IPA Example 3-11 - N204 & N214L Psychiatric / Mental Health

Interpersonal Process Analysis
Patient’s Initials: PT
Unit: 3
Clinical Instructor:
Current Legal Status (Vol, 5150, 5250, 30 day, T-Con, LPS-Conservatorship): Voluntary
Multiaxial Diagnostic System:
Axis I (Clinical Disorder): Major Depressive Disorder
Axis II (Personality Disorder / Mental Retardation): Borderline Personality Disorder
Axis III (General Medical Conditions): None
Axis IV (Psychosocial and Environmental Problems): Relational, Financial
Axis V (Global Assessment of Functioning Scale): 45
1. Description of the client: Age? Sex? Ethnicity? Marital Status? What precipitated hospitalization? Number of days in the hospital?
Mental Status, etc.
Client is a 43-year-old Caucasian female. She is in a stable relationship of 10 years with a same-sex partner, and has co-parented her
partner’s 2 sons, ages 20 and 23. Client was admitted to Kaiser Mental Health Center in Unit 3 on May 4, 2010, for major depressive
disorder and suicidal ideation with a plan to overdose on her antidepressants. She demonstrates good insight into her condition and
asked for help from her out-patient psychiatrist. Her support system is very limited, consisting only her partner and two step-sons.
Her partner has medical limitations and prevents her from visiting her in the hospital. Client come from a family with a long history
of verbal abuse and violence. She stated that she was molested by an uncle for several years. She stated that she has been suffering
from depression “all my life,” This is her third hospitalization. She attempted suicide last year by overdose. Her upper arms, neck,
and the visible portion of her torso are covered with scarring. History of alcohol abuse since age 20. She reports 3 distinct periods of
sobriety. Currently she has been clean and sober for 4 years. Reports financial difficulties due to partner’s illness adds stress to the
2. Description of environmental setting where interaction took place. Explain the reasons for a supportive or non-supportive
environment. (e.g. noise, distractions, light, temperature, etc.).
The interaction too place in the day room, and lasted approximately 40 minutes. The client was sitting alone in a corner eating while
writing on her journal. A large group of patients was crowded around the center table discussing a project they wanted to work on,
and the other patients and staff were coming and going. This environment may not have been supportive. However, we were able to
converse privately without being negatively affected by the milieu.
NURS 214L Psychiatric/ Mental Health Nursing
Interpersonal Process Analysis
Verbal (quotes) and Nonverbal
Communication (behavior, tone of
voice, eye contact, mannerisms,
List at least 5 interactions
Verbal (quotes) and Nonverbal
Communication (behavior, tone of
voice, eye contact, mannerisms,
Goal for each interaction (realistic
and measurable)
Goal: My primary goal at that
moment was to help the client feel
better and be comfortable talking
with me as well as build rapport.
Verbal: “You’re really upset, aren’t
you? Is there something you’d like
to talk about?”
Nonverbal: I was leaning forward,
attempting to make eye contact and
speaking in a soft gentle voice.
Communication Techniques
Verbal: “I was just writing some
things in my journal, and I became
so sad and emotional and I don’t
know why.”
Nonverbal: She dropped her hands
from her face and gestured at the
notebook, wiping her nose and eyes
with a tissue. She placed her hands
in her lap, she made brief eye
contact with me. She made no
attempt to withdraw from my
presence, even though I was well
within her personal space.
 Identify communication technique
used define your communication
 Was the communication
therapeutic or non-therapeutic?
 Which defense and coping
mechanisms did the client use?
Rationale based on your client.
Interpreting; Non-Therapeutic
I was interpreting her unexpressed
feelings with her nonverbal
behavior as well as her verbal
Close ended; Non-Therapeutic. She
could only answer with a single
Defense: Isolation of Affect; The
client had painful and trouble some
feelings during her journaling and
that thought was brought up from
conscious awareness by crying.
Coping: Adaptive; Selfassertion Solves problems by
expressing thoughts and feelings in
direct ways through journaling and
speaking to nursing student.
Critique and Analysis
(effective or not effective? Could
have said…)
Document your thoughts and
feelings during the interaction.
Was your goal accomplished?
Not Effective. I started off with my
observation that she seemed upset
and asked a close-ended question
and made my own interpretation.
I could have used “making
observation” and said “You seem
really upset, what can I do to help
you feel better?”
I was a little nervous approaching
her at first because she was tearful
while writing on her journal. I was
not sure if I was intruding. She
responded willingly to my question,
even though it was not therapeutic.
She also did not appear to resent my
intrusion into her journaling. Since
she did not pull away or show
indication of discomfort at my
proximity, I felt more comfortable
speaking with her and continue my
interaction and accomplish my goal.
NURS 214L Psychiatric/ Mental Health Nursing
1. Evaluation: After analyzing the interaction, provide a description on how the interaction progressed. Identify the reasons for
successful process or unsuccessful process. What did you learn from the interaction with your patient?
2. How did you personally feel about the interaction? What would you change if you had to redo the interaction?
NURS 214L Psychiatric/ Mental Health Nursing
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