PATIENT-CENTERED COMMUNICATION

(PROCESS RECORDING)

Date: September 17, 2014

Clt. Age:
13 years old
Clt. Gender: Male
Date of interaction: September 10, 2014
Diagnoses: Depression
Length of Stay (LOS) on the day of the interaction: 6 days

Dialogue

I am a
Kapiolani
Community
College
nursing
student. I am
assigned to
work with you
today.
How do you
feel today?

Client

Fine

Pt. Non Verbal

CommunicationBehaviors

Non Verbal
CommunicationBehaviors

Communication
Technique

The pt. looks at

me once and
avoids eye
contact.

I used good
eye contact,
moderate
voice tone

Introductory
Statement

The pt. is
shaking his
legs.

I lean towards
the pt.

General
Leads

In the
classroom, I
heard you said
today you feel
depressed.
Lets talk
about your
feelings of
depressed.

The pt. still

avoids eye
contact and
looks at the
wall.

I understand
you may feel
nervous to

The pt. starts to

look at me and
leans towards

Open-Ended
Questions

Student
Feelings
Nervous

Student
Thoughts
Hopefully,
the pt. opens
up today

T/N

He must be
anxious right
now because
he is shaking
his legs

Concerned

He is not
interested in
talking with
me maybe
because he
doesnt trust
me?

Relieved

Although
he does not
say anything,

Analysis
Student nurse selfreflection

4. I felt nervous because

the pt. avoids eye
contact during the initial
introduction.

4. I thought the pt. was

anxious because he was
shaking his legs. I felt
uncomfortable because
the pt. did not focusing
on communication.
4. I was worried about
the pt.s non-verbal
behaviors. I realized that
I needed to build a
therapeutic relationship
with the pt. in order to
open up the pt. My
thought made me think
about different
approaches to the pt.
3. I wanted to build a
trust relationship with
the pt. so I approached

3
talking with
me. But I am
here for
listening to
you.
Tell me about
your feeling
depressed

Do you have a
plan to kill
yourself now?

When was the

last time you
think about
suicide?

me

When I feel
depressed, I
dont want
to live.

The pt. looks at

his fingers.

No

Last night

I know he is
listening to
me now

Open-Ended
Questions

Worried

Closed
Questions

No change of
facial
expressions

Closed
Questions

Surprised

The pt. is
T
suicidal so I
need to
assess
suicide risk
of the pt.
The pt.s
T
suicide
ideation must
be ongoing
problem
because it
seems like
nothing new
to him

the pt. with honesty. It

actually contributed to
the interview positively
because the pt. starts to
open up.
2. (Self improvement) I
interpreted the pt.s
behavior as he hesitates
to talk about his feeling.
I quickly moved on the
next question because I
wanted to keep the
conversation going.
However, I could give
the pt. adequate time to
respond.

This question is related

to pt.s safety even
though this is closed
question

4. I was surprised about

the pt.s facial
expression because it
seemed like suicide
thoughts are nothing
new to him.

Tell me about
what were you
thinking about
last night

Open-Ended
Questions

I wanted kill
myself

Have you
thought about
how you would
do it?

Stab myself
with a knife.

Have you ever

done that
before?

Yes, it
happened
right before
I was
admitted to
this facility.

The pt. is
shaking his
legs.

Open-Ended
Questions

Worried

Closed
Questions

Shocked

The pt.s
suicide plan
is pretty
detail even
though he
denies
suicide plan

2. (Self improvement) I
think this question
repeats the previous
question. It would be
better if I ask, How
often do you think about
killing yourself? or
How likely was it that
you wanted to kill
yourself?

3. I was worried because

the pt. lethal suicide
method was detail and
dangerous. I think my
feeling contributed to
the interview positively
because I focused on the
pt.s safety.

5
What was
going on that
day?

What was
happening
before you
began to feel
like that?

I was
depressed.

I argued
with my
mom.

Open-Ended
Questions

Open-Ended
Questions

T
.

T
Go on

She took
away my
things.

Things?

My
electronic
devices,
Xbox and
iPod touch.

You saying
that you
argued with
your mom and
she grounded
you from Xbox
and iPod
touch.
It sounds like
you felt very
upset that day.

Minimal
encourager

T
Restatement

T
Yes

Paraphrasing

The pt. nods

Maintain
good eye
contact and
posture

Reflection of
Feelings

Confident

The pt.
nods to me
because he
agrees with
me

4. I interpreted the pt.s

nodding as he accepted
my statement of his
feeling. It contributed to
the interview positively

6
because I felt confident
communicating with the
pt.
Why did you
argue with
your mom?

My mom
doesnt
understand
me. My
school gets
hard but she
just doesnt
understand
what I say.

That must be
very difficult
for you.

Yes

The pt.
scratches his
left ear.

I was sitting
quietly next to
the pt. and
was listening
carefully with
having an
empathetic
demeanor.

T
Expression
of Empathy

1. Communication error;
Why question. I could
have said, tell me what
you guys were arguing
about?

7
You mentioned
feeling
depressed
concern over
difficulty in
school and
your
relationship
with mother.
Which would
you like to
discuss first?
How do you
feel when your
mom doesnt
seem to
understand
you?
What do you
usually do
when you feel
depressed?

Then

My mom
never listen
to me

Focusing
Questions

I mad at my
mom and I
want to kill
her. Then I
feel bad
about
myself.
I sit down in
the corner
by myself.

I am
thinking life
isnt worth
living

While I was
listening, I
nodded and
used
concerned
facial
expression

Open-Ended
Questions

Open-Ended
Questions

The pt. looks at

the wall

Minimal
Encourager

Frightened

The pt. can

be dangerous
and has
potential to
harm others

3. I was frightened when

the pt. states that he
wanted to kill his
mother. Because of my
feeling, I could not
focus on the pt.s
feeling.
2. (Self improvement)
Instead of changing
topic, I could have said,
You feel angry and
depressed when your
mother not
understanding you. It
would help the pt.
identify his feelings.

Would you tell

staff if you feel
unsafe?
Thank you for
talking with
me today.

T
No

Closed
Question

Concerned

This is another
important question to
assess the pt.s suicide
risk.