- The patient, a 36-year-old male with diagnoses of meth intoxication, major depressive disorder, and suicidal ideations, engaged in a conversation with the student nurse during his first day of a psychiatric hospital stay.
- The patient expressed feelings of depression and loneliness due to a lack of visitors. He also discussed family and social relationship problems. Further, he disclosed past suicidal thoughts and plans.
- As the conversation continued, the patient's mood and behavior fluctuated, expressing frustration, paranoia, and possible homicidal ideations towards others, causing increased concern from the student nurse.
- The patient, a 36-year-old male with diagnoses of meth intoxication, major depressive disorder, and suicidal ideations, engaged in a conversation with the student nurse during his first day of a psychiatric hospital stay.
- The patient expressed feelings of depression and loneliness due to a lack of visitors. He also discussed family and social relationship problems. Further, he disclosed past suicidal thoughts and plans.
- As the conversation continued, the patient's mood and behavior fluctuated, expressing frustration, paranoia, and possible homicidal ideations towards others, causing increased concern from the student nurse.
- The patient, a 36-year-old male with diagnoses of meth intoxication, major depressive disorder, and suicidal ideations, engaged in a conversation with the student nurse during his first day of a psychiatric hospital stay.
- The patient expressed feelings of depression and loneliness due to a lack of visitors. He also discussed family and social relationship problems. Further, he disclosed past suicidal thoughts and plans.
- As the conversation continued, the patient's mood and behavior fluctuated, expressing frustration, paranoia, and possible homicidal ideations towards others, causing increased concern from the student nurse.
- The patient, a 36-year-old male with diagnoses of meth intoxication, major depressive disorder, and suicidal ideations, engaged in a conversation with the student nurse during his first day of a psychiatric hospital stay.
- The patient expressed feelings of depression and loneliness due to a lack of visitors. He also discussed family and social relationship problems. Further, he disclosed past suicidal thoughts and plans.
- As the conversation continued, the patient's mood and behavior fluctuated, expressing frustration, paranoia, and possible homicidal ideations towards others, causing increased concern from the student nurse.
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Lisa Chee
NURS-360 Professor Chat Patient-Centered Communication (Process Recording) PR Date: September 13, 2014 Client age: 36 y/o Client gender: male Date of interaction: September 06, 2014 Diagnoses: Meth intoxication, major depressive disorder, suicidal ideations Length of Stay (LOS) on the day of the interaction: 1 day Dialogue
Good morning. My name is Lisa and I am a KCC nursing student. I will be here till about 3 PM today. How are you feeling today? Eh, not great, but Im all right.
Pt & Self Non-Verbal Communication Behaviors Placing my breakfast plate on the table and pulling my chair out to sit down beside the patient Lifts head up, acknowledges my presence
Communication Technique
Introductory statement, general lead; open
Student Feelings
Nervous
Student Thoughts This is my first time working with a patient with a mental illness, I hope it goes well. Hmm, he looks pretty bummed this morning. Im going to try to find out more.
Looking down, poking his breakfast with a fork Took a bite of food and made eye-contact w/ my patient
No one cares?
Yeah. You see,
these guys here, they have visitors. No one bothers to visit me here.
Uses fork and
points to patients in the distance
Reflection of feeling, general lead; open
Restatement; open
Curious
I hope hes in the mood to engage in a conversation with me today
Pt smells malodorous, I wonder whens the last time he took a shower
T Pts diagnosed with MDD may have significant changes in normal functioning, one of them being maintaining self-care
Hmm, there are currently no visitors visiting the other patients. Additionally, he was only admitted yesterday, I wonder if hes making stuff up.
Mm, I see. That
must be difficult for you.
Eh. Just a little bit. I
have family, but my family doesnt care about me. I havent seen them in awhile. My sister, shes in California. She used to be good, but then she got involved in the wrong crowd. My friends too, they dont want anything to do with me. And my roommate is probably mad at me because I cant get him the drugs that he wants. I hear you saying that you have family, friends and a roommate, but no one visits. Which situation would you like to discuss about today?
Nod and traced my patients fork towards the direction hes pointing at (accepting) Pokes the food around on his plate. Continues to look down. Does not try to make eye contact.
Expression of empathy; closed
Paraphrasing, Adjusted my focusing seat so that I question; open faced my patient better, leaned in towards my patient and tried to make eye contact
Overwhelmed
Whoa, that was a lot of information. I hope I can remember everything he said for my process recording
Pts with MDD
may have flight of idea thought process
(3) I began to worry
about whether or not I would be able to remember everything my patient was telling me at this point. As a result, I was tempted to offer self-resolutions, and select a topic to discuss. But I quickly recalled that it would be non-therapeutic. Thus, I tried to focus on exploring his feelings more.
(3) I noticed that after I
adjusted my seat and leaned towards the patient, he started to open up a bit more. He looked up more often.
Everything. Its making me depressed. I was really depressed last night, but Im ok now.
Patient looks up and makes eye contact; continues to eat his breakfast
You were depressed last night?
I wonder if he had any thoughts of suicide. I need to ask him that sometime during our 1to-1 MSE
Restatement; open
Pts diagnosed with MDD are indecisive and may have difficulties with decision making T (2) To improve the flow of the interview, I think that asking about his depression last night is irrelevant and should have focused on his current feelings and responded with How are you feeling today?
Yes. I keep coming
here. I have been here so many times.
Patient continues to look down while eating his breakfast Did you have any Adjusted thoughts of suicide? myself in my seat, sitting in upright posture, hands folded in my lap Yeah, I sure did!
Focusing question; closed
Concerned
Startled
I hope he doesnt have any suicide ideations right now.
Pts with MDD
may have feelings of SI or HI
What was your
plan for suicide? Oh, you know. Ive been here so many times. I know that if I can get out of these doors, I can take the emergency exit and climb the stairs to the tenth floor. And jump. Just jump. You know, thats how Id do it. I see. Well, how do you feel now? Oh, the same, depressed. Any thoughts of suicide today? No. Not today. What are your plans for today?
General lead; open
Worried
Patient looks up for a second and glances at the direction of the nurses station; continues to poke at his breakfast Nodding
Does this guy
have a plan? Hmm, he knows the layout of the hospital better than I do. I wonder if his information/ plan of action are accurate.
General lead; open
General lead; open
Anxious Relieved
General lead; open
T Ok, thats good. T
(2) My patient mentioned
that he was feeling depressed. Instead of changing the topics and asking my patient what his plans for today were, I could have explored the patients feelings of depression by saying lets explore your feelings of depression.
Gosh! I hate being
stuck here. I keep coming here all the time. I guess if Im stuck here, it gives me more time to think. To think? About what?
Patient started to flick his eggs with a fork, all around on his plate
Maintained eye contact
Surprised
Restatement, general lead; open
Pts with MDD
may display euphoric mood
I want to focus on his first concern about being depressed due to the lack of visitors, whats the best approach to bring that situation back up? He seems to have a lot on his mind
Yeah. To think. Like those guys that stole my stuff cause I didnt have the money. They might be out to get me.
Those guys?
He raised his voice all of a sudden.
Restatement; open
(2) My patient raised his
voice. I felt startled and did not know how to respond. I should have used reflection of feeling instead and say It sounds like you feel very upset and followed up with a tell me whats bothering you right now
Yeah, I owe these
guys money, but I didnt have the money. So they stole my stuff. I see. It seems like youre flustered because these guys stole your stuff. Yeah, I dont have my wallet or money or anything. Lets explore your feelings of frustration. Ok, well right now, Im thinking if Im going to be stuck here, I might as well come up with a plan. I will get them before they get me. Mm, nah, thats too much work. I just feel like going back to my room to sleep.
Patient looked up for a second and made eye contact. Patient began to shake his head.
(4) I felt concerned when
he started shaking his head. I wanted to explore his feelings a bit more. Reflection of feeling; closed
Focusing statement; closed
Patient is still shaking his head
Patient clenches his fork in a fist
Anxious
Uh oh, does he have homicidal ideations? I need to notify my primary RN.
Pts with MDD
may have feelings of SI or HI
(4) I felt very
uncomfortable when he started to clench his fist, with a sharp object in his hand, so I excused myself and told him I had some things to attend to, and for him to enjoy the rest of his breakfast.
