Acknowledgement

First and foremost, I express my deepest thanks to the Medical City Psychiatry Department for a wonderful training experience they have provided each and everyone of us. I appreciate the fact that the staff and doctors treated us like a part of the institution. They were all always approachable and made us feel comfortable in the workplace.

I would also like to thank our supervisors Ms. Alice Yu and Sir Dan De Guzman for being such considerate, affable, and guiding superiors. How they always make sure that we learn something out of our everyday tasks, and how they challenged us to show our skills, I would never forget. I have learned from them that perseverance, patience, creativity, and a genuine desire to aid mentally sick patients are most important in the clinical setting.

As always, never-to-be-forgotten is the support and guidance of our beloved Practicum Coordinator and Area Chair, Ms. Merle Salmorin. I am thankful for her knowledge of the complexities of the world of psychology because she keeps us equipped and ready to face obstacles on our own.

Also, my family and friends who stand by me and never lose patience during my most selfish times deserve due gratitude. Without them, I would not have survived this taste of the real world.

Last but most certainly not the least, I thank the Lord Almighty for everyday that I get to wake up and live my life. In the midst of all the hardships, I know that he always has the best things in store for me.

N.K.D.JIntroduction

A common assumption about people who major in psychology is that they are responsible for treating the mentally ill. Freshman college students who take up psychology usually say that they chose the course because it is very interesting to them. Some believe that the course can enable them to understand people and themselves. And most people, when talking to a psychology major, usually ask Are you reading my mind right now?All of these suppositions, to some extent, have a little truth in them. To put focus on the first mentioned assumption, a psychology major may indeed treat mental illness. But it is only after they undergo extensive studying and training, particularly in the field of abnormal psychology, can they become medical doctors known as psychiatrists. A mental disorder is described as a syndrome characterized by clinically significant disturbance in an individuals cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning (Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition). Behavioral and emotional disorders, on the other hand, are diagnosed and treated by clinical psychologists. These are individuals who hold a doctoral degree in psychology and are trained in clinical practice and research. Even as graduating students of psychology, all of us are still practically neophytes in the field. That is why training in a psychiatric facility is a very essential experience for us especially if we wish to pursue a career in the clinical setting.In junior year, we have had our first tasteof having close contact with children who are suffering from emotional or behavioral disorders. Despite the very short amount of time allotted for this immersion, it has prepared us for facing more complex cases of mental disorders specifically among adults. Different types of mentally disordered individuals are admitted in the Medical City Psychiatry Department. They may either be referred by their family or voluntary patients. The length of time they spend in the facility will depend upon the severity of their disorder. The patients medication and diet are under the prescription of their doctor. Among the patients, Substance-Abuse Disorder is most common; Schizophrenia, Bipolar Disorder, Depressive Disorders, Binge-Eating Disorder, and Dementia were also evident. One patient even had Psoriasis which is a skin disease, another showed symptoms of Gender Dysphoria, and yet another patient showed symptoms of Language Disorder. Throughout the duration of our training, we were under the supervision of the two occupational therapists of the Psychiatry Department, Maam Alice and Sir Dan. Therefore, most of the activities we administered were in line with the patients occupational therapy. The patients have a set schedule of activities within a week; every Monday, Wednesday, and Friday they have to participate ineither arts-n-crafts or group dynamics activities. These types of activities may seem simple and even unsuitable with the age range of the patients. But in truth, it helps them develop their ability to focus on a task, enhance fine motor skills, and could even improve their patience and determination. Also, for depressive and addictive patients, these activities could help distract them from withdrawal symptoms. During some Fridays, when the interns in-charge are still preparing for the morning activity, the patients can have their zumba or tai-chi exercise for atleast 30 minutes accompanied by other trainees. Also, during Friday afternoons, the patients always look forward to their karaoke time. It is actually a great way of seeing them let loose and have fun with other patients. Every Tuesday, on the other hand, baking activities are administered while every Thursday, there are cooking activities. All the necessary equipment is within the O.T. Room. Finally, on the weekends, group dynamics activities can be administered every Saturday morning and during the afternoon the patients have movie time. While on Sunday mornings, the patients have grooming time wherein they do basic hygienic practices such as cutting their nails, shaving, hand and foot spas, and even hair spas. Then during the afternoon, they have again their movie time.Fortunately, no incident was ever reported during the time we spent as interns within the facility. Praises from our supervisor, Maam Alice were also a bonus. She commended us for being hardworking, non-complaining, and compassionate towards the patients.

Company Profile

The Medical City (TMC) is a tertiary care hospital with over forty years experience in hospital operation and administration. Its world-class health care complex serves some 40, 000 in-patients and 400, 000 out-patients annually. TMC has a medical staff of over 1, 000 physicians who are established experts in their various fields of specialization. This core of professionals is complemented by a 2, 200-strong human resource complement, engaged in allied medical, administrative and support services. TMC is owned and operated by Professional Services, Inc. (PSI), and has been operational since 1967. Through the years of its corporate existence, it has learned to integrate the science of medicine with that of business management. Hence, TMC is one of the financially sound health care institutions in the country. Its history boasts of the collective aspiration and learnings of its forerunners that have laid the foundation in molding the character of the institution and in staying the course towards its vision and mission.At the heart of TMCs service philosophy are new paradigms of hospital care addressing the entire continuum of health needs, and the patient as an equal, informed and empowered partner in the pursuit and preservation of health. TMC is accredited by the Joint Commission International (JCI), the worlds most prestigious accrediting body for international health care organizations.

Company History

The Psychiatry unit was established in 1965 at the ABM Sison Hospital, now known as The Medical City. The unit was established in response to the need of the community for hospital-based treatment of individuals suffering from severe psychiatric disorders. It was administratively under the Department of Medicine at that time. The unit was located in the Lower Ground Floor of the hospital to ensure patient safety. It had an open spacious garden where patients had their sports and recreational activities. The unit became an independent department in 1971 under the chairmanship of Dr. Antonio P. Perlas. He was the first Chairman of the newly founded Department of Psychiatry from 1971 up to 1978 and then served for another term from 1980 to 1987. A Psychiatry Residency program was started in the same year when the Department of Psychiatry was recognized as an independent department. The first full-fledged Resident graduate was Dr. Elizabeth De Guia- Godino in 1982. Those who started residency training at the Department but continued their training in other institutions were: Dr. Lourna Laraya, Dr. Efren Reyes, Dr. Angela Halili-Jao, Dr. Philip Jaojoco and Dr. Jon Ortiz. The department also had Ward Administrators until 1979, to supervise department staff and services and these were: Dr. Batcagon, Dr. Carolina Lacson and Dr. Paz Zabala. The ward was later expanded to a 60-bed capacity unit in 1980.From 1987 to 1996, Dr. Teresito Ocampo took over as the Department Chairman. The nursing staff was increased to 35 (nurses, occupational therapists, aides). The graduates of the residency program under Dr. Ocampo include: Dr. Nora Avila in 1988; Dr. Imelda Batar and Dr. Patricia Lichauco-Pagkalinawan in 1989; Dr. Dulce Lizza Sahagun in 1990; Dr. Doris Primero-Carillo in 1994 and Dr. Rene Yat in 1996.Dr. Lourdes V. Lapuz was appointed Chairman of the department on August 4, 1996. On the same year, the Units bed capacity was increased to sixty-two (62). However in 2001, the ward floor area was reduced and the bed capacity was consequently reduced to 32 beds to accommodate the hospitals newly-acquired Magnetic Resonance Imaging (MRI) unit. Despite this condition, the Department continued its growth; and its clinical services became extensive. In 1998, an Out-Patient Department was established to provide the Residents with adequate training in handling outpatients and doing psychotherapy. The Section of Addiction Psychiatry was gradually developed with the introduction of its programs: Detoxification Package for substance abusers, Mentally Ill & Chemical Abusers (MICA) program in December 1999, and the Program for Detoxified Patients (PDP) in October 2000. The Section of Consultation-Liaison Psychiatry started its affiliation with the Renal Unit in 1999. The department also launched a support group for the relatives of chronic psychiatric patients, called "We Care Support Group" in June 2000.The Psychiatry Residency program had full accreditations in 1995, 1998 and in 2001. Since then, innovations in the training program were initiated to pave the way for better clinical and community learning experience. Outside rotations in Child Psychiatry (UP-PGH), Out Patient (NCMH), Neurology (St Lukes Medical Center) and Community Psychiatry (DOH - 1998; Ilugin Elementary School - 2000; Barangay Maybunga - 2001) were integrated into the training program. In the year 2000, the Department also started accepting Neurology Fellows from St. Lukes Medical Center to have their Psychiatry rotation in the department. Dr Angela Aida Halili-Jao was the Training Officer under Dr. Lapuzs Chairmanship. The graduates of the residency program under the leadership of Dr. Lapuz were: Dr. Robina Pascual and Dr. Theresa Lirio in 1998; Dr. Ma. Monica Cardinez-Tan and Dr. Aura Lee-Antonio in 1999; Dr. Felipe Francisco, Dr. Genuina Ranoya nd Dr. Herman Sanchez in 2000.Dr. Cornelio G. Banaag, Jr. became the chairman of the department in 2001, with Dr. Ruby G. Manalastas as Training Officer. Under his leadership, the Department of Psychiatry transferred to the new hospital site of The Medical City at Ortigas Avenue, Pasig City in 2004. Additional rotations for Out Patient at East Avenue Medical Center and Forensic Psychiatry at the National Center for Mental Health (NCMH) were established. Dr. Luz Casimiro-Querubin became Training Officer in 2004. The Residency Program has been given full accreditations in 2004 and 2007. The Fellowship Program for Consultation-Liaison Psychiatry was first offered in 2006. The graduates of the Residency program under Dr. Banaags term are: Dr. Eleonor E. Sanchez and Dr. Vanessa B. Cainghug in 2001; Dr. June Anne L. Daplas in 2002; Dr. Geraldine Anne C. Divino, Dr. Sylvestra Freita P. Bautista, and Dr. Sheheraza de Binag-Directo in 2003; Dr. Wendell Holmes C. Valdecantos in 2004; Dr. Maria Racelle C. Monforte, Dr. Michelle Marie Magtalas-Marinas, and Dr. Candice Vera Sia in 2005; Dr. Tristan J. Hilario in 2006; Dr. Cleto Manongas in early 2007; Dr. Josephine I. Gatdula, Dr Anna Katrina N. Lising, Dr. Myra Dee G. Lopez and Dr. Vincent John M. Lu in December 2007, Dr. Jannel G. Gatlabayan in 2008, Dr. Christian Irving C. Cayetano in 2009.The Department of Psychiatry is currently located at the lower ground floor of The Medical City with a floor area of 650.87 sq. m. The unit has 3 separate areas: the Working area, the Patients area, and the Staff area. It has a 21-bed capacity in-patient ward with 1 isolation room, 1 visiting/interview area and an ECT/Treatment room. The unit also features an Occupational Therapy Room, an indoor fitness room, and an outdoor activity area for patients. There is 1 nurses station and work area. The Residents area includes a conference room, 2 computers with printers, 2 landline phones and 1 fax machine; a double-bed is segregated into another area for Residents and interns on 24-hour duty. The Chairmans Room, an interview room and Out-Patient Rooms are located outside the Nursing Unit of the Department.

VisionTo always be a leader in shaping how Filipinos think, feel and behave about health and how health services are accessed by and delivered to them, and to use such leadership to serve equity in health, life and development.

MissionThe pursuit of our vision is animated by a passion to always keep our patient on center stage and deliver service of greater worth, engaging strategic partners who share our vision and passion, constantly proceeding from what we do best, and in the process of carrying these out, align the interests of our employees, our professional staff and our shareholders with the interests of those we serve.

Core Values Excellent and compassionate serviceWe aspire to excellence and compassion in the provision of our services, achieving increasingly superior performance through organizational synergy and continuous innovation.

Client partnershipWe forge sustainable partnerships with enlightened and empowered clients - our patients, physicians and payors - systematically creating opportunities for active engagement, informed participation, and shared responsibility.

Primacy of the human resourceWe invest in the personal and professional development of our staff, providing them with the requisite technology, capacity and voice to exercise their primacy as a resource in serving our customers and creating value for our shareholders.

IntegrityWe uphold personal and institutional integrity, consistently seeking alignment between the values that we espouse, and the strategies, decisions and actions that we pursue.Organizational Chart

The Medical City NSO-Psychiatry Department

PROCESS OF ADMISSION OF CLIENTSThe actual process of admission of clients of the institution is kept highly confidential. As interns, we do not have access to this kind of information. But based on observations, we are able to see that before a client is admitted to the ward, they undergo a series of steps care of the psychiatry departments doctors and staffs. First, a client may either be self-referred or involuntarily brought for assessment of psychiatrists within the institution. Just outside of the ward is an interview room where the assessment takes place. If deemed necessary that a client be admitted to the ward, the doctor in-charge certainly has to inform the family of the clients case. Just as in other cases of confinement, paperwork is needed to ensure the legality of the admission of the client. Consent shall be obtained from the client, but in cases where the client is incapable of making sound judgments for himself, the closest family or guardian shall be the one to grant permission. Once all the necessary paperwork is accomplished, the client is then brought into the ward. The client is first brought into the visiting area/treatment room where doctors interview them. After this, the patient is free to roam around the ward and mingle with other patients. If a patient is deemed to have violent or aggressive tendencies, they are to stay in the isolation room for as long as their doctor sees fit. The patients medication, diet, treatment, and length of stay is also under their doctors discretion. Participating in O.T. activities is also required for most patients. In some cases, patients who are already treated and ready to be discharged are forced to stay longer because their family have not yet been able to settle their financial obligations to the institution. Evidently, this has detrimental effects on the patients as it may trigger negative emotions that may cause them to relapse into their past behavior. Some patients, if prescribed by their doctor, still undergoes an out-patient program after they have been released. They are to have weekly or monthly consultations with their doctors so as to ensure that they are re-adjusting well into their community. All in all, this was the process of admission of clients that was observable for interns. Essential details of the process such as what type of questions are asked on assessment interviews or how it is decided that a client must be admitted into the ward, is not disclosed. Hence, the limited aforementioned assumptions.

Documentation

Time CardsNovemberDecember

Pictures

Patients O.T. Outputs

paper mosaic makingWelcome baste

motto mo 'to

3d christmas tree

White chiristmas

Clinic Location and Facilities

Pictures with Supervisor and Co-Interns

Ms. ALICE yu

co-interns from arellano universityDr. Sagun, resource speaker for the seminar caring for the caregiversco-interns from olfu-valenzuela

co-intern from st. paul universityco-interns from olfu-ac

co-interns from au and new era universityco-interns from plm

all internsCLINIC Layout

Observation, Comments and insightsBeing under their supervision, people we regularly see in the ward are the two Occupational Therapists. In terms of being approachable, they are both relatively easygoing. They joke around with the interns and are easy to be comfortable with. But at the same time, they still are strict and rightfully disciplinarians, especially when it comes to the interns punctuality. This is very helpful for us especially since we are graduating students who will soon be working in the real world.They both also never fail to remind us of the simple rules and regulations for interns. Examples of which are: greeting supervisors, nurse staffs, doctors, employees, and patients whenever deemed necessary; wearing proper attire (i.e., white uniform, white shoes and socks); tying up hair for girls, not wearing nail polish or too much make-up, no bracelets, necklaces, more than one pair of earrings, and no earrings for boys. All of the aforementioned were discussed to us during our orientation.Furthermore, the supervisors ask us from time to time how we are doing with the patients and our co-interns. They were particularly mindful of female interns, constantly reminding us to watch ourselves around male patients.However, when it came to decision-making, it was evident that the two supervisors have very opposing ideas. There were several instances when they disagreed about the interns tasks and even things like the date when the Christmas party should be held. It was a bit confusing on the part of the interns not knowing whose decision among the two should be followed. Still, in terms of organizing, I believe that the two supervisors did the best they can with the interns schedules. Since there were so many of us interns, certain days had to be allotted to each school. So even if we wished to report for duty everyday, the supervisors cannot allow this because it would result to over-crowding of the ward and could possibly overwhelm the patients. And aside from this, a lot of the interns would not have anything to do.The two supervisors also have different ways of handling both the patients and the interns. In dealing with some difficult patients, Sir Dan is a bit sterner and firm than Ms. Alice. Ms. Alice has just a more tender approach in saying no to patients when needed. She also is more considerate to interns, particularly about tardiness and letting some of us report for duty on days not in our schedule in order to make up for late or absences. Evaluation and RecommendationsThe Medical City is one of four hospitals in the Philippines accredited by the Joint Commission International (JCI) which is internationally recognized as a premier credential for hospitals and other medical institutions. It is a gold standard for quality patient care, safety, and organization management for health care facilities worldwide.

With this under their belt, it is no wonder that the psychiatry department of the hospital shows only prime service to their patients. Facilities-wise, TMC can boast of its state-of-the-art rooms and equipment for patients. One of the treatments they offer for patients particularly with major depressive disorder is the electroconvulsive therapy (ECT). The ward also has one isolation room for patients who might be aggressive and harmful to others or themselves. In such cases, patients may be restrained to the bed to avoid any incidents.

One of the noticeable issues however, particularly in the Psychiatry Department of TMC, is that there are too many hired interns while there are only very few patients and therefore only a handful of tasks to do. Because of this, many interns end up with little to do during their time of duty. Also, a lot of the interns do not anymore get the opportunity to conduct a case study of a particular patient since there were so many students and very few patients. It would be stressful for a patient if they will be the subject of numerous case studies as this would require talking about the reason they were admitted into the ward over and over again.

Another effect of too many interns is that the supervisors could not possibly monitor every single trainee they have and thus evaluating the students performances would most likely be affected. However, this could simply be seen as a challenge for the interns to really showcase their knowledge and skills so as to make a mark on the supervisors. That is why when proposing to the supervisors certain activities to be administered, students must really utilize their creativity to think of activities that would suit the patients conditions and yet are still enjoyable and would have something to reflect upon in the end.

In terms of the facilities, the ward has excellent, state-of-the-art bedrooms and bathrooms for the patients. The bathrooms were particularly impressive because the faucet and showers system were risk-preventive in that the patients would not have anything to harm themselves with. This is very helpful especially since many of the patients are depressive and bipolar and thus have suicidal tendencies.

However, facilities for the ward staffs and therapists are not as striking. For one, the O.T. Office is very crowded even for two people. The space is very small and not enough for all the files, materials for O.T., and office equipments such as computers, printers, and phones. The same thing goes for the nurse station/work area. Although it is less of a problem since the ward only has one clerk and nurse staffs do spend more time in the lounge, the dining area, or as doorkeepers. But still, this should be addressed.

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