1.

Anger control assistence

Definisi : facilitation of the expression of anger in an adaptive, nonviolent manner

Aktivitas :

 Establish basic trust and rapport with patient

 Use a calm, reassuring approach
 Determine appropriate behavioral expectations for expression of anger, given patient’s level
of cognitive and physical functioning
 Limit access to frustrating situations until patient is able to express anger in an adaptive
manner
 Encourage patient to seek assistance of nursing staff or responsible other during periods of
increasing tension
 Monitor potential for inappropriate aggression and intervene before its expression
 Prevent physical harm if anger is directed at self or others (e.g., restrain and remove
potential weapons)
 Discourage intense activities (e.g., punching bag, pacing, excessive exercise)
 Educate on methods to modulate experience of intense emotion (e.g., assertiveness
training, relaxation techiques, writing in a journal, distraction)
 Provide reassurance to patient that nursing staff will intervene to perevent patient from
losing control
 Encourage use collaboration to solve problems
 Offer PRN medications, as approriate
 Use external controls (e.g., physical or manual retraint, time outs, and seclusion) as needed
(as last resort) to calm patient who is expressing anger in a maladaptive manner
 Provide feedback on behavior to help patient identify anger
 Assist patient in identifying the source of anger
 Identify the function that anger, frustration, and rage serve for the patient
 Identify consequences of inappropriate expression of anger
 Assist patient in planning strategies to prevent the inappropriate expression of anger
 Identify with patient the benefits of expressing anger in an adaptive, nonviolent manner
 Establish expectation that patient can control his/her behavior
 Instruct on use of calming measures (e.g., time outs and deep breaths)
 Assist in developing appropriate methods of expressing anger to others (e.g., assertiveness
and use of feeling statements)
 Support patient in implementing anger control strategies and in the appropriate expression
of anger
 Provide reinforcement for appropriate expression of anger

2. Bibliotherapy

Definisi : therapeutic use of literature to enhance expression of feelings, active problem solving,
coping or insight

Aktivitas :
 Identify the patient’s emotional, cognitive, developmental, and situational needs
 Determine ability for reading independently
 Set therapy goals (e.g., emotional change; personality development; learn new values and
attitudes)
 Consult with a librarian who is sklilled in book finding
 Consult sources to recommend literature for therapy
 Make selections appropriate for reading level
 Select stories, poems, essays, articles, self-help books, or novels that reflect the situation or
feelings the patient is experiencing
 Read aloud, if needed, or feasible
 Use pictures and illustrations
 Encourage reading and rereading
 Assist in helping the patient identify with the characters and emotional content in the
literature
 Examine and talk about the feelings expressed by the characters
 Facilitate dialogue to help the patient compare and contrast the image, character, situation,
or concept in the literature with his/her situation
 Assist in helping the patient recognize how the situation in the literature can help with
making desired changes
 Follow up reading sessions with play sessions or role modeling work, either individually or in
therapy groups
 Evaluate gol attainment

3. Cognitive restructuring
Definition : challenging a patient to alter distorted thought patterns and view self and the
world more realistically

Activities :
 Help the patient accept the fact that self-statements mediate emotional arousal
 Help patient understand the inability to attain desirable behaviors frequently results
from irrational self-statements
 Assist patient in changing irrational self-statements to rational self-statements
 Point out styles of dysfunctional thinking (e.g., polarized thinking,
overgeneralization, magnification, personalization)
 Assist patient in labeling the painful emotion (e.g., anger, anxiety, hopelessness) that
he/she is feeling
 Assist patient in identifying the perceived stressors (e.g., situations, events,
interactions with other people) that contributed to his/her stress
 Assist patient to identify own faulty interpretations about the perceived stressors
 Assist patient in recognizing the irrationality of certain beliefts compared with actual
reality
 Assist patient to replace faulty interpretations with more reality based
interpretations of stressful situations, events, interactions
 Make statement/ask question that challenges patien’s perception/behavior, as
appropriate
 Make statement that describes alternative way of looking as situation
  Assist patient to identilfy belief system that affects health status
 Make use of patient’s usual belief system to see situation in different way

4. Cognitive stimulation

Definition : promotion of awareness and comprehension of surroundings by utilization of

planned stimuli

Activities :
 Consult with family to establish patient’s cognitive baseline
 Inform patient or recent nonthreatening news events
 Offer environmental stimulation through contact with varied personnel
 Present change gradually
 Provide a calendar
 Stimulate memory by repeating patient’s last expressed thought
 Orient to time, place, and person
 Talk to patient
 Demonstrate caregiver sensitivity by responding promptly and appropriately to cues
 Stimulate development by engaging in activities to enhance achievement and
learning by being attuned to the patient’s needs
 Offer cognitive stimulation at work such as training opportunities, cognitive richness
to work content, opportunities for growth, and multitasking
 Encourage cognitive stimulation outside of work such as reading or active
participation in cultural and artistic activities
 Encourage the use of a multistimulation program (e.g., singing and listening to
music, creative activities, exercise, conversation, social interactions, or problem
solving) to promote and protect cognitive capacity
 Ask for opinions and views rather than factual answers
 Provide planned sensory stimulation
 Use television, radio, or music as part of planned stimuli program
 Allow for rest periods
 Place familiar objects and photographs in patient’s enviroment
 Use repetition to present new material
 Vary methods of presentation of material
 Use memory aids: checklists, schedules, and reminder notices
 Reinforce or repeat information
 Present information in small, concrete portions
 Ask patient to repeat information
 Use touch purposefully, as appropriate
 Provide verbal and written instrcutions

5. Journaling

Definition : promotion of writing as a means to provide opportunities to reflect upon and analyze
past events, experiences, thoughts, and feelings
Activities :

 Discuss experiences with similar interventions and receptiveness to intervention

 Establish purpose and goals
 Explain various approaches to journaling and decide on a journaling technique (e.g., free
flowing, topical, or intensive journaling)
 Determine a time frame to complete task
 Encourage writing without interruption at least 3 times a week for 20 minutes
 Ensure the environment is optimal for task completion (e.g., client is in a comfortable
position, room is well lit, client has glasses)
 Minimize emotional, visual, audio, olfactory, and visceral distractions
 Maintain privacy and assure confidentially
 Allow the person to select media and method (e.g., pen, pencil, marker, journal, computer,
tape recorder, etc.)
 Gather all necessary supplies
 Instruct the person to date journal entries for future reference and reflection
 Encourage writing in the order that things occur without topic restrictions
 Encourage the describing and telling of events in terms of stories, images, and associated
thoughts and feelings
 Describe experiences in terms of the five senses, as applicable
 Promote expressing deepest thoughts and feelings
 Instruct to payno attention to punctuation, spelling, sentence structure, and/or grammer
 Determine ability to continue with intervention independently in the future
 Review journal entries at defined intervals
 Monitor achievement of the established goals

6. Learning facilitation

Definition : promoting the ability to process and comprehend information

Activities :

 Begin the instruction only after the patient demonstrates readiness to learn
 Set mutual, realistic learning goals with the patient
 Identify learning objectives clearly and in measurable terms
 Adjust the instruction to the patient’s level of knowledge and understanding
 Tailor the content to the patient’s cognitive, psychomotor, and affective abilities
 Provide information appropriate to developmental level
 Provide an environment conducive to learning
 Arrange the information in a logical sequence
 Arrange the information from simple to complex, know to unknow, or concrete to abstract,
as appropriate
 Differentiate “critical” content from “desirable” content
 Adapt the information to comply with the patient’s lifestyle and routines
 Relate the information to the patient’s personal desires and needs
 Provide information that is consistent with the patient’s values and beliefs
  Provide information that is compatible with the patient’s locus of control
 Ensure that the material is current and up to date
 Provide educational materials to illustrate important and complex information
 Use multiple teaching modalities, as appropriate
 Use familiar language
 Explain unfamiliar terminology
 Relate new content to previous knowledge, as appropriate
 Present the information in a stimulating manner
 Incorporate animation in mulimedia presentations when possible and appropriate
 Provide instructional pamphlets, videos, and online resources, when appropriate
 Introduce the patient to persons who have undergone similiar experiences, as appropriate
 Encourage the patient’s active participation
 Encourage the patient to share valid experiences throughout the learning experience
 Use self paced instruction, when possible
 Avoid setting time limits
 Encourage free expression of different opinions and ideas
 Provide adequate time for mastery of content, as appropriate
 Keep teaching sessions short, as appropriate
 Simplify instructions, as appropriate
 Repeat important information
 Provide verbal prompts and reminders, as appropriate
 Provide memory aids, as appropriate
 Avoid demands for abstract thinking, if patient can think only in concrete terms
 Ensure that consistent infromation is being provided by various members of the health care
team
 Use demonstration and return demonstration, as appropriate
 Provide opportunities for practice, as appropriate
 Provide frequent feedback about learning progress
 Correct information misinterpretations, as appropriate
 Reinforce behavior, as appropriate
 Provide time for the patient to ask questions and discuss concerns
 Answer questions in clear, concise manner
 Refer the patient to appropriate online resources, including support groups

7. Learning readiness enhancement

Definiton : improving the ability and willingness to receive information

Activities :

 Provide a nonthreatening environment

 Establish rapport
 Establish teacher credibility, as appropriate
 Maximize the patient’s hemodynamic status to facilitate brain oxygenation (e.g., positioning
and medication adjustments), as appropriate
 Fulfill the patient’s basic physicological needs (e.g., hunger, thirst, warmth, and oxygen)
 Decrease the patient’s level of fatigue, as appropriate
 Control the patient’s pain, as appropriate
 Avoid the use of medications that may alter the patient’s perception (e.g., narcotics and
hypnotics) as appropriate
 Monitor the patient’s level orientation/ confusion
 Increase the patient’s orientation by reality, as appropriate
 Maximize sensory input by use of eyeglasses, hearing aids, and so on, as appropriate
 Minimize the degree of sensory overload/underload, as appropriate
 Satisfy the patien’s safety needs (e.g., security, control, and familiarity), as appropriate
 Monitor the patient’s emotional state
 Assist the patient to deal with intense emotions (e.g., anxiety, grief, and anger), as
appropriate
 Encourage verbalization of feelings, perceptions, and concerns
 Provide time for the patient to ask questions and discuss concerns
 Address the patient’s specific concerns, as appropriate
 Establish a learning enviroment as early in contact with patient as possible
 Facilitate the patient’s acceptance of the situation, as appropriate
 Assist the patient to develop confidence in ability, as appropriate
 Enlist participation of family/significant others, as appropriate
 Explain how the information will help the patient meet goals, as appropriate
 Explain how the patient’s past unpleasant experiences with health care differs from the
current situation, as appropriate
 Assist the patient to realize the severity of the illness, as appropriate
 Assist the patient to realize that treatment options exist, as appropriate
 Assist the patient to realize sesceptibilty to complications, as appropriate
 Assistt the patient to realize the ability to prevent illness condition, as appropriate
 Assist the patient to realize ability to control the progression of the illness, as appropriate
 Assist the patient to realize that current situation differs from past stressful situation, as
appropriate
 Assist the patient to see alternative actions that are less risky to lifestyle, as appropriate
 Provide a trigger or cue (e.g., motivating comments/rationale and new information) toward
appropriate action, as appropriate

8. Memory Training

Definition : facilitation of memory

Activities :
 Discuss with the patient/family any practical memory problems experienced
 Stimulate memory by repeating patient’s last expressed thought, as appropriate
 Reminisce about past experiences with patient, as appropriate
 Impelemet appropriate memory techniques, such as visual imagery, mnemonic
devices, memory games, memory cues, association techniques, making lists, using
computers, using name tags, or rehearsing information
  Assist in associate learning task, such as practice learning and recalling verbal and
pictorial information presented, as appropriate
 Provide for orientation training, such as patient rehearshing personal information
and dates, as appropriate
 Provide opportunity for concentration, such as a game matching pairs of cards, as
appropriate
 Provide opportunity to use memory for recent events, such as questioning patient
about a recent outing, as appropriate
 Guide new learning, such as locating geographical features on a map, as appropriate
 Provide for picture recognition memory, as appropriate
 Structure the teaching methods according to patient’s organization of information
 Refer to occupational therapy, as appropriate
 Encourage patient to participate in group memory training programs, as appropriate
 Monitor patient’s behavior during therapy
 Identify and correct the patient errors in orientation
 Monitor changes in memory with training

9. Reality Orientation

Definition : promotion of patient’s awareness of personal identify, time, and environment

Activities :

 Address patient by name when initiating interaction

 Approach patient slowly and form the front
 Use a calm and unhurried approach when interacting with the patient
 Use a consistent approach (e.g., kind firmness, active friendliness, passive friendliness,
matter of fact, and do demands) that reflects the particular needs and capabilities of the
patient
 Speak in a distinct manner with an appropriate pace, volume, and tone
 Ask questions one at a time
 Avoid frustrating the patient by demands that exceed capacity (e.g., repeated orientation
questions that cannot be answered, abstract thingking when patient can think only in
concrete terms, activities that cannot be performed, decision making beyond preference or
capacity)
 Inform patient of person, place, and time as needed
 Present reality in manner that preserves the patient’s dignity (e.g., provides an alternate
explanation, avoids arguing, and avoids attempts to convince the patient)
 Repeat patient’s last expressed thought, as appropriate
 Interrupt confabulation by changing the subject or responding to the feeling or theme,
rather than the content of the verbalization
 Give one simple direction at a time
 Use gestures and objects to increase comprehension of verbal communications
 Engage patient in concrete “here and now” activities (e.g., moving patient’s hand through
necessary motions to brush teeth), as necessary for task completion
 Encourage use of aids that increase sensory input (e.g., eyeglasses, hearing aids, and
dentures)
  Recommend patientt wear personal clothing, assist as needed
 Provide objects that symbolize gender identify (e.g., purse of cap), as appropriate
 Use picture cues to promote appropriate use of items
 Avoid unfamiliar situations when possible
 Prepare patient for upcoming changes in usual routine and environmet before their
occurrence
 Provide for adequate rest and sleep, including short term day time naps as needed
 Provide caregivers who are familiar to the patient
 Encourage family to participate in care based on abilities, needs, and preferences
 Provide a consistent physical environment and daily routine
 Provide access to familiar objects, when possible
 Label items in environment to promote recognition
 Modulate human and environmental sensory stimuli (e.g., visiting sessions, sights, sounds,
lighting, smells, and tactile stimulation) based on patient’s needs
 Use environmental cues (e.g., signs, pictures, clocks, calendars, and color coding of
environment) to stimulate memory, reorient, and promote appropriate behavior
 Remove stimuli, when possible, that create misperception in a particular patient (e.g.,
pictures on the wall and television)
 Provide access to current news events (e.g., television, newspapers, radio, and verbal
reports) when appropriate
 Involve patient in a reality orientation group setting/class when appropriate and available
 Provide psychoeducation to family and significant others regarding promotion of reality
orientation
 Monitor for changes in orientation, cognitive and behavioral functioning, and quality of life

10. Reminiscence therapy

Definiton : using the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life,
or adaptation to present circumstances

Acitivites :

 Choose a comfortable setting

 Set aside adequate time
 Identify, with tthe patient, a theme for each session (e.g., work life)
 Select an appropriately small number of participants for group reminiscence therapy
 Utilize effective listening and attending skills
 Determine which method of reminiscence (e.g., taped autobiography, journal, structured life
review, scrapbook, open discussion, and storytelling ) is most effective
 Introduce props (e.g., music for auditory, photo albums for visual, perfume for olfactory),
addressing all five senses to stimulate recall
 Encourage verbal expression of both positive and negative feelings of past events
 Observe body language, facial expression, and tone of voice to identify the importance of
recollections to the patient
 Ask open ended questions about past events
 Encourage writing of past events
 Maintain focus of sessions, more on process than on an end product
 Provide support, encouragement, and empathy for participants(s)
 Use culturally sensitive props, themes, and techniques
 Assist the person to address painful, angry, or other negative memories
 Use the patient’s photo albums or scrapbooks to stimulate memories
 Assist the patient in creating or adding to a family tree, or to write his/her oral history
 Encourage the patient to write to relatives or old friends
 Use communication skills, such as focusing, reflecting, and restating, to develop the
relationship
 Comment on the affective quality accompanying the memories in an empathetic manner
 Use direct questions to refocus back to life events, as an necessary
 Inform family members about the benefits of reminiscence
 Gauge the length of the session by the patient’s attention span
 Give immediate positive feedback to cognitively impaired patients
 Acknowledge previous coping skills
 Repeat sessions weekly or more often over prolonged period
 Gauge the number of sessions by the patient’s response and willingness to continue