Running Head: INTERACTIONAL PROCESS RECORDING
Interactional Process Recording
Kristi R. Rittenhouse
Psychiatric Nursing and Mental Health Nursing Care- NURS 40030-601
Laura Brison
October 20, 2010
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Running Head: INTERACTIONAL PROCESS RECORDING
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Interactional Process Recording
J.G., a 23 year old-white male, was admitted to Heartland Behavioral Health on
Wednesday September 29, 2010 with depression. He admitted he was going to kill himself after
drinking the night of Tuesday, September 28th, 2010. J.G. was cooperative in a two-on-one
conversation on the 29th with J.V. and me in a quiet, lighted, and warm environment in the dining
room. I think the quietness was a positive to our therapeutic communication because it allowed
few distractions and allowed J.G. to self-disclose more than he would have if people were in the
room. We were able to develop an informal social control contract with J.G., which means we
listened to what was going on in J.G.’s life at the moment and attempted to solve some problems
that J.G. was experiencing at the time of the conversation. These problems included ways of
relieving stress and coming up with a safety plan the next time he feels like hurting himself. We
also attempted to set short-term goals, which included when to use the safety plan.
Prior to our interaction, I felt anxious and nervous because I realize how serious of an
issue suicide/depression is and I feel like I have a major responsibility in this person’s life. This
responsibility I have is to show that I care, and to give hope and reassurance; as well as, setting
into motion his desire to change his life around so he can have the opportunity to live a fulfilling
life. I have not happen prior experience before this class with communicating with a depressed
person, let alone someone who wants to commit suicide. I think I also feel anxious because I
always want to know what to say to make things better, and sometimes I fear I am not at the
communication level I need to be at in order to have an effective conversation.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
NURSE DATA
ANALYSIS
Hi, are you J.G.
(approached
patient, smiling,
sat down in the
chair next to him
to get to his level
to make eye
contact)
Greeting. Establishing recognition.
I am nervous, but made sure I did not show it to J.G. He
looks like he isn’t interested in talking. I was not 100%
certain this was J.G.; therefore, I asked. I felt odd asking
if it was him because I thought that maybe J.G. would
think that he was my assignment for the day, and that I
did not really care to speak to him. I thought that if he
thought this, then it would interfere with our
effectiveness with the communication. Looking back, I
probably should have double checked with the nurse so I
could just approach him without having to ask if he was
J.G.
J.G. seemed confused about why we would talk to him
as evidence by his puzzled look on his face. Also, his
affect is almost always sad, which is consistent with his
diagnosis of Depression (Boyd, 2008, 350).
My name is Kristi
and this is
Jasmine. We are
student nurses at
Kent State and
we’re wondering
if you would be
willing to speak
with us for a bit in
the dining room?
(still smiling)
Giving information. Offering self. Beginning negotiation
of an informal contract. Introducing and offering self is
the orientation phase of the nurse-patient relationship. It
aides in establishing rapport (Boyd, 2008, 149).
I feel like I am becoming a little less nervous, but he still
doesn’t look interested in communicating. This may be a
bad sign. Am I ever going to get a good conversation so
I can use for my IPR.
Yes.
(Looking at me
with puzzlement
and a sad
expression.)
I guess, what do
you want to talk
to me about?
(Walking to
dining room and
looking down at
floor)
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(Walking to
dining room)
We just want to
ask you some
questions and
learn about what
brought you here.
(Opened up the
door to the dining
room.)
An informal contract is negotiated.
I was grateful that he agreed to a 2:1. This means that I
can possibly use our conversation for my IPR if it is
decently good. He still seems withdrawn and hesitant to
participate in a 2:1, but this is often a sign of depression
(Boyd, 2008, 350).
Giving information.
I don’t want to get into a lot of detail when explaining
what J.V. and I want to talk about because I feel like the
conversation can go anywhere based on what J.G. opens
up about. Therefore, I think what I said worked well.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
(Sat down at
table)
Okay, well what
do you want to
ask me?
NURSE DATA
ANALYSIS
(Sat down at table
across from
patient, hands on
table and turning
my wedding rings
around my finger)
I guess I was not clear as to what I wanted to talk about,
or does he want to know what my first question is going
to be? It must be what we are going to first ask as I
thought I made myself clear as to what I wanted to
figure out.
Wow, I am nervous, I thought it was decreasing. It may
be because I feel like it is my responsibility to change
how he is thinking, and I realize I cannot do that in one
conversation.
Open-ended or broad question. This allows us to initiate
conversation and encourage J.G. to talk about his
activities (Foley, 2010, 40).
I want to attempt to create rapport with J.G., so I don’t
want to jump into why he was brought to Hartland. This
is also my way of letting him get more comfortable with
me. It is the least invasive subject.
Creating rapport with the patient is important in
establishing and building the nurse-patient relationship
(Boyd, 2008, 143).
I realized I was messing with my rings and saw that it
was a distraction by the way he kept looking at my
hands, so I folded them and was hoping I wouldn’t
distract J.G. again. I am beginning to feel a little more
comfortable.
Well, lets first just
talk about what
activities you like
to do.
(Still messing
with my ring
while looking at
J.G.)
(Leaning forward,
looking at my
hands and me
messing with my
rings, then made
eye contact)
I like to read, it
relaxes me. I
usually don’t have
time to read, but
now I do since I
am here. I am
reading Robinson
Crusoe now.
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(I stopped
messing with my
ring and folded
my hands)
So, what brought
you here to
Hartland?
(I leaned toward
J.G, and made eye
contact)
Changing topic (Psychiatric nursing and mental health
nursing care, 2010, 20). This is a non-therapeutic
technique that hinders rapport and thus affects the nursepatient relationship (Boyd, 2008, 143).
I am not sure why I changed the subject. Looking back, I
should have asked if gets stressed often and what he
does to relieve his stress.
Mental Note to Self: Ask this Later.
I also used the therapeutic technique of using an Openended or broad question.
By leaning forward, I show J.G. that I am interested in
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
NURSE DATA
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ANALYSIS
what he has to say.
A bad weekend.
(Looking down,
slouched and
leaned back in
chair)
Silence
(Still looking
down)
(Made eye contact
with me for a
brief moment.)
(Looked away and
crossed arms.)
(Looked to J.V.)
What do you
mean by “a bad
weekend”, what
happened?
(I reestablished
eye contact for a
brief moment.)
Drank too much.
Said some things I
shouldn’t have.
Like what?
(Still looking
away, at table)
(Leaned forward a
little more.)
This must be a bad subject for J.G. as he quickly looks
down at the table, slouching, leans back, and is silent for
awhile. Also, his nonverbal tell me he is withdrawn.
This is a common psychosocial assessment finding in a
depressed individual (Foley, 2010, 384).
He doesn’t like to say more than he has to. This is as
evidenced by the fact that he only answers the questions
with short phrases.
Therapeutic use of silence. It when we remain quiet to
allow J.G. to gather his thoughts and to proceed at his
own pace (Boyd, 2008, 139).
The silence seemed to take forever, so I looked toward
J.V. to see what we should do, but I wanted to give him
the opportunity to explore his feelings and his to
elaborate on what he meant by “A bad weekend”.
Exploring. Focusing. By using these therapeutic
techniques, I can get more information about a certain
topic (Psychiatric nursing and mental health nursing
care, 2010, 17).
I am a little more nervous now because I know we are
about to talk about his suicidal thoughts. This makes me
nervous because I don’t want to say the wrong thing.
I notice J.G. is uncomfortable with speaking about what
he did and said by the crossing of his arms and losing
the eye contact. He is closing himself off.
I wish he would go into more detail and help me out
here.
Substance abuse, such as alcohol in this situation is an
associated behavioral finding in someone with
depression (Boyd, 2008, 350).
Probing: Non-Therapeutic (Psychiatric nursing and
mental health nursing care, 2010, 19).
Oops, that was probing. Why didn’t I think about what
to say before I said that? Looking back, I can tell it is
probing. I should have used a therapeutic technique
using exploring, for example: “A lot of people say and
do things they want to take back all the time, can you
tell me what it was you said.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
I said I was going
to kill myself.
NURSE DATA
(Very quiet voice,
still looking down
at table.)
(Still looking
down at table.)
What was going
on that caused
you to say you
were going to kill
yourself?
(Spoke quietly,
trying to establish
eye contact.)
I just wanted to
push someone’s
buttons.
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ANALYSIS
I am wondering if J.G. is ashamed of what he said or just
uncomfortable speaking to females around the same age
as him. I am wondering this because of how he leaves a
lot of information out at first until we “probe” to get the
answer. Also, he speaks very quiet and avoids eye
contact.
Suicidal thoughts are a common psychosocial
assessment finding in an individual who is depressed
(Foley, 2010, 384).
Exploring. Focusing.
I almost asked why he said that, but quickly realized it
was non-therapeutic. I felt relieved with how I asked this
question because I feel like I wasn’t probing, but still
interested with what lead to his verbal “cry for help”
J.G. is definitely minimizing his situation. His comment
irritated me a little because I feel like he is leaving so
much out. Also, I don’t believe someone would say they
are going to kill themselves just to upset others.
(Brief eye
contact.)
Whose buttons
did you want to
push?
(Spoke quietly,
and trying to
establish eye
contact.)
My mom’s
mostly, and my
girlfriends a little.
(Brief eye
contact.)
J.G. seems to not be very spontaneous with explanations
or his feelings. He answers questions to the bare
minimum.
Silence
(Looking down.)
Focusing, but probing at the same time, which is nontherapeutic (Psychiatric nursing and mental health
nursing care, 2010, 19).
Looking back, I feel like I was demanding him to tell
me. I would have rather asked “Can you tell me me
more about that.”
(Trying to
establish eye
contact.)
Therapeutic use of silence.
I wanted to give him an opportunity to elaborate on why
he wanted to push his “mom’s and girlfriend’s buttons”.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
My mom was
being too much of
a mom, too
controlling, and it
was stressing me
out.
(Looked away.)
NURSE DATA
I drink beer.
(Started messing
with my rings.)
How much would
you say you
drink?
(Spoke softly,
hands folded.)
Quite a bit. Every
chance I get. I’m
drunk about every
day. It’s like I
start drinking and
I get to a point
where I don’t
think and my
problems seem to
go away.
(Brief eye contact,
less irritable
sounding.)
ANALYSIS
Why did you want Requesting an Explanation: Non-therapeutic (Psychiatric
to push buttons?
nursing and mental health nursing care, 2010, 19).
I can’t think of how else to get J.G. to explain this.
(Held eye
Looking back, a better way to ask this is, “Can you
contact.)
explain some of the reasons that caused you to want to
push their “buttons”?”
It seems as if every time I establish eye contact and say
what I need to, he looks away, then answers me.
Anxiety is an associated behavioral finding related to
depression (Boyd, 2008, 350).
What are some
things you do to
relieve your
stress.
(Brief eye
contact.)
(Sounded a little
irritated, arms
crossed.)
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Exploring. Focusing.
I feel like his main problem is the stress; therefore, I
wanted to focus on some things he could do to relieve
that stress.
I am beginning to mess with my rings again because I
am getting nervous, but I stop. I believe I am getting
nervous because J.G. is sounding a little irritated and I
don’t want anything to happen.
For a depressed individual, irritability is a common
psychosocial assessment finding (Foley, 2010, 384).
Probing: Non-Therapeutic
I should have been more direct with him so he wouldn’t
minimize the amounts that he drinks.
Looking back, I should have rephrased the wording, but
even now I don’t know how else I would have asked
without probing.
Ah, I should have worded my previous question a little
differently so that I could get an actual number or
average a day instead of “quite a bit”.
It is common for an individual with depression to not
want to think (Boyd, 2008, 362). Which I believe is the
case in J.G.’s situation.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
NURSE DATA
8
ANALYSIS
Earlier you said
you enjoy reading
and that it relaxes
you.
(Re-establishing
eye contact.)
Restating. Changing Topic: Non-therapeutic.
I made a mental note to self to bring this up again, I am
glad I remembered. By asking this we can solve
problems together about reducing his stress level, but
looking back, I should not have changed the topic. I
should have pursued what his problems were and what
he wanted to stop thinking about.
He leaned forward and uncrossed arms, he must either
be feeling more comfortable with us students, or he is
just feeling more comfortable with the conversation
since it became a little less invasive.
Have you thought
of ways you could
make time to do
what you want to
do that relieves
stress?
(Eye contact.)
Encouraging formulation of a plan of action. This is a
therapeutic technique used to encourage the patient to
come up with their own ideas (Psychiatric nursing and
mental health nursing care, 2010, 18).
It would be healthier if he stopped drinking and in place
of that he could read. I don’t want to give him advice at
this point. I want him to come up with it on his own,
which made me like what I said.
Wow, if stress is a big problem, why has he not thought
about this? I do not understand.
Do you ever think
about giving up
the beer? If you
get stressed,
maybe instead of
drinking you can
spend that time
reading.
(Maintaining eye
contact, hands
folded, leaning
forward.)
This is kind of Advising in a way, which is a nontherapeutic technique. This is when I offer the patient
specific suggestions (Foley, 2010, 42).
Alcoholism is a prominent factor in suicide. Its
destabilizing effects increases suicidal risk (Boyd, 2008,
264). Therefore, he should try to stop drinking.
Looking back I should have probably left the second
part out (the advising part).
It does, but I don’t
have the time.
(Good eye
contact, uncrosses
arms, and sits up.)
No, I never really
thought about it.
(Shook head, no.)
I guess that would
work.
(Looks down.)
I don’t think he seems very willing to give up the beer at
this point. What should I do to make him more willing?
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
9
NURSE DATA
ANALYSIS
Do you still have
thoughts of killing
yourself?
Focused Question: Therapeutic technique.
I wonder if he still thinks about killing himself. Should I
just come out and ask it? Yeah.
Looking back, I think I should have said “hurting”
instead of killing. “Killing” is an intense word in which I
feel uncomfortable saying.
I don’t know if I should believe him. His nonverbal are
not congruent with his verbals. The shifting in the chair
and loss of eye contact gives me the impression that he
is either contemplating it, ashamed of his feelings, or
uncomfortable with the situation.
(Direct eye
contact)
No, I don’t.
(Looked down
and shifts in
chair.)
Next time you
feel depressed
enough to want to
hurt yourself,
what might you
do so you don’t
get far enough to
do that?
(Hands still
together, reestablishing eye
contact.)
I don’t know, I
haven’t thought
about it.
Encouraging formulation of a plan of action.
I feel like he may have these feelings again, so I think it
is essential we come up with a plan of action so he can
do something productive to keep from harming himself.
I am surprised he has not thought about a safety plan. If
it were me, I would want to know my warning signs and
what to do if I notice those signs.
(Eye Contact.)
Silence
(Eye Contact.)
I guess now I
could talk to my
mom about being
too controlling
and when I feel
like hurting
myself I could
(Eye Contact.)
Therapeutic use of silence.
I wanted him to think more about what he would do so
he wouldn’t harm himself.
I guess I can’t look at it like I was in his situation.
Looking back, I realize we all think differently and when
one is in a depressed state, one does feels hopeless and
helpless, and therefore, can’t think straight or just don’t
want to do anything about it (Boyd, 2008, 350).
He is coming up with some good solutions.
I hope I am being helpful. The workers here don’t talk
much with them, so I really want to make a difference in
his life and have him view it a little differently now.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
talk to someone.
(Speaking softly,
and sitting up.)
NURSE DATA
Ok, can you think
of anything else?
(Eye Contact.)
I could attempt to
stop drinking.
(Brief eye
contact.)
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ANALYSIS
Accepting: Therapeutic technique
Focused question.
I want him to realize drinking is a major problem. My
hope is that he can think of it on his own to stop.
Good, Good, Good. We are getting somewhere.
Do you know
about the Crisis
Center Hotline?
Focused Question.
If he has no one to talk to, the Crisis Center Hotline
would be a great service. I wonder if he knows about it.
(Hands still
together, reestablishing eye
contact.)
Yes, I can call
them too when I
need someone to
talk to.
Good, he knows about it. My only hope is that he will
use it to his advantage. It is a wonderful service to those
who don’t know where to turn.
(Eye Contact.)
Well, you are on
the right track and
we wish you luck.
We have some
other people to
speak with, so we
will have to go.
Thank you so
much for
speaking with us.
(Eye contact,
smiling.)
Giving Recognition: Therapeutic technique (Psychiatric
nursing and mental health nursing care, 2010, 17).Now
only if he sticks to what he said he can do for his “safety
plan”.
It is about time to go talk to other people I suppose; I
might want to wrap this up.
Running Head: INTERACTIONAL PROCESS RECORDING
PATIENT
DATA
You’re welcome.
Thank you.
NURSE DATA
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ANALYSIS
I feel rewarded that he is smiling. He seems to have been
thankful for our conversation; I only hope he remembers
it all.
(Smiling.)
I hope we helped
in some way.
Have a good day.
(Getting up from
table and
smiling.)
I really hope we were helpful and he is not just smiling
because he is free from us.
Running Head: INTERACTIONAL PROCESS RECORDING
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Patient Themes
J.G. is diagnosed with depression. He stated prior to his arrival to Hartland Behavioral
Health that he was going to kill himself. Throughout our interaction, J.G. was withdrawn,
difficulty thinking, sad expression, irritable, minimizing his situation, and not offering much
information. These are all consistent with the diagnosis of depression. Anxiety and alcoholism
were also common patient themes throughout our interaction. Anxiety was created from the “too
controlling” mother and the alcoholism was his escape route from all of his problems.
Alcoholism is a prominent factor in suicide. Its destabilizing effects increases suicidal risk
(Boyd, 2008, 264). Hence, his drunkenness when he said he was going to kill himself.
During our interaction, I attempted to show empathetic understanding, respect, and
genuineness. I did all these things by speaking quietly, and by trying not to judge. In this
situation, I do not feel like action dimensions would have affected our interaction. I was not
comfortable using confrontation and we are not to do this unless we have the teacher there. Also,
I didn’t have anything to self-disclose and there wasn’t a time for role-playing.
I felt a little resistance on J.G.’s behalf when he would not open up about his thoughts
and feelings. Also, when he would only answer with the bare minimum, I felt resistance. He
would not elaborate on much when it was truly needed. I do not believe transference or
countertransferance took place during our interaction. My non-verbal communication showed
that I was nervous in that I would twist my ring around my finger. This caught J.G.’s attention
and distracted him for a minute until I stopped.
Outcomes of therapeutic nurse-patient interaction
By the end of J.G. and my interaction, we ended up in the orientation or introductory
phase. This is the phase where the introduction occurs, the contract is established, data is
Running Head: INTERACTIONAL PROCESS RECORDING
13
gathered, and feelings, thoughts and actions are beginning to be explored (Foley, 2010, 45).
Looking back, I realize that J.G. did not go into much detail about his thoughts and feelings. This
is one of the main reasons we were still in the orientation phase. If I had a second chance to
speak to him, I would ask him to explain what he was thinking and feeling at certain times.
During our orientation phase, I believe J.G. benefited from our interaction. He said he
was going to talk to his mom about being too controlling. Also, when he feels like hurting
himself he is going to talk to someone and if no one is available to speak with, he will call the
Crisis Center Hotline. And finally he is going to attempt to stop drinking and possibly read or do
something he like to do that is fun in order to reduce his stress level.
During my therapeutic nurse-patient interaction, I realized that I still have a ways to go to
being a more effective communicator. I learned that speaking therapeutically is much harder than
just talking with them, and that at times I need to think more before I speak. At times, I felt like I
would just spit out words and most of the time it was non-therapeutic. I became much more
comfortable speaking with J.G. about half way through the conversation. Therefore, I was able to
focus a little more on the non-verbal communication and how it relates to J.G.’s diagnosis of
depression.
Reflecting back on my therapeutic nurse-patient interaction, I learned that I change the
topic a little too often, which is when one says a statement that ignores the current topic and
introduces a new topic (Foley, 2010, 42). This is non-therapeutic because it hinders rapport and
thus affects the nurse-patient relationship. I also used other non-therapeutic techniques that I
need to work on eliminating from my interactions with patients. I am going to do this by
studying these non-therapeutic techniques in more depth, and at the same way taking a statement
and rewording it so it becomes therapeutic.
Running Head: INTERACTIONAL PROCESS RECORDING
14
I also learned that I need to be more aggressive in certain topics. For example, J.G. says
he wanted to kill himself because he wanted to “push buttons” due to his mother. Now, that I
look back, I realize there must be so much more going on in his life than his mother being too
controlling. From what we learned in class, suicidal thoughts or ideations develop from a
combination of things. Next time, I would be more aggressive, and ask what else was going on in
his life and I would have come out and asked if he had a plan. This would have allowed the
interaction to become more effective because I could have gotten the whole story and we could
have together attempt to solve some of those problems.
Through completing this interactional process recording, it has helped me become more
self-aware and has given me the ability to demonstrate what I have learned about the therapeutic
nurse-patient relationship as a basis for providing behavioral change in mental health patients. It
has also assisted me in my ability to examine components of the communication process and
identify functional and dysfunctional communication. Finally, I learned and understand that a
nurse’s response influences a therapeutic outcome for mental health patients.
Running Head: INTERACTIONAL PROCESS RECORDING
15
References
(2010). Psychiatric nursing and mental health nursing care. NURS 40030. Kent, OH: Kent State
University College of Nursing.
Boyd, M. A. (2008). Psychiatric nursing: contemporary practice (4th ed.). Philadelphia, PA:
Wolters Kluwer Health- Lippincott Williams & Wilkins.
Foley, M. (2010). Lippincott’s handbook for psychiatric nursing and care planning.
Philadelphia, PA: Wolters Kluwer Health- Lippincott Williams & Wilkins.