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Therapeutic Communication: Process Recording

Shawnee Cuthbert
Cedar Crest College


Therapeutic Communication: Process Recording

On February 10, 2014, at lunchtime, this nursing student met the client. R.R. is a 62 yr.
old woman from Allentown who was admitted to the hospital the night before with the chief
complaint of severe abdominal pain. R.R. was selected to be interviewed because she was sitting
up in a chair, having just finished lunch, and appeared alert and receptive to being interviewed.
This was the first time the nursing student met R.R. This paper will discuss what this nursing
students thoughts and feelings were going into the first nurse-client interaction at the hospital.
The paper also discusses what the goals were going into the meeting and what outcomes this
nursing student was hoping to accomplish. Included in the paper is a five minute transcription of
the conversation that took place between this nursing student and the client.
Thoughts and Feelings
My thoughts and feelings, as a new nursing student, were varied. The night before
clinical, I felt nervous and anxious, as this was my first time interviewing a client or even
meeting a client. Physically, I felt my stomach jumping a bit and I had a little trouble getting to
sleep. However, I also felt excited in a very positive way and really wanted the morning to arrive
quickly. This was my beginning, my first attempt at interacting in a nurse-client relationship, and
I wanted to do this in an effective and compassionate manner. Yet I was a little concerned that I
would not have the comfort level to do this. My mother recently died of pancreatic cancer, and
this patient could possibly be a cancer patient as well. I know it is important, as a nurse, to be
professional and to keep our personal story and feelings out of the equation; but, as a student on
my first attempt at therapeutic communication, I could not help but have some thoughts of my
Mom enter my head. The morning of the interview I felt positive and really good but I couldnt
drink any coffee or eat because my stomach was a bit upset. When we went up to 5T and began


walking around looking for a client, I felt really good and very excited, until Professor Weeks
gave me a nudge and told me to take the client in the room next to where we were standing. My
heart went thump but Im not one to back away from a challenge so I knocked on the door and
began my first nurse-client interaction. Surprisingly, my nerves faded immediately and I felt
Goals and Outcomes
This nursing student wanted to use newly learned therapeutic communication techniques
and be able to maintain a professional nurse-client conversation. One of the goals this nursing
student wanted to accomplish during the nurse-client interaction was to use active listening by
maintaining good eye contact, focus conversation on the client and nod to show interest in what
the client had to say. Another goal was for this nursing student was to use awkward silences to
encourage the client to reflect on thoughts and build on the conversation. This nursing student
wanted to establish trust and to use therapeutic touch appropriately.
The outcomes this nursing student set were:
The nursing student will maintain a client-centered discussion for the entire 5 minute discussion.
The nursing student will use therapeutic touch 3x during the 5 minute conversation.
The nurse will actively listen by maintaining eye contact for the 5 minute conversation, nodding
and leaning forward for at least 5x during 5 minute discussion.
The nursing student will use at least three awkward silences to practice therapeutic


Nurses behavior


Patients behavior


(I knocked on the open

door, I peeked my head
into the room and

I knocked to give the

client privacy. I
peeked into the room
because the client had
a no-contact, C. Diff
card on her door and I
wanted to make sure
she was able to talk
before donning PPE. I
smiled because I
wanted to present
myself as friendly to
make the client feel

(The client looked up

from her chair, smiled
back, raised her
eyebrows and made
eye contact. She was
on the phone.)

The client was

receptive to a visitor.
Client appeared eager
to find out what I was
doing. The clients
gestures were inviting
and she hung up the
phone to meet me.

Hello, my name is
Shawnee. Im a nursing
student with Cedar
Crest College. Do you
have about 15 minutes
to talk with me?

I introduced myself to
be polite and socially
appropriate. I
mentioned my college
and that I was student
to be professional. I
estimated the time
frame for the
conversation in order
for the patient to
decide if she wanted to
talk to me.

(The client sat up and

waved her arm in an
inviting manner.)

(Entered the room and

donned the PPE.)

I wanted to offer an
explanation for putting
on the PPE in case this
made the patient feel
intimidated. I felt that
being direct was most
appropriate. I donned
the PPE due to the
pending C. Diff

(The client nodded and The client eased my

watched me put on the concerns by smiling.
PPE. Client smiled.)
Client nodded to
show understanding.
I know the routine.
Client watched me
patiently to give me
time to set up without
feeling rushed.

I need to put on the

gown and gloves for
infection control.

I have to go.
Someone is here to see

Absolutely! Please
come in.

The client was

genuinely happy to
have company. The
client was very open
and friendly. The
client was excited to
see why I was there to
speak with her.

(I approached where
she was sitting and
noticed there was no
other chair.)

I wanted to get closer

to the client to see if
she finished her lunch.
I also wanted to get
move to a more
personal distance. I
wanted to be
respectful and not sit
down without her

(Client extended her

arm towards the bed,
shaking her head and

This was a way to

show her my interest
in what she had to say.
I wanted to facilitate
active listening. I
needed to be honest in
This is my first
regards to my status as
semester, and my first
a student so she was
time meeting a patient. aware of my
limitations and
establish trust.

The client sat upright

and smiled broadly.)

(I redirected the
conversation to be
about her.)

This was an attempt to

keep this a clientcentered conversation.
I wanted to show
concern for her health.
This was an openended question to get

(Smile faded.)

This was to allow the

client time to reflect. It
gave her time to add
more to her statement
or share other feelings.
The silence also gave

(Client nodded, then

she perked up.)

Would you mind if I

sat on the end of your

(I leaned a bit towards

her and made eye
contact, smiled, then
responded to her

So what are you in the

hospital for today?

(I waited about 10
seconds after she spoke
to respond.)
Being back in the
hospital must be scary
for you.

Not at all. Please sit

down. How far along
are you in school?

Oh how exciting!
What do you want to
talk about?

I had really bad

stomach pains last
night. It felt like bad
constipation but I
think its because I
have metastatic breast
cancer. I found out last
time I was here that it
spread in my bones
and other places.

It is, but my family

keeps my mind off it
and they keep me very

Client was inviting

me to sit down. Client
shook her head to
overtly say no, that I
wasnt being intrusive
in asking to sit down.
The client asked to
show interest in me.

The client seemed

surprised. The client
was excited to help
me. The client
actively engaged in
the conversation by
beginning it.

The client was

reminded of her
illness and became
sad. The client knew
her condition and
appeared concerned
she was getting
worse. The client
knowledgeable about
her condition.
The client was
introspective during
the silence. The client
quickly regained her
positive attitude. The
client directed the


me time to get my
feelings under control
and gather my
thoughts before I
spoke. I wanted to
show empathy for her
(I sat up a little
straighter and smiled.)
Do your children that
live around here, too?

(I leaned forward again

and briefly touched her
Ten grandchildren?
Wow, they must keep
you busy.

(I laughed and nodded.)

Is he the youngest?

conversation to her
family and away from
her illness.

This change in posture

showed I was
intrigued and
interested. Smiling
showed I was engaged
in the conversation.
Asking about her
children kept the
conversation clientcentered.

(Clients smiled and

raised her eyebrows.)

I kept this touch brief

in order to stay within
her comfort zone.
Leaning forward
showed maintained
interest in her.
Restating the number
of grandchildren
showed I was actively

(The client sat back in The client was

her chair and laughed.) enjoying interacting
with me. The client
Oh no, nine of them
was engaged in the
are easy, its that one
conversation. The
grandson of mine that client wanted to speak
keeps me jumping.
about her one

This showed that I was

actively involved.
Nodding in agreement
showed that I
understood what she
was implying. Asking
for more information
showed that I was
actively participating.

(The client shook her

head slowly, tilting her
head down a bit,

I have five kids that

are all around the area.
Four boys and one
girl; and, 10

No. The youngest is

two months old. My
terror of a grandson is
four and hes my
daughters son.

The client enjoyed

talking about her
family. The client was
excited to tell me
about her family.
Giving numbers, the
client was proud of
how large her family

The clients gestures

showed she was
proud and amused
about how her
grandson is. The
client was enjoying
the conversation. The
client added more
information about the

(I raised my eyebrows,
smiled and nodded.)
It sounds like youre
close to your daughter
and her family?

(I sat back a bit and

tilted my head.)
That must be great for
you to see her and your
grandkids a lot.

(There was a pause in

the conversation. I readjusted my gloves a
bit and broke eye
contact, then regained
eye contact before I
I really enjoyed
hearing about your
family. They sound

This gesture showed I

was genuinely
interested. Open-ended
question/statement for
client to elaborate on
her family. This also
kept the conversation
client-centered though
I wanted to add with
my own family.

(The client smiled

warmly and nodded.)

This showed I admired

her family for being so
close and helpful.
Staying positive kept
the conversation
engaging. My
statement reinforced
that I had heard and
understood her.

(The client sat back

and relaxed her
shoulders, looking

The pause was an

awkward silence. My
movements showed
the silence was a bit
uncomfortable. I
restarted the
conversation, keeping
it positive and upbeat.

(The client looked

down and then looked
towards the window
during the silence. She
quickly regained eye
contact when I spoke.)

We are very close.

She is my personal
caregiver so I get to
see her a lot.

It is. My daughter
and I sometimes do
battle but shes always
there for me.

Its a pleasure talking

about them. I also
have sisters who live
nearby too. Thats who
I was on the phone
with when you came

The client is
appreciative for her
daughter. The client
wanted me to know
how close she and her
daughter are. The
client displays a lot of
love for her family.

The client seemed

proud of her family
and the time she
spends with them.
The client clarified
that sometimes there
are difficulties. The
client ends thought by
restating how she has
a close, good
relationship with her
The silence was not
sad for the client but a
time to think about
what more to say. The
client was eager to
continue with our
conversation. The
client added more to
keep the conversation

(I leaned forward and
touched her hand.)
You are so blessed to
have so many
wonderful people who
love you.

(The phone rang. I

gestured that I would
leave. I quietly
removed my PPE and
washed my hands, then
left the room.)
Thank you so much
for speaking with me. I
really enjoyed it. Goodbye.

This was therapeutic

touch to reinforce that
my words were
sincere. Leaning
forward was to reach
for her hand but also
shorten the personal
space. I felt I really
connected with the

(The client smiled and

patted my hand with
her free hand.)

The phone was an

conversation ender. I
gestured to give her
respect and not
interfere with her
phone call. I
whispered my
departing words and
quietly removed PPE
to show respect.

(The client seemed

surprised but pleased
to hear the phone

I really am. In fact,

my daughter will be
over to see me right
after work and my one
sister will be coming
up tomorrow.

Oh, thats my sister

calling back. Thank
you for coming by.
(Client smiled and
began telling her sister
about my visit.)

The client smiled to

show appreciation.
The client
reciprocated the
therapeutic touch
which showed she
gained comfort from
it. The client kept the
conversation on her
The client wasnt sure
if she should answer
the phone at first. The
client was enjoying
our conversation but
knew her family was
calling. The client
showed me she was
happy with our
conversation by
telling her sister right
away about it. The

This nursing student achieved the outcome of maintaining a client-centered discussion for
the entire 5 minutes, except when the client began speaking while this nursing student was
putting on PPE. When the conversation started with the client asking about this nursing students
school, the student quickly directed the conversation to the client. The nursing student also
achieved the outcome of actively listen by maintaining eye contact throughout the discussion,
nodding and leaning forward for at least 5x during the conversation, when it was appropriate.
This nursing student did not accomplish using at least three awkward silences to practice
therapeutic communication. The conversation flowed easily and there were only two breaks in


the conversation where silence was appropriate for this nursing student to use. Another outcome
not achieved was using therapeutic touch three times. This was an attainable outcome but this
nursing student has difficulty completely being comfortable around people. The client was very
pleasant and made it very easy for the nursing student to relax and be more open. The two
therapeutic touches that were used didnt feel completely genuine. This nursing student didnt
want to come across as feigning interest or forcing therapeutic behaviors so only two touches
were used where the student felt comfortable.
This student nurse is not typically able to keep a conversation going with a stranger and is
not able to keep the conversation completely about the other person. In stepping out of this
nursing students comfort zone, the student learned a lot in a short time about the client, such as
information about the clients family, medical condition and the vast support network. The client
was very pleasant and this student truly enjoyed time spent with the client. This nursing student
was able to see beyond the clients diagnosis and see the client as a person, not just a client. The
nurse-patient interaction helped this nursing student realize that meeting clients shouldnt cause
so much worrying or any need to be nervous and that each client is a real person.