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Saint Louis University

School of Nursing

Graduate School Program

In Partial Fulfillment

Of the Course

Masters of Science in Nursing

In Partial Fulfillment

Of the Course Requirement

In Behavioral Perspectives in Heatlh

A Case Analysis

Using Health Models and Nursing theories

Submitted to:

Ms. Teresa Basatan, MSN

Professor

Submitted by:

Charmaine Acosta Baniqued

MSN student

September 25, 2012



Case Analysis

Charmaine Baniqued

2

Table of Contentsi. BACKGROUND .................................................................................................................................. 3

ii. DISCUSSION/ ANALYSIS ................................................................................................................ 6

iv. EVALUATION................................................................................................................................... 17

v. REFERENCES ................................................................................................................................. 18

APPENDICES

CONSENT

DOCUMENTATION



Case Analysis

Charmaine Baniqued

3

i. BACKGROUND

Worldwide, between 80,000 and 100,000 kids start smoking every

day. Approximately one quarter of children alive in the Western Pacific Region* will die

from smoking.

The World Health Organization (WHO) has compiled worldwide smoking statistics for

the year 2002. The smoking facts and stats presented are sobering.

GLOBAL SMOKING STATISTICS

About a third of the male adult global population smokes.

Smoking related-diseases kill one in 10 adults globally, or cause four million

deaths. By 2030, if current trends continue, smoking will kill one in six people.

Every eight seconds, someone dies from tobacco use.

Smoking is on the rise in the developing world, tobacco consumption is rising by

3.4% per year.

About 15 billion cigarettes are sold daily - or 10 million every minute.

Among WHO Regions, the Western Pacific Region - which covers East Asia and

the Pacific - has the highest smoking rate, with nearly two-thirds of men smoking.

Youth

Among young teens (aged 13 to 15), about one in five smokes worldwide.

Between 80,000 and 100,000 children worldwide start smoking every day -

roughly half of whom live in Asia.

Evidence shows that around 50% of those who start smoking in adolescent years

go on to smoke for 15 to 20 years.

Peer-reviewed studies show teenagers are heavily influenced by tobacco

advertising. About a quarter of youth alive in the Western Pacific Region will die from

smoking.

*The 37 countries and areas comprising the WHO Western Pacific Region include

Philippines.



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With the concrete presented statistics above, it’s definitely alarming for me to turn

a blind eye with the rising incidence of smoking especially to those who are still studying

basically who are already employing a maladaptive coping towards stress. Another

reason for choosing him as my patient was that, if he is not into his smoking and

drinking, he seems so kind, respectful and responsible towards other people. What

gives him that “hard man” effect is that when he does the inhaling and exhaling of

smoke! So, I wanted to explore what is beyond his smoking and alcohol drinking.

My case is that of Mr. RT who is a 22 year old male with a history of smoking

way back since 3rd

year high school apparently all because of curiosity to try it. It is not

known from his family because accordingly, he will be reprimanded for the behavior. He

is the last child in the family having 3 siblings, 2 females and a male. No other family

smoke aside from his father whom he also claimed is into gambling.

When he reached college and being away from his family, he already started

smoking regularly with the freedom provided. He claimed that it makes him calm when

tense especially with regards to his problems (school and relationships). He also

claimed that he is into reinforced drinking every time he has money (allowance)

because of the urge to spend the money at hand. Accordingly because of his allowance

is not sufficient and is not given on time which makes a problem for him.

With school, he verbalized problems like lacking motivation to study, and that he

garnered couples of failing grades already and because of this, the more he smokes

because of frustrations and the feeling of losing control to what is happening.

Furthermore, he felt pressured because all of his siblings are already finished college.

Adding insult to an injury, his past 2-year relationship with his ex-girlfriend has no

closure. He verbalized that at the time of the interview, he really has a lot of things

making his thought messed-up. One is that, his ex was the one who became unfaithful

to their relationship resulting to their breaking apart and after some months later now

she claims that he is the father of the child she has gave birth.



Case Analysis

Charmaine Baniqued

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With all of these troubles he is into, he claimed that he is not open to any

member of his family to have at least one whom he can vent out his feelings, emotions

and problems. He also tends to keep these from his college friends. So, to

compensate, he struggles to appear happy by having a “happy-happy moments with

them”. That is, by having more frequent smoking episodes and drinking sprees.

Mr. RT chooses not to be in detail of these things but at the time of the interview,

he seems bothered. Anyway, he claimed to be aware of smoking hazards that it

imposed to his health, but he also claimed that, smoking is the only way that calms his

nerves and that’s the time he could think clearly then about things that troubles him.

Accordingly, he tried to stop smoking but he can’t just do it especially if he is faced with

problems/troubles again like that of his ex kept demanding from him, the school grades

are failing and the like.

All of these factors as he claimed had aggravated his smoking and alcohol

indulgence.



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Charmaine Baniqued

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ii. DISCUSSION/ ANALYSIS

Basing from the case, the appropriate model for giving interventions for this

particular client is the Cognitive Behavioral Model- Laps e-Relapse Proces s . Clearly

because of the imbalanced lifestyle, and yes, I cannot deny the fact of the severity of his

problems he is going through, but instead of directing through these problems, he is

coping in a maladaptive way which is smoking and drinking but more into his smoking

and not seeking any social support. He decided somehow to start smoking cessation

but have been unsuccessful for many times, and these past attempts gave him the

feeling that he cannot do the behavioral change desired and so the further involvement

in the vices.

There is the existence of maladaptive behavior, together with the desire for it. If

one is not equipped/ guided through the knowledge of effective coping mechanisms,

one would easily give in. Especially so, because Mr. RT uses rationalization or denial

that makes that maladaptive behavior correct or the effects that could serve him right. In

our life where stress is everywhere and it could be basically anything owing to our

individual differences. Stress is the one that provokes him to indulge to this maladaptive

behavior so stress management is very important to address this problem and self-

efficacy plays a pivotal role in doing this change.

It is also appropriate to integrate Health Promotion Model by Pender, the Health

Belief Model and Theory of Reasoned Action together with nursing theories of Betty

Neuman which is the Health Care Systems Model and of Imogene King which is the

Goal Attainment theory along with that of Tannahill’s Model of Health Promotion.



Case Analysis

Charmaine Baniqued

7

Pender’s Model

Prior related behavior:>Ineffective copingmechanism

Smoking Drinking

Personal factors: Male College

student Ineffective

Stressmanagement

Perceived benefits fromsmoking:

Makes him calm

Helps him tothink well

Perceived self-efficiencyin stopping smoking:

Cannot stopsmoking

He believes tobe addicted to it

Belief that it is intheir bloodline

Interpersonal influences: Father also

smokes Peers in school

and his cousinsalso smoke anddrink ROH

Situational influences: Nothing could

relieve his stressexcept for smoking/drinking(situational)

Presence of problems (failinggrades, failurerelationship)

SMOKING/ DRINKING

No commitment/ plan tstop smoking/ drinking

1



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CBT-RP

2

Existence of maladaptivecoping:Smoking,alcohol andnot seekingsocialsupport

Desire for indulgence;so muchmore if there is/areproblemsencountered/ stress:schoolproblems,relationshipissues

Gives into theurgesandcravingsand itspositiveeffects itoffers:smoking,alcoholdrinking

Rationalizesthat thismaladaptivebehavior isthe only waythat helpshim relaxand thinkclearly

Exposure todifficultsituationswhere copingis needed(failinggrades,unsuccessfulrelationships,no one toverbalizeupon):maladaptivecoping

Problemsnotaddressed;lack of copingmechanismandproblemsolvingcapabilities

Due tounresolvedproblems;feeling of inadequacy(decreasedself efficacyisexperienced)

Substanceabuse(smoking/alcoholdrinking)

Abstinviolatieffectnot hathe poto stosmokbecauconstastress& the of beifailureeveryhe triestop,

just ca

do iteffect

creasing lifestyle balance:

Encouraged him to developpositive addictions like playingmetal puzzles and Sudoku whenhe is under stress to makehimself busy since he said thathe loves playing those. Suggested that if he needed abreak, maybe, he could go for astrolling with his peers Reinforced him to study and notto be lazy about it by keeping inmind those people whom are thereasons why he is studying andkeep his goals and continue

striving for his dreams by doinghis part as a student

Stimulus controltechnique: Taught him of

avoiding or removing of items/ situationsthat is associatedwith his smoking(Not stocking or buying cigarettes,not going toevents that wouldsmoking)

Revisedecisionmatrix:Weidentifiedtogether thepositive&negativeeffects of smokingto him(Pros &Cons)

Relapse road maps andcycle is explained to him.We identify together theusual situations whichposes inevitable risks for him to smoke: he saiddrinking with his peersand when some mishapsoccurred like if he hasfailing grades, quizzes/exams, and when his exkeeps confronting him)

Self-monitoring and

behavior assessment:

When he experienced

difficulty of saying “NO”

to a temptation of

smoking, try not to

smoke to relax him.

Suggested act.: listen to

music, watch television,

have a time for self

alone to meditate andthink what was really is

the problem

Efficacy enhancingstrategies:

Counseled him to

think of a

possible solution

that is attainable

at a shortest

time.

Reminded himthat this is a formof skill acquisition,so keep avoidingit and practiceresolving

problems directly.

Lapse mgt: Setting contract to l

smoking again Taught him how to

up with a lapse by nhaving a negative sconcept.

He was also given by telling it immediato the nurse.

We had evaluatedreadily what hadtriggered the lapse.(failed grades)

As a form of urge mgt:

Taught him of distractionsmethod like watchingmovies and informed himabout urge surfing

Educated himon warningsignals of relapse. (Givingas an examplewas what heexperiencedpreviously)

Avoidancestrategies: Saying no to

high risksituations

Told to keepin mind thathe couldcontrolhimself

We also brought up to the present the experiences and howhe looks at up himself after giving into his past relapses

Coping skillstraining: Suggested

opening up histo his siblings if he cannot directit to their parents.

Stress mgt:(praying,confrontproblems, focuson emotions,use problemsolving

technique)

Eliminating myths

and placebo effects: The beneficialpsychologicaleffects of smokingto him: cannotdefecate withoutsmoking, cannotthink clearly & thecalming effect

Taught him onimmediate andlong term effectsof smoking andhe has beenscared of to learnthat smoking mayalso cause CA ingenitourinarys stem.

Cognrestru Told

thatnot thatinefrathcopmec

Go streskilltrain

HEALTH PROMOTING BEHAVIOR

3

4A



Case Analysis

Charmaine Baniqued

9

TRA+HBM

2

Plan or complianceto stop/controlsmoking &drinking

Attitude beliefs: Evaluation: It’s a good

decision to stop smoking

Perceived self-efficiency: After interventions done in

the CBM-RP, perceived self

efficiency improves “I can do this time” as

verbalized by Mr. RT

Cues to action to stopsmoking: Counseled upon by the

nurse of the long and shortterm effects of smoking

Feeling of a weakened body Apparently, he reported

there’s blood in his urineand he associate thispossibly by smoking

Advocacy program of city

Susceptibility to the disease: Family history of cancer in

maternal side Male is commonly more

affected by lung cancer Statistics say that the

leading cancer is lung

cancer for males.

Severity Aware about smokers body

diseases and afraid of itsomehow

He is also afraid of havingliver diseases associatedwith reinforced drinking

Perceived benefits of stopping:

Health promotion Smoking-related diseases

prevention

Normative beliefs: His siblings expect him to

stop smoking His current girlfriend wants

him to stop smoking

Attitude: Trying to stop smoking

Motivation to comply: He value much of his

girlfriends want andexpectations



Case Analysis

Charmaine Baniqued

10

3

Stressors: Failing grades du

lack of motivationstudy

Failed relationsh When stressed:

seeking socialsupport

BasicEnergy

Re-sources

Basic structure: factors: Innate survi

factors Genetics (m Response p

(maladaptivcoping)

Strength/weaknesses

E o

Environment

Primary prevention: Advised to reduce

possibility of encounter withstressors byavoidance strategytowards the ex

Counseled onadaptive and copingmechanisms use

Response pattern:(personal factors) Feeling of loss Feeling of pain Being hopeless at the

moment Smoking and drinking

behaviors

Feelings of

guilt

Feelings of

inadequacyInterventions: Strengthen physiologic response

towards stress by advising adequatefood intake, balance between rest andplay

On psychological: Stress managementtechniques

Developmental: the need to beresponsible by studying as his part

Sociocultural: Socializing with peers yetdoing the right things (avoid vices);identify balancing factors: seeking helpfrom f riends/cousins

Spiritual: Advising to go to church,saying prayers

Goal: Control/ stop smoking anddrinking. Learns increasing balance inlifestyle, makes use of effectivecoping mechanisms and stressmanagement and problem solvingtechniques

Anticipated outcome: able tocontrol/stop smoking and drinking as acoping mechanism for stress

Prevention of progression to the

need of secondary and tertiary

prevention

Reconstitution: Could begin at any

degree/ level of reaction

Support for successful

A

HEALTH CARE SYSTEMS MODEL



Case Analysis

Charmaine Baniqued

11

r. RT has lack of nowledge regarding

ress managementnd adaptive copingechanisms

4

Mr. RT

Mr. RT isaware of his mal-adaptivecopingresponse

Learning

Time

Space

Growth& Dev’t

Body

COMMUNICATION COMMUNICATION

TRANSACTIONMr. RT and the nurse communicates

about goal-setting and agreement

GOAL

SETTING

AGREE-

MENT

GOAL

Goal Setting: To develop effective copingmechanism/ problem solving and stressmanagement techniques

Agreement: To stop/control smoking anddrinking

Goal Attainment Scale: Health promotingbehavior

5

Learning: Takes place when there is

effective communication Mr. RT gained knowledge

of his maladaptivebehavior and proper techniques to handle it.

GOAL IS

ATTAINED

A

GOAL ATTAINMENT THEORY



Case Analysis

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5

Educate on health promoting behaviorsReinforce on the use of proper stress

management and use of adaptive copingmechanisms and problem solving strategies

By supporting psychological,physiological and sociologicalstrengthening of the clienttrough ways of under health

education, my client is alsospared from secondary/tertiary prevention is alsospared.

In support of the gov’t for

the smoking hazards,Baguio city governmentimplemented law on nosmoking at public places

TANNAHILL’S INTERLAPPING SPHERES



Case Analysis

Charmaine Baniqued

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iii. PLANS/ INTERVENTIONS

Upon the first meet up, the client was cooperative and opens himself to the nurse

readily. This may indicate that he is actually willing to make a behavioral change,

geared toward health promoting behaviors and to learn on how to manage these

“undesirable health habits” that he is currently having.

To be further aware of my clients needs and for appropriate models to be

employed for initiating change, I validated with him my “findings” on his case and the

client validated that understanding upon his case is correct and he participated well with

the planning of interventions for the succeeding weeks. Here, we could integrate the

transaction process and learning concept of King from her model.

Prior to that, the model by Pender was used to explain the current behavior of

the client on how things lead to the behavior.

It is therefore useful for Mr. RT to adapt the interventions from the model of CBT-

Relapse Model because this is the key for achieving the goals from the different

models and theories that could be integrated in this study. To start with: to increase

lifestyle balance, I encouraged him to develop positive addictions like playing metal

puzzles and Sudoku when he is under stress to make himself busy since he said that he

loves playing those. I also suggested that if he needed a break, maybe, he could go for

a strolling with his peers. I also reinforced him to study and not to be lazy about it by

keeping in mind those people whom are the reasons why he is studying and keep his

goals and continue striving for his dreams by doing his part as a student

**The client said that he would be trying these things and that he will inform me of his

possible signs/symptoms that he could experience related to the desired goal.

For stimulus control technique, I taught him of avoiding or removing of items/

situations that is associated with his smoking (Not stocking or buying cigarettes and

alcohol, not going to events that could entail the need for him to smoke and drink). And

as a form of urge management, I taught him of distractions like watching movies and



Case Analysis

Charmaine Baniqued

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informed him about urge surfing for him not to think immediately that he cannot do it if

he experienced urge.

**True enough, Mr. RT at the 1st

3days of managing his urges experienced difficulty and

thought of giving up the process and almost gave in to his cravings. The difficulty

experienced is brought about by the need to adjust without the cigarette or drinking.

So, with the experience of urge surfing, I introduced him immediately to revised

decision matrix. We identified together the positive and negative effects of smoking and

drinking to him. Like if he has been drunk, this would definitely impair his functioning

instead of him studying his lessons. I also educate him on warning signals of relapse.

(Giving as an example was what he experienced previously). Relapse road maps were

also initiated. (We identify together the usual situations which poses inevitable risks for

him to smoke: he said drinking with his peers and when some mishaps occurred like if

he has failing grades, quizzes/ exams, and when his ex keeps confronting him). We

also brought up to the present experiences and how he looks at up himself after giving

into his past relapses. This is done for analyzing his past relapse fantasies.

**Mr. RT further looks himself as a big failure when he was reminded about his past

relapses and does not want to experience losing control of his self again. This gave him

however a positive effect: He said to himself then and to the nurse that he should do

this by this time!

So to reinforced him that when he experienced difficulty of saying “NO” to a

temptation of smoking (like when he is presented with the stimuli he just said earlier),

might as well try not to smoke to relax him, rather. I suggested for him to listen to music,

watch television, have a time for himself alone to meditate and think what was really is

the problem and think of a possible solution that is attainable at a shortest time that is a

form of enhancing the feeling of self-efficacy. I reminded him that this is a form of skill

acquisition, (how to resist temptations apparently and have that behavioral change).

And if it is a skill, one needs to practice it over and over again. So, for him, he just

needs to practice not holding on to smoking also when there is an opportunity that he

was faced with a stressor. Practice avoiding it and practice resolving problems directly. I



Case Analysis

Charmaine Baniqued

15

also suggested opening up his problems to his siblings if he cannot direct it to their

parents but he refused saying that all of them are not really opening up to one another.

**Mr. RT realized that, of course, there is no easy way to acquire skills. So, he needs to

work upon it by not giving to the urges and cravings.

**He also said that, there is one cousin who is really close to him, at that he is the one

he will try to open up upon when problems crashes him.

To further enhance the coping mechanisms and self efficacy, concepts from

Health Care Systems Model are lifted particularly; the strengthening or supporting the

intervention from the primary prevention so that it would not lead further that

necessitates secondary or tertiary prevention or penetrating all of his defenses and

worst: entropy.

We then moved in to eliminating myths from him, typically the beneficial

psychological effects of smoking to him. Like he said, he cannot defecate without

smoking, he is apparently constipated and that he cannot think clearly if there is an

existing uneasiness within him. He also learned about the immediate and the long term

effects of smoking and he has been scared of to learn that smoking may cause any

cancer in the body. Like in the genitourinary system particularly, because lately, he

claimed that he has blood in his urine without any other cause. Moreover, he also

claimed that recently, he has again another ineffective relationship with his new

girlfriend because of his ex and his smoking and drinking habits. According to him, his

girlfriend matters to him ant that she is the one that matters most aside from his siblings

in stopping his smoking and drinking when feeling troubled.

With the preceding paragraph above, this is in relation to Health Belief Model

and Theory of Reasoned Action conceptual framework. The subjective norms andattitude beliefs also influence him to further contribute for the proposed goals. In

conjunction with the Goal Attainment, wherein the perspective of the nurse of what is

deficit leads to the formulation of appropriate goals, learning is a key concept for the

client to move towards achieving his potentials. That is where health education is also

needed to be emphasized. Moreover, in King’s theory, health is the focus, which is the



Case Analysis

Charmaine Baniqued

16

counterpart of disease prevention in Tannahill’s Model and it is also in this model that

legislations in influencing the health is taken into consideration since Mr. T also

verbalized that the regulation on smoking of the city government has also a bearing on

minimizing his smoking in public places since then.

After for some time of not seeing him, I had been to Mr. RT to see how he was

coping with his progress to the proposed behavioral change.

**He said that for many times, he had been tempted to start smoking again especially if

he sees people who are smoking and also when he was upset about his school

requirements but insisted to keep up with the planned interventions and what has taught

to him for effective coping.

After the midterm examinations, Mr. RT experienced the initial lapse of

substance use because apparently he has almost sure failing subject again just after

taking the exams. He said that he suddenly thought of about her ate who sends him to

school. He seemed distraught with the outcomes of his grades and the lapse he

experienced.

**Lapse management has been initiated then with Mr. RT by setting contract to limit

smoking and drinking again, and taught him how to cope up with a lapse by not having

a negative self concept. He was also given credit by telling it immediately to the nurse.

We had evaluated readily what had triggered the lapse. I immediately assessed him for

abstinence violation effect. He might be feeling some decreased self-efficacy to

continue with the behavioral change. We did cognitive restructuring by not letting him

feel he is a failure.

**He said the next time he would be confronted again with such immense problem, he

would try to go and seek the availability of the nurse and his available social supportwhich is the dearest cousin to him ASAP.



Case Analysis

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iv. EVALUATION

Ineffective stress management and coping mechanism; impaired problem solving skills:

smoking and drinking

The goal/s with Mr. RT are fully met basing it to the Lapse-Relapse Process

Model and Goal attainment theory. Change is in line with the time frame provided in

Goal attainment scale. Also, the other models/ theories that helped in enhancing the

efficacy and coping mechanisms in achieving the health promoting behavior also

succeeded in enhancing the desired behavior change. It has been almost 4 months

since we set the goals. It is not because Mr. RT experienced relapse made my goal for

him partially met. Because, infusing him with an insight is the primary goal, and he had

been receptive to those. Behavior change is not achieved over night but it is achieved

over time.

The client identified the presence of a problem, the client identified the triggering

factors that let him do to smoke, helped the client verbalize feelings and thoughts

regarding the coping mechanism used, the client eradicated the smoking as a coping

mechanism and he also addresses problem directly by having a confrontation with his

ex and he initiated the closure accordingly (however, the client is still under observation

and monitoring, the last time he smoked was September 9, 2012 and as of this moment,

he still not smoke), The client developed and maintained a healthy coping mechanism.

According to him, he plays guitar, sings and he even clean the house when he feels

stress now.



Case Analysis

Charmaine Baniqued

18

v. REFERENCES

George, Julia (2002). Nursing Theories: The Base for Professional NrsingPractice 5th ed. Singapore. Pearson publishing

Global lifestyle self control strategies handout from Mam Basatan in BehavioralPerspectives in Health

Marlatt, Allan G. (1984) Society for the Study of Addiction to Alcohol and other Drugs. Relapse Prevention: Introduction and Overview of the Model. Bntish

joumalof Addiction79(1984), 261-273 Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance

strategies in the treatment of addictive behaviors. New York: Guilford Press. World Health Organization - Smoking Statistics http://recoveryroadmap.com/Members/RP-Pages/RP8-TheoryPractice.html http://books.google.com.ph/books?id=Fx9oqIbIQ_QC&pg=PA4&lpg=PA4&dq=La

pseRelapse+Process&source=bl&ots=tllzVeBNej&sig=QGDNBmx4qEaFgrLBIJjgGJulaQI&hl=en#v=onepage&q=Lapse-Relapse%20Process&f=false

Downie RS, Fyfe C & Tannahill A (1990). Oxford: Oxford University Press, Tannahill A.( 1985) What is health promotion? Health Education Journal

Health Protection Agency. What the Health Protection Agency Does. 2010 (last

updated 12 April). Last viewed 22 June 2011.

http://recoveryroadmap.com/Members/RP-Pages/RP8-TheoryPractice.html

http://books.google.com.ph/books?id=Fx9oqIbIQ_QC&pg=PA4&lpg=PA4&dq=LapseRelapse+Process&source=bl&ots=tllzVeBNej&sig=QGDNBmx4qEaFgrLBIJjgGJulaQI&hl=en#v=onepage&q=Lapse-Relapse%20Process&f=false




http://www.hpa.org.uk/AboutTheHPA/WhatTheHealthProtectionAgencyDoes/








http://recoveryroadmap.com/Members/RP-Pages/RP8-TheoryPractice.html



Case Analysis

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APPENDIX 2

DATE ACTIVITIES DONE SIGNATURE

July 7,

2012

Asking for informed consent and divulging

intentions/ purpose

Building rapport

Interview/ eliciting initial database

July 14,

2012

Validating data for correct understanding of the

case situation

Formulation of planning and interventions with

the client for the next weeks

July 21,

2012

Interventions on increasing lifestyle balance

How to avoid high risk situations

Urge management

July 24,

2012

Identified the positive and negative effects of

smoking to him

Discussed on warning signals of relapse. (giving

as an example was what he experienced

previously)

Identifying usual situations which poses

inevitable risks for him to smoke

We reflected at his past experiences and how he

looks at up himself after giving into his past

relapses

Constant reinforcements of interventions

previously taught



Case Analysis

Charmaine Baniqued

Problem solving techniques discussion

Stress management options

Discussion on effective coping mechanisms

Discussion on the beneficial psychological

effects of smoking to him and about the

immediate and the long term effects of smoking

August

12, 2012

Visit to Mr. RT

He related his experiences about being tempted

to smoke/ drink

Sept. 9,

2012

Mr. RT experienced the initial lapse of substance

use.

Lapse management by setting contract to limit

smoking again, and taught him how to cope up

with a lapse by not having a negative self

concept.

He was also given credit by telling it immediately

to the nurse.

We had evaluated readily what had triggered the

lapse.

I immediately assessed him for abstinence

violation effect. We did cognitive restructuring.

framework case ana

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