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Lisa Chee

NURS-360
Professor Chat
Patient-Centered Communication
(Process Recording)
PR
Date: September 13, 2014
Client age: 36 y/o
Client gender: male
Date of interaction: September 06, 2014
Diagnoses: Meth intoxication, major depressive disorder, suicidal ideations
Length of Stay (LOS) on the day of the interaction: 1 day
Dialogue

Good morning.
My name is Lisa
and I am a KCC
nursing student.
I will be here till
about 3 PM
today. How are
you feeling
today?
Eh, not great, but
Im all right.

Pt & Self
Non-Verbal
Communication
Behaviors
Placing my
breakfast plate
on the table and
pulling my
chair out to sit
down beside the
patient
Lifts head up,
acknowledges
my presence

Communication
Technique

Introductory
statement,
general lead;
open

Student
Feelings

Nervous

Student
Thoughts
This is my
first time
working with a
patient with a
mental illness,
I hope it goes
well.
Hmm, he
looks pretty
bummed this
morning. Im
going to try to
find out more.

T/N
Analysis Student Nurse
Psychodynamics
Self-Reflection

You seem sad.


Whats on your
mind this
morning?

Trying to make
eye contact w/
the patient

Well, you know. I


just feel like no
one cares about
me anymore.

Looking down,
poking his
breakfast with a
fork
Took a bite of
food and made
eye-contact w/
my patient

No one cares?

Yeah. You see,


these guys here,
they have visitors.
No one bothers to
visit me here.

Uses fork and


points to patients
in the distance

Reflection of
feeling, general
lead; open

Restatement;
open

Curious

I hope hes in
the mood to
engage in a
conversation
with me today

Pt smells
malodorous, I
wonder whens
the last time he
took a shower

T
Pts diagnosed
with MDD may
have significant
changes in
normal
functioning, one
of them being
maintaining
self-care

Hmm, there
are currently
no visitors
visiting the
other patients.
Additionally,
he was only
admitted
yesterday, I
wonder if hes
making stuff
up.

Mm, I see. That


must be difficult
for you.

Eh. Just a little bit. I


have family, but my
family doesnt care
about me. I havent
seen them in awhile.
My sister, shes in
California. She used
to be good, but then
she got involved in
the wrong crowd.
My friends too, they
dont want anything
to do with me. And
my roommate is
probably mad at me
because I cant get
him the drugs that he
wants.
I hear you saying
that you have
family, friends and
a roommate, but no
one visits. Which
situation would you
like to discuss
about today?

Nod and
traced my
patients fork
towards the
direction hes
pointing at
(accepting)
Pokes the food
around on his
plate.
Continues to
look down.
Does not try to
make eye
contact.

Expression of
empathy;
closed

Paraphrasing,
Adjusted my
focusing
seat so that I
question; open
faced my
patient better,
leaned in
towards my
patient and
tried to make
eye contact

Overwhelmed

Whoa, that
was a lot of
information. I
hope I can
remember
everything he
said for my
process
recording

Pts with MDD


may have flight
of idea thought
process

(3) I began to worry


about whether or not I
would be able to
remember everything
my patient was telling
me at this point. As a
result, I was tempted to
offer self-resolutions,
and select a topic to
discuss. But I quickly
recalled that it would
be non-therapeutic.
Thus, I tried to focus
on exploring his
feelings more.

(3) I noticed that after I


adjusted my seat and
leaned towards the
patient, he started to
open up a bit more. He
looked up more often.

Everything. Its
making me
depressed. I was
really depressed last
night, but Im ok
now.

Patient looks
up and makes
eye contact;
continues to
eat his
breakfast

You were
depressed last
night?

I wonder if he
had any
thoughts of
suicide. I need
to ask him that
sometime
during our 1to-1 MSE

Restatement;
open

Pts diagnosed
with MDD are
indecisive and
may have
difficulties with
decision making
T
(2) To improve the
flow of the interview, I
think that asking about
his depression last
night is irrelevant and
should have focused on
his current feelings and
responded with How
are you feeling today?

Yes. I keep coming


here. I have been
here so many times.

Patient
continues to
look down
while eating
his breakfast
Did you have any
Adjusted
thoughts of suicide? myself in my
seat, sitting in
upright
posture,
hands folded
in my lap
Yeah, I sure did!

Focusing
question;
closed

Concerned

Startled

I hope he
doesnt have
any suicide
ideations right
now.

Pts with MDD


may have
feelings of SI or
HI

What was your


plan for suicide?
Oh, you know. Ive
been here so many
times. I know that if
I can get out of these
doors, I can take the
emergency exit and
climb the stairs to
the tenth floor. And
jump. Just jump.
You know, thats
how Id do it.
I see. Well, how do
you feel now?
Oh, the same,
depressed.
Any thoughts of
suicide today?
No. Not today.
What are your
plans for today?

General lead;
open

Worried

Patient looks
up for a
second and
glances at the
direction of
the nurses
station;
continues to
poke at his
breakfast
Nodding

Does this guy


have a plan?
Hmm, he
knows the
layout of the
hospital better
than I do. I
wonder if his
information/
plan of action
are accurate.

General lead;
open

General lead;
open

Anxious
Relieved

General lead;
open

T
Ok, thats
good.
T

(2) My patient mentioned


that he was feeling
depressed. Instead of
changing the topics and
asking my patient what
his plans for today were,
I could have explored the
patients feelings of
depression by saying
lets explore your
feelings of depression.

Gosh! I hate being


stuck here. I keep
coming here all
the time. I guess if
Im stuck here, it
gives me more
time to think.
To think? About
what?

Patient started to
flick his eggs with
a fork, all around
on his plate

Maintained eye
contact

Surprised

Restatement,
general lead;
open

Pts with MDD


may display
euphoric mood

I want to focus
on his first
concern about
being depressed
due to the lack
of visitors,
whats the best
approach to
bring that
situation back
up? He seems to
have a lot on his
mind

Yeah. To think.
Like those guys
that stole my stuff
cause I didnt
have the money.
They might be out
to get me.

Those guys?

He raised his
voice all of a
sudden.

Restatement;
open

(2) My patient raised his


voice. I felt startled and
did not know how to
respond. I should have
used reflection of
feeling instead and say
It sounds like you feel
very upset and followed
up with a tell me whats
bothering you right now

Yeah, I owe these


guys money, but I
didnt have the
money. So they
stole my stuff.
I see. It seems
like youre
flustered because
these guys stole
your stuff.
Yeah, I dont have
my wallet or
money or
anything.
Lets explore
your feelings of
frustration.
Ok, well right
now, Im thinking
if Im going to be
stuck here, I might
as well come up
with a plan. I will
get them before
they get me. Mm,
nah, thats too
much work. I just
feel like going
back to my room
to sleep.

Patient looked up
for a second and
made eye contact.
Patient began to
shake his head.

(4) I felt concerned when


he started shaking his
head. I wanted to explore
his feelings a bit more.
Reflection of
feeling; closed

Focusing
statement; closed

Patient is still
shaking his head

Patient clenches
his fork in a fist

Anxious

Uh oh, does he
have homicidal
ideations? I
need to notify
my primary
RN.

Pts with MDD


may have
feelings of SI or
HI

(4) I felt very


uncomfortable when he
started to clench his fist,
with a sharp object in his
hand, so I excused myself
and told him I had some
things to attend to, and
for him to enjoy the rest
of his breakfast.