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MENTALHEALTHNURSING

PROCESSRECORDINGGUIDE

Theinteractionbetweenthenurseandthepatient,asyourecall,isrecordedandexaminedinthe
processrecordingCthatis,arecordoftheongoinginteraction,the processoftwopeoplerelatingwith
eachother.Therecordingincludesadescriptionofthepatient'snonverbalandverbalbehaviors,the
nurse'sresponse,identificationofthetherapeutictechniqueusedbythenurse,andanexplanationofthe
nurse'sevaluationandinterpretationoftheinteraction.
Themajorelementsoftheprocessrecordingarereviewedhere:

Patient'sNonverbalBehavior:
First,noticethepatient'snonverbalbehavior,becauseitoftenspeakssomuchmoreloudlythanthe
patient'sactualwords.Lookatthepatient'sappearanceCisclothingappropriatetotheweather,the
activity,theplace?Arejewelryandmakeuplikewiseappropriate?Isthepatientneat,clean,freeof
odors,etc?
Next,lookatthepatient'sbodylanguageCishesmiling,laughing,crying,maintainingatensefacial
expression?Ishispostureerect,stooped,slouched?Doeshewalkrapidly,shuffling,notmoveatall?
Arehisbodymovementsslow,fast,jerky?Whatarehismotoractivities(kickinghisfootagainstachair,
fallingasleepduringaconversation,etc.)?Isthepatientabletoestablisheyecontactwithyou?Does
talkingaboutcertaintopicscausetheeyecontacttoincreaseordecrease?Aretheresignsofanxiety
(moistpalms,restlessness)?
Basedontheseobservations,youmayassessthepatient'saffect(orfeelingtoneCareflectionof
mood).Ishehappy,sad,lonely,apathetic,cheerful,angry,etc.?Ishisfeelingtoneappropriatetothe
situationandrecentevents?
Youmaymakemanymoreobservationsofnonverbalbehaviorandincludetheminyourprocess
recording.Thebehaviorsmentionedhereareonlytoserveasaguide,abriefoutlinetohelpyougather
ideastogether.

Patient'sVerbalBehavior:
Now,considerthepatient'sactualconversationwithyou.Whileyouaretalkingwiththepatient,
thinkaboutthefollowingpointsandincludetheminyourassessment:
1. Noticethepatient'stoneofvoiceCisitsoft,harsh,commanding,frightened?

2. Arethepatient'sconversationsappropriatetothepersonshe'swithandthesituationhe'sinCfor
example,inthemidstofabaseballgame,doeshebegintocryandtalkabouthisrejectionbyhis
mother?
3. ArehismoodsexpressedappropriatelyCthatis,doeshelaughorcryinresponsetohearingavery
sadstory?
4. Arehisthoughtsandideasconnectedandfollowingalogicalorder,ordisconnected,hardto
follow,etc.?
5. Doeshisconversationdemonstratethatheisrealityoriented(thatis,intouchwithreality)and,
therefore,awareofwhoheis,whereheis,whootherpeopleare,andwhatmonthandyearitis?
Whatdoesthepatientactuallysay?
Onceagain,considertheseverbalbehaviorshereassessedtobeamereguideforyou.Pleasedonot
berestrictedbytheguide,foryoumayhavemanymoreverbalbehaviorsofyourpatientthatyouwishto
record.Butremember,themoreaccuratelyyourecordthe patient'sactualwords,theeasieryouwillfind
ittounderstandthecommunication.

Nurse'sResponse:
Aninteraction,asyourecallfromyourexperiencewiththerapeuticcommunication,byitsnature,isa
twosidedevent.Forexample,thepatientmayseemtoexhibitcertainnonverbalandverbalbehaviors
whenalone. However,thesebehaviorsare,inactuality,aresponsetononverbal(and/orverbal)stimuliin
theenvironment!Theseinfluencescanincludesuchthingsasrulesandregulations,punishmentsor
rewardsforbehavior,andveryimportantly,theverbalandnonverbalbehaviorofyou,thenurse.
Asyourselfawarenessincreases(anditwill!):
1. Youwillprobablyfindyourselfreflectingonyourownbehaviorinspecificsituationsand
wonderingwhyyourespondedtoyourpatientinthiswayorthat.Also,whyyourpatient
respondedtoyouinthiswayorthat.
2. Youmaywanttorememberwhatyousaidinresponse toyourpatient'sverbalizations.
3. YoumayalsowanttoknowwhatnonverbalcuesyouhavetothepatientCwhileyoutoldthe
patientthatyouweregladtoseehim,didyourvoicesoundstrainedordidyoubegintowring
yourhandsanxiously?TheseverbalandnonverbalresponsesCobjectivelydescribedandwhether
theyactually Amatch@oragreewitheachotherCwillgiveyouandyourinstructorimportant
informationtoassessyourprogressioninusingtherapeuticcommunicationtechniques.

TherapeuticTechnique:
Throughoutyournursingprogram,youhavebeenlearninghowtointeracttherapeutically
withyourpatient.Learningbetterandmorehelpfulwaystocommunicateis(andwillbe)a
neverendingprocessinyournursingcareer.
Youstartedstudyingaboutcommunication,includingthosetechniqueswhicharetherapeutic
andthosewhichblockcommunicationinyourfirstnursingcourse.Atthispoint,youmaywant
toreviewthosetechniquesandblocks.
Forexample,yourpatientmayspeaktoyouinawaythatisillogicalandconfusing.You
wouldwanttostophisflowofconversationtoaskhimtoexplainandclarifyingreaterdetail.
Thetherapeutictechniqueusedinthisinteractionwouldbe Aaskingforclarification.@
Inanothersituation,yourpatientmaybegintorevealsomeofhisdeepestfeelings.Ifyou
becameanxiousandcouldn'ttoleratewhathewassaying,youmightinterruptbychangingthe
subject.Changingthesubjectinthisparticularsituationwouldprobablyloweryourownanxiety
butmostlikely Ablock@furthercommunicationwithyourpatient.
Remember,theProcessRecordingisalearningexperienceforyou.Itwouldbemosthelpful
toyouifyouhonestlyrecordthetherapeutictechniquesandthosetechniquesyouusedwhich
blockedcommunication.

EvaluationandInterpretation:
Asyouwriteyourprocessrecording,certainthoughtsmaycometoyourmind.Youmay
wanttostatewhyyoudidorsaidaparticularthingorwhyyouneglectedtodoorsaysomething.
Youmaywishtocommentonwhataparticularflowofbehaviormeans,asyouinterpretit.You
maywanttosuggestanothertherapeuticactionthatmighthavebeenmorehelpfulthantheone
youchose.Bypracticinginmakinginterpretationsofyoursandthepatient'sbehavior,youwill
developnewwaysoflookingateventsandnewinsightsintobehavior.