwithit.

EVALUATION

Determineif
heisableto
realistically
identify
problem
areas.
GOALMET
Assessifhe
canidentify
anyprevious
successesin
herlife.
GOALMET
Assessfor
environmental
withdraw
(timespentin
roomversus
timespent
withothers).
GOALMET

N C P |7

needs and
role
expectations
Statements
indicating
inability to
cope

behaviortoward
(including

self
excessive

eating,
LongTerm:

drinking,or

Definition:
otherillnesses
6.Practice
Inabilitytoform
relatedto
newcoping
validappraisalof
emotional
skills.
thestressors,
tension,isa
7.Focuson
inadequate
chronic
strengths
choicesof
worrier,or
practiced
exhibits
responses,
chronic
and/orinability
depression.
touseavailable

resources.

Source:

NursesPocket
Guide10th
Editionby
MarilynnE.
Doenges,Mary
Frances
Moorhouse,
AliceC.Murr

C.InvolvePU
intreatment
and
socialization
activities.
Stress
importanceof
activityin
helping
recoveryfrom
depressionand
thathewill
havetomakea
conscious
efforttofight
it.

D.AssistPUin
discussing,
selecting,and
practicing
positivecoping
skills(jogging,
yoga,thought
stopping

f. Byfocusing
onpast
successes,
hecan
identify
strengths
andbuildon
theminthe
future.

d.Severely
depressed
individuals
need
assistancewith
decision
making,
groomingand
hygiene,and
nutrition

Assessifthe
patient
follows
throughon
learningnew
skills
andlearneda
lotabouthis
medication
and
committedin
complying
withhis
medication
regimen.
GOALMET
Continueto
practicenew
copingskillsas
stressful
situations
arise
GOALMET

N C P |8

E.Educate
regardingthe
useofalcohol
andits
relationshipto
depression

F.Assist
patientin
copingwith
bipolar
disorder,
beginningwith
education
aboutit

e.Bykeeping
individuals
whoare
depressed
active,social
withdrawalis
prevented.

f.Social
activityhelps
theclientdeal
withthe
depression.
Patientshould
havea
thorough
knowledgeof
themedication
andside
effects