University of the East RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER INC #64 Dona Imelda, Aurora Boulevard, Quezon
City College of Nursing
NURSE-PATIENT INTERACTION
Submitted by: Fadriquela, Rachel Anne F. N3B Submitted to: Prof. Rover Capili (Clinical Intructor, National Center for Mental Health)
I. Client s Profile Name Age Sex Nationality Status Education Occupation Primary Language Spoken Primary Care Provider AA 29 y/o Male Filipino Single Grade 5 Farmer Filipino National Center for Mental Health
II. Mental Status Examination Appearance and Behavior Patient A appears much older than his chronological age. During the interaction, the client is obtunded; with rigid posture; stumbling gait; and slow movements; responds slowly with confusion; with skin lesions on both lower extremities; dirty nails noted; foul odor noted; with poor eye contact upon interaction. Speech and Language Upon the interaction, Patient A responds to yes or no without elaboration; slow response noted; some contents of client s speech is irrelevant to the questions being asked; slow rate of speech noted; difficulties of finding words noted. Mood Patient A shows restricted affect noted; anxious mood response noted upon the interaction; smiles little as he responds; appears dull and uninterested in some points of the interaction; stares upon the conversation.
Thought Processes; Though Content; Perceptions Upon the interaction, patient is confused; obtunded; responds slowly to the questions asked; shows inhibited thinking on some points of the conversation; shows tangential thinking; shows thought blocking; inconsistent with the content of the conversation; expressed thoughts are jumbled; ; coherence lacking in necessary details; unable to follow directions through with directives such as brushing up and down.
Cognitive Functions Patient A is oriented to place; unable to maintain attention span. Intellectual Performance Patient could not recall remote events; short attention span noted; responds slowly upon showing a picture.
Judgement Patient A could not answer question based on sound rationale.
III.
Nurse Patient Interaction(Process Recording) Client Smile. Stares. Therapeutic Communication Giving Information
Analysis Therapeutic: Greeting the client by name, indicating awareness of change, or nothing effort the client has made all show that the nurse recognizes the client as a person, as an individual. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Greeting the client by name, indicating awareness of change, or nothing effort the client has made all show that the nurse recognizes the client as a person, as an individual. Therapeutic: Broad openings make explicit that the client has the lead in the interaction. Therapeutic When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if
Nurse Good morning.
Andito po ako ngayon, bukas at hanggang Wednesday para po makipagkwentuhan sa inyo. May gusto po ba kayong pag-usapan? Ilang taon na po kayo?
Stares with eye contact.
Giving Information
Wala naman.
Broad openings
20.
Exploring
Kailan po kayo ipinanganak?
June
Focusing
June po, tama po ba?
Oo.
Restating
Tapos po?
Stares with eye contact.
General leads
Saan po kayo nakatira?
Aklan
Exploring
explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Indicates nurse is listening and validates, reinforces, or highlights something patient has said. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client
Ahh sa Aklan po. Nodding
Oo.
Restating
Ano pong trabaho niyo po dun?
Araro
Encouraging description of perception
Ano po ang inaarero niyo po?
Talong
Encouraging description of perception
Ano po ang naitutulong sa inyo ng pag-aararo?
Pagkain. Kita.
Focusing
expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Indicates nurse is listening and validates, reinforces, or highlights something patient has said. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: To understand the client, the nurse must see things from his or her perspective. Encouraging the client to describe ideas fully may relieve the tension the client is feeling, and he or she might be less likely to take action on ideas that are harmful or frightening. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Encouraging the client to describe ideas fully may relieve the tension the client is feeling, and he or she might be less likely to take action on ideas that are harmful or frightening. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck.
Ano pong nararamdaman niyo nung nabanggit niyo ang pag-aararo?
Masaya.
Encouraging expression
Ahh. Nodding.
Silence.
Accepting
Paano po kayo napunta dito sa Manila?
May kaso
Focusing
Pwede ko po bang malaman kung ano yung kaso mo?
Homicide.
Exploring
Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse asks the client to consider people and events in light of his or her own values. Doing so encourages the client to make his or her own appraisal rather than to accept the opinion of others. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate agreement but is nonjudgmental. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health
Pwede ko po bang malaman kung anong nangyari?
Silence.
Exploring
Sige po. Silence.
Silence
Silence
Nasabi niyo po na nagaararo po kayo sa Aklan.
Oo.
Restating
Sino po ang kasama niyo doon?
Pamilya ko.
Focusing
Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Silence often encourages the client to verbalize, provided that it is interested and expectant. Silence gives the client time to organize thoughts, direct the topic of interaction, or focus on issues that are most important. Much nonverbal behavior takes place during silence, and the nurse needs to be aware of the client and his or her own nonverbal behavior. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Indicates nurse is listening and validates, reinforces, or highlights something patient has said. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps
Ilan po ba kayo sa bahay niyo doon?
Apat.
Exploring
Sinu-sino po?
Nanay, Tatay, ako,..... Stop to answer.
Exploring
Nabanggit niyo po si Nanay, Tatay, ikaw at sino po yung isa?
Stares for a while. Magulang
General lead
Magulang po?
Oo.
Consensual Validation
from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Thought blocking: stopping abruptly in the middle of a sentence or train of thought; sometimes unable to continue the idea (Reference: Videbeck. Psychiatric Mental Health Nursing. P 162) Therapeutic: General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. (Reference: Videbeck. Psychiatric Mental Health
Sino po ulit, nanay mo Stares. po, tatay mo po, ikaw at?
Clarification
Sige po. Hindi ko na po ipipilit kung sino yun. Silence.
Stares with eye contact
Silence
Nabanggit niyo po na nag-aararo kayo sa Aklan, tama po ba?
Oo.
Seeking information
Sino pong kasama niyong nag-aararo?
Tatay ko.
Focusing
May mga ginagawa po ba kayo sa Aklan na ginagawa niyo rin dito.
Wala naman
Encouraging comparison
Nursing. P 112) Therapeutic: Help to clarify patient s feelings; ideas; and perceptions; provides explicit correlation to patient s actions (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Silence often encourages the client to verbalize, provided that it is interested and expectant. Silence gives the client time to organize thoughts, direct the topic of interaction, or focus on issues that are most important. Much nonverbal behavior takes place during silence, and the nurse needs to be aware of the client and his or her own nonverbal behavior. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse should seek clarification throughout interactions with client. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse asks the client to consider people and events in light of his or her
Napapansin ko lang po palagi po kayo nagkakamot. Observe the patient scratching his foot. Pwede ko po bang malaman kung ano po yung mga sugat na yan?
Looks at his foot while scratching
Making observation
own values. Doing so encourages the client to make his or her own appraisal rather than to accept the opinion of others. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Client cannot verbalize or make them understood. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Help to clarify patient s feelings; ideas; and perceptions (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health
Galis.
Exploring
Galis po?
Oo.
Clarification
Pwede ko po bang malaman kung saan niyo nakuha yan?
Still looking at his foot and scratching
Exploring
May ikukuwento po ba kayo sa akin?
Wala naman.
Broad Opening
Ano pong ginawa niyo kanina?
Exercise
Exploring
Ano pong naramdaman niyo nung nag-exercise tayo?
Masaya.
Encouraging expression
Pagkatapos po ng exercise, ano po yung next na ginawa natin?
Basketball
Placing event in time or sequence
Ano pong naramdamanan niyo nung naglalaro?
Masaya.
Encouraging expression
Nursing. P 112) Therapeutic: Broad openings make explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings may stimulate him or her to take the initiative. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse asks the client to consider people and events in light of his or her own values. Doing so encourages the client to make his or her own appraisal rather than to accept the opinion of others. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Putting e vents in proper sequence helps both the nurse and client to see them in perspective (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Expression of feelings encourages the client to make his or her own appraisal rather than to accept
Gusto niyo po bang maulit magbasketball?
Oo.
Focusing
Ganun po ba?
Oo.
Clarification
Nakakatuwa naman po na nag-enjoy kayo sa pagbasketball.
Smile
Giving recognition
Ano pa pong nagustuhan niyong ginawa natin ngayong araw?
Kumain.
Exploring
Kumain? Masarap po ba yung pagkain?
Sarap.
Encouraging expression
the opinion of others. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Help to clarify patient s feelings; ideas; and perceptions (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Such recognition does not carry the notion of value, that is, of being good or bad (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: Expression of feelings encourages the client to make his or her own appraisal rather than to accept the opinion of others.
Ano po bang kinain niyo?
Spaghetti
Focusing
Ano pong lasa?
Masarap
Exploring
Ahh. Nodding.
Smile
Accepting
(Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: When client deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112) Therapeutic: An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate agreement but is nonjudgmental. (Reference: Videbeck. Psychiatric Mental Health Nursing. P 112)
IV.
Evaluation:
In this process recording that I conveyed to Patient A, I have used many therapeutic techniques to the patient mostly focusing, exploring and validating. This techniques aid Patient A to respond normally to the questions that I have asked to him. Not only I have established rapport to Patient A, I also get the chance to know the feelings of Patient A as well as his mental status during the interview. However there is still lack of sharing of information from Patient A since he responds shortly to the questions. Patient A still have the hesitation to share to me his feelings that will decrease his anxiety. V. Goals and Objectives: In line with the evaluation above, the goal for the communication growth of this nurse-patient interaction is that after 1 hour of nursing intervention, Patient A will be able to increase the level of trust and self-confidence in conveying the information. Objectives: After 1 hour of nurse-patient interaction, Patient A will be able to: y Report his reasons of depression and anxiety y Describe his plan of action in decreasing his level of anxiety y Report his feeling of self-worth and satisfaction in life
After 1 hour of nurse-patient interaction, I, the student nurse will be able to: y y Jot down the additional recording of Patient A s feelings Demonstrate additional therapeutic communication techniques
