NURSE-PATIENT INTERACTION

I. PATIENT PROFILE
Name: Sarah Dada
Age: (not mentioned)
Gender: Female
Civil Status: Married
Diagnosis: Depression

II. SCENARIO
The interaction took place in the morning, inside of Dr. Jad’s clinic, where Sarah, the patient is seated
in front of Dr. Jad. The environment is an area/ room that provides privacy because only the doctor
and the patient is around. Sarah is seated on a chair, as well as Dr. Jad with a table between them.

III. NURSE-PATIENT INTERACTION

Therapeutic
Mental Health
Patient Communication Analysis of Behavior
Worker
Techniques Used
*Doctor Jad opens *Sarah steps inside
the door for Sarah* the room*
• It shows that the nurse recognizes
“Good morning, I’m “Good morning ▪ Giving recognition the client as a person, an individual
Dr. Jad, I will be doctor.” ▪ Giving information that gives the client fulfillment of
seeing you today.” his worthiness. This makes the
client feel respected and
comfortable.
• Informing the client of the facts
increases his knowledge about the
topic and what to expect on the
interaction. It also builds trust with
the client.

*Doctor Jad shakes *Sarah shakes the • Non-verbal therapeutic

Sarah’s hand* doctor’s hand* techniques such as hand shakes
are important because this gesture
may make the client feel
*Doctor points to a *Sarah sits down*
welcomed and comfortable.
chair where Sarah
could sit*

*Doctor sits down on

the chair in front of
her*

“Can you please tell

me your name?” “Sarah Dada.” ▪ Open-ended • Oftentimes, open-ended
questions questions are regarded as non-
 therapeutic, especially if it
answerable by yes or no. But in this
case, since Sarah is being asked her
name, it can
be therapeutic.

“Tell me, Sarah. ▪ Broad openings • Broad openings allow the patient
What is troubling to take the initiative to introduce
you?” “I don’t know what’s the topic and talk more. It also
wrong with me. All allows patient to explain more
my body aches. My about what he/she is feeling. For
head, my stomach, Sarah, she has explained what she
has been feeling and her
my knees. And experiences. During the
sometimes I have a interaction, the patient showed
strange tingling little to no emotions and she kept
sensation in my left looking down. Signs of flat affect
cheek.” has also been witnessed. These
signs are commonly seen in
patients experiencing depression.

• This means delving further into a

▪ Exploring
subject or an idea. This also
“Is there anything explores the patient to help them
else bothering you?” “I’m worried it might examine the issue more fully, not
be cancer. I am not only superficially. Sarah, the
patient, has also stated that she
eating well. And I’ve
has lost weight and appetite. This
lost about 5 kg this may put her at risk for nutritional
month.” imbalance as she has not been
eating well. To add, depression is
also a common factor for patients
who has eating disorders such as
anorexia nervosa.

“I can see you are • Acknowledging what the patient is

▪ Making
feeling may help them to delve
worried.” observations/
further and may help them realize
acknowledgement that there is something wrong.
This may also help them feel that
they are not alone and that they
are being listened to. Listening
intently is important, especially for
 patients who have mental health
problems as they tend to feel as
though no one cares and tend to
also self-blame.

“Do you mind if I ask ▪ General leads • This gives the patient an
a few questions, to encouragement to continue on
better understand what he is saying. It also indicates
that the nurse is listening and
what you’re going following what the patient is
through?” talking about without taking away
“No, not at all.” the initiative for the interaction. By
asking if the patient is willing to
answer, the nurse makes the
patient feel respected and that
he/she has a say in the interaction.
The patient is also being very
participative by being open to
answering the doctor’s further
questions.

“Do you have any

▪ Focusing • Focusing is a technique used to
medical illness?” concentrate on a single important
“No.” point. And in this case, the patient
is being asked about the conditions
she has. This is an important
question to be asked because, by
knowing so, we are able to know
her history, the symptoms that she
*Sarah shakes her may present and the possible risks
head. * for her condition. But in Sarah’s
case, she did not have any medical
illnesses.
“And I don’t take any
medications.”
▪ Silence • Provides limit to put clients’
*Sarah pauses and actions, thoughts or feeling into
continues* words and shows place of
interaction. Silence gives time for
patient to form thought and
“I was fine until one continue expressing herself.
month ago.”

• Focusing is a technique used to

concentrate on a single important
“How did all of this “Well, I don’t know if ▪ Focusing point. And in this case, the patient
start one month it is related but 3 ▪ Encouraging is being asked about how her
expression symptoms started presenting. This
ago?” months ago, my technique also encourages her to
husband lost his job express some more. Sarah was a
and we had to move bit confused in the beginning but
in with my in-laws.” she remained participative by
narrating to the doctor what she
remembered. During this point of
the interaction, Sarah showed
*Sarah looks up, as if signs of being forgetful. She has
trying to remember* also verbalized that she has been
forgetting things lately. To note,
forgetfulness is also a known
symptom of depression.

*Doctor provides ▪ Silence • Provides limit to put clients’

silence, looking at “No!” actions, thoughts or feeling into
Sarah and writing words and shows place of
down notes. * interaction. Silence gives time for
patient to form thought and
*Sarah corrects continue expressing herself.
*Doctor provides herself. *
silence, maintaining ▪ Silence • Provides limit to put clients’
eye contact* actions, thoughts or feeling into
“I think it was 5 words and shows place of
interaction. Silence gives time for
months ago.” patient to form thought and
continue expressing herself.

*Doctor provides “I don’t know what is ▪ Encouraging
silence, allowing happening. I keep on
Sarah to continue forgetting things.”
speaking. *
*Sarah goes back to
her initial thought*
“Anyway, they are
nice people. But their
house is small and I
have 3 children. I
work all day long and
I’m not eating well. I
am also very worried
about my husband.
He is having a hard
time finding a job.
Before I knew it, I
was not eating well,
*Doctor provides or sleeping well and ▪ Silence
silence, allowing started having pain
all over my body.”
• Helps the client appraise his own
expression rather than accept the opinion of
others. The patient also complies
well and continues verbalizing.
• In this part of the interaction,
Sarah verbalizes about how they
moved from their home to their in-
laws’. This indicates that Sarah has
had a hard time adjusting and was
not able to cope up well with the
changes happening around her.
She also expresses her worries
towards her husband, this
indicates that Sarah is also having
a social problem and lack of money
to sustain the family’s needs,
which is a very common cause of
depression.
• Provides limit to put clients’
actions, thoughts or feeling into
words and shows place of
Sarah to continue interaction. Silence gives time for
speaking. * *Sarah explains with patient to form thought and
continue expressing herself. To
hand gestures as if add with silence, the doctor also
explaining what had maintained moderate eye-contact
happened. * and open posture. This non-verbal
technique allows patient to feel
*Sarah looks at the comfortable in disclosing
information.
Doctor*

“Besides pain, have ▪ Encouraging • Helps the client appraise his own
you noticed anything expression rather than accept the opinion of
others. The patient also complies
else?” well and continues verbalizing.
“Like what?” The patient is also being
participative by seeking
clarification from the doctor.
“Like bleeding or ▪ Giving • Informing the client of the facts
increases her knowledge about
cough or fever for *Sarah shakes her information
the topic and what to expect on
example.” head. * the interaction. It also builds trust
with the client.
“No. Nothing like
that.”

“You said that the ▪ Restating • Restating what the client has said
pain is all over your *Sarah hums* ▪ Exploring allows the client to feel heard and
body. Does it hurt ▪ Encouraging understood. This helps them feel
more in any specific “No. It comes and expression acknowledged and their feelings
respected. Exploring has also been
area?” goes. Especially
used because this allows both the
when I get angry with doctor and patient to delve
my children. I feel further and for the patient to
like my head is going express some more of his/ her
to explode and my thoughts and experiences. Due to
this, Sarah was able to verbalize
hands start shaking.”
that she feels much more pain
when she’s upset. The pain that
she experiences is a common
occurrence in people with
depression. This condition is
called psychosomatic pain. This
refers to a pain that is aggravated
*Doctor hums* by emotional stressors. This
happens due to the hormonal
“Hmm, okay.” imbalance that is happening to
the body.
“So, the pain gets *Sarah cries silently* ▪ Restating
• Restating what the client has said
worse when you are ▪ General leads allows the client to feel heard and
angry. Are you often understood.
angry lately?” ▪ Encouraging
expression • This gives the patient an
encouragement to continue on
 what he is saying. It also indicates
that the nurse is listening and
following what the patient is
“Only at my children. talking about without taking away
I feel so bad. I don’t the initiative for the interaction.
*Doctor nods* know what is
happening with me. I • Sarah stated that she feels guilty
was never like that!” as she is always angry with her
children. She stated that she
understands that children are like
“They are children, that, however, she could not
of course. They want control it. Sudden bursts of anger
to play and run and constantly being guilty are
around. My little girl common symptoms among
depressed patients.
*Doctor nods, urging is only one. I hardly
Sarah to continue* feed and clean her. I • She has also stated that she could
don’t talk to her or not do her motherly duties. That
play with her having been said, Sarah is also at
anymore! risk for impaired role and
impaired parenting due to her
condition. She has also been doing
“Not only that!” poorly in terms of her routine
activities or ADLs and feels guilty
“Sarah continues. I because of it.
am not cooking or
cleaning the house
either!”

*Sarah cries* • People who suffer from

depression cries a lot because
they are easily triggered by things.
Depression crying is understood
“Sorry if I am crying.” to be a form of self-soothing; as
such, it regulates emotion,
*Sarah inhales induces a state of calm, and might
deeply* improve mood. With the crying
also comes the apologies. People
with depression often feel guilty
about a lot of things, even if it’s
not their fault. They also tend to
self-blame.

“I can see how much “I don’t mean to get

• It shows that the nurse recognizes
this is affecting you. angry with them but I ▪ Giving the client as a person, an individual
Would you like to tell just can’t control it. I recognition that gives the client fulfillment of
me more about it?” feel so bad. Then I ▪ General leads his worthiness. This makes the
start crying and client feel respected and
blaming myself.” comfortable.
• This gives the patient an
encouragement to continue on
what he is saying. It also indicates
that the nurse is listening and
following what the patient is
 talking about without taking away
the initiative for the interaction.
“No need to
apologize. It is fine to
cry here!” ▪ Accepting • Accepting means that you
acknowledge the patient as a
person and that you respect their
feelings. This also assures them
that what they feel is valid and
that it’s okay to feel them.

“Are you crying a lot ▪ Focusing • Focusing is a technique used to

lately?” “Almost every day! I concentrate on a single important
point. And in this case, the doctor
feel that my heart is
is also slowly trying to make Sarah
so heavy. Anything see that there is something wrong
can make me cry.” in random crying spells by asking
her focused questions.

“When you are “My husband tries
upset, what to help me but
comforts you?” nothing really works.
I feel like nothing can
really get me out of
this sadness.”
*Sarah pauses and
continues*
“When I think about
the future, I feel like I
have no hope!”
▪ Focusing • Focusing is a technique used to
concentrate on a single important
point. And in this case, the doctor
is also slowly trying to make Sarah
see that there is something wrong
in random crying spells by asking
her focused questions. The
patient’s answer also indicates
that her husband is a great
support system to her, which is
very important for her to have
▪ Offering Silence
due to her condition. However,
she stills feel guilt. The patient has
also stated feelings of
hopelessness, which is also a
common occurrence when a
person is depressed. It’s
important that as health workers,
we look closely for the little signs
so that we may prevent a person
from committing suicide or self-
harm. The whole duration of the
interaction, the client showed
little to no emotions, she did not
smile. The only time she showed
emotions was when she cried.

“Can you explain to ▪ Seeking • All throughout the interaction, the

me what you mean clarifications nurse must always be attentive
and seek clarification from the
when you say ‘I have patient. This will help the nurse
no hope’?” avoid assuming. It also helps the
patient reflect and articulate her
thoughts clearly and thoroughly.
 “I keep thinking of all
the bad things that
happened to me in
the past. I don’t ▪ Offering silence • When Sarah was verbalizing what
seem to be able to she means, the doctor offered
enjoy anything.” silence while maintaining
moderate eye-contact and open
posture. This non-verbal
*Sarah pauses and technique makes the patient feel
continues* as though we are actively listening
to them and this also urges them
“I wonder how this is to continue speaking. Sarah
going to be better in showed signs of being
unmotivated to do the things she
the future.” once used to do. This adjustment
or change in her life adds to the
*Sarah pauses and guilt and hopelessness she feels.
continues* She is also not looking forward to
what lies in the future.
“I don’t know if there
is a future.”

“Sometimes, when a ▪ Exploring • This means delving further into a

subject or an idea. This also
person goes through
explores the patient to help them
such a hard time, she examine the issue more fully, not
might think that it only superficially.
would be easier to
die. Are you thinking
about that?”

“I do wish sometimes • In this part of the interaction,

Sarah verbalizes her thoughts on
to sleep and never
dying however, she has also
wake up but I would stated that she cannot go through
never end my own with it as there would be no one
life.” to take care for her children and
her religion prohibits it as well. In
assessing a patient with mental
*Sarah inhales
health problems, sociocultural
deeply and shakily* factors such as the people around
them and their beliefs play a huge
“It is against my role.
religion and who
would take care of
my children?”
“Do you often wish ▪ Focusing • Focusing is a technique used to
that you’d never *Sarah frowns* concentrate on a single important
wake up?” point. It is also evident in the way
the doctor asks that he is already
 subtly making Sarah see and
observe her condition by asking
these types of questions.

“No, not really.” • It is important that we know what

could be triggering for the patient.
*Sarah continues*

“It is just that

sometimes, it gets
hard to handle.”

“I don’t know how I

would be able to
manage if it wasn’t
“So, your husband is for my husband.” ▪ Restating • Restating what the client has said
an important ▪ Seeking allows the client to feel heard and
support for you?” *Sarah looks down* clarifications understood.
• All throughout the interaction, the
nurse must always be attentive
and seek clarification from the
patient. This will help the nurse
avoid assuming. It also helps the
“Yes.” patient reflect and articulate her
thoughts clearly and thoroughly.
*Sarah continues*

“He is a good man. I

don’t know how he
can stand me these
days. I’m sure no one
else would!”
“Besides your ▪ Focusing • Focusing is a technique used to
concentrate on a single important
husband, is there any
point. It is also evident in the way
other person that
the doctor asks that he is already
you feel can give you subtly making Sarah see and
support?” observe her condition by asking
these types of questions.

“My family! But they

live far from here. I
was telling my
husband that I would
like to take the
children and go to
my parents for a
while.”
“Would that be ▪ Focusing • Focusing is a technique used to
possible?” concentrate on a single important
point. It is also evident in the way
the doctor asks that he is already
“I think so. But I
subtly making Sarah see and
haven’t given it much observe her condition by asking
thought.” these types of questions.

“Sarah, did you talk ▪ General leads • This gives the patient an
with anyone about encouragement to continue on
what he is saying. It also indicates
what you are going that the nurse is listening and
through?” *Sarah shakes her following what the patient is
head* talking about without taking away
the initiative for the interaction. It
“No.” is also vital for the health worker
to ask if Sarah has a support
system. However, she said that
she does not tell anyone about
what she has been feeling.

“Sarah, what do you ▪ Reflecting • This directs the patient’s actions,

thoughts and feelings back to the
think is happening
patient and encourage patient to
with you?” recognize and accept his own
“I don’t know. I feelings.
heard on the radio
the other day that if
you feel tired and
you lose weight, it
might be cancer. So, I
came to see you.”

“Do you have any ▪ Reflecting

• This directs the patient’s actions,
other explanation for thoughts and feelings back to the
what is happening to patient and encourage patient to
you?” recognize and accept his own
“No.” feelings.

“Is there anything ▪ Encouraging • Asking for patient to describe

else that you would description of feelings, perceptions, and views of
like to share with perception their situations. To understand
me?” the client, the nurse must see
“No, that’s about it., things from her perspective.
doctor. What do you
think I have?”

“We will discuss that ▪ Giving • Informing the patient and letting
soon.” information them know as to what will happen
next implies respect.

*Doctor continues*
“If you don’t mind, I ▪ General leads
• This gives the patient an
still have a few ▪ Exploring encouragement to continue on
questions to ask, what he is saying. It also indicates
then I will do a that the nurse is listening and
physical exam, and following what the patient is
afterwards we will talking about without taking away
the initiative for the interaction.
talk. Is that okay with
• This means delving further into a
you?” subject or an idea. This also
explores the patient to help them
“Sure.” examine the issue more fully, not
only superficially. Sarah has also
been consistently participative in
the interaction.

“Do you drink ▪ Focusing • Focusing is a technique used to

alcohol?" concentrate on a single important
point. These routine questions are
important to be asked as these
“No, of course not!” things can be contributing factors
to Sarah’s condition.

“Sorry! I didn’t mean ▪ Giving

• It shows that the nurse recognizes
to offend you.” recognition the client as a person, an
individual that gives the client
*Doctor explains fulfillment of his worthiness. This
further* makes the client feel respected
and comfortable. The doctor
immediately apologized after
*Sarah looks down* offending Sarah. This makes the
patient feel acknowledged and
heard.

“It is just a routine *Sarah looks at the ▪ Giving • Informing the patient and letting
them know as to what will happen
question that we ask doctor* information next implies respect.
everyone.”

“I have to ask you *Sarah sighs* ▪ Giving • Informing the patient and letting
more routine information them know as to what will happen
next implies respect.
questions as well.”

“Do you use any

medication to calm ▪ Focusing • Focusing is a technique used to
yourself?” “No! I don’t like concentrate on a single important
point. This is also a vital question
medication at all!”
because as a health worker,
assessment being done should be
thorough with all the information
needed.
 “Okay, one last ▪ Exploring • This means delving further into a
question. You ▪ Focusing subject or an idea. This also
mentioned that you explores the patient to help them
examine the issue more fully, not
have a one-year-old *Sarah frowns and
only superficially.
baby. Do you shakes her head*
• Focusing is a technique used to
breastfeed her? concentrate on a single important
“No.” point. These routine questions are
important to be asked as these
things can be contributing factors
to Sarah’s condition.
• Based on Sarah’s response and
behavior, it is evident that she
feels guilty for not having been
doing her role as a mother
efficiently and that not spending
time with her child is making her
lonely.

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• Sources/ References:

(My American Nurse Therapeutic Communications Technique, Retrieved

fromhttps://www.myamericannurse.com/therapeutic-communication-techniques/ on 2021)

(Varcarolis, Retreived from https://www.scribd.com/document/371903166/Essentials-of-Psychiatric-

Mental-Health-Nursing-Revised-Reprint-2E-Varcolis on 2018)