PROCESS RECORDING

Patient-Centered Communication
(Process Recording)
Student: Naomi Masuda Date: 2/6/2016
PR Date: 1/23/2016
Client Age: 38
Client Gender: Female
Client Dx: Major Depressive Disorder
Length of Stay on the day of the interaction: Three days
Dialogue

Non Verbal
Communication
Hi, my name is
Looking at
Naomi. Im a
client, smiling
Kapiolani
and sitting down
Community College next to client.
nursing student.
Open posture,
Like I told you
moderate voice
earlier, Id like to
tone, calm
talk with you for
manner, and
about 10-15
good spatial
minutes. How is
boundaries.
that sounds like?
Okay.

Sitting quietly
half on the chair
with slight
slumped posture.
Looking down at
a round table, no
smile and no eye
contact.

Technique
Introductory
statement,
Giving
information,
and Open
general lead

Student Feelings
Hopeful

Nervous

Student
Thoughts
I wish she feels
comfortable and
talk to me.

T/N
T

Analysis
#3
The Client agreed to have
conversation, however, she
didnt smile and didnt
look at me. I still felt
nervous. I tried to maintain
my positive attitude and
monitor her behavior to
identify any non-verbal
communication.

PROCESS RECORDING
Thank you, and
your name is?

Smile and hands

on my lap,
looking at client
with open
posture.

Im L.

Looked at me a
moment, but
back to slight
slumped posture.
No posture
change.
Remain open
posture with no
arm and leg
crossed, looking
at client, and
moderate voice
tone.

Hi, L. How are you

feeling today?

Not so good.

Not so good?

Yah.

Dazed with halfopened eyes.

Affect became
flat.
Looking at the
client with
moderate voice
tone.
Flat affect, and
eyes not
focusing. Soft
voice tone.

3
Identifying
the client.

Nervous

I wonder how to
start the
conversation and
to get the point
without being
too invasive.

#2
Identifying the client
demonstrates my desire to
understand her, however, I
should have just called her
by her name.
I could omit this question,
and continued how are
you feeling today, L?

Open general
lead

Curious

She looks so
sleepy or
drowsy.

#3
I noted that she had a very
vacant stare all the sudden,
and affect became flat
right after I asked about
her feelings.

Open
restatement

Curious

She seems not

T
willing to talk
about her
feelings. I should
maintain positive
attitude so that
she can disclose
herself.

#4
The client seemed not
willing to talk about
herself, however, I didnt
want to her to feel that I
was rushing. So, I used
restatement to encourage
her to continue.

PROCESS RECORDING
()

Silence. Facing
client with
concerned facial
expression.

I feel safe here now,

though.

Flat affect, and

eyes not
focusing. Soft
voice tone.
Open posture,
eye contact, and
concerned facial
expression.

What do you mean

when you said you
feel safe now?

I have a depression.
It was getting worse
and worse, I couldnt
do anything. I was
out of my mind.
U-Hum.

Flat affect with

half-opened not
focusing eyes.
Voice became
softer.
Looking into the
client face.
Nodding.

I couldnt take it
anymore. I wanted to
say good bye and
disappear from my
family.

Sad and worried

facial expression.
Eyes not focusing
with half-opened.
Soft voice tone.

4
Silence

Anxious

Please say
something.
I want to say
something, but I
know I
shouldnt.

#3
I felt uncomfortable with
the silence. I had to
reminded myself to remain
silent to provide the client
the time to think and
respond.

Curious

I can see she is

depressed but I
want to her to
express the
feelings from
herself. I should
clarify it.

#3
I felt that I wanted to jump
on and give my
assumptions.
I was thinking how I
should ask about her
feelings.

Relieved

Im glad that she

is disclosing
herself.

Curious

It must be hard
for her. She
looks like shes
in lots of pain.

Uncomfortable

I think that
good bye
means suicide.
I dont want to
know but I have
to ask.

#4
I noted the clients affect
showed some emotion, so
I tried to have eye contact.
I decided to ask the
question about suicidal
ideation.

Curious

Open
clarification
question

Minimal
encourager

PROCESS RECORDING

Did you think hurt

or kill yourself?

Looking at
Closed
client and sitting question
with hands on
table.

U-Hum.

Nodded slightly
and eyes closed
tightly.

What was your

plan?

Looking and
leaning toward
the client,
moderate voice
tone

I drank alcohol, and

took lots of Tylenol.

Slumped posture
with head slightly
slouched
forward. Eyes
remained closed.
Looking at the
Minimal
client with
encourager
moderate voice
tone, and calm
manner.

Then?

Thats why I came

here.

Flat affect and

eyes not
focusing. Soft
voice tone.

Open
focusing
question

Anxious

Im sure she had

the thought but I
dont want to
know.

#3
Even I was ready to ask
the question about suicidal
ideation, I had a tight
feeling in my chest when I
verbalized suicide. After
I verbalized it, I had more
confidence talking about
her feelings and thoughts.

Engrossed

I wonder if they
(nurses and
doctors) know
she actually
attempted.

#3
I noted that I leaned
toward the client since she
verbalized her feelings, I
was focusing on her any
movement to identify any
non-verbal communication
cues.

I wonder, I feel
so silly asking
then?, but I
want to her to
explore her
thoughts of
hurting self.

#4
I felt anxious when her
affect became flat, so I
could not wait for her
response.

Shock

Anxious

#2
I could have waited for her
next response with silence,
so that she could have
verbalized her concerns at
the moment.

PROCESS RECORDING
Tell me how you are Looking at the
feeling now?
client and
slightly leaning
toward her.
Hands on my
lap.
I feel safe here, but I
still think about it
always.

Flat affect, eyes

half-opened and
not focusing. Soft
vice tone.

About it?

Sitting still.
moderate voice
tone, and calm
manner.

Yah. Killing myself.

Flat affect, and

dazed with halfopened eyes.
Very soft voice
tone.

You look worried.

Looking at the
client with

6
Open
clarification
question

Engrossed

I hope I am
appearing not
judgmental. But
did I change the
topic? Or was it
appropriate
question to ask?

#3
I wanted to engage her to
focus on her feelings at the
moment, so I tried to
maintain a calm manner
and waited for her
response.

Open
restatement

Concerned

I know it
means killing
self, but I
should clarify it.

Sorrowful

She looks so
depressed. How
should I
approach to
listen to her
feelings?

#4
The client looked very
tired and drowsy, and her
voice was so soft that I
could hardly hear. I felt
uncomfortable because I
was not sure if the topics
made her uncomfortable or
she is not resting well, but
I didnt want to change the
subject. So I used
restatement to explore her
feelings.

Empathy

I hope she can

open up some

#4
Since I noted her affect

Reflection of
feeling

PROCESS RECORDING

concerned facial
expression.
Moderate voice
tone.
I dont know what to
do.

Remained flat
affect. Very soft
voice tone.

What do you
mean?

Look into her

face. Moderate
voice tone.

I mean. ()

more.

Worried

Open
clarification
question

Flat affect, and

eyes half-opened
with no focusing.

Im here for you.

Can you tell me
what you are
thinking right now?

Looking at the
client with
concerned face.

()

Silence. Blinking
a couple times.

()

Silence. Looking
at the client.

had been changed to flat, I

thought a ROF could help
her to clarify her feeling
and connect the feeling
with her thoughts.

Open
focusing
statement

Curious

Is she saying she

doesnt know
how to get better
or doesnt know
how she feels
about herself? I
need to clarify it.

Anxious

Is she hesitating
to speak up?

Empathy

How can I help

her?

#2
I could have stated more
specific, such as: What do
you mean when you said
that you dont know what
to do?

NT

#1
Use of can for open
question.
#5
What you are thinking
right now?

Silence

Anxious

I hope she open

up.

#4
I noted that the client
blinking a couple times, so

PROCESS RECORDING
I feel Im
depressed, sad. I feel
so hopeless. I dont
know what to do
with this.
L, that must be
hard for you.

Looked down her

hands. Soft voice.

I couldnt take it
already. I wanted to
disappear, I still
think about it. I feel
guilt.

Flat affect, eyes

half-opened and
no focusing. Very
soft voice.

Uh-Huh.

Looking at the
client while
slightly leaning
toward her.
Nodding.

() Sorry. Can we
take a break?

Silence. Slightly
slumped posture
with head
slouched
forward. Eyes
closed.

Looking at the
client while
slightly leaning
toward her.

Expression
of empathy

Curious

It seems I could
help her to
address her
thoughts.

Sympathy

Her emotion
disappeared
again.

I decided to keep silent,

and wait for her response.

I can share her

feelings and
thoughts with the
primary nurse.

Minimal
Encourager

Anxious

Confused

She looks so sad. T

Did I make her

upset? Looks
like she is not
ready to disclose
herself yet.

#4
I noted that her affect
became flat again, so I
used expression of
empathy to express my
empathy.
#2
I could have asked her
feeling more depth, such
as how you feel having a
depressed feeling.
#3
I noted the client posture
became slightly slumped
and closed her eyes again,
and these changes made
me feel anxious because I
thought I upset her.

PROCESS RECORDING
Yes. Thank you for
sharing your
feelings and
thoughts of
depression today.

Smile. Eye
contact with
open posture.
Moderate vice
tone.

Sorry. Thank you for

listening me.

Stood up and
looked at me
before facing
away.

9
Summarizing Hopeful

Relieved

I hope that we
can have
conversation
again later.
I really hope that
she trusts me
enough to talk
about herself
later.

#2
I could use more specific
words to summarize the
conversation so that she
could combine her
thoughts and feelings.
Correction: We talked
about your current feeling,
such as feeling safe now
but feels depressed, sad,
and hopeless. Also your
thoughts about ending of
your life.
By the end of the day, this
client and I held several
conversations and I
conducted further
assessment using with
TM33, Burns Anxiety and
Burns Depression. I
believe that the
conversations were
therapeutic for the client
and helped to build rapport
and a trusting relationship
with her.