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Health Alterations I

4205 Psychiatric Nursing


Process Recording
Communication is the essence of psychiatric nursing. Greater understanding of verbal
communication through observation and analysis of both the words and the body
language of each individual in an interaction leads the learner to achieve a growing
awareness and ultimate understand of the communication rocess! "he comonents of
the communication rocess include# stimulus$ sender$ message$ medium$ receiver$
feedbac% which are influenced by the sender&receiver$ ercetions$ values$ culture$
environment$ relationshi$ content$ conte't$ socioeconomic$ %nowledge$ life&family
e'eriences!
Verbal Interaction
(! "he rocess recording is a medium that allows the learner to analy)e
a! "o what e'tent does the nurse control the interaction*
b! "o what e'tent do the words of the nurse elicit or ermit meaningful
resonses from the atient*
c! +etermine if the communication was ,meaningful-$ was it client.centered
and did it assist the client to achieve a ma'imum level of health*
2! "he urose of a articular rocess recording
a! /earner may focus on communication broadly
b! /earner may focus secifically on only the learner0s 1uestions$ resonses$
aroriateness of resonses$ silence or on the words of the client
c! /earners conversation as to the tyes of 1uestions as%ed
i! +o they invite client e'ression or do they inhibit further
e'ression*
ii! +o the 1uestions elicit elaboration or a ,yes- or ,no- answer*
d! 2ord cogni)ance as well as voice intonation and modulation
i! "o what e'tent are these consistent or inconsistent with the words
Non-Verbal Communication
(! "houghts and feelings are revealed through body osition and body movements!
2! "he autonomic nervous system communicated thoughts and feelings
a! Alteration in s%in color
b! "emerature and moisture of hands
3! "he learner focus is not only on the client but on his&her self
Analysis of the Interaction: Ealuation
(! Provides an oortunity to
a! Assess both client0s and learner0s behaviors$ attitudes$ and feelings
2! +evelo awareness
a! Avoids resonding
b! 4verwhelms the client with elaborate information
c! 5hanging of sub6ect when toics that are uncomfortable to the learner are
introduced
3! 2hich events initiates verbal interaction
a! 4rder of events
4! 2hat were the words$ 1uestions$ or hrases that guided the interaction*
5! 2hich resonses or 1uestions inhibited or changed the focus of the interaction*
!he Process Recording "ill #ho$ Eidence of or A$areness of the %ollo$ing
Effectie &ehaiors
Initiating the interaction
7tates nursing diagnosis
7tates written nursing goal8s9
Guide the interaction from simle to comle'
Guide interaction away from the e'ression of delusional materials and towards
reality oriented conversation
'uestioning
:se of indirect method to gain information
;estates client0s comments$ 1uestion$ or demands
:ses direct 1uestions when aroriate
(istening
2aits out silence or allows client to fill ause
Allows client to comlete e'loration of toic
Allows client to e'ress an idea before ma%ing a comment
)bseration
Notes verbal cues
o 7ignificant oening and&or closing comments
o Abrut shift in conversation
o ;eetition of material
o /ac% of unity in comments
Notes non.verbal cues
o Gestures$ facial$ body osture$ tone of voice
o Incongruence with verbal messages
Problem #oling
o 7ummari)ation or restates goal to %ee conversation goal directed
o <ncourage client to e'ress feelings or meaning of behavior
o 7ee%s out clients0 feelings or the meaning of behavior
o <ncourages client to identify roblems$ $ithholds advice
o <ncourages client to suggest solutions and e'lore alternatives
Interpretation
o Identifies communication techni1ues= theraeutic&non.theraeutic$ etc!
o Interrets interaction based on sufficient observations in terms of factors that
influences interaction 8mental mechanisms9 or underlying causes of atients0
roblems
o 2rites interretation of learners0 own resonses and feelings
Ealuation
o ;ecogni)es use of closed 1uestion&interaction shoers
o 2rites strengths and wea%nesses
o 2rites ob6ective for self imrovement
o <valuated nursing goal of interaction
o 2as it met*
o 2hat could have been done differently
Recording Interaction
o 2rites introductory data including= setting$ client aearance$ and other
influencing factors 8medications$ theraies$ etc!9
o 2rites observations descritively
o Nurses note&charting
o ;eflects interaction of sufficient length 82 or more ages9
!herapeutic Responding !echni*ues as Related to #teps of the Nursing Process
o 4rientation
o Assessment and nursing diagnosis
Introducing self
4ffering self
Active listening
>uestioning
7ilence
<mathi)ing
;eality orienting
;estating
5larifying
4ffering reality
7tating observations
?ostering descrition of ercetions
Placing the event in time and order
@oicing doubt
Identify themes
<ncouraging comarison
7ummari)ing
?ocusing
o 2or%ing
o 4utcome identification$ lanning and imlementation
<valuating
<ncouraging lan formation
Assisting in goal setting
Providing information
4ffering alternatives
;ole lay
Providing feedbac%
5onfronting
7etting limits
o "ermination
o <valuation
<valuating actions
;einforcing health behaviors
<ncouraging ost hosital transition
Ineffectie Responses !hat +inder !herapeutic Communications
o 4ffering false reassurances
o Not listening
o 4ffering aroval
o Ainimi)ing the roblem
o 4ffering advice
o Giving literal resonses
o 5hanging the sub6ect
o Belittling
o +isagreeing
o Cudging
o <'cessive robing
o 5hallenging
o 7uerficial comments
o +efending
o 7elf.focusing
o 5riticism of others
o Premature interretation
Process Recording
,ate: -edications: Classification of -edication:
Client Initials: #ide Effects
,iagnosis: ,osage
.ender: Nursing Responsibilities
Physician:
Nursing ,iagnosis Addressed in this Interaction:
Nursing .oal /s0 of Interaction:
Introduction: /+escribe the setting in which you found your client$ what was the client
doing$ client0s dress and aearance$ client0s mannerisms9
Interaction: !his should be set up in CARE P(AN %ormat /temlate on 2eb9
(! By definition a theraeutic interaction is communication between nurse and client
where the client e'resses thought$ feelings$ or concerns! "he nurse hels the
client do this by thoughtful listening and use of facilitating communication
techni1ues while avoiding bloc%ing communication techni1ues!
2! As you assess a client you will hear cognitive and &or affective themes! "hat is$
areas where the client has thoughts$ feelings$ or concerns! Dou will discuss this
assessment data with your instructor before imlementing a theraeutic
interaction! Dou will develo a client.centered urose for the theraeutic
interaction with your instructor before imlementing a theraeutic interaction!
3! Dou will lan with the client that you will return following consultation with your
instructor! At your return to the client$ you will share the client.centered urose
with your client 8!you were mentioningEEE! I0d li%e to send more time tal%ing
about that!99
4! Dou are now involved in a theraeutic interaction! /isten and resond using the
theory of facilitating techni1ues! ;emember that this is not a time to be as%ing
1uestions$ teaching or solving a roblem! Assessing$ teaching and roblem
solving are other nursing interventions! "his is the time for you to hear what the
client is saying and hel the client hear him1herself.
5! "he theraeutic interaction should last a minimum of (0 minutes! 2hen the
theraeutic interaction is comlete you need to find a 1uiet lace to comlete
5olumns I and II of the rocess recording!
a! 5olumn I is the dialogue that went on between you and the client! :se 2
different colored in%s$ 2 different fonts to demonstrate which sentences the
client sea% and which are so%en by you also the numbering of ( for
client and 2 for student!
b! 5olumn II is for nonverbal communication of the nurse and client! "he
color$ font$ and number should match column I! "he feelings of the
student are also included in this column with a different color$ font and
number 3!
c! 5olumn III identifies the nurse0s resonses 8verbal and nonverbal9 as
theraeutic or nontheraeutic 8" or N"9! Name the secific techni1ue$
tye out the reason this techni1ue facilitates or bloc%s communication and
cite the age in source where you found that information! ;emember a
theraeutic communication does not mean that the client continues to tal%
but e'resses feelings$ thoughts or concerns about the client0s health!
d! 5olumn I@ is the evaluation of each of your resonses 8verbal and
nonverbal9 was effective or ineffective! <ffectiveness reaches the client.
centered urose not in terms of the erson %et tal%ing! "ye the reason
for your decision! If the techni1ue you used was N" and your resonse
was ineffective you must tye out a secific alternative resonse!
e! 5olumn @ is the evaluation of the whole interaction! Dou must go bac% to
the client.centered urose and determine if it has been met and identify
data$ not conclusions that suort your decision!
Ealuation of Interaction:
#trong and $ea2 points
!houghts and %eelings of Interaction
Charting %or Nurses Notes

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