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Dialogue

SN: Hello, I
am Jonathan
and I am a
nursing
student from
Kapiolani
Community
College.
Today I will
be spending
the next 1530 min with
you
discussing
the feelings
you have
regarding
your
admission
here and
your illness.
P: Sure, thats
fine.

Non Verbal
Communication

Communication
Technique

SN:
Introductory
Approached Statement
patient as
patient sat
down in
front of the
television. I
sat in the
chair
adjacent to
the patient
with a
straight
posture and
hands on
my lap. Eye
contact
maintained
on patient.
P: Patient
sitting in
chair, slightly
reclined
back,
alternating

Student
Feelings
Nervous

Student
Thoughts
I hope the
patient
isnt in a
bad mood
and is
willing to
talk to
me.

T/N
Psychodynamics.
Therapeutic or
nontherapeutic
Therapeutic
(T)

Analysis
Student nurse self
reflection
(4) I felt anxious
with the patients
nonverbal
communication
because I felt that
the patient was not
going to disclose
much information
to me just by the
divided attention
the patient was
giving me.

SN: Thank
you for
taking this
time to talk
to me so
tell me what
brought you
to Kahi
Mohala?
P: I had a fight
with my
parents, and
my girlfriend,
and I got
super mad
that I went to
the police and
told them that
I needed help
or I was going
to hurt
someone. The
police took me
to the
ER/Comprehe

vision
between me
(SN) and
television.
SN:
Repositione
d my chair
so it was
facing
towards the
patient, eye
contact was
maintained
with hands
clasped
together.
P: Patient is
making hand
motions while
talking, eye
contact
shifting
between
myself and
his hands.
Patient sitting
more upright
now.

Open Ended
Question.

Intereste
d

I wonder
what the
patient will
tell me
because I
did not see
the
patients
chart yet.

Therapeutic
(T)

(4) I was very


interested in what
the patient had to
say because I was
conducting this
interview without
having any prior
knowledge of this
patient, and the
patient was very
open and with the
patients nonverbal
communication
(frequent hand
motions to go along
with the patients
speech) I was
worried that it
would trigger the
patient to become
upset or mad.

nsive center
on the Big
Island, then I
was sent here.
SN: You
mentioned
that you got
into a fight
with your
parents and
your
girlfriend.
We will
discuss both
events, but
which would
you like to
discuss first?
P: My parents
because I
always get
into fights
with them and
they are like
the main
cause of why I
am here.

SN:
Focusing Question Intereste
Maintain
d
eye contact,
repositione
d legs to a
wider base,
hands
resting on
knees,
slightly
leaning
forward.
P: Patient
sitting down,
eye contact
is made, but
patient legs
are fidgety
and rubbing
his hand.

I wonder
how the
parents
and
girlfriend
affects the
patient.

Therapeutic
(T)

(2) Suggestion for


Improvement: You
mentioned that you
got into a fight with
your parents and
your girlfriend, tell
me more about
your fight with
them and your
feelings. I would
have rephrased my
question to this
because the way I
originally asked it
sounded more like a
closed focusing
question because
the patient could
have answered with
a one or two word
answer, so with my
rephrased
questioned, I would
have asked or
initiated an open

SN: Okay, so
tell me more
about your
feelings
regarding
your parents
and your
fight with
them.
P: Its not just
now, but like
my whole life.
Its like they
dont care
about me and
they only care
about their
religion.

SN: Active
listening,
Focusing on
client. Eye
contact
maintained
while
seated and
hands
interlocked.
P: Patient
makes eye
contact, and
leg continue
to fidget.

Open Focusing
Statement

Concern
ed

I wonder if Therapeutic
the patient (T)
is getting
enough
attention
at home
and just
seeking
attention
or is
something
wrong
between
the parents
and patient

focusing statement
that allowed the
patient to talk
about both fights
and I would have
been able to
gathering more
information
(hopefully).
(3) I feel that being
concerned and
thinking of the
possible outcomes
from the patients
response allowed
me to focus in on
what the patient
said. Prior to
initiating this
interview I did not
look at the charts
and I was on a
different unit so I
was not present for
morning report.
Thats why my
thought was as is
due to not knowing
if this was a seeking
attention problem

SN: It
sounds like
you feel
angry about
your
parents
priorities.
P: Yeah, it
does and they
like run my
life according
to their
religion and I
feel so
restricted like
I cannot do
anything.

SN:
Reflection of
Maintained
Feelings
eye contact.
Hands were
in my lap,
resting.
P: Patient
looking down
at the
ground, and
leg is
fidgeting.
Hands are
together, not
interlocked,
but more like
a high five.

Concern
ed

I wonder
Therapeutic
what kind
(T)
of family
dynamics
the patient
has with
the parents
and rest of
the family,
I wonder if
he will tell
me more.

or a family dynamic
problem.
(4) The patients leg
was fidgeting which
gave me the
impression that he
was nervous or felt
uncomfortable
talking about this.
(2)Suggestion for
Improvement: It
sounds like you feel
angry because your
parents think more
about religion than
you. This is what I
would have
rephrased my
reflection of
feelings to. With
my rephrased
version I have the
feeling or emotion
and the content
that causes it. My
original statement
kind of sounds like
its assuming that it
is a priority issue,
which I feel it is, but

SN: What
did you
mean when
you said that
you feel
restricted?
P: Like I
wanted to join
the football
team, and my
parents
signed the
waiver forms,
but they were
against it and
they told me
that I would
need to pay
for any
equipment or
hospital bills
on my own if I
got injured.
So I got a job

SN: Eye
contact
maintained,
leaning
forward,
focused on
the patient,
hands
resting on
knees.
P: Patient
not making
eye contact
very much.
Patient using
a lot of hand
movement
and gestures
while
speaking.
Patient
shakes head
occasionally.

Open Clarifying
Question

Curious

I wonder
what the
patient will
tell me and
how
serious will
it be.

Therapeutic
(T)

I felt that I should


have let the patient
tell me what the
problem was
exactly.
(3) I felt that my
non-verbal
communication
allowed the patient
to talk freely
because I was
focused on my
patient, and I feel
that my posture
was open. I think
during this
exchange I was
able to explore one
of the root causes
for the patients
illness and reason
for admission to
Kahi Mohala.
(4) The patient
seemed to be
distracted by the
thought and the
patient was using
more hand gestures
to explain the

to support
myself but my
parents told
my coach that
I forged their
signature and
told my boss
that I couldnt
work and that
I was going to
quit so I got
cut from the
team and I
lost my job.
SN: So your
parents
didnt want
you to join
football, but
allowed you
to, and you
found a part
time job, but
they directly
spoke to
your coach
and boss
telling them
that they
didnt sign

SN: Eye
contact
maintained.
Used simple
hand
gestures
(counting)
to keep
track of the
key points
of what the
patient
said.
Posture is
straight,
seated in

Paraphrasing

Confused Im not
sure what
to believe,
did I just
hear the
patient
correctly?

Therapeutic
(T)

situation. The
occasional head
shakes portrayed a
sense of
disapproval and
anger. The patient
had a full affect and
portrayed some
what of a pressured
speech pattern, and
by the tone the
patient used, this
really affected him
greatly.
(3) I feel that I
needed more
clarification about
the situation, and
after hearing what
the patient said, I
needed to
paraphrase what he
previously said to
make sure I wasnt
misunderstanding
anything. I was
confused, well more
like shocked
because the patient
said that the

your forms
and gave
your boss
doubts that
you werent
going to
work for
long and
therefore
you lost your
job and got
kicked off
the team.
P: Yeah, and
like that
caused more
problems for
me and
everyone else.

SN: More
problems?

seat.
Focused on
patient.
P: Patient
seating down
in chair,
slightly
leaning back,
hands in lap,
legs
stretched
out. Patient
rubbing
hands
together
again.

SN:
Focused on
the patient,

Restatement

Concern
ed

I wonder if
the
problem

Therapeutic
(T)

parents allowed him


to play football, but
later told the coach
that they didnt
sign the form and
that the patient
forged the
signatures.
Whether I believe it
or not is another
aspect, but just
listening to the
patients story,
confused me, like
does this really
happen?
(4) How the
patients non-verbal
communication/
posture was I felt
that the patient was
trying to calm down
or relax a little after
telling me more
about the
relationship he has
with his parents.
(3) I felt concerned
for the patient
because I had a

P: In January,
I was
supposed to
come here
because I
tried to
overdose on
whatever
medicine I
could find in
the house, but
my parents
told the social
worker that I
didnt need to
go and that
they would
help me.
After, all my
parents said
was that I
need to go
back to the
church so they
could help me.
SN: Please,
go on.
P: Thats
what my

eye contact
maintained.
Seated.

became
worse and
how is the
patient
coping with
this.

P: Shaking
head
occasionally.
Legs
fidgeting.
Hands
interlocked.
Patient
makes eye
contact but
closes eye
once in
awhile during
conversation.

SN: I
straightene
d my
posture
from

Minimal
Encourager

Nervous

I hope the
patient
doesnt
have an
outburst or

pretty good feeling


that the patient
wasnt too happy
about talking about
the parents, and
how he portrayed a
lot of nervous
nonverbal
communication
signs, but I felt that
the patient was on
the verge of telling
me important
information, which
is why I felt that
showing concern,
and my body
language helped
the patient push
through and talk to
me.

Therapeutic
(T)

(3) I feel that


changing my
posture, and using
a minimal
encourager allowed

parents
always tell
me. They will
help me only
if I go back to
the church,
but I dont
want to be like
them, I want
to live my life
normally, but
because of
their rules and
strong
religious
beliefs, I feel
helpless like I
have a rope
around my
neck like a
leash and Im
pulled back
whenever
they dont
want me to do
something.

leaning
forward to
sitting up
with eye
contact
towards the
patient, and
hands on
my lap.
P: The
patient
switched
between
making eye
contact with
me to looking
away (looking
at the ground
or at his
hands). The
patient used
hand motions
to express
feelings such
as the rope
around the
neck and
being pulled
back.

become
angry
talking
about
this.

the patient to tell


me what exactly
triggered his past
substance abuse,
and this admission.
I think that if I
showed more
nervousness and
kept my posture
closed (hands
together and
leaning forward),
the patient might
not have disclosed
all this information
to me.
I also wanted to
comment on the
Cognitive
Behavioral Model
where I connect the
patients, thoughts,
feelings, and
behaviors together.
I feel that this
whole interview
sheds light on why,
but the last
exchange (see

SN: It
sounds like

SN: Eye
contacted

Reflection of
feelings

Empathe
tic

I thought
about how

Therapeutic
(T)

above), this
exchange, and the
next couple of
exchanges shows
what the patient
thought (wanting to
live life, have
support from the
parents, but not
getting it), feelings
(patient felt
restricted like
having a rope
around the neck
like a leash, and
being pulled back
when he couldnt
do something), and
behavior
(previously tried to
overdose on
medication from
cabinet, and this
most recent event
leading to
admission, going to
the police asking
for help.)
(2) I feel that a
better technique I

its very
frustrating
for you.
P: Its like
that all the
time, my
parents get
mad at me if I
dont go to
the church,
and my dad
yells at me
saying he
cant wait till I
turn 18 and
move out
because I will
be on my own.
To top it off
the day I went
to the police, I
was already in
a bad mood,
and my
girlfriend and I
had a fight
and she said
that we were
going to break

maintained,
hands
resting on
knees.
Turned my
head to
check the
time to
make sure I
wasnt
keeping
patient
from any
activities.
Focused on
patient
primarily.
P: Patient
continued to
divide
attention
(eye contact)
between me
and his
hands.
Patient was
thump his
feet and
bobbing his

my mom
was really
strict with
me
growing
up.

shouldve used was


expression of
empathy. By
changing my
statement to That
must have been
frustrating for
you, it should
convey a feeling of
empathy, aids in
building rapport,
and allows the
patient to explore
the feelings more.
(3) Without making
a communication
error, I could
understand a little
about how it is to
have strict parents,
Im not normalizing
the patients
feelings or
situation, but I had
my fair share of
arguments with my
parents, and I just
felt like I
understood a little.

up and that
sent me over
the edge.

head slightly.

SN: What
did you
mean when
you said
over the
edge?

SN: Eye
contact
maintained.
Posture is
straight.
Feet flat
against the
floor.
Maintained
focus on
patient.

P: Like, I was
already
feeling down
and to hear
that my
girlfriend, the
person who I
tell everything
to and who
knows how to
make me feel
better, wants
to break up
with me, I just
felt that I was
at my lowest
and I didnt
know what to

P: Patient
covered his
face, and
wiped it with
his hand
(sweat?).
Patient made
eye contact
with me,
hands were
interlocked.

Open Clarifying
Question

Concern
ed

I wonder if
the patient
had a
meltdown,
or is the
patient
suicidal?

Therapeutic
(T)

Thats why I felt


empathetic and
wanted to use an
expression of
empathy.
(4) I initially
thought that the
patient was going
to cry because the
patient covered his
face initially after I
asked him the
question. However
he was just wiping
sweat away from
his forehead. The
patient seemed like
this was still
sensitive to the
topic so whatever
the patient told me,
I wouldnt probe too
much, unless
required.

do.
SN: This
must have
been very
difficult for
you. Earlier
you
mentioned
that you
previously
tried to
overdose on
medication
from your
cabinet at
the
beginning of
the year
related to
another
fight with
your
parents, and
you just
mentioned
that fighting
with your
parents now,
and fighting
with your

SN: I was
sitting
straight up,
with my
hands on
my knees,
and my feet
flat on the
group. Eye
contact
maintained.
P: Patient
was leaning
forward and
watching the
television,
but when I
asked the
question, the
patients
posture and
body
language
changed.
Patient was
more upright
and hands
were clasped,

Closed question

Anxious

What will
Therapeutic
the patient (T)
say, or how
will the
patient
react to
asking

(2) Suggestion for


selfimprovement: I
connected the
patients past hx of
overdosing to his
current problem to
have a smoother
transition, but after
thinking about it
while doing this
process recording, I
felt that it might
have been
confusing and
perhaps led the
patient to think I
was referring to
that event and if
the patient was
suicidal now due to
his past overdose
attempt. I could
have rephrased my
question as do
you have feelings of
suicide or harming
others now?
rather than linking

girlfriend
made you
feel really
low and you
didnt know
what to do.
That being
said, do you
have any
feelings of
committing
suicide now?
P: Not now,
but back then
I just wanted
to numb my
feelings
because I
couldnt take
it.
SN: Tell me
more about
your feelings
regarding
suicide or
self-harm in
relation to
your
admission to

almost
between his
knees.

SN: Eye
contact
maintained.
I was
seating
straight up,
hands in my
lap. I had
to wipe my

a past event to my
original statement.
I feel that with my
rephrased question,
its straight to the
point and I am able
to assess the
patient for SI/HI in
this moment.

Communication
error: Topic
change

Anxious

Talking
about
suicide, I
thought of
completing
a TM33,
but maybe
I should
wait till

Nontherapeutic
(N)

(1) Therapeutic
technique, but I
continued to remain
focused on suicide
even after the
patient answered
my question
previously (topic
change). I felt that

this facility.
P: Its hard
dealing with
my parents,
and it
becomes very
hard to live
my life under
strict rules
and parents
who puts
religion over
me. I dont
want to die
and thats
why I went to
the police for
help before I
did
something.
Being here is
better than
being with my
parents. I feel
safe and the
staffs help me
with thinking
positive and
dealing with

forehead
during this
exchange
due to
sweating.
P: Patient
was more
attentive and
maintained
eye contact
with me.
Patient was
tapping his
foot on the
ground.

after.

it was pertinent to
explore the
patients feelings
regarding suicide
and self-harming
since the patient
has a history of
substance abuse.
Im aware that the
patient already said
that he is not
suicidal, but I
wanted to hear his
thoughts regarding
suicide and how his
actions can affect
him in the facility
and his potential
discharge.
I could perhaps ask
the patient, Tell
me how your past
attempts of
substance abuse
make you feel
regarding you
admission to Kahi
Mohala, plan of
care, and

my worries
and feelings. I
cant wait to
turn 18
because I
wont need to
listen to my
parents, and I
want to find a
part time job
and work,
save up and
go to college.
I just want to
be
independent
and live life
like everyone
else.

SN: You just


mentioned
some goals

discharge. This
would be a open
focused statement,
and If I were to ask
this question I think
I wouldve gotten
similar if not the
same information
as what the patient
said in the dialogue.

SN: Seated
in front of
the patient,

Open Focusing
Statement

Intereste
d

How will
the patient
work with

Therapeutic
(T)

Even though my
original dialogue
was an error the
patient was very
talkative and told
me more than I
expected, but if it
was a different
patient, I feel that
this wouldve led
me to problems
such as the patient
being guarded or
get agitated that
Im asking the same
question.
(4) The way the
patient was sitting
and his body

that you
have in mind
once you get
discharged;
tell me more
about those
goals and
ways to
achieve
them.

hands on
my knees,
feet flat on
the ground.
Eye contact
maintained
on patient,
except
when I
checked the
surrounding
P: When I
to maintain
came here,
safety and
the doctor or
privacy for
whoever
the patient.
talked to me
This was
first, said that done before
I was
I started my
depressed and dialogue.
I had an
option to start P: Patient
some
remained
medications
silent for a
for it, but I
little while
didnt want to. during the
After that the
time I
staff like the
checked the
lady over
surrounding.
there teaches Patient was
us about
more relaxed

the staff
and doctor
to meet his
treatment
plan goals
and be
discharged.

language made me
think if he was
relaxed talking with
me, or if he was
tired or bored of
talking. He was
primarily focused
on the television
until I started
talking again, but
his body language
didnt change
except when the
patient talked to
me, he made eye
contact with me,
but once in awhile
the patient would
look up at the
television. I wasnt
sure how focused
the patient was on
the our
conversation which
allowed me to
structure my
following questions
the way I did to
engage the patient
more.

different
techniques on
how to think,
meditate, and
cope with our
problems. If I
work with my
doctor and the
staff and show
good behavior
and can
demonstrate
that I can
properly cope
with my
feelings and
problems, I
think I can get
discharged
soon, and
once that
happens I can
try start to do
all the stuff I
told you like
finding a job.
SN: Earlier
in our
conversation
you

and had arms


rested on the
backrest of
the chair.
Patient was
watching
television
again until I
started
talking.

SN: I was
seated in
the chair
across the

Open Focusing
Statement

Confused I thought
Therapeutic
that the
(T)
patient had
a job

(3) During this time


in our interview I
was confused
because the patient

mentioned
that you
previously
had a job
but your
parents
prevented
you from
keeping it
and you
mentioned a
couple times
that once
you turn 18
you will be
able to do
what you
want. Tell
me more
about your
feelings and
concerns
about these
factors in
regards to
how it will
be different
now or when
you are 18
compared to

patient. I
was leaning
forward
with my
hands at my
side.
Maintained
eye contact.
Had to wipe
my hands
on my pants
because
they were
getting a
little moist.
P: Patient
was leaning
forward in
the seat,
hands resting
on his lap.
Patient was
intermittently
clapping his
hands and
eye contact
was focused
on his hands
rather than

before but
the parents
prevented
him from
working,
how is this
going to be
different.

was talking about


the desires to be
independent and
doing what he
wants. Im not too
sure when the
patients birthday is
but according to the
patient its not for
another several
months. Especially
during an acute
stay, once the
patient is
discharged, the
patient will be sent
home to parents,
and what has
changed between
the patient and
parents that will
allow him to keep a
job. Earlier the
patient said that
the parents are
focused on their
religion and refers
to the church in
helping and solving
problems. This

before.
P: According
to my parents
religion, once I
am 18, they
cannot tell me
what to do,
Im considered
an adult.
They cannot
tell me that I
have to go to
the church or
remain in my
religion. Im
aware that
finding a job is
kind of hard
right now and
that its
expensive in
Hawaii, but I
have some
friends like my
girlfriends
parents who
offered to let
me live at
their house

me.

makes me wonder
how things will
change once hes
back home or when
the patient
becomes 18, if it
will change. I asked
this question to
spark some
thinking in the
patient to see if his
story is congruent
to what he told me
thus far, and to
determine whether
he realizes the
difficulties of trying
to be independent
at a young age.

and help me
get a job and I
can pay rent.
SN: Towards
the
beginning of
the
conversation
you
mentioned
that your
girlfriend
broke up
with you,
tell me more
about how
the break up
has
impacted
your feelings
and what
you want to
do here and
after
discharge.
P: I did say
that my
girlfriend
broke up with

SN:
Open Focusing
Seated, feet Statement
flat on the
ground,
hands on
my lap.
Maintained
eye contact.
P:
Maintained
eye contact,
patient was
leaning
forward, arms
rested on his
laps, hands
clasped
together.
Patient did
check the
clock couple
of times to
check the
time.

Curious

The
patient
said that
his
girlfriend
broke up
with him,
but he still
is referring
her as a
support
system
along with
her
parents.

Therapeutic
(T)

(3) Initially when I


brought up the
topic of the
girlfriend breaking
up with him, I
wasnt sure what to
expect. I was
curious as to what
the patients
answer would be
because the patient
and the girlfriend
broke up but in
the patients
response the
patient is still using
her and her parents
as a support group
like they were still
together. Thats
why I asked this
question because I
wanted to verify
whether the patient
understood what
has happened and
they might not be a

me, but it was


a mistake, I
didnt
understand
completely
because I was
already in a
bad mood, but
she was still
trying to help
me, and kept
in contact with
me when I
was at the
ER/Comprehe
nsive center
back on the
Big Island. I
just told you
how I felt in
the moment.
So we are not
broken up,
and her
parents are
willing to let
me stay there
once I get
everything
settled here.

possible support
system anymore, or
if the patient would
shed more
light/information
regarding the
situation with the
girlfriend. I am glad
that I did because I
got the patients
insight about the
situation and per
patients response,
they are not broken
up and he has some
form of support
rather than the
patients family.

SN: It
seems our
time is up,
according to
the schedule
you have
group
activities in
a bit. Before
we conclude
our
conversation
I just wanted
to say thank
you for
sharing your
personal
feelings and
story behind
your
admission
here. We
discussed
the event
that
triggered
your
admission
here, a little
about the

SN:
Summarizing
Remained
seated,
facing the
patient
while
summarizin
g our
conversatio
n. I used
simple hand
motions/ges
tures such
as using my
fingers to
keep track
of what we
discussed.
I stood up
along with
the patient
and walked
patient to
the group
activity.
P: Patient
was sitting
down,
leaning

Confiden
t

I was able Therapeutic


to get a lot (T)
of
information
about my
patient
through
our
conversatio
n.

(3) I feel that using


a summarizing
technique and
sitting up in the
chair and using
more hand gestures
portrayed a more
confident
appearance. I also
showed the patient
that I was listening
and was able to
mention each topic
we covered. I feel
that this also
helped the patient
and I develop a
better rapport. The
patient was more
relaxed as well. I
felt this MSE turned
PR turned out really
well, and I explored
a lot of areas of the
patients
psych/social life.
I also think that my
exchanges with the
patient (our

history of
your family
dynamics
that triggers
your
feelings/tho
ughts, your
short and
long term
goals you
have while
here at the
facility and
after
discharge,
and
potential
support
systems that
can aid you
in reaching
your goals. I
will be here
on the unit
for a little
while more
so if you
want to talk
or have any
questions or

forward,
hands
together.
One of the
staff came by
to give him a
snack, which
he took and
started
eating as I
was talking.
Patient
maintain eye
contact with
me while I
spoke, and
got up with
me as we
walked over
to the group
activity.

conversation) really
focused on the
important aspects
of the problem. We
focused on
discharge, goals,
triggers, cause of
the admission, and
more.

concerns,
please feel
free to talk
to me or any
of the staff.
Once again,
thank you
for taking
this time to
talk to me
and take
care.
P: No problem
man, thanks a
lot too. Take
care.

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