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PSYCHODYNAMICS
BIOLOGICAL
PSYCHOLOGICAL ENVIRONMENTALPrenatal Infancy
(0-1)Toddlerh
ood(1-3)
Preschool
(3-6)
Schoolage
(6-12)
Adolescence(12-20)
Youngadulthood
(20-40)
Internal External
y Bothpaternal andmatern
al sideof Mr.Capsfamilyhas noknownhistoryof any
mentalillnesseshowever inthemothersidethey
havehistoryof livercancerand thefatherhasdiabete
s
y He wasawantedbaby.
y Hismotherhadregularcheckups whenshe was
pregnant.
y Hismotherwasworkingwhilebeing
pregnant
y Mr.Capsmotherwas
y Theclientwasborn
through acaesareansection atBrokenshire
hospital inDavaoCity.
y He wasahealthy
baby,weighed 7pounds andnophysical
y He hadalargebody
builtcomparingtootherchildren.
y
Teethingstarted attheageof 8months.
y Hewasstarted attheageof o
y Playswithhisbroth
erandotherneighbor.
y Hewas
veryshy ofinteractingwithotherpeoplevisitin
gtheirhouse.
y Whentheirfather
y Hewascircumcised
at theage of7
y Mostof thedeciduous
teetharelostandreplacedwithpermanent
teeth.
y Helovesto playbasketballwith
y A changein voicepitch isevident.
y Duringhis highschoolyear, hebecameanathlete.
y He was asportsmindedperson,he wasaffiliatedin sportsgroup in
theirschool.
y He wasonceparticipants ofSMARAA
y Becomesaloof withhisbrother
since hisbrotherwasstudyingat Davaoand hewas withhis
parents inDavaoOriental inhis highschoolyears.
y Atcollege,
hisfavoritesubjectwas math
y Hefinishedhis
y Feels thathis fatherdoesntlove him
when hewas achild.
y He wasin hiscollegeyears
when hebegan tousedrugs
y Findshimselfeasily getirritable
y Healwayssmokesanddrinksalcoholwith
y He grewin a familywhere hisfather was
alcoholicand asmoker.
y He wasraised byhis fatherthrough a
militarytraining.
y His fatherset a rulesandregulationinside thehouse
that mustbefollowed.
y He wasshy ininteractingwith other
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mellitus.
y Patientand hisbrotherhavesimilarcharacteristicssuchas
shyness,silentandfemininemovements
y Inmaternalgrandlineagethereare 12childre
n whileinpaternalgrandlineagethereare 14childre
veryhappyandexcited
duringherpregnancy.
y Bothhismother
andfatherhaveharmoniousrelations
y Thefatherwas notpresentduringthepregnancybecaus
e he isout forhiswork.
y Hisfatheraccepte
d fully
deviationfound.
y Hewasonlybreastfedonceon the
day hewasbornbut hismother wasnotable toproducemilk.
y Duringthisstage,Mr.Cap
wasunderthecaredof anannybecause his
parent
months.
y Hewasveryplayful,lovestoplaywith
hisbrotherandactive.
y Follows hismotherandfather'scommand.
y Disciplinedby hisfatherthroughspanking
even
is athometheywere
notallowed toplayoutside.
y If
rulesaredisobeyed,theyarebeingpunishedby thefather.
y If athome, heonly
watchestelevision.
y Mostof hisfriend
s
hisbrother andother
neighbors.
y Scared ofhismother when
itcomeswithhiseducation, hestudies hislessonwell tomakehismotherproud.
y He
usedtoteasehisclassmateofopposite sex.
and inter-schoolcompetition in
soccerevent.
y He wasnot thatapproachable tosome
girls,y He did
not evenhave anyrelationship tooppositesex atthisstage.
y Hisrelationshiptowardshisbrother
lie-lowed
y Hebecamealoof tohisfamily.
collegeyears witha operatoron year
1995.vocationalcourse ofradio
y He hadhisserious
relationship with theoppositesex afterhegraduatedin college
y At year2000, heproceeded intoBusinessManagementcourse inPanabo
StateCollege.
y He gotinto circleof friendsthat wereinvolved
in drug
friendsand withhisbrother
y Impairedconcentration, heeasily getbored
y Low self esteem
and isdepressed due tohisadmission
y Has anintrovertpersonality.
y Aloofpersonality.
y Wasdepresse
d whenhe knewhis fatherwasadmitteddue tocomplications of
diabetes.
people.
y Heassumesthat hewas theone beingtalkedabout byothersandlaughed
at.
y Believesthat hesawobjectswhichotherscannotsee.
Inference:
y Althoughtheprecisecause ofthe BPDremainsunknown,it isgenerallyassumed
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n.
Inference:
Considering thenumber oftherelatives ofthe patientand the
similarity ofthe traitsbetweenhim andhis brotherwe wouldlike tobelieve
that thepatient isvulnerableto developthe illnessundertheseinferences;
y BiologicTheory:Temperamentis aproces
thepregnancy ofthe
clientsmotherandensured thatheprovided and
supported hisfamilyevenhe isawayfromhome.
y At thisstageclientsbrotheraccepted thepregnancy of
hismotherand didnot felt
jealousandenvy.
Inference
s arebusytotheir
work.
y HisnannyensuredthatMr.
Capwillreceive hisphysiologicneedsevenbothparents isnotpresent.
y Hisnanny
actedas hissecondmother andshereallyloved
thoughthesesmall
mistakes.
y Wasscared ofhisfather
everytimehisfatheris athome. Heimposescertainrulesandregulationinsidetheir
housethatmustbefollowed.
y Hismoth
wereof thesamesex.
y Thepatientattemptedsuicide
Inference:
y InPsychose
xualtheory,preschoolbelongs tothe
phallicstageinwhich aboychild
y Veryfocused onhisstudiesbecause hewasafraidof
beingscolded byhisfather
Inference
y
InFreudspsychosexualtheory,
school agebelongs tothelatencystage
y Secretiveeven tohismother
y He wascloser tohisfriendsthat hisfamily.
y He dontusuallygo tochurch.
Inference:
y
Thisstage isthe stageof identityvsconfusionaccording to ErikErikson.;
Dramaticphysiologicalchangesassociated withsexualmaturatio
addiction
y They tookcoughsyrup,cannabisand evenshabu
y Helearnedhow to
smokeand drinkin collegewith hisfriends.
y Feels
hesitant ingoing intoa jobbecausehe isscaredthe drugtest.
y Causedfrustrations to hisfather dueto hisunemployment.
y Wants togive upsince hecantunderstandeverythingabouthimself.
y The
attemptedsuicide.adhisseriousrelationshiphoweverit only
lasted for3 monthsand theotherrelationship is 1month
y Drugabuser
Inference:y Depressi
on andanxiety isvery
that BPDis anacquiredcondition
derivingfrom theexperience ofgrowingup in aviolentfamily.(An
tai-Otong,2003)
y It isperhapsnotsurprisingthatindividuals withBPD aremuchmorelikely tosufferfrom
mooddisorder(depression),substanceabusedisorders,or otherassociate
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ses ofsensation,associ
ationandmotivation thatunderlieintegration of
skillsandhabitsbasedonemotion and itis veryfamilial
since itruns tothefamily(Videbeck,2008)
y Withthesameconcept,temperamenthave 4traits
:
y Consideringtheage oftheMrs.Earswhichis 38,pregn
ancywouldbe notveryidealsincetheeggcellthatsheproduced isnotthatreallygood
andtheageidealforpregnancyor theprime
Mr.Capanddid not
eventry tospankhim.
y He
wasbeingfedusually byhisnannyand
mother, hisfathersometimesfeedhim.
y He
crieswhenhismotherseizesfromcradlin
er didnothavedifficu
lty intraining himtourinate anddefecate.
Hewasbeingtrainedeverymorning byhis
mother ornanny.
y Hedepends in
hismother intermsofdecision forchoosing a
deeplylove
hismother(OedipusComplex)and
thegirlchilddeeplyloveherfathe
r(ElectraComplex)inwhich
theyareableto actaccordingtotheir
whereinsexua
lattraction issuppressedandattention is
divertedtowardsplaying,groupactiviti
es,peersandstudies.Socialization is
important inordertoharnessinterperson
n markedthisstage.There is
a markedpreoccupation withappearance andbodyimage.This
stage inwhichidentitydevelopmentbeginswith thegoal ofachieving
someperspective ordirectionanswersthequestion,Who am
I?(Antai-Otong)
y It is bynaturethat anadolescent is
y He drinksalcoholicdrinkswith his
olderbrother
y After hefinishedcollege,he wasencourag
ed by hisfather tofind a joband get adriverslicensebut herefusedbecausehes afraidthatothers willknow thathes usingdrugs.
y Argues
with hisfatherabout hisbeingunemployed and hisnointerest ingoing to
event topatientsdiagnose
d withborderlinepersonality disorder(Lewinson, Rhode,Seelly, et
al. 2000)
y Cluster Billnessesoftencorrelated withhistory
withmooddisorder,alcoholism,somatizationdisorders
amongfamilymember,parentaldeprivation,inconsistentdiscipline
dpersonalitydisorders,
particularly AntisocialPersonalityDisorder,thanperson
withoutBPD(Alloy,2004).
y Achildhoodhistory ofphysicalabuse is
common(Videbeck, 2008).
y Environment is oneof thefactorsthat affect
humanpsychology,ethnicityandsurrounding helives in(Hartwell,
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andtheseareharm
avoidance,noveltyseeking,rewarddependence
andpersistence,inpersonalitydisorders suchparanoi
d, theharmavoidance isveryhigh, inobsessive-
compulsivethere ishighpersistence,innarcissist
eggcell isfrom15-40
(Piliterri,2007).Theeggcellshesprodu
cing isdiminishing.
According toGregorMendels
theory, agoodseedwillgrow agoodfruit
(Kneisl,2004)
y Duringtheintrauterinestage
g him.
y Like hismother, hisfatherwasalsobusyso hewasnot
able totakegoodcareof himwhenhewasaninfant.
y Whenhisfatherwenthomehe
ensuredthattheywillhavetime toboundand
dress.
y At thepresentpatient isstillunmarried,
jobless,
drugdependedanddepends tohisparents.
Inference:
y AccordingtoFreudspsychosexualtheory themajorsource of
gender
yStageofInitiative vs.Guilt.
y AccordingtoErik
EriksonChildrenlike topretendand
tryoutnewroles(Antai-Otong).
y Children trytoinitiatebothmotorand
alrelationship
y School-agechildren areeagertoapplythems
elvestolearningsociallyproductive
skillsandtools.Theylearntoworkandplay
withtheirpeers.Withoutpropersupport for
becoming moreclose tofriends
than thefamilysincepeers isthe majormode forsocialization
(Knesl,2004)
church.
y Observati
onspatientrarelytalks toeverybodyelse andevidentsocial
withdrawal.
inference:
y Accordingto ErikErikson,
this is thestage ofintimacyvsIsolation;Youngadultshavedeveloped
a sense ofidentity,deepenstheircapacityto loveothersand care
for them.
andfailure ofthe child
todevelopintegratedcognitive,affectivebehavioral moods
in earlylife maylead tocluster bdisorder.
y BorderlinePersonali
tyDisorderhavegeneralize lowselfesteem,need to
controlenvironment andpeopleandunstableordelayed
2001)
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personalityhere ushigh
noveltyseeking andborderlinepersonalityhave
highrewarddependence.Theresponse willbeoccurri
ngduringat ageof 2 to3 yearsold(Svrakic and
Cloninger,2005)
y Neurochemical andNeuroanatomi
ofdevelopment,the
embryoor fetusrelieson thematernal bloodflowthrough
theplacenta tomeet itsbasicsurvivalneeds.Thehealth
of themotherisessential forpropergrowthand
development(Buchanan,CuretandHis,2002).
helovedto playpick a
boo
y He wasin hiseighthmonthwhenhe
hadhisfirsttooth.
y He wasbaptized asRomanCatholic.
y Observation: datagathered thatpatientissmoker andhedrinks.He
gratification is
throughanal;toilettraining isthefirst
confrontationwithexternaldemands
whichdevelopsegoandcontrol
impulses.Thispleasurecanberegul
intellectualactivity. If
toddlers aremadeto feelinadequateabouttheir
behavior orinterest,theymayemergefrom
thisperiod withasenseofguiltabout
self-initiatedactivity(Kneisl,2004).
learning ofnewskills
or ifskillsaretoodifficult,children may
thendevelop asenseofinadequacyandinferio
rity.
y School ageperiodis atime inwhich
peerassumesmajorimportance.
y Thenegati
This is thetime tobecomefully
participative in thecommunity,enjoyingadultfreedomand
responsibility. Ifyoungpersonshave notachieveda sense ofpersonalidentity,
they mayexperience feelingsofisolationfromothersand the
inability toformmeaningfulattachment (Antai-Otong,2003).
gratification(Kneisl,
2004)
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caltheorybelieves that a
personwithMentalillnesshavelessbraintissue,
lessspinalfluidandhighlevelsofserotonin,
dopamine,norepinephrineandepinephrinemalfun
ctionneuronalnetworks andtransmission(Egan&
y Consideringthenature
of Mrs.Ears
jobwhichis anelementaryteacher
, duringthispregnancy shehadundergonetremendous
stressandthoughsheclaimedthatshehadnt
experienceloneliness letus thinkaboutthe factthat hishusban
keepshimselfdistant
toothersand hewantsto bealone.Duringthe
orientationphase,apprehensiontowards thestuden
t nurseisevidentandlackcooperativeness.
Inference:
y Caesarianbirth
atedif thechild
copeseffectivelyhowever ifhefails
hisegowouldundergogreatanxie
tythatengenderspersonalityproblem
(Alloyet al,2004).
y Thedevelopme
y The
childis
abletomoveindependentlyandvigoro
usly.Byplaying withpeers, childlearnshowto
interactwithothers(Antai-Otong
).
y Togain asenseofinitiative,child
veoutcome ofthis
stagemaydevelop fromseveralsources such
discriminationagainst toschool; maybe toldthat
he isinferior; thechildmaybeoverprotec
ted athomeorexcessivelydependenton theemotio
y Positiveresolutionmaymanifest
the abilityto giveandreceivelove,commitments,mutuality,
collaboration inwork, andresponsible sexualbehaviors.Unresolvedbehaviors
arepersistentaloneness,prejudice,lack ofestablished vocation
andseekingintimacythroughcasualsex(Balita,2008).
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Hyde,2000).
yBorderlinepersonalityDisorder aremoreprevale
nt inwomenthan inwomen, 5 outof 15patientsdiagnosedwithBorderlinePersonalityDisorder are
men(Alloy,2004).
y 10%-23% ofthegeneral
d wasmost ofthetime
absentand asapregnantwomanthewanting
ofbonding andlongingisevident.
Astressed
Pregnantwomanwouldhave afluctuating andincreas
e levelsofdifferenthormones suchasestrogen,
placesnewborn to
greater riskforrespiratoryillnessessince
thechestlackspressurethatpromotes
respirationsandeffectivelyexpelsfluidsfrom
thelungsunliketothosenewbornswho
ntaltaskof thetoddle
ryearsacc.toEriksonspsychosoci
altheory isthatthedevelopment ofa
senseofautonomyversusshame and
doubt(Kneisl,2004).
y According to
needsexposure toa
widevariety ofexperiencesandplaymater
ialssotheycanlearnasmuchaboutthe
worldaspossible(Elderet al,2005).
y Suicide inBorderlinepersonalitydisor
nalsupport ofthe
family;or thechildmaycomparehimself
unfavorablywiththesame-sexparent.
y Goodteachers andgoodparents whoencourage
theirchildren tovaluediligence andproductivityand to
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populationhaveperson
alitydisorders andarehigherinincidence in
peoplewhobelongtolowersocio-economicand
disadvantagedgroups(Videbeck,2008)
epinephrine,progesterone
andamongothers,that willtriggerchildresponse
towardsstressandeventuallyputtingthefetus indistress
(Pilliteri, 2007)
undergonevagina
l birth;at thispointthebondingbetween the
childandmother ishinderedsincethe
mother didnotmakeanyeffortto givebirth
to thechild(Pilliteri,2007)
y Stageof
ErikErikson,this is
thetimeeithertoretainfeces(holding in)
or toeliminate(letting go),bothbehaviorhavin
g aneffectonthemother.Wherein
toorigoroustoilettraining canproduce anoverly
derpatients
canbeinterpretedas acryforhelp
forbeingpowerlessorselfpunishmen
t forfeeling toomuchguilt(Alloy,2004
).
preserve in adifficult
enterprisearebulwarkagainst asense
ofinferiority.
y Thisstageissocially
decisivebecause thechildlearnshow towork
withothersto anddevelops asenseofdivision of
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TrustvsMistrust
beginsat thisage.
According toErikErikson, an
impairmentofbasictrustleadstobasicmistru
st. Anaffectionate,lovingmother whogivesconsis
tent,high-qualitycareprovides thebasisfor thedevelo
compulsivepersonality
that isstingy,meticulousandselfish. If
parentspermit thechildtofunctionwith
someautonomyandaresupportivewitho
utbeingoverprotective,toddlersgainself-
laborandequality of
opportunity.
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pmentoftrust.Prolon
gedseparationfromthemother atthis
timecanlead todepression,hospitalism,analytic
depression,ordepressivetonethatbecom
espart ofpersonsadultcharacterstructure.
confidenceandfeel
theycancontrolthemselvesandtheir
world.Otherresolutionslikeselfdoubt,depe
ndency, andsenseofbeingout ofcontrol of
oneslifeoccurwhenparents areoverlyprotective
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Fixationswouldindicat
eunmetneeds(Balita,2008).
y Trust
issynonym tolove.
y By thewayinfantsarehandle
d, fedandheldtheylearnto loveandrecog
nizethattheyareloved(Kozier,2008).
anddiscourageindep
endence(Balita,2008).
y Childr
enwhoaremadeto feelit iswrongto feelindep
endentmayleavethestagewith astron
gersenseofshamethanofautonomy
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y Infantswhohavenumer
ouscaregivers,whomaybe fedoneday on
a rigidscheduleandthenextonlywhenthey
arehungry, whosometimesaretreated
roughly andsometimesgently,canhavedifficulty
(Antai-Otong,
2003).
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learning totrust(Antai-
Otong,2003).
y Ifinfantscannottrust,theycannot
enjoydeeplysatisfyinginteractionswithothersand
canhavedifficultytrustingthemor
experiencinghighselfesteem.Theymayhave
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difficultyestablishing
relationshipsasadults(Alloy,2005).
Vulnerability todevelopillness
StressfulPrenatalLife
Mistrust Shameand Doubt
Guilt Inferiority Identity Isolation Confusion and Frustration
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Weakened Ego
Low self-esteem
State of Equilibrium
Predisposing Factorsy Age: 34 years old
y Gender: male
y Introvert Personality
y Intake of prohibited drugs (cough
syrup, shabu, marijuana)
Precipitating factors:
y Confrontation with the father
STATE OF DISEQUILIBRIUMDepression, anger, agitation and anxiety
BALANCING FACTORS
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R: Benzodiazepine help anxiety and depression
5. Anti-convulsant
R: Anti-Convulsant may improve global functioning of patient.
6. Serotonergic Agent
R: Serotonergic Agents are helpful in some cases of personality
disorder.
7. Psychotherapy
R: this is an area of intensive investigation and has been treatment
of choice.
8. Behavioral therapy
Nursing Intervention:
y When first communicating with the client, use simple, direct
sentences; avoid complex sentences or directions
R: The clients ability to perceive and respond to complex stimuli isimpaired
y Be comfortable sitting with the client in silence. Let the client
know you are available to converse, but do not require the
client to talk.
R: Your silence will convey your expectation that the client willcommunicate and your acceptance of the clients difficulty withcommunication
y Provide positive feedback at each step of the process. If the
client is not satisfied with the chosen alternative, assist the
- Pharmacokinetics
Absorption- Rapidly absorbedDistribution- PB: 90%Metabolism- t1/2: 24 h
Excretion: In urine 70% and feces 14% Rivotril 2mg tab Hs
- Classification: Anticonvulsant, Atypical
- Pharmacokinetics
Absorption- PO: 1-2 hMetabolism- t1/2:18-50 hExcretion: urine
- Pharmacodynamics
Duration: weeksNursing Interventions:
Promote clients safety
R: since client has attempted suicide prior to admission, he
needs to be monitored closely for suicidal ideation.
The patients vital signs were checked and recorded
R: This is to note if there are alteration in patients health
The student nurse established therapeutic
communication with the patient
R: Therapeutic communication is essential to build trustbetween the student nurse and the patient
Assisted during Activities of daily living.
R: This is to help patient attain his needs
Encouraged patient to participate in the different
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client to select another alternative.
R: Positive feedback at each step will give the client manyopportunities for success, encourage him or her to persist in
problem solving and enhance confidence. The client also can learnto survive making mistake.
y Provide a safe environment for the client
R: Physical safety of the client is a priority. Many common itemsmay be used in a self destructive manner
y
Continually assess the clients potential for suicide. Remainaware of this suicide potential at all times
R: Depressed clients may have a potential from suicide that may ormay not be expressed and that may change with time
y Reorient the client to person, place, and time as indicated
R: Repeated presentation of reality is concrete reinforcement for theclient
y Spend time with the client
R: Your physical presence is reality
y If the client is ruminating, tell him or her that you will talk
about reality or about the clients feelings, but limit theattention given to repeated expressions of rumination
R: Minimizing attention may help decrease rumination. Providingreinforcement for reality orientation and expression of feeling willencourage these behaviors
y When approaching the client, use a moderate, level tone of
activities and therapies.
R: To enhance patients self esteem and improve hishealth
Encouraged patient to verbalize his feelings.
R: Exploring patients feelings can allow the nurse identifypatients concerns
Ensured clients safety by staying with him and being
a good observant in all of his actions
R: Ensuring the clients safety is one of the priorities of thestudent nurse.
Encouraged patient to increase fluids intake before
and after taking his medication
R: Due to some side effects of medication, increasing fluidintake can replace the fluid loss of the patient and helppatient to swallow medicine easily
Nurse Patient Interaction was established.
R: It allows the nurse gathers pertinent information of theclient such as the history of his admission and can help ingaining trust of the patient
Therapies Performed:
Introductory:y Frame my Name
y First Impression Pop-outR: These therapies are designed to help the studentnurse and the patients know each other and gain trustin the part of the patient; It aids in establishing rapport.
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voice. Avoid being overly cheerful.
R: Being overly cheerful may indicate to the client that beingcheerful is the goal and that other feelings are not acceptable
y Use silence and active listening when interacting with the
client. Let the client know that you are concerned and that
you consider the client a worthwhile person
R: The client may not communicate if you are talking too much. Yourpresence and use of active listening will communicate your interestand concerns.
Working Phase:
y Rhythm of my Life
y Easter Egg Painting
y Pinoy Lympics
y Masquerade BallR: Therapies of the working phase allows the patient toparticipate in such activities that will give them idea onhow to enjoy life and improve their current situation; italso gives them idea on the possible occupation theywanted in the future.
Termination Phase:
y Environmentalist WallR: This phase evaluates the patients learning on thepast days that they were together with the studentnurses; this is a phase where they will be detachedfrom the student nurses.