INTERACTION PROCESS ANALYSIS (IPA)

Student’s Name: Jacob Velasco Client’s Name: NF

Interview Date: ____2-7-18________________

I. PURPOSE OF THE SESSION: List three goals for your patient for the day of the IPA.

1. Pt will verbalize understanding of their mental illness

2. Pt will have effective coping strategies ready for use in the future

3. Pt will feel empowered through treatment instead of shame due to the stigma of their mental illness

II. EXPECTATIONS OF THE SESSION: List three goals for yourself during this interaction.

1. To initiate and end a therapeutic relationship with the Pt

2. To gain a better understanding of the Pt’s mental illness

3. Encourage Pt to build plan for after discharge

II. OBSERVATION: Include observations related to the patient and the unit environment.

Arriving on the unit, Pt was not seen on floor along with other Pts. She was found in her room with the light off. Pt emerged

wearing the floor pants and gown, hair slightly unkempt. The environment was fairly quiet as other Pts were still waking up,

however Pt led us to library for discussion instead, citing that it “..had a better frequency” than the floor.

Many patients with psychiatric disorders have difficulty communicating. A process recording (IPA) assists the
new psychiatric nursing student to record the verbatim interaction after the conversation takes place with an
assigned patient then identify and analyze symbolic meanings, themes and techniques and blocks in therapeutic
communication ( Boyd, 146-152)
III. CONTENT:
INTERVIEWER
(the student)
Hi, I’m Jacob and I’m a
nursing student from YSU.
Do you mind if we sit and
talk?
Can you tell me when you
arrived on the unit, and the
events that brought you here?
That must be difficult to
endure. What do you do to
cope with a situation like that?
That’s a great way to cope.
What caused you to develop
that mechanism, does it
include prior hospitalizations?
That’s really good! You’ve
seemed to embrace your
mental illness instead of being
embarrassed about it.
How do you feel you take
control of your disorder if you
aren’t on any medication?
INTERVIEWEE
(the patient)
Sure. I’m NF, and I would
like to talk in the library. It
has a better frequency.
I got here on January 19th,
I’m bipolar- but I’m rare.
I’m manic a lot of the time
instead of depressed. I was
so manic I was going to take
out two guys with a broom
Art and writing. I do a lot of
fiction. Bright colors, very
Matisse-like. I channel my
mental illness into my art.
Yes, actually. I used to go
off my medication a lot. I
would stay up for four to five
days straight, and I would
black out a lot. Focusing on
my art helped me contain
some of my mania.
Yeah, I’ve had bipolar for a
long time, I’m not my
disorder. It’s something I
deal with.
I was off my meds for about
a week, and normally I can
control my mania by
smoking like a mofo and
drinking. It brings me down
to what normal people feel.
IDENTIFY ANALYSIS OF THE
COMMUNICATION INTERACTION
(Was the technique effective? Why
TECHNIQUES or why not?
Was there anything else that could
have been explored?
What were the major themes?)
Introduction of self, Communicative technique was
initiating therapeutic effective, goal was achieved by
relationship, Pt giving showing appropriate introduction
information of both self and patient.
Open ended question, Technique effective, goal achieved
exploring by patient stating understanding of
her mental illness. Patient also
elaborated in response to question.
Communicative techniques
Verbalizing the implied. effective- goal was met by patient
Open ended question. opening up and elaborating about
Exploring. her coping mechanisms.
Giving approval. Communicative techniques
Open-ended question. effective- goal was met by patient
opening up and elaborating about
her mental illness and how she
copes.
Giving approval. Communicative technique
effective. Goal met by reinforcing
positive therapeutic relationship
for Pt.
Open-ended question Communicative technique
Exploring effective. Goal met by Pt
elaborating about possible
substance abuse.
 Do you feel unsafe when you
go off your medications?
Yes. It gets pretty dark and
confusing down there. It’s
more unsafe for me than for
others, definitely. I don’t
think I’m dangerous to
anyone but myself.
Open ended question Communicative technique
Exploring effective. Goal met by Pt
elaborating on her medication non-
compliance.

That’s good that you
recognize that your behavior
might endanger you
sometimes. Do you have any
plans to continue feeling good
like this after discharge?
I want to continue taking my
meds and keep exploring my
creative side. Maybe
transition my Facebook into
a place to share my art with
others.
Giving approval Communicative technique
effective. Goal met by
Open-ended question
strengthening therapeutic
Exploring
relationship, as well as Pt
Goal setting elaborating on her goals after
discharge.

IV. IMPRESSIONS/ASSESSMENT: 1) What did you observe throughout the session -- behavior and affect; 2) was the
behavior/affect appropriate, explain; 3) how does this behavior/affect fit with what you know about the client’s past
behavior/affect; and 4) identify the major themes/issues that emerged.

The Pt’s behavior was appropriate for the situation, as well as for the conversation and topic itself. Pt remained
calm and was able to express herself clearly without any tangential thinking. Pt was educated on her disorder and
also saw the need for medication based on the outcomes of previous attempts to go off it on her own. A major theme
I saw throughout our conversation was how she felt her medications caused her art to suffer, but her reliance on
tobacco and alcohol didn’t.
V. USE OF PROFESSIONAL SELF: Choose two significant interventions you made: 1) identify/describe; 2) what was your
impression of your effectiveness; and 3) what would you change.

Immediately I established a therapeutic rapport with the patient, which is very necessary for any nurse-patient relationship to blossom.
I did this by providing direct communication and using positive body language and facial expressions while listening to the patient.
The patient also made this very easy by returning the positive body language and remaining open and willing to communicate with me
about her disorder. I think the main strength that I had was maintaining a non-judgmental attitude toward this patient. Overall our
interaction was very positive and I don’t think that I would change the way the therapeutic relationship started, was maintained, or was
ended.

Secondly, I felt that another significant intervention I made was by giving approval and positive acknowledgement to the patient when
she made good rationalizations and understandings of her disorder. In doing so, I felt that I strengthened the rapport I had with the
patient, as well as helped her remain open to any constructive feedback I might have to help her continue along the path of self-
evaluation. If there was something I could change, I think that maybe I would try to balance between giving constructive feedback
evenly with positive acknowledgement so that I could come off as more therapeutic than friendly.

VI. PLANS: (Brief statement of your plans for the next session, long range goals, short range goals that are relevant for this client.)

For the next session, I would set a short term goal of coming up with a plan to increase her medication compliance. The patient stated
that she understood the need for compliance, and that without her medications she felt she was a danger to herself. By encouraging a
more open dialogue with her normal psychiatric physician, I think that medication compliance could be improved and would decrease
her chance of ending up hospitalized again.

A long term goal I would have for NF would be to successfully live one calendar year on medication and without the need for
hospitalization. I think that her confidence in not only herself, but her art would improve if she saw that she could sustain herself and
create with the best of her abilities despite her medication.

VII. ISSUES, QUESTIONS OR PROBLEMS: Include issues of diversity, value dilemmas, counter-transference etc.

Although there were quite a few patients on the floor, I don’t think any of them had the type of Schizoaffective disorder that NF had-
therefore I don’t think any group type therapies worked well for her. Also, the patient said she didn’t like to medicate, as it affected
her art, but she admitted to regularly drinking and using tobacco to “down” herself so that she could focus. This would be an example
of a value dilemma.

VIII. EVALUATE THE OVERALL EFFECTIVENESS OF THIS INTERACTION: Relate this back to the goals you
established for you and the patient.

Overall I felt that this interaction was very positive, both for the patient and for myself. I accomplished each of my goals that I had set
forth before the start of our session. The patient displayed a clear and constructive understanding of her disorder and what led her to
being involuntarily hospitalized there. Even though she was not taking her medication at the time of the incident, she also expressed
the understanding for the necessity of medication compliance with her disorder. She had a clear goal for herself after discharge. I felt
that I helped empower the patient to feel confident in herself and in her abilities to adhere to her medication schedule, as well as to
continue with her art as a coping mechanism.

References:

Townsend, M. (2011). Psychiatric mental health nursing: Concept of care in evidence-based

Practice (7th ed.). Philadelphia: F.A. Davis.