INTRODUCTION

Effective communication will always become the means by which a therapeutic relationship is initiated upon
the first nurse-patient interaction, maintained throughout the working phase and eventually becomes terminated as the
span of time elapses for the student nurse and her patient’s therapeutic relationship. This is where an interpersonal
interaction is expected to transpire focusing on the client’s needs to promote an effective exchange of necessary
information. Alongside, proper therapeutic communication techniques are needed to be practice skillfully to meet the
quality standards of care needed by our patient.

On this day, April 17, 2020 we had our initial interaction with our different client from the Female ward of
Cavite Center for Mental Health (CCMH). Truthfully, I may say that establishing an effective communication with a
mentally-impaired patient is quite harder compared to a patient which is in a sound mind yet having a physical illness.
Nevertheless, since establishing a therapeutic relationship is one of the most important responsibilities of the nurse
working with clients, I tried to converse with patient Z.C.M. sincere and in return actively listened to her stories told. At the
start, I had a hard time understanding the things she was saying because when I asked her certain questions, she
responded correctly for several minutes and eventually lead her answers to a different topic. In addition, she was able to
name certain products in her personal hygiene kit correctly indicating that she is partially oriented to her surroundings.

We also had our interaction while performing the activities planned for this day which is the art therapy. This
aimed to assess the patient’s expressions of their feelings and concerns through arts so that in one way or another,
student nurses will have the idea of what the patient needs specifically at the moment. Throughout the entire interaction,
eye contact, appropriate facial expressions, vocal cues, suitable gestures and postures were practiced to gain an effective
communication with the patient and definitely establish rapport no matter how difficult it is to deal with behaviors, beliefs
and practices which is out of reality observed within the patient.
SPECIFIC OBJECTIVES FOR THE STUDENT NURSE

 Establish rapport with the patient by being empathetic, genuine, caring, and unconditionally accepting of the patient
regardless of her behavior, beliefs and practices shown during the entire therapeutic communication.
 Actively listen to the patient to identify the hidden issues and concerns she may need to unfold and verbalize freely
and to formulate a client-centered goal for the interaction that is based and focusing more on the concerns she
expressed.
 Gain an in-depth understanding of the patient’s perception of the issues in her life by way of seeking clarifications,
allowing the patient to reflect on her own vocalized concerns and feelings and by restating what the patient merely
complaints and through this, the student nurse will foster empathy and genuine interest to listen during the nurse-
client relationship.
 Assess the client’s perception of the problem by allowing her to reflect on her verbalized concerns through restating
and paraphrasing.
 Reduce patient’s anxiety and suspiciousness by being open and verbalizing concerns freely and without hesitations
and also share stories of her life one-by-one.
 Learn in boosting patient’s self-esteem through the usage of encouraging words and appraisals.
 Learn to observed and react appropriately in terms of how the patient shows her abilities, follows a command and
performs fie and gross motor skills in the planned activities.

SPECIFIC OBJECTIVES FOR THE PATIENT

 Gain a sense of trust towards the student nurse as evidence by consistent eye contact and an ease positioning
during the entire interaction.
 Share and unfold her concerns and needs so that appropriate interventions may be given.
 Portray a decrease level of anxiety and suspiciousness resulting to a better therapeutic relationship to arise.
 Express appropriate feelings, affect, gestures, and vocal cues while sharing issues that she wants to talk about.
 Learn to develop new skills in problem-solving and in coping and learning to apply appropriate ego defense
mechanisms with issues she considers as her problem as of the moment.
GENERAL OBJECTIVES

 Establish a good interpersonal interaction with the patient during the course of interaction aiming for an effective
exchange of information so that patient-centered interventions may be appropriately addressed to the patient’s
issues and concerns. Alongside, maintain a trusting relationship between the student nurse and patient to gain
necessary details about her life. Effectively communicate, socialize, and interact with her co-patients and other
student nurses and at the same time forgetting of being a negativist. Facial expressions, vocal cues, gestures,
insights and judgments will be used skillfully and appropriately in accordance to the feelings expressed.

EVALUATION

Upon evaluating the desired goals and objectives for patient Z.C.M. from the beginning, working with the
activities asked for them to perform and as I return her to the Female ward, I may say that my objectives were partially
met as of the moment. Considering that we are both in the introductory phase, patient Z.C.M. and me, as the student
nurse assigned to attend to her needs and render care is still knowing each other and we are on the process of
establishing a therapeutic relationship. Partly, I can say that she already developed a sense of trust in me as evidenced
by her active participation on the therapy done. More so, she unfolded few issues in her life as we talked one-on-one and I
was able to observe on her slightly a decreased level of anxiety because she often smiles and answered my questions in
the best way she could remember related to her experiences in her life.
 For the upcoming days, I am looking forward in working with patient Z.C.M. actively and as open as possible
so that she will eventually learn to trust me to handle her needs thus helping her improve and recover from her illness as
of the moment.

INTERPERSONAL COMMUNICATION PROCESS RECORDING

Initial of Patient: Z.C.M. Date:April 17, 2020 (Day 1; PR 1)

Patient’s Appearance: On the initial interaction with the patient I saw her wearing blue sando tucked in her blue shorts
as well. She has a clean hair cut but I have seen that even it is already in the afternoon that we interact with them, she
was not able to wash her face and brush her teeth since they were not given the privilege to do so. I also tried to actively
observe the way she exhibit nonverbal cues and as I have noticed, patient Z.C.M. has an expressive face that portrays
her thoughts, feelings and needs moment-by-moment in different facial expressions. Patient’s body positioning was facing
the student nurse with both of her feet on the floor, knees parallel, hands were at the side of the body and legs were
uncrossed indicating an open posture for communication. In terms of eye contact, she was intermittently looking at me
when we were talking and pauses in communication were observed. Patient manifested episodes of catatonia (stupor),
mutism for a span of 15-20 seconds, being a negativist evident by refusing for help sometimes and flight if ideas as
manifested.

Environment’s Condition: The nurse-patient interaction started around 1:45 p.m. and ended with our feeding time until
4:00 p.m. Since we are on the summer season, the weather was slightly cloudy and a bit humid as we held our activity
prepared for the patients at the Bayanihan hall. Initially, I took my patient’s vital signs and talked with each other that is
why I sat on a bench and my patient sat on a chair in front of me on an L-shape with a space of half a meter. It was bit
noisy because other patients were talking as well with the student nurse assigned to them but my patient tried to be at
ease and responded to questions asked in an audible manner.

SUMMARY

This day became my initial interaction with my patient Z.C.M. and I can say that we were both introduced
well with each other during our introductory phase. Even though we both feel anxious at first, eventually we became good
partners at the end of the day and I am looking forward to work with her in the upcoming days with ease and a
comfortable feeling.

She became a good partner for me even though at times she tried to seclude herself from others just as the
other patient told me on what she often do in the ward. We had a good conversation even though at times her answers
were shifting into another topic (flight of ideas). I tried to refocus her concentrating on a single point to talk about and she
responded appropriately. I have observed her as relax and not that irritable unless someone or something caused her to
be. For instance, she does not want to be given foods that are open because she thinks that something is putted on it.
She also wants to work for herself independently like putting a powder and she will just be assisted whenever there is a
need to do so.

We also had our bonding while doing the exercise and art therapy because she looks interested in the
exercise routine while slightly serious in the drawing session. She became active again during the feeding time and ate
well. As I observed her, she was excited while eating because as she stated the food given to them in the ward were not
able to suffice their hunger because most of the time, they were given only a small amount to eat or there are times that it
does not tastes good. At the end of our activity, she smiled and thanked me hoping for my return the next day.