Harrison

Process Recording
Date: 8/31/2016
Clients Dx: Depression
Age: 26 years old
LOS: Day 1
Dialogue

Non Verbal
Technique
Communication
Patient was
Introductor
siting slouched
y
on her chair
Statement.
leaned back with
a flat affect, but
brightened on
approach and
straightened her
posture.
Appeared stated
age and well
groomed. I sat
across from her
on a small table
in the common
area as she ate
her breakfast.

Student
Feelings
Nervous
about
interaction
but relieved
when she
brightened
up and
greeted me
with a
smile.

Student
Thoughts
When
observing
patient
before
approach,
she seemed
isolative
sitting
alone and
had a flat
affect
looking
down, I
hoped shed
be willing
to talk to
me

T/N

How are you

feeling today?
I still feel sad, not
right now but it
comes and goes and
is probably worse
at night when Im
alone.

Patient
maintained eye
contact with me,
only looking at
her plate to grab
her next bite of
food and look
right back up to
me.

Open
ended
question
with a
general
Lead

I was
pleased she
was willing
to start
opening up
to me and
talk about
her feelings
so quickly.

I wanted to
discuss her
feelings
more in
depth.

Would you say

you feel helpless or
hopeless too?
I think I feel

Patient looked
up at the ceiling
briefly before
starting to speak,

Closed
question

I realized
after I asked
that
question she

I wanted to
identify if
she felt
depressed

Hello, Im
Kristina a nursing
student from KCC
and I was assigned
to work with you
today from
7:30am until
about 12:30pm. Is
it okay if I sit
down?
Yeah of course,
Hi, my name is
______. You can
ask me whatever
you want.

Analysis
2.I could have
included that I was
going to interview
her for the next hour
3. I think I did not
include what I was
going to do because
I was feeling
nervous. And it felt
like that might have
been too long.
4. I was relieved she
was willing to talk
to me and told me
she was open to
answering questions
which most people
dont do when you
first meet them as a
student.
3. I was hoping I
wasnt sounding too
friendly and happy
so she would feel
comfortable opening
up about these sad
feelings she was
having.
1. Asking a closed
question could have
cut off he dialogue
if she answered with

Harrison
hopeless about my
situation but maybe
not helpless
because I think I
can get help from
my family and from
doctors and stuff
so, yeah, just
hopeless and sad.

but leaned in and

seemed to open
up and expand
on her feelings.

Tell me more
about feeling
hopeless
Well Ive always
felt a little sad and
depressed from
time to time, but
recently I just
found out I was
pregnant and my
boyfriend broke up
with me so I didnt
know what I was
going to do and
how I would do this
alone and I wanted
to die but I just feel,
like, really bad and
guilty that I would
do this to my baby

Patient stopped
eating while
talking and
stopped having
direct eye
contact, looking
down at her
food.
I maintained
eye contact and
listened quietly
as she spoke.

Open
Focusing
Statement

could have
easily
answered
that
question
with a Yes
or No but
was glad
she
expended
on her
feelings.

with
feelings of
hopelessnes
s and
helplessnes
s since she
identified
she does
feel sad

I felt like
she was
really
starting to
open up to
me and was
relieved but
also felt
empathy for
her and
could
understand
how
difficult it
must be to
be in her
situation
right now.

She
showed
some
insight and
remorse
and was
starting to
open up
about her
reason for
admission.

a Yes or no It
may have been
better if I asked her
to expand on her
feelings of sadness
and later clarified if
she felt helpless or
hopeless.
2. I could have
asked her to talk
more about her
feelings of sadness
instead.
3. Her Dx is
depression and she
said she felt sad so I
wanted to clarify if
she felt feelings of
helplessness and
hopelessness also.
5. Tell me more
about your feelings
of sadness. And
clarified about the
helplessness and
hopelessness later.
3. I felt empathy for
her and being
around her age I
could understand
how being put in
this stressful
situation and finding
out you are going to
be a single mother
paired with having
depression could
lead a patient to
have SI.
4. She stopped
making eye contact
and started looking
down, I wanted to
expand on her
feelings but also
wanted to make her

Harrison
and my parents.

Guilty you would

do this to your
baby and
parents?
Yeah, I said I
wanted to die but I
dont want to put
my baby in danger.
I also love my
parents and made
them so worried. I
didnt mean to
make everyone so
upset and stress out.

Patient looked
up at me and
started making
eye contact
again, leaning in
a bit. She had a
sad expression
on her face as
compared to the
beginning of our
conversation and
looked like her
eyes were
starting to water.

Restatement

It made me
feel a little
torn, I felt
sorry for
this woman
but if she
puts herself
in danger,
she will also
be putting
her baby in
danger too.

I wanted to
encourage
the patient
to continue
talking
about her
feelings
using this
restatement

So you are feeling

guilty because you
made your parents
upset and stressed
out by verbalizing
you were having
thoughts about
dying?
Mhmm, I dont
want to do this to
them but they said
they just want to
help me and they
said theyll be there
for me and my
baby.

Patient nodded
her head yes
when answering,
continuing to
avoid eye
contact and
gazing at her
food or at the
table with her
eyes watering.

Paraphrasing

I felt a little
helpless
because I
cant make
these
feelings go
away or
solve it for
her and
being a
single
mother will
only make
things even
more
complicated

She looks
like shes
about to
cry, so I
moved on
to talking
about her
Suicidal
Ideations.

You look sad when

you talk about

Patient made eye

contact, with her

Reflecion of
Feeling

I can
understand

I am
hoping she

feel comfortable and

have a beneficial
and therapeutic
conversation with
her.
4. She looked like
she was starting to
tear up, which made
me a little nervous
because I want to be
comforting but I
also didnt want to
cross the line as a
student nurse and
keep the
conversation
professional and
focused like it needs
to be.
2. I could have
asked the patient to
list possible
solutions for herself
but ended up
moving on instead
after paraphrasing.
3. I really felt like
she was under so
much stress and all
these problems
going on in her life
would be difficult
for me to deal with
personally and
didnt know how to
explore this in more
depth.
4. I moved on to
talking and did not
know exactly how
to comfort her so
moved on to the
next subject.
4. Seeing her about
to break out in tears

Harrison
how you made
your parents feel.
They are just really
important to me
and I hate that I put
them through this
but Im going to get
help and therapy
and meds and stuff
so they wont have
to worry about me
trying to kill myself
and be so sad
anymore.

eyes watering
and her facial
expression
visibly sad but
did not cry. She
sits with her
arms crossed.
I am sitting up
straight and
slightly leaned
towards her
side, making
sure not to cross
my arms or
legs.

how she
feels about
letting the
people who
care about
her down.

Do you have any

feelings or
thoughts about
wanting to commit
suicide today?
When its quiet,
like when I was
lying in my bed last
night, I do think
about dying. But I
dont feel like that
right now. It just
comes to me
randomly. Mostly
when Im alone at
night just thinking.

Patient starting
Closed
to avoid eye
Question
contact again,
looking down at
her food still
looking tearful.
I am leaned a
little in at an
attempt to
make our
conversation
more private
since we are
sitting out in the
open area and
to physically
show interest
and concern.

will want to
get better
for other
reasons
besides just
letting her
parents
down. I
would be
scared if
she go into
a fight or
argument
with them
if she
would act
on her SI if
they are her
main
concern
and reason
for getting
better.
I knew she
This is my T
was
first
depressed
conversatio
and had said n with a
she wanted
depressed
to die which patient who
is what
has +SI and
brought her I hoped she
into the
would open
hospital, I
up to me
wanted to
especially
know if she if she still
had +SI and wanted to
it made me
end her
feel sad and life.
concerned
for her
safety.

Do you have a
plan?
No I dont have a
plan.

Patient has a
blunt affect and
has leaned back
in her chair, she

I felt
relieved she
does not
have a plan

Closed
Question

I think this
is a very
important
question to

made me feel
sad/empathetic and
also a little
uncomfortable
because Im scared I
will say the wrong
thing to comfort her
so I moved onto the
suicide assessment.

5. I think I could
have used a
different skill or
different phrasing to
ask this question
and be able to be
direct but still
therapeutic and not
make it a closed
question.
3. I wanted to
comfort her and felt
sad but I didnt let it
affect my nonverbal
body posture or
affect because I
wanted to stay
appropriate and
professional.
4. It seemed by her
tone of voice and
facial expression she
had been asked this

Harrison
is now peeling
her banana to
eat.

at the
moment and
she wasnt
in
immediate
danger.

How will you

manage if you feel
like hurting
yourself or
become suicidal
today, do you
know who to tell
or where to go?
Yeah I talked to a
Doctor about this, I
agreed I would go
see my psychiatrist,
call a number, or go
to the emergency
room if I feel like I
am really going to
do it. But when Im
here I can just tell
someone who
works here.

Patient makes
Open
eye contact when Question
replying and
goes back to
smiling at the
end of her
sentence and
starts eating her
food again. I am
making eye
contact the
whole time as I
ask and she
answers my
questions
making sure not
to cross my
arms or slouch.

I am again
feeling
relieved she
has
contracted
for safety
today and
has a plan
on what to
do if she
feels like SI
again tody
and when
she leaves
he hospital.

Do you know what

you need to do to
be discharged?
Im going to talk
more to my
therapist but I just
started making

She had pushed

her tray away
and sat back in
her chair, talking
more cheerfully
and smiling.
I am smiling

Open
ended
Question

ask to
someone
who has SI
but dont
know if she
means it
and is
opening up
truthfully
with the
way she
answered.
Shes no
T
longer
focused on
her food
and is
making eye
contact
with me
and smiling
again, I
hope she is
being
truthful and
means what
she is
saying.

I believe
she has a
good
understandi
ng of what
needs to
happen for

question multiple
times and did not
want to elaborate
herself like she has
been with previous
questions.

2. I could have
broken this into
multiple focused
open questions,
asking about her
support systems,
who and where she
will go to all
separately and
gotten more
dialogue from her,
explaining her own
thoughts and
feelings and
understanding in
more detail.
4. When she
brightened again
and smiled it made
me feel a little better
and more
comfortable about
the interview so far
and it made me feel
comfortable to keep
going and asking
more questions.
2. I could have
rephrased this
question as goals
she identifies
instead of what the
hospital needs for
her to be

Harrison
these new
antidepressant
meds and I know I
need to learn ways
to deal with my
depression and start
coming in to talk to
my therapist when I
leave too cuase
they dont want me
to commit suicide. I
think that was it,
then I can go back
home.
How are you
feeling on your
new
antidepressant?
I dont really see
the difference I feel
the same.

and listening to
her.

Well most
antidepressants
you need to keep
taking daily for up
to 6 weeks until it
starts becoming
more effective and
you should never
just stop taking
them suddenly.
Oh yeah the doctor
told me that, I told
him I will keep
taking them when I
go home. I want to
get better and take
care of myself so I
can be a good mom
too.

Patient nods and

smiles.

You say you want

to be a good mom,

her to get
discharged.

Patient shrugged
her shoulders.

Focusing

Discharged.
4. She seems to be
in a better mood
than before and
open to talking
again.

Maybe she T
doesnt
know they
dont work
right away.
This is a
good
opportunity
for patient
teaching.
Nervous
I hope she
T
about giving sticks with
the wrong
this and has
information good med
or bad
compliance
patient
.
education.

3. I thought this was

a good time for
some patient
education since med
compliance with
depressant meds are
important.

I feel
empathetic

2. I think I could
have focused on

She is able
to identify

2. I could have
given more
information but was
not sure about what
med she was taking
so I wanted to move
on and come back to
this topic after I had
a chance to look on
the electronic MAR.

Harrison
tell me more about
that.
Well I obviously
didnt think I would
be pregnant with
(Boyfriends name)
and I dont really
know how things
are going to be with
us now since we
broke up before I
knew I was
pregnant. But I still
have my parents
help since I live
with them in (City)
and I dont want to
hurt her by hurting
myself and I was
just kind of nervous
and scared when I
said all that stuff
yesterday.
So you have a
good support
system from your
parents and are
feeling nervous
and scared about
the baby you
werent expecting
that triggered you
to want to die?
Yeah, I was already
pretty sad about
breaking up with
(Boyfriends name)
but when I found
out I was pregnant I
just got really sad
and scared and
stressed out but I
think I can talk to
people about it. My
parents and

Patient leaned
over the table to
talk and spoke in
a quieter voice.
I leaned in
closer to listen.

Paraphrasi
ng

for her.

how she is
feeling and
what
triggered
her to have
SI and why
her parents
brought her
to the
hospital.

I feel
stressed out
and sorry
with this
poor woman
who is
having a
hard time
with the
situation she
is in and can
understand
why that
would make
her feel sad
and scared
an stressed.

Finding out
she was
pregnant
was what
triggered
her to have
SI but she
was
depressed
before that.

how she was feeling

about being a mom
instead of just
asking about her
pregnancy. Tell me
more how you feel
about that

4. The way she

spoke quieter and
leaned in made me
think she was
opening up to me,
sharing thoughts and
feelings she didnt
want others to know.

Harrison
(Boyfriends
name)s parents
have already come
to talk about how
they will help me
and theyre there
for me. Everyones
being really sweet
and helpful.
[Someone comes to
ask Patient to go to
speak to someone
who is here for
them] Oh I have to
go it was nice
meeting you
Kristina thanks for
listening to me talk
forever maybe Ill
be back before you
leave.
Yes thank you
____ for opening
up to me I will still
be here until 12 so
I will see you when
you come back

Patient gets up
and is pushing
her chair in as
she says this and
the staff member
is standing next
to her waiting.
I get up and
smile as I talk,
pushing my
chair in and
walking over to
the computers.

I wished it
went on
longer and
felt a little
frustrated
we were cut
off but was
glad our
conversatio
n went well
and she
opened up
more than I
anticipated
she would
when I
came in that
morning.

I thought
N
the
conversatio
n went well
and was
glad I was
able to
assess her
thoughts
and
feelings
and have
more than a
superficial
conversatio
n with her.

3. I was frustrated
our conversation
was cut off but tried
to sound friendly
and not bothered
about it because this
hospitalization and
assessment is about
her, not me.

I also spoke to the patient some more after she came back and went to the group milieu therapy
with her.