Running Head: Interpersonal Process Analysis

Valerie Reese

Interpersonal Process Analysis

West Coast University

Student: Valerie Reese Date: 04/16/2016

Clinical Instructor: Dr. Brown Unit: 4 (Duel Disorder)

Patient Initials: ME Current Legal Status: Voluntary

Multiaxial Diagnostic System: Axis I (Clinical Disorder): Schizoaffective Disorder, Bipolar Disorder, Major Depression,
and PTSD

Axis II (Personality Disorder/Mental Retardation): N/A

Axis III (General Medical Conditions): Obesity, GERD, and Asthma

Axis IV (Psychosocial and Environmental Problems): Problems with primary support

Axis V (Global Assessment of Functioning Scale): 30

Description of Patient

A 35 year old Caucasian of non-Hispanic decent and was admitted to the mental hospital 13 days ago on normal
nutrition status. Patient is female and married with three children. My client’s children currently reside with her parents.
Patient admitted to the mental institute due to an emotional phone call from father informing her that her children and
ex-husband do not want her in their lives. Her father also informed her she is no long allowed to visit her children. News
resulted in a suicide attempt with a gun. My client was dressed in a pink shirt, black yoga pants, socks provided by the
facility. Patient had blond hair, black metal frame glasses, and had clean yellow skin. Her appearance was groomed and
neat with an exception of her messy bun. ME was cooperative, friendly, and labile. Her mood was positive but slightly
anxious throughout the conversation. She also spoke at a normal rate with a soft, light tone. Patient revealed she has
experienced visual and auditory hallucinations. Patient was very goal oriented had a grasp of her surroundings. Her
memory recall was intact. However, her concentration was short before medication and high afterward.

Environment Description

The Patient interaction took place at 8:15 am at the group table in her unit. The table was a rectangular shape,
light brown wood, and table about the size of a dinner table. There were four chairs, two on each horizontally, on each
side. The walls were bare and white with a white erase board on the left side of room. The board had phone call times
and what the group activates were for the day. The room was fill with soft cushioned chairs in a semi-circle facing the TV
right above the table and away from the nurse’s station. The TV secured inside a plastic case on a low volume with the
remote being held at the nurses station. The room was very clean to the point you could even see your refection on the
white laminated tile floor. The temperature was slightly chilly with a clean and fresh scent. The environment was calm,
fairly quiet, with normal lighting. The environment was supportive for conducting an interview. It was quiet which
limited chance of miscommunication promoting a positive start in the nursing process. The client seemed comfortable
and relaxed due to the calm and low stimulating surrounding. There was limited distractions making it easier to keep my
patients attention. The temperature was chilly which could potential cause my patient to become uncomfortable and
distracted.
 Interpersonal Process Analysis

Interpersonal Process Recording

 Verbal and Nonverbal  Verbal and Nonverbal  Communication  Based on your patient  Effective or not effective
technique  Could have said….
 Therapeutic or  Thoughts
nontherapeutic  Was your goal met and why
 Defense and coping
mechanisms used

Goal: Introduce myself Technique: Closed- Rationale: A closed ended Analysis: Effective
Verbal: “Hello, My Verbal: “Sure we can talk. ended question question minimizes the Critique: I could have said….
name is Valerie. I am a My name is Melanie. The Type: Non-therapeutic response and information Hello, my name is Valerie. I am a
student nurse at WCU. floor is yours. “ Defense: Palliative received from the patient. nursing student at WCU. Would
Do you mind if I talk with Nonverbal: On and off The patient did not maintain you be open to an interview with
Coping: Willingness to eye contact with me to
you?” eye contact, no facial me?
talk prevent to reduce the
Nonverbal: Smiling, expression, and shakes my Thoughts: How I asked for an
amount of anxiety she was
making eye contact, hand. interview reminded me of how
feeling. The patient’s
extending hand for a someone with authority asks to
willingness to talk is a good
handshake, and light soft speak to you when you’re in
coping technique to help
trouble. I felt like it gave my
tone. manage emotions.
patient that impression and caught
her off guard.
Goal met: Yes
Why?: I was able to introduce
myself and received an
introduction from the patient.
Goal: Find out how the Technique: Encouraging Rationale: The patient is Analysis: Effective
patient is feeling today. Verbal: “I’m feeling good. expression of feelings being discharge after getting Critique: I could have said….
Verbal: How are you I am actually really excited Type: Therapeutic help, complying with the How are you feeling most days
feeling today Mrs. because I get discharged Defense: Adaptive program and medications, instead of nearing it down to today
Melanie? today!” and utilizing its resources to Thoughts: I happy to hear my.
Coping: Dancing assume a better and healthier
Nonverbal: Smiling, Nonverbal: Large grin on patient was being discharge. This
sitting across from patient’s face, conducting a mental status. urged me to find out how long she
patients with feet flat on mini dance, and had been hospitalized.
the ground and leaning maintaining strong eye Goal met: Yes
forward. contact.
Why?: The patient revealed how
she was feeling today and
expressed her feeling nonverbally.
Goal: Discover Technique: Exploring Rationale: Patient went Analysis: Effective
reasoning for Verbal: “I tried to shoot Type: Therapeutic from maintaining strong eye Critique: I felt as if I somewhat
hospitalization myself but I’m the one that Defense: Omnipotence contact to avoiding eye belittled her excitement because I
Verbal: “I can see checked myself in here.” contact. I feel the patient did quickly moved to the next
and minimizing
you’re very excited about Nonverbal: Facial not want to acknowledge her question. I should have took a little
Coping: Drawing/tracing suicidal attempt but
your discharge. Can you expression became flat, more time with her excitement
something onto the table unconsciously emphasized
tell me what brought you patient looked downward and shown genuine excitement for
to alleviate anxiety and she was voluntarily admitted.
to the facility?” at the table and began to her.
distract herself from her By emphasizes a voluntary
Nonverbal: draw something on the thoughts and feeling. Thoughts: I felt as the patient
status she minimizes the
Maintained strong eye table with her finger. felt her situation was not as
severity of the event and
contact. serious because she took the
somewhat puts down those
who are involuntary. actions to get help. It came across
as she was putting herself above
others due to her legal status.
(voluntary vs involuntary)
Goal met: Yes
Why?: ME told me the reasoning
behind her hospitalization
 Interpersonal Process Analysis

Goal: Find out the Technique: Giving Rationale: The patient does Analysis: Effective
events that led up to the Verbal: “Well, (pauses) Recognition not remember everything Critique: I could have giving
attempted suicide. my dad called me and told Type: Therapeutic about that night. She says she more acknowledgement to her
Verbal: “That very big me I aint gone see my kids Defense: Dissociation blackout out right when she regarding seeking help. I
anymore and they don’t got the gun. ME seems as if acknowledge it and quickly
step in positive direction. Coping: Avoidance
want nothing to do with she purposely does not followed up with another question.
Can you tell me what led mechanism.
me. He was saying some remember this critical time. I should have paused or used
up to this event?
really bad things about me This might be her attempt to silence before asking another
Nonverbal: surpass the situation like a
and I got extremely sad and question.
Placed hands on the type of denial. She clearly is
overwhelmed. I was Thoughts: At this moment, I
table to promote a still emotional about the
already drinking so hearing
relaxed and un- situation because she quickly learned a lot about my patient and
that made my mind start
judgmental tone. wanted to change the from her perspective. I gave me a
racing. It’s like I blacked
subject. She is avoiding facing close look on how she feels about
out. I just knew there was a
her feelings and coming to the situation and if she has come
gun in house and I wanted
to terms with it. However, I felt as
to shoot myself. (Long terms with the events.
if she blocked out a section of the
pause) I don’t remember
everything I just remember event as a way to cope with it.
wanting to shoot myself Goal met: Yes
and getting the gun. Can we Why?: I was able to find out what
talk about something else happened before the event and
now?” what led up to her attempted
Nonverbal: Patient suicide.
began bouncing left leg up
and down rapidly (restless
leg), made eye contact, low
soft voice, troublesome/
concerning facial
expression.
Goal: Make the patient Technique: Using active Rationale: ME looked away Analysis: Not effective
feel comfortable and Verbal: “Thank you. I listening trying to avoid eye contact Critique: I could have informed
show genuine care. think I can talk about it Type: Therapeutic with me. She seemed like she my patient at the beginning of the
Verbal: “Yes of course later after I talk my meds. I Defense: Palliative was trying to make herself interview that if she felt
we can talk about just can’t without my feel comfortable. ME had a uncomfortable and overwhelmed
Coping: Medication
something else. Just meds.” prescription for anxiety at any point that we could take a
know I am here if you compliance medication that she sought break. I also should identified her
Nonverbal: Reached and
decide you want to talk touched my hand while out to calm her. She can coping techniques so when she did
about it. thanking me, small quick correctly identify her anxiety feel emotional or overwhelmed I
Nonverbal: Leaned smile while making eye level and take the necessary could encourage and participate in
forward towards patient contact, quickly broke eye steps to reduce it. her techniques.
made eye contact while contact and looked towards Thoughts: I feel that ME felt that
nodding my head. the nursing station. I genuinely cared about her
wellbeing. She seemed to able to
identify when she is becoming
overwhelmed and anxious. She
knows she needs her medication
and has a good understanding of
what her meds are for and what
they do.
Goal met: NO
Why?: Although the patient
reached out and touched my hand
she quickly looked away
attempting to distract herself. She
might have felt it was slightly
awkward but it felt like more of a
defense mechanism.
 Interpersonal Process Analysis

Evaluation

As the interview progressed, I felt it was going in a positive direction. After my patient received her
medication, she came back to continue the interview. I began with identifying coping and hobbies she enjoys
and ending in how close she is with the patients in the facility. We were able to talk about the night of her
suicide again with success. She also confided her life story starting at the age of five. I think the interview was
a success because the patient confided in me, trusted me, and I was able to get answers to all my questions
and more. I learned that you can’t rush an interview and I truly takes time for a patient to warm up to you. I
learned the kindness goes a long with patients and they will be more willing to engage and open. After the
interview, I went to fill out my worksheet and noticed questions I did not ask. This helped me identify other
questions I needed to ask and also create a flow/order for my questions.

Thoughts and areas of Improvement

I was extremely nervous to conduct an interview on my own at first but I was happy with my results. I
need to improve my introduction and giving recognition for patients making progress. I did not utilize silence
in moments that would have made a tremendous difference. This is one of the biggest areas I want to improve
in. I want to improve my flow of my interviews, helping patients feel comfortable and cared about, and feel
confident about my interviews. I think with a few more weeks of practice I will be able to accomplish and
improve these areas.
 Interpersonal Process Analysis

References

Halter, M. J., & Varcarolis, E. M. (2014). Varcarolis' foundations of psychiatric mental health nursing: A
clinical approach (7th ed.). St. Louis, MO: Elsevier. pg. 150- 163 and pg. 283