You are on page 1of 9

Date:  9/25/15  

Client  Age/Gender:  17-­‐year-­‐old  male    
Date  of  interaction:  9/5/15  
Diagnoses:  Depression,  anxiety  disorder  
Length  of  stay:  Admitted  on  7/16/15  
 
 
 
 
Dialogue  

Pt’s  Non  Verbal  
Communication-­‐  
Behaviors  

Student:  Hi,  
my  name  is  
Gary.  I  am  a  
nursing  
student  from  
KCC.  How  are  
we  doing  
today?  
Patient:  I  am  
writing  a  book.  
I’m  on  page  42.    

Student:  
Introductory  
Maintained  
statement  
eye  contact  
with  patient  
with  hands  
together  on  
my  lap.    
Patient:  sitting  
in  a  chair  with  
legs  spread  and  
arms  to  the  
side.    

Student:  Could   Student:  

Communication  
Technique  

Open  ended  

Student  Feelings  

Student  Thoughts  

T/N  
Psychodynamics.  
Therapeutic  or  
nontherapeutic  

Analysis  
Student  nurse  
self-­‐reflection  

Nervous  

I  did  not  know  
what  to  expect  
from  my  client.  
I  did  not  know  
whether  he  
would  react  
positively  or  
negatively.    

Therapeutic    

Relieved  

I  can  get  him  to  

Therapeutic    

My  feelings  of  
nervousness  
could  have  
affected  this  
interaction  
negatively.  If  
my  patient  
noticed  that  I  
was  nervous  it  
would  have  
prevented  him  
from  being  
comfortable  
talking  to  me.  
Luckily  my  
patient  did  not  
notice  and  had  
a  lot  to  say  to  
me.  
A  

you  please  tell  
me  more  
about  this  
book?  What  is  
it  about?  
Patient:  It’s  
about  my  life  
and  what  I  have  
gone  through.  
It’s  going  to  be  
100  pages  and  I  
want  it  to  be  
published.    
Student:  Oh,  
please  go  on.  
That  sounds  
interesting.    
Patient:  I  talk  
about  how  I  got  
beat  by  my  
uncle  when  I  
was  still  living  
with  him.    
 

Maintained  
question  
eye  contact.  
Moved  hands  
to  table.  
Patient:  pointed  
to  himself.    

Student:  
Minimal  
Listened  
encourager  
attentively  to  
what  patient  
has  to  say  
about  his  
book.  
Patient:  made  a  
fist.  Patient  also  
pointed  
towards  the  
window.    

Happy  

He  is  opening  
up  to  me.  This  
is  great.  I  
wonder  what  
he  has  to  say.    

Non-­‐
therapeutic    

I  made  a  
judgment  when  
I  said,  “That  
sounds  
interesting.”  
This  is  a  
communication  
error.  An  
alternate  
response  could  
have  been,  
“please  tell  me  
more.”  

Student:  Beat  
by  your  uncle?  
Patient:  Yea,  
whenever  I  got  
home  he  would  

Student:  
Continued  to  
listen  about  
what  patient  
has  to  say.  

Curious  

What  does  he  
mean  when  he  
says  this?  How  
often  does  this  
happen?  Is  this  

Therapeutic  

I  felt  that  my  
interaction  was  
appropriate.  My  
statement  
encouraged  my  

Restatement  

open  up  to  me  
by  asking  him  
to  tell  me  more  
about  the  book  
he  is  writing.    

communication  
error  I  made  
was  asking  
multiple  
questions  to  the  
client.  I  should  
have  just  asked,  
“could  you  
please  tell  me  
more  about  this  
book?”  

always  beat  me.  
Sometimes  we  
would  drink  
alcohol  
together  
though.  It  got  so  
bad  that  I  had  
to  run  away  
from  home.    
Student:  That  
sounds  very  
difficult.    
Patient:  Yea,  I  
also  got  
mobbed  by  
these  people  in  
a  red  car.  They  
thought  I  was  
with  these  
other  guys,  but  I  
wasn’t.  I  got  so  
tired  of  getting  
beat  up  that  I  
learned  how  to  
fight.  I  joined  
three  gyms  but  
I  got  kicked  out.  
I  was  kicked  out  
for  being  
violent.      
Student:  I  
hear,  that  you  
were  beat  by  

Patient:  used  
hands  to  
gesture  
drinking.    

what  brought  
him  to  the  
hospital?  

client  to  talk  
more  about  the  
issue  in  detail.    

Student:  
Frowned  and  
gave  a  look  of  
concern.  
Patient:  Patient  
made  a  fist  
during  speech.  

Expression  of  
Empathy  

Empathetic    

This  guy  has  
Therapeutic  
been  through  a  
lot.  Maybe  this  
is  what  brought  
him  into  the  
hospital.  Maybe  
it’s  the  violent  
behavior.    

My  feelings  of  
empathy  
contributed  
positively  to  my  
interview.  I  
allowed  me  to  
understand  
what  he  was  
feeling  on  a  
deeper  level.  By  
showing  
empathy  I  was  
able  to  show  
him  that  I  was  
listening  to  
what  he  had  to  
say.    

Student:  
Gestured  with  
both  hands  

Paraphrasing  

Cautious  

I  can’t  believe  
that  he  did  all  
the  damage  he  

I  made  a  
communication  
error  of  asking  

Therapeutic  

your  uncle  and  
others  and  
that  this  
caused  you  to  
want  to  learn  
how  to  fight.  
Was  this  a  
coping  
mechanism?  
Can  you  tell  
me  what  else  
you  do  to  
cope?    
Patient:  Yea  this  
was  a  coping  
mechanism.  I  
got  angry  really  
easy.  When  I  
first  came  to  
this  hospital,  I  
was  the  worst.  
You  see  all  the  
damage  around  
here?  Most  of  
the  damage  was  
done  by  me.  
Writing  helps  
me  relax  too.  I  
also  tell  myself  
that  there  is  no  
point  in  
fighting.    
Student:  It  

pointed  
towards  
patient.    
Patient:  Opened  
his  hands  to  
indicate  he  was  
talking  about  
the  hospital.  

Student:  

said  he  does.  He  
seems  to  be  
cooperative  and  
relatively  
relaxed.    

 

Relaxed  

I’m  glad  that  he  

multiple  
questions  to  my  
client.  Rather  
than  asking  if  
this  was  a  
coping  
mechanism,  I  
should  have  
asked  only  one  
thing.  A  
correction  to  
this  would  be  to  
ask  the  client,  
“Can  you  tell  me  
what  you  do  to  
cope?”  

Non-­‐

I  displayed  

sounds  like  
you  have  come  
a  long  way.  
Patient:  Yea,  I  
like  it  in  the  
hospital.  I  don’t  
want  to  leave.    

Gestured  with  
both  hands  
towards  client  
to  indicate  I  
was  talking  
about  him.  
Patient:  pointed  
towards  the  
floor.  

Student:  I’m  
not  sure  I  
understand.  
What  do  you  
mean  when  
you  say,  “I  
don’t  want  to  
leave?”  
Patient:  I  like  it  
here,  like  I  feel  
safe.  Before  I  
came  here  I  
lived  in  foster  
homes.  I  liked  it  
at  the  foster  
homes.  They  
showed  me  
love,  but  when  I  

Student:  
pointed  to  
myself.    
Patient:  points  
to  the  ground.  
Showing  his  
hands  to  
indicate  he  has  
been  to  more  
foster  homes  
than  he  can  
count.    

likes  it  here.  
therapeutic    
After  all  he  has  
told  me  I  finally  
know  how  he  
ended  up  here.  
It  must  be  nice  
here  compared  
to  where  he  
lived  in  the  
past.    

Clarifying  
question    

Amazed  

Oh  wow!  He  has   Therapeutic  
been  to  that  
many  foster  
homes?  That’s  a  
lot.  He  cannot  
stay  here  
forever;  where  
will  he  go  and  
what  will  he  do  
after  being  
discharged?  

approval  when  I  
said,  “it  sounds  
like  you  have  
come  a  long  
way.”  This  is  a  
communication  
error.  An  
alternate  
response  could  
be,  “You  are  
saying  you  
don’t  have  a  
reason  to  fight  
anymore.  Is  that  
right?”    
Self-­‐
improvement:  I  
could  have  also  
asked  the  
patient  what  he  
likes  about  the  
hospital  that  
makes  him  
want  to  stay.  
This  will  give  
would  have  
given  me  a  good  
idea  of  what  his  
hospitalization  
has  been  like  so  
far.  

got  comfortable  
I  was  moved  to  
another  foster  
home.  They  just  
keep  moving  
me.  One  time  I  
just  stayed  in  
my  room  and  
did  not  meet  
my  parents  
because  I  knew  
they  were  just  
going  to  move  
me  again.  
Eventually  I  
came  out  of  my  
room  and  got  to  
know  them.  I  
got  moved  
again  after  that.  
I  hated  being  
moved  so  much.  
I  have  been  to  
more  foster  
homes  than  I  
can  count.    
Student:  It  
sounds  like  
you  felt  
abandoned  
because  you  
kept  moving  
homes.    

Student:  
frowned  and  
pointed  hand  
towards  the  
door.    
Patient:  anger  
expressed  in  

Reflection  of  
feelings  

Sad  

I  felt  sorry  for  
Therapeutic  
my  patient.  It  
must  have  been  
tough  to  get  to  
know  someone  
well  and  then  
have  to  

My  patients  
facial  
expression  
showed  that  he  
was  not  happy  
with  his  life  in  
the  foster  

Patient:  I  felt  
betrayed.  CPS  
does  not  know  
what  they  are  
doing.  They  are  
just  doing  
anything.    

patients  face    

Student:  It  
sounds  like  
you  have  a  lot  
on  your  mind.  
You  
mentioned  
getting  beat  by  
your  uncle,  
getting  kicked  
out  of  gyms  
and  going  
from  foster  
home  to  foster  
home.  What  
concerns  you  

Student:  made   Focusing  
a  fist  with  one   statement  
hand.  Used  
both  hands  to  
gesture  
towards  
patient.    
Patient:  
shrugged  to  
indicate  that  he  
doesn’t  know.      

suddenly  leave.    

Relieved    

I  am  glad  that  
Therapeutic    
he  doesn’t  have  
anything  else  to  
say.  What  he  
told  me  earlier  
was  a  lot  to  take  
in  already.    

homes.  It  
showed  
thinking  about  
it  gets  him  a  
little  agitated.    
My  client  felt  
betrayed  
because  of  what  
happened  to  
him  in  the  past.  
His  thoughts  
about  foster  
homes  are  
negative  and  he  
expressed  this  
through  his  
facial  
expression.  
Self-­‐
improvement:  I  
don’t  think  that  
it  was  very  
therapeutic  of  
me  to  make  a  
fist  when  I  was  
talking  about  
my  patient’s  
past  history  of  
violence.  
Another  gesture  
or  no  gesture  
with  my  hands  
would  have  

the  most  at  
this  moment?  
Patient:  I  don’t  
know.  I’m  just  
glad  I’m  here.    
Student:  Could  
you  tell  me  
about  your  
plans  after  you  
are  discharged  
from  the  
hospital?  
Patient:  I  did  
landscaping  
when  I  was  
young.  I  grew  
things  like  taro  
and  other  
plants.  
Student:  You  
want  to  work  
in  
landscaping?  
Patient:  Yea,  I  
want  to  make  
money  in  that.  I  
don’t  know  
where  I’m  going  
to  go  when  I  
leave  though.  
Maybe  another  
foster  home.    

been  more  
appropriate.    

Student:  
placed  hands  
on  lap.  
Patient:  
gestured  with  
hands  to  
indicate  
plowing.    

 

Curious  

What  are  his  
Therapeutic    
plans  after  
discharge?  
Where  will  he  
go  after?  Has  he  
given  any  
thought  to  this?    

Student:  
Neutral  facial  
expression.  
Patient:  looked  
down  with  the  
mention  of  
foster  home  

 

Hopeful  

I  glad  that  he  at   Therapeutic  
least  gave  some  
thought  to  as  
what  he  wants  
to  do  after  
graduating.    

I  believe  that  
my  statement  
was  
appropriate.  I  
wanted  to  know  
about  his  
discharge  plan  
his  plan  for  
discharge.  A  
discharge  plan  
is  important  to  
keep  the  patient  
from  returning  
to  the  hospital  
again.    
My  client’s  
nonverbal  
communication  
revealed  that  he  
was  not  looking  
forward  to  
living  in  a  foster  
home.  Looking  
down  indicates  
a  negative  
feeling  towards  
foster  homes.    

Student:  What  
else  is  
concerning  
you  at  the  
moment?    
Patient:  
Nothing,  I’m  
okay  here.  I’m  
happy.    
Student:  
Thank  you  for  
talking  with  
me.  Please  let  
me  know  if  
there  is  
anything  else  
you  want  to  
discuss  later  
on.      
Patient:  Okay  
no  problem.    

Student:  
maintained  
eye  contact  
with  patient  
Patient:  used  
hands  to  
gesture  at  self  

 

Relieved  

I  think  this  is  
the  end  of  the  
talk.  It  was  
interesting  to  
hear  all  that  he  
had  to  say.    

Therapeutic  

Student:  used    
hands  to  point  
to  myself.  
Patient:  patient  
nodded  
indicating  
understanding.    

Relaxed  

This  went  
pretty  well.  He  
did  not  mind  
sharing  at  all.    

Therapeutic    

Student:  
Thank  you  
again.    
Patient:  Thanks.  
I  will  let  you  
know  when  my  
book  comes  out.    
 

Student:  
 
Nodded  to  
express  
understanding  
of  patient.    
Patient:  nodded  
at  me.    

Happy  

I  have  to  write  
this  down  
before  I  forget.    

Therapeutic  

I  believe  that  
this  statement  
was  
appropriate  to  
assess  for  any  
further  
concerns  the  
patient  may  be  
having.  
Self-­‐
improvement:  
rather  than  just  
ending  the  
conversation  
the  way  I  did.  I  
could  have  told  
me  client  what  
time  I  will  be  
leaving  and  
how  many  
weeks  I  will  be  
in  the  family  
treatment  
center.    
It  was  
appropriate  of  
me  to  express  
my  gratitude  
for  the  patient  
time.