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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)
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)
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)
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)
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
Therapeutic
(T)
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.
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.
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)
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
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.
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
SN: I was
seated in
the chair
across the
Open Focusing
Statement
Confused I thought
Therapeutic
that the
(T)
patient had
a job
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.
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)
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
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.