PROCESS RECORDING

Shy Wegiel

PATIENT-CENTERED COMMUNICATION (PROCESS RECORDING)

PR Date: 01/22/14 Clt. Age: 26 Clt. Gender: Male Date of interaction: 01/22/14 Diagnoses: Drug Depression Syndrome Length of Stay (LOS) on the day of the interaction: 4

PROCESS RECORDING

Dialogue

Pts Non Verbal CommunicationBehaviors

Communicati on Technique

Student Feelings

Student Thoughts

T / N

Analysis Student nurse self-reflection

Good Morning, my name is Shy. I am a KCC nursing student. I will be working with you today. Lets go to the dining area and talk. Yeah, sure.

Facing client, eye contact, hands clasped Facing interviewer, eye contact, arms down side

Introduction

Excited

Yay, he wants to talk to me.

T 2. The introduction went well but I couldve personalized it by including the patients name. I couldve said, Good Morning ****, my name is Shy. I am a KCC nursing student. I will be working with you today. Lets go to the dining area and talk. Self-improvement: personalize introductions with the patients name T 4. He had a flat affect and monotone voice. He appeared to be fatigued and admitted to being exhausted. This reflected a congruent expression between his feelings and behavior. He is currently taking clonidine for the management of opioid withdrawal. One of the most frequent symptoms of this medication is drowsiness. T 3. It was important to address if he was feeling depressed because fatigue is a symptom of depression.

How are you feeling this morning? Exhausted but better than yesterday. I dont have a headache anymore.

Facing client, eye contact, hands clasped Facing interviewer, eye contact, arms down side.

General lead

Curious

Hes exhausted. Maybe its due to depression. I need to ask more questions and clarify this suspicion.

Do you ever feel sad or depressed? Sometimes I feel a little down but Im just exhausted you

Facing client, eye contact, hands clasped on lap. Facing interviewer,

Closedended

Concerned I wonder if he doesnt want to admit to feeling depressed or if he

PROCESS RECORDING know. Do you ever have thoughts of hurting yourself or someone else? No. eye contact.. Closedended Worried really is just exhausted. I wonder if he had any SI or HI because he had a history of SI. I wonder if he will be open to asking for help.

Facing client, eye contact, hands on lap. Facing interviewer, looking away. If that feeling ever changes, Facing client, eye do you think you would be contact, hands on able to talk to someone, like a lap. Facing interviewer, counselor or nurse? Yeah, I think so. Right now, eye contact. Arms Im just feeling tired. at side, slouching. So, tell me about your Facing client, eye addiction. contact, hands I basically brought myself to the clasped together hospital cause Im tired of my in lap lifestyle. Facing interviewer, eye contact, arms down side

Closedended

Hopeful

General lead

Interested

What do you mean when you say, tired of this lifestyle? Im an addict. I use meth, opioids, and anything else that I can get my hands on. I have no money. When was the last time you used drugs? I was high on heroin when I

Facing client, eye contact, hands clasped together in lap,. Facing interviewer, no eye contact. Facing client, eye contact, hands clasped.

Clarification

I was wondering what he could tell me about his addiction and how it led to him being in the hospital. Maybe hes ready for sobriety because he selfadmitted himself. Concerned I wonder if he means by tired of this lifestyle.

T 3. He may have thoughts about hurting himself or other people so it was important to be direct and ask about it. He also had a history of suicidal ideation. T 3. Although he denied any current SI or HI, it was important to contract for safety in case his feelings change. This verbal contract addressed future safety risks. T 3. I asked him directly about his addiction. Being direct was a good way to start discussing his addiction. This way he knows the topic were discussing. If I was indirect, he couldve became confused which would not have been therapeutic.

Open-ended

Interested

He openly admitted to being high during

T 4. He avoided eye contact. It may have been because he was ashamed or didnt want to make eye contact while he admits to being a drug addict. I need to find out more information about his addiction. T 2. It is important to identify the last time he used drugs to determine his length of withdrawal

PROCESS RECORDING admitted myself into the emergency room. But I use anything I can get my hands on. What do you mean when you say, anything I can get my hands on? I use coke, meth, opiates, and basically if its a drug I probably use it. Facing interviewer, eye contact, hands together Facing client, eye contact, hands clasped. Facing interviewer, eye contact, hands together Clarification and to assess whether or not he is still experiencing any of these symptoms. He is currently on day 4 and appears fatigued. Alarmed He openly T He clarified the types of drugs that admitted to using a he used. variety of different 2. He abuses a number of drugs. different substances. I should have asked more about the frequency of his drug use and identified which substance is of more concern to him. Concerned I wonder if he has T 3. It was important to assess been experiencing whether he was currently any hallucinations. experiencing hallucinations. It wouldve been difficult to have a conversation if he was hearing voices or seeing things. He was making eye contact and didnt appear to be distracted by any type of hallucinations. Interested He has a child and T 4. He seemed to be upset by his wants to change. I difficulties and inability to be a wonder what his father. Although his voice was plan is for monotone and he had minimal sobriety. emotional expressions, his eyes were a bit teary. Earlier in the conversation he identified himself as an addict and now he is expressing the desire to change. The conversation moved from recognizing a problem to an interest in change. admittance into the hospital.

Have you been experiencing any hallucinations? Sometimes I hear or see things when Im high but I havent hallucinated in a few weeks.

Facing client, eye contact, hands clasped together in lap. Nod. Facing interviewer, eye contact, elbows on the table. Eyes slightly watery. Facing client, eye contact, hands clasped together in lap. Nod. Facing interviewer, eye contact, elbows on the table. Eyes slightly watery.

Close-ended

How does being an addict affect your ability to function? Its difficult. I have no money. I use it all on drugs. I cant provide for my son. I cant do anything. I feel like I just get high so I dont feel sick. Its not even fun anymore. Im tired of this sh**. I want to change.

Open-ended

PROCESS RECORDING Okay, so you are saying that you are an addict who wants to change and provide for his son. Yeah. Facing client, eye contact, hands on lap. Facing interviewer, eye contact, hands together Paraphrasing Attentive He has the motivation of family and desire to change. I wonder if he has trigger that set him off. T 3. I reviewed his statement to summarize what he had previously said. This was so he was able to hear someone else say his words. It also let him know that I was listening and paying attention. Active listening is important when building a therapeutic relationship He must be going T 3. It was important to through a really acknowledge the difficulties he difficult time in his was experiencing. I nodded to life. show my understanding of his difficulties. I now see that this head nod could have been interpreted as agreeing with his feelings. I should be more aware of my nodding and body language during therapeutic conversations. Self-improvement: become more aware of my own nodding and body language during conversations

That must be really difficult for you. Yeah.

Facing client, eye contact, nod. Facing interviewer, eye contact, hands

Expression of empathy

Sad

PROCESS RECORDING What triggers do you experience before using drugs? Well, I usually get high with my friends but Ive decided to delete their numbers and leave them behind with my old life. Ill just make new friends. Itll be hard but I love my son more than I love drugs. Its just really frustrating. Facing client, eye contact, hands on lap. Facing interviewer, eye contact, teary eyed Open-ended Intrigued He was able to T 2. It is important to address any self-identify his triggers that he may experience own triggers and before using drugs. I couldve how to avoid them. improved this question by simply I wonder if itll be asking, Are there any triggers that that easy for him you experience before using to just go and drugs? It is a direct close ended make new friends. question. I asked the question as an open ended question because I didnt want him to just respond with just yes or no. He wants to avoid his triggers (old friends) and make a new life. I wonder what he else hes frustrated about. T 3. Looking more into his frustration revealed his son as his motivation to stay sober. He used the defense mechanism of undoing. He feels frustrated about missing out on his sons life and wants to make it up to him by getting involved.

Frustrated? I started using at a young age and it just took over my life. I have a 2 year old son who I dont get to see. He is my motivation to stay sober. Right now hes staying with my brother. Its frustrating cause I want to be there for him. My dad raised my brother and I on his own. I owe it to my son to be a good father. I need make up for lost time. You feel frustrated because you desire to be a good father. Yes, something has got to give.

Facing client, eye contact, hands on lap. Facing interviewer, looks away teary eyed, hand on table.

Restatement

Worried

Facing client, eye contact, hands on lap. Facing interviewer, looks away teary eyed, hand on table, head nod.

Reflection of feelings

Concerned He keeps bringing up his son. He must really feel frustrated.

T 4. He became teary eyed when he started talking about his son. I reflected on his feeling to let him know that I understood what he was saying and how he felt saying it.

PROCESS RECORDING What plans do you have for recovery? Well right now, Im just attending groups, taking my meds, and applying to 2 rehab facilities. Im almost done with the apps. I might try and get a sponsor, and go to NA meetings like 2-3 times a week or something. Facing client, eye contact, hands clasped together in lap. Facing interviewer, eye contact, hands together Open-ended Optimistic I wonder what steps he plan on taking to become sober. T 2. Instead of asking what plans do you have for recovery? I couldve asked What plans do you have to maintain sobriety? This question would make more sense because he has already gone through detox and is creating a plan for sobriety.

What strategies have you tried before? None, this is the first time Im trying to get clean on my own. Usually, I get arrested or something.

Facing client, eye contact. Facing interviewer, eye contact, hands together

Open-ended

Curious

Self-improvement: incorporate the word sobriety in place of recovery when speaking to people recovering from addiction. By asking about sobriety instead of recovery. I can have the patient focused on maintaining this sobriety. He hasnt tried any T 3. The patient self-identified a plan of these strategies. for maintaining sobriety. I asked I wonder how him if he had tried any of these motivated he is to strategies before to assess whether or he needs to make a change in his approach.

Im sorry. Would you mind if I laid down? Im feeling really tired. Yeah, lets just do a quick recap first. You identified yourself as an addict who is ready to change. Your plan

Facing client, eye contact, hands clasped together on lap., head nod.

Summarizing Optimistic

By doing a quick recap. He will be able to hear the progress weve

T 4. The patient verbalized that he is tired and starting slouching but before checking out, it was important to review all that we had

PROCESS RECORDING for sobriety, includes: taking your medications, attending community group meetings, attending a rehab facility, getting a sponsor, and attending NA meetings. Yes, Im really determined to quit. I need to change and get my life back. Its simple.. Im choosing my son over drugs. I will be on the unit until 3 oclock if there anything else you would like to discuss. Okay. Thank you. Facing interviewer, eye contact, hands together. made in our discussion. talked about. He verbalized that he is determined to quit and care for his son. He has expressed this interest more than once in our conversation.

Facing client, eye contact, hand in lap. Facing interviewer, eye contact, hands on table.

Offering self

Accomplis He has motivation hed and a plan. He is preparing to implement it.

T 3. This closing allowed for more concerns or last minute thoughts to be expressed. I also let him know what time I was available until.