Process Recording Supplement PDF

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Psychi at r i cNur si ng Cl i ni calExper i ence Clinical sites vary according to whether you are a student in Austin or Fredericksburg. Your clinical instructor will share specific information with you regarding your clinical site, the dates of the rotation, and an orientation to the facility. There may be a community-based learning experience completed away from the hospital during one of the clinical days. The date and site will be determined and announced by the instructor.

Requi r edWr i t t enAssi gnment sf or Psychi at r i c/ Ment alHeal t hCl i ni calExper i ence 1. Pr ocessRecor di ngs:You complete a daily process recording of interactions with a patient. These recordings will demonstrate use of therapeutic communication techniques, as well as the development of the therapeutic nursepatient relationship. You will do this from recall and will not be making notes during the conversation. The conversation may be as short as five minutes or it can be longer. It must include enough content to document at least one phase of the nurse-patient relationship. It must demonstrate a variety of effective communication skills. After the interaction, and out of the view from patients, you will write word for word as close as you can, what you said to the patient and what the patient said to you. You will describe the nonverbal behavior demonstrated by you and the patient. You will identify the communication techniques you used. You will evaluate the effectiveness of your techniques and how you might improve or change your communication techniques in the future. This is a learning tool. Your instructor will go over your process recording and make comments designed to help you improve communication with patients. You will receive feedback on areas which demonstrate appropriate efforts to meet your goal(s) for the interaction and your efforts to use therapeutic communication techniques. You will be given feedback on how to avoid the use of ineffective, non-therapeutic (blocking) communication techniques.

VNSG 1461

Pr ocessRecor di ngDet ai l s I.

Definition: “A process recording is a record of an encounter with a patient that is as nearly verbatim as possible” (Varcarolis, 2009, p. 120). It includes the nonverbal behaviors of the nurse and the patient as well as verbal interactions. The process is a learning tool.

II.

Purpose: To help the student to develop a process of effective communication which leads to a therapeutic relationship with the patient by such means as: (1) identifying barriers to communication (2) increasing awareness of nonverbal communication (3) becoming more skillful in appropriate use of a variety of therapeutic communication techniques and (4) becoming aware of his/her own feelings and issues related to patient.

III.

Method: 2.

1. Do not write in presence of patient. Review therapeutic communication techniques, and the phases and characteristics of the nurse-patient relationship. 3. Review barriers to communication. 4. Identify goals for the interaction such as: Build a trusting relationship, develop rapport, communicate empathy. Use therapeutic communication techniques appropriately. 5. Initiate process by telling the patient who you are and why you are here. “I’m , a student vocational nurse. I’m here to talk with you - I’m going to be here on this unit from to .” 6. Avoid focusing conversation on you (the nurse). If this happens, gently steer the conversation back to the patient. 7. Listen to what is being said, give some sign you are listening, e.g. by responding in some manner such as “go on - tell me more.” or by attentiveness. 8. Observe patient for non-verbal behavior and signs of emotional distress. 9. Notice how you react when conversation stops or becomes uncomfortable for you. Try to figure out why. 10. Be yourself. You bring a unique quality to the interaction. 11. Write up interaction as soon as possible. Write from memory what you said, what patient said, how you felt, and nonverbal behaviors.

VNSG 1461

I nt er per sonalTechni ques Therapeutic Techniques

Examples

1.

Using silence

2.

Accepting

   

3.

Giving recognition

 Good morning, Mr. S.  I noticed that you’ve combed your hair.

4.

Offering self

 I’ll sit with you awhile.  I’ll stay here with you.  I’m interested in your comfort.

5.

Giving broad openings

 What are you thinking about?  Where would you like to begin?  How have you been doing?

6.

Offering general leads

 Go on.  And then?  Tell me about it.

7.

Placing the event in time or sequence

 What seemed to lead up to...?  Was this before or after...?  When did this happen?

8.

Making observations

   

9.

Encouraging description of perceptions

 Tell me when you feel anxious.  What is happening?  What does the voice seem to be saying?

Yes. Uh hum. I follow what you said! Nodding.

You appear tense. Are you uncomfortable when you...? I notice that you’re biting your lips. It makes me uncomfortable when you...

10. Restating or Paraphrasing

Patient: I can’t sleep. I stay awake all night. Nurse: You have difficulty sleeping.

11. Reflecting

Patient: I think I should tell the doctor. Nurse: You think you should tell the doctor?

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Therapeutic Techniques 12. Setting Limits

Examples Nurse:

Nurse:

You are talking too fast. I cannot understand. Take a deep breath and slow down. You are standing too close. I’m uncomfortable. Step back.

13. Focusing

 This point seems worth looking at more closely.

14. Exploring

 Tell me more about that!  Would you describe it more fully?  What kind of work?

15. Giving information

   

16. Seeking clarification

 I’m not sure that I follow.  What would you say is the main point of what you said?  What did you mean when you said…?

17. Presenting reality

 I see no one else in the room.  That sound was a car backfiring.  Your mother is not here; I’m a nurse.

18. Voicing doubt

 Isn’t that unusual?  Really?  That’s hard to believe.

19. Seeking consensual validation

 Tell me whether my understanding of it agrees with yours.  Are you using this work to convey the idea...?

20. Verbalizing the implied

Patient: I can’t talk to you or to anyone. It’s a waste of time. Nurse: Is it your feeling that no one understands?

21. Encouraging evaluation

 What are your feelings in regard to...?  Does this contribute to your discomfort?

My name is... Visiting hours are... My purpose in being here is... I'm taking you to the...

VNSG 1461

Therapeutic Techniques

Examples

22. Attempting to translate into feelings

Patient: I’m dead. Nurse: Are you suggesting that you feel lifeless? or Is it that life seems without meaning?

23. Suggesting collaboration

 Perhaps you and I can discuss and discover what produces your anxiety.

24. Summarizing

 Have I got this straight?  You’ve said that...  During the past hour you and I have discussed...

25. Encouraging formulation of a plan of action

 What could you do to let your anger out harmlessly?  Next time this comes up, what might you do to handle it?

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