NURS323 Mental Health Nursing

Written Assignment #3 Process Recording

Student Name Allyson Anderson ____________________________________________________________Date__February

10, 2017_______

Patient Information and History _Patient has a 20 year diagnosis of PTSD and was desiring to be admitted due to paranoia
_______________________________

Purpose of Conversation: __To admit patient to the

facility_________________________________________________________________________________

Interviewer Patient Responses Nonverbal Response Communicat Analysis (Patient Nursing

Statement/Questio by Patient ion Feelings/Affect, Interventions
ns Technique Effectiveness) Needed
What brought you My cell phone got turned off Patient speech is Exploring Anxious and Help patient to
here? and I am just too scared to very rapid and fearful realize that this is
be at home without my cell patient seems a safe
phone. There are people anxious and jittery. environment and
waiting to hurt me at my develop
house. therapeutic
relationship
Could you tell me They killed my niece and Patient continues to Encouraging Patient is Confirm that you
a little bit more they want to kill me too talk very rapidly. description experiencing understand that
about these because I know too much. Easily distracted by of paranoia. she has those
people that are They listen in on my phone people walking past perception fears to establish
following you? calls and can see me through the door and gets off trust but do not
my phone using one-way topic easily. encourage
skype and they can hear me paranoia.
when I talk in my
apartment.
You told me that Yes, they killed her and left Patient is wearing a Seeking Patient has ideas Be understanding
these people want her at a river and I was the lot of dark makeup, clarification of grandiosity of patients
to hurt you one doing the investigation. I clothing is dark (ex: she was in perceptions but
because you know was on TV and all over the colored. charge of the do not validate/
too much about news and so because of that investigation and encourage them.
how they killed they couldnt come after me, was always on TV
your niece. Is that but now they can. and she knows
correct? too much.)
How much anxiety Well, I feel less anxious Patient is able to Exploring Anxiety is Ask about anxiety
NURS323 Mental Health Nursing

do you have right being here so it is probably remain seated in the beginning to medications and
now on a scale only a 6, but when I am at chair for long period. decrease but is when her last
from 1-10 home it is probably a 10. Patient is still very still fairly high. medication was.
jittery.
Do you have any Well, my son lives here but Patient smiles when Encouraging Patient is Help patient write
type of support he is always really busy and speaking about her formulation compliant and out a plan to
system? Like so I dont like to bother him children. of a plan of wants to work to move closer to
family members but I am thinking about action change situation daughter and help
or friends who can moving closer to my so that she can her determine
help you when daughter. get more support. what to do to
you are feeling make it happen.
anxious?
What things do Because I am native I like to Patient gets excited Encouraging Patient is Get supplies so
you do that help make dreamcatchers. I also talking about culture. formulation beginning to feel that she can make
you to cope with really like to cook. Begins to smile and of a plan of less anxious and a dreamcatcher
your anxiety? tell stories of action is able to find and encourage
different ways to help her her to start doing
dreamcatchers she cope with anxiety that more at
has made. producing home as well.
situations.

Analysis
1. Identify presenting issues. Include the clients cognitions (basic beliefs about self, others, and the world) and the
impact those had on you.
2. Identify any recurring themes and patterns, if applicable.
3. What cultural factors were you aware of during the interaction? How did these factors influence the session?
4. What specific observations should the nurse make with regard to mental status? Thought processes?
5. How did the patients behavior/affect fit with what you know about their past behavior/affect?
6. What are two issues that emerged?
7. What were your thoughts and feeling about the interaction?
8. What are the goals and functions of the therapeutic nurse-patient relationship? Explain if you feel you were able
to establish a therapeutic relationship?
9. What were the boundaries and roles in this relationship?

Reflection:
1. What behaviors did you exhibit that you would want to change, based on the experience?
NURS323 Mental Health Nursing

2. What are your feelings about the interview process?

Analysis:
The issues that this patient presented with stemmed from PTSD. The patient had delusions of people following
her and listening in on her conversations on the phone and in her home. She believed that these people were after her
so that they could kill her because she knew too much. She also had symptoms of grandiosity such as feeling that she
was the major investigator for her nieces death and that she was famous and had been on TV all the time during that
investigation. These issues impacted me because at certain times it was difficult to understand where she was
coming from because the things she said a lot of times didnt really make very much sense but to her they were reality.
This made it difficult to comprehend exactly how scared she must feel. One recurring theme that I noticed throughout
our interview was the fact that she was a little hyperactive and she bounced around from one idea to another and spoke
very rapidly which may be because of her anxiety. One cultural factor that I picked up on was the fact that she believed
in native cultural practices of healing. She also had a strong belief in the importance of forgiveness and she mentioned
that a few times during her interview. A specific observation that a nurse in this situation should make with regard to
this patients mental status was the fact that the patient had several ideas that may have stemmed from real situations
but where taken way out of proportion. This patient was able to think and reason properly although she did experience
flight of ideas. The patients behavior fit with the past patient behavior because fear and anxiety are typical behaviors
of a person diagnosed with PTSD. Two issues that emerged during the interview were first the patients fear and anxiety
that caused disruption in her daily activities and also risk of harm to others. When we were talking the patient stated
several things about not being afraid to hurt anyone that she thought would hurt her. I thought that our interaction was
a really good learning experience to help me better understand what metal illness is like for the patients that
experience mental illness. The goals and functions of a therapeutic relationship are to help the patient feel safe so that
he/she can open up and share his/her concerns so that the nurses and medical staff can help the patient progress to
mental health. I think that in my conversation with this patient we were able to establish a therapeutic relationship
because the patient was able to open up and share things about her mental illness that would help me to know how to
care for her. Finally, the boundaries and roles of this relationship were simply to help me to be able to have the
information needed to help the patient. Once the patient was helped, the relationship was terminated.

Reflection:
One behavior that I would like to change based on this experience is I would like to be more bold when I ask
questions. When questions are asked with insecurity, the patient doubts the importance of the information and may
decide not to share important information with you. Finally after this interview I feel like I have come to know more
about the importance of empathy in a therapeutic relationship. I also feel like I better understand the importance of the
nurses role in the therapeutic relationship and what the goals are that need to be accomplished.