Tim Thomas Nursing 360 Process Recording

DATE: 2016
Client Dx: Alcohol Use Disorder, Dementia

Dialogue

Nonverbal
Technique
Communication
1 SN: Hello, my SN: Smiling as I
Introductory
name is Tim. I am a approach and take statement.
Kapiolani
a seat across from
Community College client at a table.
student nurse. I will
be working with you
until noon today.

Student
Feelings
Interested.

Student Thoughts T/N

I hope he is
N
agreeable to talking
with me.

Analysis
(4) Client was seated quietly at
the table which made him easy to
approach and helped me to
engage him in conversation.
(5) I could have used a
therapeutic opener such as, How
are you feeling today? to get the
conversation started.

Client: Hi.
Client: Already
seated quietly at
table.

2 SN: Tell me how SN: Maintaining

you feel about being eye contact and a
in the hospital.
calm expression.

Technique:
Open.

Feeling:
Surprised.

Thoughts:
He is still
working?
What? He has

(3) I made an effort not to show

my surprise through my body
language upon learning that he
still works. To have shown

Client: I dont like

it, I should be at
work.

Client: Maintained
eye contact, serious
expression.

3 SN: You sound

bothered by this.

SN: Facing client,

maintaining eye
contact.

dementia and is 82
years old!

surprise might have embarrassed

him.

Technique:
Reflection of
feelings.

Feeling:
Thoughts:
T
Concerned. He is in denial. He
is blaming others
for his behavior.

(2) My comment was borderline

assumptive. I should have
rephrased the comment into a
question, such as, How is this
affecting you?

Technique:
Open,
focused.

Feeling:
Curious.

(4) Clients tense body language

indicates frustration and agitation,
which made me a little hesitant. I
should encourage him to

Client: Yeah, if my Client: Sitting more

wife wasnt so
upright now.
dramatic, I wouldnt
be here right now.

4 SN: Tell me how SN: Maintaining

you feel about your eye contact, hands
relationship with
clasped on table.
your wife.

Thoughts:
T
He sees the
problem as caused
by his wife.

elaborate and clarify.

Client: Well weve
been married 56
years. Things are
okay when she isnt
criticizing me.

Client: Still sitting

upright, tense.

5 SN: What do you SN: Maintaining

mean by
eye contact, hands
criticizing?
clasped on table
leaning slightly
toward client.

Technique:
Open,
clarifying.

Feeling:
Interested.

Thoughts:
He seems
aggravated by his
wife's behavior.

(4) The client showed an obvious

sign of discomfort with this
subject, which made me consider
looking further into why this
makes him uncomfortable.

Feeling:
Uncertain.

Thoughts:
It does not seem
like he
comprehends his
wife's fears.

(3) It seems the client places a lot

of the blame on his wife. It made
me aware of his denial and I am
wondering how I could get him to
consider the role he plays in this.

Client: Shes always Client: Client

nagging me about my seeming to tense up.
drinking.

6 SN: You sound SN: Looking at

Technique:
frustrated by this. client with interest. Reflection of
feelings.
Client: I am,

Client: Looks away

because she over

then back at me when
exaggerates. She tells he responds.
me shes afraid of
me.

7 SN: How do you SN: Confused

feel when she says expression.
shes afraid of
you?

I will try and focus in on his

perception of his behavior.

Technique:
Feeling:
Open, focused Confused.

Client: I dont
Client: Crosses arms
understand it. Ive hit leans back in chair.
her in the past, but
never enough to hurt
her.

8 SN: You don't

understand it?

SN: Sitting, looking Technique:

at client, nodding
Restatement.
head when he
responds.

Client: Yeah, I guess Client: Serious look,

Feeling:
Curious.

Thoughts: This
T
comment points to
the root of the
problem. Does he
really see some of
the hitting as
acceptable?

(3) My confused expression may

not have contributed to the
interview in a positive way. A
more calm expression may have
encouraged more open and honest
communication between the
client and myself.

Thoughts:
T
He is using alcohol
as means of
coping.

(2) Using It at the end of my

question made the question
unclear. I should have asked,
Tell me what you do not
understand.

its usually when Ive leans toward me for

been drinking. She
emphasis.
says I have a drinking
problem, but I don't
see it that way.

9 SN: How do you SN: Leaning in

Technique:
see it?
toward client, hand Open,
gesture with
focused.
question.

Feeling:
Interest.

Thoughts:
He will not solve
this issue until he
accepts that his
drinking is a
problem.

(2) I should have phrased my

question in a more specific way. I
should have asked, Tell me what
you feel triggers your drinking?

Feeling:
Relaxed.

Thoughts: That is T
a lot of alcohol to
consume on a daily
basis.

(2) My question should have been

more open such as, Tell me a
little more about your daily
alcohol consumption.

Client: I dont think Client: Posture

its a problem, I just relaxed, starts to
like to enjoy a few
smile a little.
occasionally.

10 SN: How many SN: Looking at

Technique:
is a few?
client with interest. Closed,
clarifying.
Client: I guess
Client: Still smiling
maybe 4-5 glasses of leans back in chair.
wine depending on
the day.

11 SN: What are

some things that
trigger your
drinking?

SN: Looking
intently at client.

Technique:
Open,
focused.

Feeling:
Interested.

Thoughts: He is
blaming his wife
for his drinking,
but his drinking
contributes to the
problem.

(4) Although I wanted to know

more about what triggers his
drinking, his evasive eye contact
made me a little unsure if I should
continue to pursue this.

12 SN: Can you

SN: Sitting facing Technique:
think of some things client with hands on Open.
you could do to help table.
you manage your
stress?

Feeling:
Confident.

Thoughts:
T
This may be a way
for him to avoid
drinking when he
is stressed.

(4) Client perked up when

mentioning the gym and
exercising. This seemed to make
him happy which also made me
feel more comfortable continuing
on this subject.

Client: Usually if
Client: Evasive eye
Im dealing with a lot contact, gestures with
of stress or if she is hand.
complaining a lot.

Client: I do enjoy

Client: Seeming to

going to the gym and perk up, slight smile.

exercising.

13 SN: I hear
youre saying you
feel that exercise
helps you manage
your stress.

SN: Shifted
forward, leaning
toward patient.

Technique:
Feeling:
Paraphrasing. Upbeat.

Thoughts: He
T
certainly needs
more than just
going to the gym,
but it could
become a coping
mechanism if he
utilizes it that way.

(2) Although I explored how

exercise might be used to reduce
his drinking by helping him to
relax, I should have asked, What
other things might help you to
relax when you feel stressed.
This may have prompted him to
think of more options.

Technique:
Open.

Thoughts:
T
He really does
seem to be affected
by missing work.

(2) Could have phrased the

question different or asked
another one entirely, such as,
What changes do you think
might be helpful in reducing
stress?

Client: Yes, I enjoy Client: Seems more

the gym and I think it relaxed, places hands
causes fewer
on table.
problems in my
marriage than my
drinking does.

14 SN: How would SN: Continuing to

having fewer
look at client.
problems in your
relationship affect
your life?

Client: Well for one, Client: Relaxed

Feeling:
Curious.

I wouldn't be in here posture, calm.

and missing work,
but I guess less stress
in my life.
15 SN: Tell me
your thoughts on
improving your
stress level.

SN: Looking at
client, making eye
contact.

Technique:
Open.

Feeling:
Unsure.

Thoughts: Wasn't T
the answer I had
hoped for, but he at
least seems to want
to drink less and
fight less with his
wife.

(2) I could have asked, What are

some other things you enjoy like
the gym that might help you
reduce stress? This may have
given him a chance to think of
more options.

16 SN: Thank you SN: Turns head,

Technique:
for your time today. notices doctor
Closing
approaching. Turns statement.
back to speak to
client.

Feeling:
Pleased.

Thoughts:
N
I hope I can
remember
everything. Will
take notes as soon
as possible.

(4) The client nodded and

acknowledged the end of our
conversation which made me feel
pleased. Overall, the conversation
went well. It is easier to ask
therapeutic questions with more

Client: First would Client: Shifts in seat,

be to get out of here, places hands on
second would maybe knees.
be drinking less and
fighting less with my
wife.

(Doctor walks up to
table and asks to
speak with client.)

Client: Yeah, sure

thing.

Client: Client looks

at doctor and then
back to me and
nodded.

practice. I see that the client is in

denial over his drinking habits
and the stress it is causing in his
life. I also see that his triggers
might be related to his marriage.
My hopes are that he can get
help, especially at his age. I can
only imagine the toll it has taken
on his mind and his body.