Republic of the Philippines

NORTHERN NEGROS STATE COLLEGE OF SCIENCE & TECHNOLOGY

Old Sagay, Sagay City, Negros Occidental
(034)722-4120/www.nonescost.edu.ph
CERTIFICATE NUMBER:
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
Chapter I

i
ii
iii
iv
v
Introduction
Background of the Study
Statement of the Problem
Significance of the Study

Chapter II

Review of Related Literature

Conceptual Framework
Assumption
Definition of Terms

Chapter III

Findings
Conclusion
Recommendation
References
Appendices

1
3
4

22
26
26

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

- 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).

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

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

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 nursepatient relationship emphasized mutuality as an essential

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

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

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

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

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.

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.

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

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

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.

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

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

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,

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.

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

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
Low Self
Esteem

PATIE
NT

Socially
Withdrawn

RESOLUTION PHASE

EXPLOITATION
PHASE

IDENTIFICATION
Severe
Tendency
Towards
Loneliness

PHASE
ORIENTATION
PHAS
E

Nurse
Patient
Relations
hip

WellRounded Person
with Restored
Socialization,

Nurse as
a:
v Stranger
v Teacher
v Resource

Person
v Counselor
v Surrogate
v Leader

Confidence, Self
Integrity and
Effective Coping
Mechanism.

PATIENT
A Schematic Diagram Depicting the Relationship of Utilizing the
Effectiveness of Peplaus Interpersonal
Relations Theory practicing the Nurses Roles throughout the phases towards the
success of patients Rehabilitation.

36

CHAPTER III
Application of the Nursing Theory
Client Profile
Name: P. U.
Age: 16 years old
Sex: Male
Birthday: July 7, 1998
Address: Esteban Subdivision, Pulupandan, Negros Occ.
Civil Status: Child
Educational Attainment: 4th year High School Student
Religion: Roman Catholic
History of the Present Illness
The patient had manifest first depression upon returning
home from school one day having ambivalent expression and had
his packed lunch untouched. Since then, he consecutively had
bouts of sudden crying of getting restless and mad for no
apparent reason. He had been skipping classes and found to be
with peers who are having recent substance abuse records. He
would escape their house at the middle of the night and suddenly
resort to being a loner and complain having insomnia.
The patient then had been under the care of Dr. Charibel
Escandelor on June 2012. He exacerbated again late last year
(2013) and is presently still very symptomatic showing both
psychosis band very manic symptoms. His folks have difficulty
keeping him at home and ensuring he takes his medicines. He
recently had a negative (-) drug test and has no known illness.
On March 24, 2014 he had been admitted at the Negros Occidental
Drug Rehabilitation Foundation, Inc. and and was discharged June
6, 2014 provided being still on strict medication and a monthly

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

PATIENT ANAMNESIS

Once cell differentiation is

mostly complete, the embryo enters

A. Prenatal

the next stage and becomes a fetus.

v Pregnancy was planned

The early body systems and structures

v Mother had pre-natal

established in the embryonic stage

v Mother is in good

continue to develop. The neural tube

develops into brain and spinal cord
and neurons form. Sex organ begins to
appear during the third month of
gestation. The fetus continues to

condition
v Mother has no vices
and is not into drugs
v No illnesses during
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.

v 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

(0-1 year old)

(0-1 year old)

Libido is

Trust V.

v Normal Delivery
v Mother is the most
significant person
v Father is a seaman

focused on the

Mistrust

and is absent at

mouth

times since on board

Individual may

while the child is

be frustrated

growing up
v Mother is always at

by having to
wait on

the patients side

another

v Patient grew in rural

person, being

area

dependent on

v He has 5 siblings (2

another

boys,3 girls) being

person,

the 4th child in the

family
v

D. Anal Stage

Toddler Period

v Patient was toilet

Autonomy Vs,

trained by mother and

Shame and

sometimes yaya in the

Doubt

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

year old
E. Phallic Stage

Pre-School Period

v Entered the school as

(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
v More close
relationship to the
mother since the
father is working
abroad
v Patient is active at
school being a cub
scout and always
volunteering for
roles in every school
activities

F. Latent Stage

School Age

v Being active at

(6-12 years

(6-12 years old)

school while joining

old)

Industry Vs.

the campus band

Inferiority

v Likes to play
football and enjoy
being with peers

G. Genital Stage

Adolescence

(12-18 years

(12-18 years old)

old Above)

Intimacy Vs.
Isolation

v Started to try
smoking cigarettes
v Peer pressures
v Became a computer
addict
v Being hooked with RPG
games, had riot with

co-players and
experienced having
income solely on
bidding game
characters and items
via net
v Cellphone confiscated
once at school
because of pornviewing
v

Skipping school
hours and playing
games on computer
shops

v Always reprimanded
being leader of the
mischief in class

Summary of Patients Precipitating Factors:

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

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

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
v 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?

>> 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.

Good

Poor

Onset of Illness
A. Early 20 and above 40

B. Between 20 and 40
II.

Education Attainment
A. Highschool

B. College
III. Sex
A. Male

B. Female
IV.

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.

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
abi mo. Tak
rehab ka man?
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

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
when approached
busy subong lang liwat
initiative in
sir aw..
himu pispis
introducing the
topic
Ano na
Ahh activity Encouraging
Open gesture and
siya nahimo ni namon
demonstrate
description
paper origami
mo sir? Daw kagina pi-ud2x
To understand
papel
making of a bird
ga
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
Te anhon
I-display ni
Formulating a plan
Shows enthusiasm
of action
mo na dayun kuno namon sa
sir?
table didto
Asking the
karun huh, pa
client to
nami2 a.
consider what
plans he is
considering

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;
a.
sir. Updan ta
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..

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

Nurse
Patient
Nurse Inference
Patient
Interaction Interaction
Inference
Hi sir.
Huo. Pa kwa
Broad Opening
Responds well
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
abot sa
ya ka
balay.
computer
session nyo
nag cut
kamo
classes?

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

Nurse
Patient
Nurse Inference
Interaction
Interaction
Daw kasubo sa
Bag o lang di
Making Observations
aton sir aw?
halin bi mga
Verbalizing what
bisita ko. Daw
the nurse perceives
nasubo an man
ta pag bye2x
nila bha..
Nahidlaw ka
Oo.
Consensual Validation
gid sa ila
Searching for
siguro?
mutual
understanding
Nahidlaw ka
Kasadja kung
Restating
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
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
sir daw ka
ka ako na lang
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?

Patient
Inference
Openly
responds

Falls silence

Responds
solemnly

Opens up

Reflects
deeply

Methodology
Assessment Tool
An adapted questionnaire the UCLA Loneliness Scale is used
as a measure of loneliness. Its name derives from its having
been developed at the University of California, Los Angeles
(UCLA). It was first published in 1978 by Russell, D., Peplau,
L.A., and Ferguson, M.L., and was revised in 1980 and 1996. The
internal consistency of the scale was high and the reported
correlations with measures of emotional loneliness, social
loneliness, self-esteem, depression, and personality traits,
supported the convergent and discriminant validity of the scale.
The scale consists of 20 items (11 positive and 9
negative), describing subjective feelings of loneliness, none of
which refers specifically to loneliness. A 20-item scale
designed to measure ones subjective feelings of loneliness as
well as feelings of social isolation. Participants rate each
item as either O (I often feel this way), S (I sometimes feel
this way), R (I rarely feel this way), N (I never feel this
way). The 20 items are rated on a 4- point Likert scale in
accordance with the rate of frequency, the following
corresponding weights were assigned to every response. Scores on
the scale range from 20 to 80 with higher scores reflecting
greater loneliness.
Using data from prior studies of college students, nurses,
teachers, and the elderly, analyses of the reliability,
validity, and factor structure of this new version of the UCLA
Loneliness Scale were conducted. Results indicated that the
measure was highly reliable, both in terms of internal
consistency (coefficient alpha ranging from .89 to .94) and
test-retest reliability over a 1-year period (r = .73).

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.

Formula for Mean

The mean is obtained by dividing the summation of scores in
all the questions in the assessment tool.

Table 1. Initial Assessment Score

(initial assessment phase)
(final assessment phase)
Scale
Value

Summation of MEAN
Frequency in
each
Scale
0
0
0
0

1
2

Never
Rarely

3
4

Sometimes 11
Always
9

Total/ Overall
Average
Mean Score

20

UCL
A
Scor
e
71

0.55
0.45
1

Summation MEAN
of
Frequenc
y in each
Scale B

3.55
80
0.89

UCLA Scoring:

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

UCL
A
Scor
e

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

Incompletely
Answered
Questionnaire

Relatively
High Tendency
to Loneliness

Figure 2. Evaluative Scale

Utilized

Figure 3. Evaluative Scale of Mean

Assessment

During Initial

Relatively Severe Tendency

to Loneliness

47

57
Planning Phase
Table 2. Nursing
Care Plan

ASSESSMENT
Subjective
Data:
v Nasubuan na ko di..
v Indi ko kisa mayo ka
tulog
gid.
v Wala pa sila ka bisita sa
akon
bi.
v Kadugay pa ko
makapuli
guru ni. Takan na ko
di.
v Subo e. La daan
kalingawan
gid.
Objective
Data
v Lack of goaldirected
behavior
v Use of forms of coping
that impede adaptive
behavior (including
inappropriate use
of defense mechanisms,
verbal
manipulation)
v Inability to meet role
expectation (no exercise,
poor concentration)
v Behavioral changes:
Impatience
Frustration
Irritability
Discouragement

NURSIN
G
DIAGNOSI

Ineffective
Coping
related to
depression
and
feelings of
hopelessn
es s as
evidenced
by
verbalizati
o n of
loneliness,
decreased
use of
social
support,
poor
concentrat
i on,
impatience
,
irritability,
insomnia,
lack of
energy,
non
participati
o n at
times, low
self
esteem
and a
score of
71 in
UCLA
which
indicate a
person
experienci
n g severe
loneliness

OBJECTIVES OF CARE
Within 14 days of nursing
intervention at NEGROS OCCIDENTAL
DRUG REHABILITATION CENTER the
patient will be able to:
1. Improve or increase
collaboration with the
rehabilitation nurse/staff.
2. Assess coping abilities and
skills.
3. Assist client to deal with
current situation:
a. Encourage communication
with staff/S.O.
b. Provide continuity of care
with the same personnel
taking care
of the client as often as
possible. c. Schedule
activities so periods of
rest alternate with nursing
care while increasing
activities slowly.
d. Assess client in use of
diversion, recreation,
relaxation techniques.
e. Encourage client to try
new coping behaviors while
confront when behavior is
inappropriate, pointing out
difference between words
and actions while providing
external locus of control,
enhancing safety.
4. Provide meeting
psychological needs.
5. Promote wellness.
a. Provide and encourage an

Table 3. Monitoring
Chart
Nursing
Intervention/
Rational
e
Independent:
1. Visit Mr. PU in

NEGROS
OCCIDENTAL DRUG
REHABILITATION
CENTER. Discuss the
purpose of the study
and interview will be
conducted. Establish
rapport with Mr. Pu.
[Establishing rapport
will increase patient
participation and
ease in date
gathering.]
2. Gather pertinent
data about Mr. PU
from
the NODRC
records and
staff.
[Baseline data will
serve as the basis
for comparison of
any significant
changes or
alteration.]
3. Observe Mr. PUs
self management
towards his illness
or towards the
signs and
symptoms of the
disease (Bipolar).
[Observation of his
reaction towards
illness will provide
significant data
and concrete
confirmation of his

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

Evaluation/Outcom
es
After 14 days of
continuous
nursing
intervention,
effective illness
management of the
patient was
attained as
evidenced by:

1.

Increase
collaboration with
healthcare
providers.
2. Participate in his
plan
of care.
3. Exhibit self
esteem and
motivation.
4. Continuous
takes his
medication while
demonstrating
improvement in
rehabilitation.
5. Alleviate
sense of
despair, social
isolation and
loneliness.

4. Determine Mr. PUs

health beliefs,
patterns of coping
with illness and
attitude towards
rehabilitation.
[Determining Mr.
PUs health belief
pattern, self
awareness, and
perspective of his
condition to have
a concrete
understanding of
the subjective
data gathered.]
5.

Initiate Nurse
Patient Interaction
(NPI) with Mr. PU.
[Provide care
for clients in
need of
psychosocial
intervention.]

6.

Provide a
safe
environment
for the client.
[Physical
safety of the
client is a
priority.]

Allow client to
express
opinions,
perceptions,
emotions in
appropriate
and safe
manner while
providing
privacy if he
desires and it
is safe to do
so. [Client may
not feel
comfortable in
expressing

7.

or privacy.
8.

9.

Encourage
client to
ventilate
feelings in
whatever way
is comfortable
verbal and
nonverbal. Let
the client
know you will
listen and
accept what is
being
expressed.
[Expressing
feelings may
help relieve
despair,
hopelessness
and so forth.
Feelings are
not
inherently
good or bad.
You must
remain
nonjudgmental
about the
clients
feelings and
express this to
the client.]
Teach the
client about
problem
solving
process:
explore
possible
options
examine the
consequences,
of each
alternative,
select and
implement an
alternative,
and evaluate

problemsolving
process
facilitates the
clients
confidence in
the use of
coping skills.]
10. Provide
positive
feedback at
each step of
the process. If
the client is not
satisfied with
the chosen
alternative,
assist the
client to
select another
alternative.
[Positive
feedback at
each step will
give the client
many
opportunities
for success.
Encourage him
to persist in
problem
solving, and
enhance
confidence. The
client can also
learn to
survive
making a
mistake.
Dependent Nursing
Action:
11. Monitor intake
of daily
medication
(Olanzapine,
Haloperidol,
Valpros)
[Assures
adherence to

should be
followed.]
Collaborative
Nursing
Action:
12. Collaborate
with the
Rehabilitation
nurse in the
provision of
daily
medication.
[Continuum of
care.]
13. Review
endorsement
procedure and
referral
processes
followed in
NODRC
14. Coordinate
with the
psychiatrist,
Administrator,
nurse and
authorized
persons
regarding
every
interaction
and results or
progress with
the
intervention
taken on
the client.
15. Assist in
patients
taking of
assessment
tools and
follow up
results to be

Implementation Phase
The progress of Mr. PU on his coping up patterns were monitored and recorded for a
period of
14 days from November 24, 2014 to December 7, 2014. Reflected on the table
below are the changes of his behavioral pattern while the nursing interventions
were implemented throughout the 14day period.
Nursing
Diagnosis

Day 1
(November 24,
2014)

Day 2
(November 25,
2014)

Ineffective
Coping
related to
depression
and
feelings of
hopelessne
ss as
evidenced
by
verbalizatio
n of
loneliness,
decreased
use of social
support,
poor
concentratio
n
,
impatience,
irritability,
insomnia,
lack of
energy,
non
participatio
n at times,
low self
esteem
and a score
of
45 in UCLA

Difficulty in
socializing
with others
noted.
Looks

Busy doing

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

something
but openly
respond
when
approached.

Quite hesitant
but willing
to
participate
in
discussion.

Day 3
(November
26,
2014)
Remains

Day 4
Day 5
(November (November
27, 2014)
28,
2014)
Patient
Patient
takes
the
has been
calm but
Duilford
visited by
quite
Zimmer
friends.
distant
Responds
ma
n
Somewhat
solemnly
hesitant Tempera
m
ent
in deep
Slightly
Survey
in
reflection
drifting
the
Unattentiv
in
rehabilita
e
thought
ti
on.
Express
s
Quite
feelings
reflectiv
of
e
loneliness
Shares
and
missing a
a
cozy
bit of
atmospher
remorse.
e.

Reminisce
nce.

Day 6
(November 29,
2014)

Day 7
Day 8
(November 30, 2014) (December 1,
2014)

Present in the
Attended
activity but does
communio
not participate.
n.
Low energy
Participative and
Quite distant and
listens intently on
in deep thoughts
the homily.
Polite but
still
prefers to
be
undisturbed
.
Privacy given.

Nurse
and
patient
interactio
n
conducte
d.

Expresse
d feelings
of despair
and
loneliness
.
Delved
deeper
into cause
of
loneliness.
Patient
expressed
missing
past
activities
and
hobbies.
Patient

Day 9
Day 10
(December 2, (December 3
2014)
, 2014)
Patient is
ambivale
nt.
Joined in
the
activity
but lacks
enthusias
m
Patient
converse
with
other
patients
briefly.

Patient is
hesitant
at first in
interacti
ng with
the
activities
.
Patient
is
being
watchful
with
the
mechanics
of the
game.
Encourage
to
take part in
the game
and
cheered on
by both staff
and fellow
patients.

Day 11
(December 4
, 2014)

Day 12
(December 5
, 2014)

Day 13
(December 6
, 2014)

Patient is nostalgic
after viewing favorite
cartoons.
Patient is being
attentive in
discussion about the
cartoons.
Possible coping up
has been
established
especially in
motivating the
patient for planning

Patients
Attended
relatives
the
arrived.
Holy

Patient
Mass.
interacted in the Patient
living room with
interacte
the family.
d with
some
friends.
Answered
the UCLA
Loneliness
Scale

Patient
has
played
soccer
after school.

Patient eats
dinner
and
quite tiresome,
take
his
medicines, rest
for a bit while
watching his
favorite show
and finally get
to sleep.

Day 14
(December 7
, 2014)

Table 4. Final
Assessment Score
(final assessment phase)
Summation of
Frequency in
each Scale B
4
9

Mean Difference

MEAN

0.20
0.45

5
2
20

UCL
A
Scor

0.20
0.45

45

0.25
0.10

2.25

80
0.5
6

0.30
0.35

1.3
0

Table 5. Mean Difference between the Initial and Final Assessment

Scale
Value

(initial assessment phase) (final assessment

phase)
Summation MEAN
Summatio MEAN
of
n
UCL
UCL
A
A
Frequenc
of
Scor Frequen
Scor
y in each
e
e
Scale
cy in
each
Scale B
0
0
4
0.20
71
45
0
0
9
0.45

1
2

Never
Rarely

3
4

Sometime 11
s
Always
9

Total/ Overall
Average
Mean Score

20

0.55
0.45
1

3.5
5

5
2

80
20
0.89

0.25
0.10

2.2
5

80
0.5
6

Mean

0.20
0.45
0.30
0.35

1.3
0

Figure 4. Comparative Level of Loneliness Tendency Between the Initial and

Final Assessment
Result of Mr.
PU

1.3
0

Figure 5. Comparative Level of Initial and Final Assessment in

Chart
12
60.00%
10
50.00%
8
40.00%
6
30.00%
4
20.00%
2

10.00%
0
Sometimes Always
3

Value Never
Always
Role

1
Count
Percent

Rarely Sometimes
2

0.00%

Evaluation Phase
The clients mean difference was extracted by subtracting
Mr. PUs initial assessment results of overall means from the
initial assessment results. Overall mean of 1.30 was observed
implying a significant improvement in clients tendency to
loneliness.

Findings
The overall mean score Mr. PU in the initial assessment is
3.55 that shows his relatively high tendency to loneliness.
After 14 days of nurse-patient interaction and provision of
nursing intervention, the clients overall mean score in the
final assessment decreased to 2.25. The mean difference from the
initial mean score is 1.30. This shows that there is improvement
from the clients tendency to severe loneliness to be relatively
tolerable while he keeps warding off from his loneliness
tendency.

Conclusion:
Through the statistical findings presented, it can be
concluded that by recognizing tendencies to loneliness of the
client is an essential assessment tool to be utilized in
Peplaus Nurse-Patient Interaction to further assist the patient
in his needs and to understanding condition thatcan be the key
to patients trust and further assistance to the restoration of
self-integrity and promotion of health. The 14 day trial is just
a short course and if the clients score keeps on improving in
moderating his inclination towards loneliness, self-esteem,
confidence, trust in others and successful rehabilitation would
be inversely attain.

Recommendation:
The utilization of UCLA Loneliness Scale Assessment
tool in resonance to Peplaus Interpersonal Relationship Theory
as a concrete measurement in determining the loneliness and the
gravity of emotional need and psychological support of the
patient is highly recommended. It is essential not only to the
psychologically challenged but also applicable to different
kinds of patients with regards to emotional stability of a
person.

References:
Bailey,

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.

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/

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:

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]

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

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

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

Appendix B
Assessment Tool
NEGROS OCCIDENTAL DRUG REHABILITATION
CENTER
Managed by:
NEGROS OCCIDENTAL DRUG REHABILITATION
FOUNDATION, INC.
Camp Gen. AnicetoLacson Compound, Victorias City, Neg. Occ.
PSYCHOLOGICAL ASSESSMENT
GUILFORDZIMMERMAN
TEMPERAMENT SURVEY
I. PATIENT INFORMATION
Patient: P.
U. Age: 16
y. o. Sex:
M
II. TEST RESULTS

RS

22

15

17

16

20

10

14

16

13

55

10

20

10

30

15

15

35

10

AA

VLA

BA

VLA

BA

VLA

BA

BA

BA

VLA

III. TEST INTERPRETATION

Results show that the patient displays a highly impulsive behavior. He tends
to act on the first thought that comes into his mind, without thinking about the
possible consequences his actions might bring. As a result of this behavior, he has
the tendency to get himself in trouble most of the time. It is also shown that his
energy level is higher compared to most people of his age and sex. This would mean
that he would enjoy doing activities at such a fast pace, as he does not get tired
quickly. He may get things done as fast as possible. There might be times where he
would get restless as well.

In terms of sociability, the patient shows signs of introversion. He is most

likely to stay in the background when attending social events. He seems to be
socially withdrawn. He would usually isolate himself from crowds, as he prefers
spending time alone. He does not seem to mind having only a few

friends with him. Apart from his introversion, he is also shown to be too submissive,
meaning he is likely the one to follow rather than to lead. He is inclined to follow
whatever he is being told to do, even if he feels that he cannot handle the
responsibility given to him. It is also indicated that he has a hostile personality.
Because of this, people might find it hard to get along with him. He tends to have
an aggressive side which would come out when someone would provoke him. Also,
he seems to be fond of belittling and mocking others. Whenever one commits a
mistake, he is likely to make fun of that individual without being considerate of
his/her feelings.
Results also indicate that the patient may be suffering from a possible mood
disorder. His feelings tend to shift from time to time, without any reason. He seems
to be quite negative when it comes to himself. He may feel insecure most of the
time, especially when being watched and criticized by others. He does not appear to
take constructive criticisms lightly and would get affected easily. Also, he tends to be
emotionally expressive. He has no difficulty with showing his feelings to others.
Lastly, it is shown that he may have paranoia tendencies. He is usually suspicious of
those around him, and he may find it hard to trust people easily.

Prepared by:

Approved by:

Daphne Elyse Keng

Ms. Juvy

Pepello
Junior
Administrator

Psychologist

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.

NCP |
81

Appendix C
Nursing Care
Plans NURSING
CARE PLAN # 1

ASSESSME
NT
Actual
Cues

NURSIN
G
DIAGNOS

Impair
ed
social
Subjective: interacti
on r/t
Self
The

patient
concept
verbalized
disturban
,
ce AEB
Discomfor
t in social
Kis indi
situations,
ko kabalo
receive a
panu
satisfying
ihambal
sense of
namean
social
ko na
engageme
maintindih
nt, family
an gid nila.
report of
Natayugan changes in
na sila
interaction,
dysfunction
kuno.
al
interaction
Wala ko
with

RATIONALE

Social
isolation is
the condition
of aloneness
expe rienced
by
the
individual
and
perceived as
imposed by
others and
as a
negative or
threatened
state;
impaired
social
interaction is
an insufficient
or excessive
quantity or

DESIR
ED
OUTCO
ShortTerm:
1. Verbalize
awareness
of factors
causing or
promoting
impaired
social
interactions
2. Identify
feelings that
lead to poor
social
interactions.
3. Express
desire to be
involved in
achieving
positive
changes in

NURSIN
G
INTERVENTI
Independent:

JUSTIFICATI
ON

EVALUATION

After 14 days
of Nurse
A. Assess
a. This may
Patient
causative/contr result
to
Interaction,
ibu ting factors. conforming or
the
rebellious
client will be able
pattern
/ behavior
to:
while
noting
Verbalize
prevalent
feeling that
interaction
lead to
B. Assist
pattern.
poor
patient/SO to
social
recognize/make
interactio
positive
n
b.
Once
changes in
GOAL
impaired social recognized,
MET
client
can
and
choose to
interpersonal
Involve in
change as he
interactions.
social
learns to listen
interaction.
and
GOAL
communicate

japon sa
trip
nila.
Objectiv
e:
v Discomfort
in social
situation

v Do not
ask
question

v Observed
lack
of
attention
during
activities

Insufficie
nt
or
excessive
quantity
or
ineffective
quality of
social
exchange.

interpersonal
relationships.

Long Term:
4.

Give self
positive
reinforceme
nt for
changes
that are
achieved.

5.

Develop
social
support
system; use
available
resources
appropriatel
y.

Source:

Nurses
Pocket
Guide
10th
Edition
by
Marilynn
E.
Doenges
,
Mary
Frances
Moorhou
se, Alice
C.
Mur
r

GOAL MET
C. Work with
client to
alleviate
underlying
negative self
concepts

Collaborative:
D. Promote
wellness by
seeking
community
programs for
client
involvement
that promote
positive
behaviors the
client
is striving to

c. Negative
self concept if
left
unresolved
often impede
positive social
interactions.
Attempts at
trying to
connect with
another can
become
devastating to
selfesteem
and emotional
well being.
D,There is a
direct
correlation
between the
musical
portion
of the brain
and the
language
area, and the
use of these
programs may
result
in

Assess for
environment
al withdraw
(time spent
in room
versus time
spent with
others).
GOAL MET

NURSING CARE
PLAN #2
ASSESSMEN
T
Actual
Cues

NURSING
DIAGNOSIS

Chronic Low
Self
Estee
Subjective:
m
r/t Feelings of
The
abandonment
patient
secondary to
verbalized
separation
,
from
significant
Nahuya na
other/s AEB
ko kis a kag
Longstanding
na guilty sa
self negating
napang himu
verbalizations,
ko,,
Expressions of
shame and
Wala ko
guilt, Poor body
pulos ya.. La
presentation
na ko
(eye contact,
putoro.
posture,
movements)
Objective:
Nonassertive/pass
ive

Emotionally
stressed.
Facial

Definition:
Longstanding

RATIONA
LE
Developme
nt of a
negative
perception
of self
worth in
response
to a current
situation.
Low self
esteem
disturbanc
e describe
as
negative
feelings
about
themselve
s,
including
the loss of
confidence
and self
esteem,
sense of
failure to
reach the
desire,
self

DESIR
ED
OUTCO
Short
Term:
1. Accept
support
through
the nurse
patient
relationsh
ip
2.
Identify
areas of
ineffecti
ve
coping
3.
Examine
the
current
efforts at
coping
4.
Identify
areas of
strength
5. Learn
new

NURSIN
JUSTIFICATI
G
ON
INTERVENTI
Independen
t:
a. When
areas of
A.
concern
Identify
are
current
verbalize
stresse
d by the
s in
patient,
PUs
he will
life
be able
includin
to focus
g
on one
bipolar
issue at
disorde
a time.
r

B. Assess
current
level of
depression
using UCLA
Loneliness
Scale.

b. If she
identifies
the
mental
disorder
as a
stressor,
he will
more
likely be
able to
develop
strategies

EVALUATION

Determin
e if he is
able to
realistical
ly
identify
problem
areas.
GOAL MET
Assess if
he can
identify
any
previous
successes
in her
life.
GOAL MET
Assess for
environme
ntal
withdraw
(time
spent in

 Narrowed
focus

Feelings of

helplessness,
hopelessness,
or
powerlessnes
s
Confusion
about self,
purpose, or
direction of
life

Source:

Nurses
Pocket Guide
10th Edition
by Marilynn
E. Doenges,
Mary
Frances
Moorhouse,
Alice C. Murr

productivit
y,
which is
directed
destructive
to others,
feelings of
inadequacy
, irritable
and being
withdrawn
socially.

new
coping
skills.
7. Focus
on
strengths

C. Involve
PU in
treatment
and
socializati
on
activities.
Stress
importanc
e of
activity in
helping
recovery
from
depression
and that he
will have to
make a
conscious
effort to
fight
it.

c. By
focusing
on past
successe
s, he can
identify
strength
s and
build
on them
in the
future

d.
Severely
depressed
individual
s need
D. Assist
assistance
PU in
with
discussing, decision
selecting,
making,
and

Assess if
the
patient
follows
through
on
learning
new skills
and
learned a
lot about
his
medicatio
n and
committe
d in
complying
with his
medicatio
n
regimen.
GOAL
MET
Continue
to practice
new coping
skills as
stressful
situations
aris
e
GOAL MET

Collaborati
on: E.
Educate
regarding
the his
medicine
and
medical
regimen
such as his
therapy
and
session
with the
rehabilitati
on staff
with its
relationshi
p to
depression
F. Assist
patient in

e. By
keeping
individual
s who are
depressed
active,
social
withdraw
al is
prevented
.
f. Social
activity
helps the
client deal
with the
depression
. Patient
should
have a
thorough
knowledge

Nursing Care
Plan #3
ASSESSMENT
Actual Cues

NURSIN
G
DIAGNO

Ineffecti
ve
Subjective:
Individu
al
The
Coping
patient
r/t Altered
verbalized
mood
,
(depression)
caused by
changes

secondary to
body
Objective:
chemistry
(bipolar
disorder)
Decreased use
AEB
of social
Verbalization
support
in inability to
Destructive
cope or ask
for help
behavior
Reported
toward self
difficulty with
or others
life stressors
Difficulty
Inability to
asking for
problem
help
solve
Fatigue
Alteration in
Inability to
social

meet basic

RATIONAL
E
Ineffective
individual
coping may
be manifest
when a
person
verbalizes
an inability
to cope or
to ask for
help, is
unable to
meet basic
needs or
role
expectation
s, cannot
use
problem
solving
techniques,
has a high
rate of
illness or
accidents,
exhibits
destructive
behavior

DESIRE
D
OUTCO
Short
Term:
2. Accept
support
through
the nurse
patient
relationsh
ip
2.
Identify
areas of
ineffecti
ve
coping
3.
Examine
the
current
efforts at
coping
4. Identify
areas
of
strengt
h

NURSING JUSTIFICATI
INTERVENT ON
ION
A.
d. When
Identify
areas of
current
concern
stresses in
are
PUs life
verbalize
including
d by the
bipolar
patient,
disorder
he will
be able
to focus
on one
issue at
a time.
B. Assess
current
e. If she
level of
identifies
depression
the
using UCLA
mental
Loneliness
disorder
Scale.
as a
stressor,
he will
more
likely be
able to
develop

EVALUATION

Determin
e if he is
able to
realistical
ly
identify
problem
areas.
GOAL MET
Assess if
he can
identify
any
previous
successes
in her
life.
GOAL MET
Assess for
environme
ntal
withdraw
(time
spent in
room

needs and
role
expectations
Statements
indicating
inability to
cope

behavior
toward
self
Definition:
Inability to
form valid
appraisal of
the stressors,
inadequate
choices of
practiced
responses,
and/or
inability to
use available
resources.

Source:

Nurses
Pocket
Guide 10th
Edition by
Marilynn E.
Doenges,
Mary
Frances
Moorhouse,
Alice C.
Murr

(includin
g
excessive
eating,
drinking, or
other
illnesses
related to
emotional
tension, is a
chronic
worrier, or
exhibits
chronic
depression.

Long
Term:
6.
Practice
new
coping
skills.
7. Focus
on
strengths

C. Involve
PU in
treatment
and
socializati
on
activities.
Stress
importanc
e of
activity in
helping
recovery
from
depression
and that he
will have to
make a
conscious
effort to
fight
it.
D. Assist
PU in
discussing,
selecting,
and

f. By
focusing
on past
successe
s, he can
identify
strength
s
and build
on them
in the
future.

d.
Severel
y
depress
ed
individu
als need
assistance
with

Assess if
the
patient
follows
through
on
learning
new skills
and
learned a
lot about
his
medicatio
n and
committe
d in
complying
with his
medicatio
n
regimen.
GOAL MET
Continue to
practice
new coping
skills as
stressful
situations
aris
e
GOAL MET

E. Educate
regarding
the use of
alcohol
and its
relationshi
p to
depression
F. Assist
patient in
coping
with
bipolar
disorder,
beginning
with
education
about it

e. By
keeping
individual
s who are
depressed
active,
social
withdraw
al is
prevented
.
f. Social
activity
helps the
client deal
with the
depression.
Patient
should
have a