NURS 3910 MENTAL HEALTH NURSING

Process Recording Form

Brief description of client and milieu
Pt was a 54 year-old, Caucasian female, slightly overweight, and sitting in a wheelchair. She
was admitted on 9/5/14 and is diagnosed as 5250 for GD and DTS. She was wearing street
clothes with her hair unkempt. Pt was friendly on approach as well as willing and compliant to
talk to. She also suffered from anxiety, bipolar disorder, schizophrenia, diabetes mellitus,
hypertension, and hypothyroidism. The interview took place in the day room. Due to the pt
being in a wheelchair, I decided to sit as well during the interview. The day room is a spacious
room consisting of tables, chairs, a sink and counter, as well as a television to entertain the
patients.

I Said and Did: Your

Verbal and Non-verbal
Response

Client Said:
Verbal

Client Did:
Non-verbal

I Felt: Your
Feelings

I Thought:
Your thoughts

Hi. Im LeAnna and I

am a student nurse
from CSU Stanislaus.
Is it alright if I ask you
a couple of questions?
I pulled up a chair to
sit eye level in front of
my patient and making
eye contact.

Oh sure. Of
course.

She just sat in

her wheel chair
with her hands
quietly in her lap
and smiled as I
pulled up a chair.

I felt more at
ease and happy
that my patient
wanted to talk
with me.

I thought that
this interview
might not be
so bad since
my patient is
willing and
compliant.

Ok great. Thank you.

Can you verify your
name and date of birth
for me?
I am looking at the
patients wrist band to
verify her name and
date of birth.

Patient states her

full name and
her date of birth.

She looked at me
looking at her
wrist band.
Its noted that
patients hands
and jaw had
some tremors
when talking.

I felt as if I were
back in my
original clinical
rotations and
starting to feel a
little more at
ease.

I was
thinking, Ok,
patient got her
name and date
of birth
correct,
therefore she
is oriented to
self.

Therapeutic
Technique
used:
Therapeutic or
Nontherapeutic
Therapeutic: I
pulled up a
chair to sit
eye-level with
my patient and
made eye
contact. I also
sat slightly
turned to avoid
sitting directly
in front of my
patient to
appear less
intimidating
with my hands
laying relaxed
in my lap, not
crossed.
Therapeutic:
Exploring

Great. Now, before

we get started, is it ok
if I take some notes of
our conversation?
Sitting quietly, with
my pen and notebook
in hand.
Thank you so much.
Do you know what
time it is or what
todays date is?
Smiling at the patient
to show that I am
thankful that she is
being so compliant.

Oh, no not at all.

Go ahead.

Actually, it is 10
oclock in the morning
and todays date is
September 10, 2014.
Do you know where
you are?

Yes. Im at
Doctors
Behavioral
Center because I
stopped taking
my meds and
became manic.
This is the third
time Ive been
here.
Because my
husband threw
them away.
They made me
feel drowsy and
gain weight. I
also started to
hallucinate on
them. My
husband did not
like how they
made me feel so
he threw them
away.

Can you tell me more

about you not taking
your medication?

I believe its
around 9:30 and
that today is
September 12th.

Patient smiles
and appears
happy that she is
having someone
to talk to and
give her
attention.
Patient looked a
little unsure
about her
answers but
confident that
she was in the
ballpark of the
time and date.

I felt happy and

relieved that my
patient is being
so compliant and
open to letting
me take notes.

I was thinking
This is great
and will be
easier to
remember
since I get to
take notes.
I felt confused
I thought, Ok
since the patient well she had
was a little off
her back
the correct time
towards the
and date as to
clock and its
document her as actually 10
oriented to time
a.m. and
or not.
today is the
10th, not the
12th. Does
that count or
is it too far
off?
Client still sitting Feeling relieved I thought, Ok
content in her
that patient knew she does not
chair looking
exactly where
seem that
very confident
she was, why she crazy because
with her
was here, and
she knows
information she
how many times exactly what
had just given.
she had been
is going on
here before.
and is aware
of her actions.

Therapeutic:
Exploring

Client still sitting

content in her
chair. Her
tremors are
starting to go
away.

Nontherapeutic:
probing

Feeling bad that

the medications
where not
making the
patient feel good.
However, I was
also thinking
how naive she
and her husband
are because most
antipsychotic
drugs make
people relaxed,
therefore
drowsiness is
pretty standard

I thought to
myself I
cant believe
that the
husband
threw the
medication
away instead
of the patient.
Why would
anyone in
their right
mind do that
before talking
to the doctor
first?

Therapeutic:
asking direct
questions
regarding
orientation.
Exploring.

Therapeutic:
Presenting
Reality

and her husband

should know
better to keep his
wife on her
medication.
Felt happy that
patient had her
short-term
memory and got
each word right.

Im sorry that your

medication made you
not feel well.
However, it is
important that you
continue to take your
medication and for
your husband to know
that he should not
throw away any
medication unless the
doctor oks it. Now
Im going to have you
repeat some words
after me ok? Chair,
car, blue.
Good job. Do you
remember when you
graduated high school?
Smiling to reassure
patient.

Chair, car, blue.

Patient smiles
because she got
it right.

Patient states the

year she
graduated high
school.

Patients tremors
are no longer
visible.

Do you have any

religious preference?

Yes, Greek
Orthodox or
Catholic will
work too.

Feeling happing
that patient is
continuing to
stay on track.

Ok, so Greek
Orthodox or Catholic.
Either religion you are
ok with?

Yes

Feeling happy
that I
remembered to
use the
therapeutic
technique of
restating.

Felt relieved that

patient had her
long-term
memory.

I thought, Ok
great. My
patient has her
short-term
memory.

Therapeutic:
conveying
empathy.
Presenting
reality.

I was thinking
Great patient
also has her
long-term
memory and
is being
concise and
staying on
track for now
I was
wondering if
Greek
Orthodox and
Catholicism
had any
similarities .
Still
wondering if
Greek
Orthodox and
Catholicism
were similar.

Therapeutic:
smiling to
reassure
patient that I
am listening.
Exploring.

Therapeutic:
Exploring

Therapeutic:
Restating

Great. What would

you say your cultural
preference is?
Continuing to smile
for reassurance.

I would say
Italian.

Did you continue your

education after high
school?

Yes. I went to a
university back
east and got my
associates
degree.
That depends on
how well my
husbands
business does.

Patient smiling,
proud of her
accomplishment.

Ya. When I
leave her I plan
on going back
home and living
with my husband
and seeing my
boys.
Well I am going
to move back
home when I am
out of here and I
cant wait to see
my sons.

Patient smiling
again.

Feeling confused
still.

Patient looking
at me as if I
asked her this the
first time.

Feeling a little
discouraged
about how to get
a proper answer
for the actual
question Im
asking.

Honey. If I am
in a wheelchair
and having a
hard time
moving, do you
think Id be
trying to escape?

Patient laughs

Feeling silly for

asking the
question even
though it is
standard
procedure.
However, I am
glad my patient
had a good sense
of humor for her

O wow. Thats great.

Do you feel like
harming yourself?

Ok. Do you have a

plan?

That sounds nice. Do

you have a plan on
how to harm yourself?

Ok great. Do you ever

feel like leaving this
place without
permission?

Feeling caught
off guard
because I would
have never of
guessed Italian.

Patient looking a
little concerned
now.

Feeling amazed
that my patient
went to school
all the way back
east.
Feeling confused
and concern.

Thinking Ok,
that was
simple. I
would have
never
expected that.
I thought
Wow thats
great. Thats
also a long
ways away.
I thought
Does that
count as a yes
or no? I need
to ask my
instructor.
Thinking Ok,
she clearly did
not
understand
the question.
Ill restate it.

Therapeutic:
Exploring

I was thinking
Ok, I will
move on
because she is
not
understanding
the question
and Im pretty
sure this
means she
does not have
a plan.
Thought Ya
that does
make sense
but I still had
to ask

Therapeutic:
Restating.
Seeking
clarification.
Exploring.

Therapeutic:
Exploring

Therapeutic:
asking a direct
question about
suicidal
attempt.
Therapeutic:
Exploring.
Asking a direct
question about
plan for
suicide.

Therapeutic:
Exploring

condition.

Thanks for being so

good with these
questions. They are
just standard
procedure to ask. Do
you have a family
history of suicide?
Im going to list some
feelings. Stop me if
any of these feelings
apply to you.
I then listed the
feelings that were
listed on the suicide
assessment sheet.

Great. Thank you. Is

there any reason or
anything here that
makes you feel safe or
prevents you from
harming yourself?
Can you elaborate
more on the
lockdown?
Using my hand to
gesture her to keep
going.
Oh. I see. You feel
safe being locked in
the buildings and
gates.

Feeling like
theres one
reason why my
patient made her
threats because
thats what she
was use to
growing up.
Felt that even
though patient
denied any of
these feelings, I
would look over
them again
myself and make
sure patient did
not show any
physical signs of
these feelings.
Not quite sure
what the patient
means.

Thought well Therapeutic:

the apple
Exploring
doesnt fall
far from the
tree.

Thinking the
lockdown?

Therapeutic:
Exploring

Ya. Being
locked in here.

Feeling relieved
that I now know
what she is
talking about.

Thinking Oh,
being locked
within the
building

Therapeutic:
Offering
general leads.
Focusing.

Yes. Exactly

Feeling proud
that I was able to
figure out what
she meant.

Thinking that
I did a good
job figuring it
out and
restated her
answer to
have her
confirm it.

Therapeutic:
Reflecting

Ya. My mom
would make
threats that she
would commit
suicide but that
was to just get
everyones
attention.
Patient denied all
of these feelings.

Yes the
lockdown.

Patient appeared
to be reminiscing
and laughing to
herself.

Patient still
sitting content in
her wheelchair.

I thought Ok, Therapeutic:

well I will
Exploring
double check
this list after
my
interview.

Well, thank you so

much. I believe that
concluded our
interview. Do you
have any questions for
me? Thanks again for
your time.
I get up from my chair
and wave goodbye to
my patient

Nope. Of
course. Thank
you.

Patient smiles
and waves back
at me.

Feeling happy
that the
interview was
finally over since
it took a long
time due to
patient getting
off topic. I also
felt
accomplished
that I got most of
the information I
needed.

I thought I
Therapeutic:
am finally
Exploring
done with my
interview. I
just need to
find my
instructor to
verify some of
questions and
some of the
patients
answers.

NURS3910 MENTAL HEALTH NURSING

Self-Critique and Analysis of Interpersonal Process Recording
1. Your goals for this interaction? What were you trying to accomplish?
My main goal for this interaction was to become comfortable talking to a patient that is
mentally unstable. This is because I have never spoken to someone in a clinical setting,
that I am aware of, that has had a mental disorder. I originally found it intimidating due
to such patients being unpredictable and possibly being upset by the slightest thing. My
second goal for this interaction was to fully assess my patient mentally and to answer any
questions regarding her history that I could not find in her chart.
2. Students perceptions of how the interaction went. How would you evaluate your
response?
I felt that the interaction from a social perspective went very well. My patient was very
compliant and actually quite thrilled that someone was talking with her. However, from a
health care professional perspective, the interview does need some improvement. For
example, my interview took over an hour without a break. I now know that my interview
should take about twenty minutes and if it takes longer, I should break up the interaction
time into increments. This is because, when being a full time nurse with multiple
patients, I would not have so much leisure time to spend with one patient. Also, my
patient got off topic and got distracted easily. I now know, from watching my instructor
interact with my patient, how to be direct and specific with my questions and how to
bring the patient back to the original topic of discussion.

3. How did the interaction affect your goal(s)?

I do not feel that my interaction affected my goals. My goals were to become

comfortable interviewing a mentally disabled patient, properly assess my patient, and
have her answer questions regarding her health history. By the end of the interaction, I
had achieved all three goals.
4. Overt (verbal) and covert (non-verbal) content of communication. Patient and self.
Overall, both mine and the patients overt and covert were appropriate for the setting. As
far as covert communication, I sat at eye level with my patient, sitting up straight and
slightly off from sitting straight on. I also made sure to sit with my hands in my lap and
not crossed to appear less intimidating and more open if I wasnt writing notes. My
patient was sitting in her wheelchair with her hands relaxed in her lap and appeared
content and calm. As far as overt communication, both my patient and I used calm,
casual voices with appropriate volume. We both spoke respectfully to one another as
well as I tried to use therapeutic techniques such as reflecting, restating, good eye
contact, and encouraging the patient to continue.
5. General communication themes (overall, what was being communicated?).
Overall, the topic focused on my patient. I asked her questions to check her orientation,
to get a good idea of her background such as religious and cultural preference, as well as
her medical background such as other episodes of mental instability, her recent diagnosis
of Diabetes Mellitus, etc.
6. What, if anything, would you do differently next time?
There are two things that I would do differently next time. The first thing is that I would
cut my interaction time down or break up the interaction time if it goes longer than
planned. Also, I will be better about asking the questions and be more direct so the
patient has a better time staying on topic. With that being said, if the patient gets off
topic, I will do a better job at getting them back on topic.