Diagnosis

J.H was admitted to Unit 9 with a diagnosis of alcohol dependence causing induced mood disorder with depressive features. The diagnostic criteria outlined by the DSM-IV for substance dependence states that three or more of the following impairments must be seen in the patient, a tolerance for the specific substance, withdrawal symptoms if the substance stops being taken, persistent desire or unsuccessful efforts to cut back or control substance use, reduction or even cessation of important social, occupational, or recreational activities, and substance use in spite of knowledge of having a substance abuse problem (Austin & Boyd, 2008). The etiology behind substance abuse is still being researched but the evidence suggests that there are both psychological and biological aspects to addictive personalities. It is also evident that substance abuse and dependence can lead to problems in all parts of the biopsychosocial well being.

The interaction took place on unit 9 of the QEH hospital on September 24th at approximately 1530 hrs. The client and the student nurse had discussions in the pantry area of the unit as well as in the common area the conversation of focus took place in the common area.

Preceding Critical Events

The student nurse had met the client once before and had already started the orientation phases of the nurse-client relationship. The client was cleaning the pantry area of the unit while making himself a cup of coffee. This is when the student nurse approached the client and began a conversation which led to the discussion of focus.

Phase of the Nurse-Client Relationship

During the conversation of focus the student nurse and the client were in the working phase of the nurse-client relationship. They were in this phase because the client was beginning to outline areas of his illness that needed to be worked on in order to recover. Client and Nursing Partnership Goals

Client Health Goals

Short Term 1.) Client wants to get into an addiction center outside of PEI. The client has already tried the addiction center at Mt. Herberts and feels that the program does not work for him. This goal was identified by asking the client about the various treatments he has used in the past few years and he mentioned his application to a treatment center in Ontario. 2.) Client also wanted to go on a three hour pass that evening in order to complete some errands at his home. This goal was established after I asked the client what his plans were for the rest of the day. Long Term 1.) Client wants to gain control over his alcohol dependence by attending more AA meetings and getting the proper psychiatric treatment including medications and group work. 2.) Client wants to better his relationship with his two daughters but feels that he first needs to get control of his illness. 3.) Client wants to finalize his divorce, at the current time he is legally separated in order to complete the divorce the client must speak to his lawyer and finish some paperwork. Nursing Partnership Goals Short Term 1.) Establish a nurse-client relationship by defining boundaries, assuring confidentiality, and explaining the purpose of the relationship. 2.) Provide client with information regarding treatment center in Ontario. 3.) Gain enough trust with the client so that he feels comfortable to discuss his illness and his history with the student nurse.

What I Observed

Client was in the pantry area of the unit cleaning while making a cup of coffee. He seemed a little anxious and somewhat rushed (it was later observed that this is simply a part of the client personality.) When I entered the room J immediately greeted me saying “Hello Greg, I’m just making myself a cup of coffee. I like to try and do my part to keep the place clean” his tone, volume, and rhythm were all within normal limits and he seemed to be in a pleasant mood. The client then said “Oh, I don’t clean up that often the other people here are pretty good at cleaning up after themselves I just like to keep busy.” After the patient finished making his cup of coffee he moved to a couch in the common area. His mood was still pleasant and he was very talkative. After J was finished he said something that really caught my attention “I know I have a problem but I only binge drink, it’s not like I drink all the time.” Pause “Well I shouldn’t say that because it is bad enough to just binge drink and I need to get better ” At this point the patient started to ask questions about me such as where I was from, what I thought of the nursing school, and a few other things. The client was now very relaxed in the couch with his feet up on the coffee table drinking his coffee.

What I Thought and Felt

When the client greeted me so quickly and in such a pleasant tone I felt that the nurse-client relationship was developing very well and that it was time to start the working phase of the relationship. By the way the client talked about his co-patients and the staff I could tell that he was quite comfortable on the unit. I felt that this would be a good time to start a conversation. I thought that now would be a good opportunity to ask J about what brought him to the unit and to explore his diagnosis. I felt a little nervous thinking of what to say I feared that I may be asking something to private this early in the relationship

I was surprised at how easily J opened up about his history and I was slowly starting to feel more comfortable with asking questions about his illness. Again I felt that J was being very honest with me and I could sense that he trusted me as a nurse.


 

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Complete a process recording on a classmate, friend or family member and not at work.

What is a Process Recording?

The Process Recording is a method to record the content of a student’s interview or interaction with a client for learning purposes. In the Process Recording all communication, verbal and non-verbal is written down based on the student’s best recollection. The student also records their own feelings and reflections during the interaction with the client. Students may also be asked to reflect on how effective they were, and how they might improve their interviewing skills.

Why do Process Recordings?

Process Recordings give students the opportunity to assess and improve their practice skills through reflection and feedback. This process assists in the development of communication skills as well as critical-thinking skills. Reflecting on the interaction can help students see their client interactions more objectively, and learn to distinguish between thoughts and feelings. Process recordings are also useful tools for faculty, allowing the faculty to review the student-client interaction, identify strengths, note challenges, and help the student formulate alternative approaches for future interactions.

What should be included in the Process Recording?

All communication during the interview or interaction, both verbal and nonverbal.

Verbal communication includes everything that was said by both the client and the student. Record the interaction word for word, as well as you can remember it. Resist the urge to “improve” your comments or client interaction. Process Recordings are not graded on the student’s performance in the interview, but on student’s ability to apply therapeutic communication principles and use self-reflection to assess strengths, weaknesses, and communication effectiveness.

Nonverbal communication is all other types of communication. This includes speech tone and speed, body language, eye contact and other non-verbal signals. When including descriptions be sure to include any “evidence” that supports your impressions and assessment. You should also include setting, pertinent observations and descriptions, and intrusions such as ringing phones, etc.

What about Confidentiality?

Students should ensure that confidentiality is maintained. Be sure to disguise all information that might make it possible for someone to identify your client, such as the name of the client or agency, the town, or location. Even when you have disguised the information, do not share the process recording with anyone other than as required for the assignment.

Preparing the Process Recording

Begin by recalling all communication during the client interaction, both verbal and non-verbal. While it may seem hard to remember everything, most students find that as they begin to write down what they remember, more of the interview comes back to them. Do not take notes for the Process Recording during the interview with the client as this can have a negative effect on the interaction with the client.

While Process Recordings are typically done in a client interview setting, the Process Recording method can be applied to many other kinds of professional interactions. Students should not simulate an interview or interaction for the Process Recording assignment.

Process Recording Format

I. The Introduction

The first section of the Process Recording provides the context for the interview. Start with a short description of the setting (e.g. kitchen, yard). Briefly describe the client including basic demographic information such as age, gender, race, socioeconomic status, education, and occupation. Summarize the client’s family structure, social support system, and community or cultural context. Describe the client’s appearance and affect. Summarize what you knew about the client before the recorded interview and why they came to the facility. Finally, explain the purpose for the current interview (get experience practicing your techniques).

II. The Interview

This section of the Process Recording includes the word for word record of the interview as well as analysis and feedback relating to the interactions between the student and the client. This section uses separate columns for these different types of columns.

Column 1 – Interview Content

In the first column record the dialogue of the interview, word for word as it occurred to the best or your memory. Do not summarize or paraphrase what each person said, or change the wording. The dialogue should be recorded in the drama format, like that used for a play. For example:

Intern: “How long have you been worried about this problem?”

Client: “For a very long time…ever since my son was born.”

Column 2 – Observations, Impressions and Evaluation

In this column the student should record their observations and impressions of their own reactions, and the client’s response to the interactions. This can include observations of physical actions as well as the student’s impression of what the client might be thinking or feeling. Students should also record their own thoughts, feelings and reactions to the interview. Students should also label which therapeutic technique was used and also identify non-therapeutic communication.

Column 3- Suggestions for Improvement

In this column record ideas how the communication could have been improved. Each non-therapeutic interaction must have a suggestion on how to make the interaction more therapeutic.

Column 4 – Faculty Comments

In Column 4 the Instructor provides feedback on the interaction. This includes affirmation of the student’s practice skills or analysis, constructive criticism and suggestions for alternate approaches in the future.

III. The Summary

The Process Recording is concluded with a summary. This includes a brief assessment of the client problem and the client’s experience in the interview. In the summary the student should also critically assess his/her own practice skills in the interview. Students should address the following:

What was accomplished in the interview?

Did you accomplish what you had intended? If not, why not? What got in the way? Did you

focus on something different, yet equally important?

Include any new insights you gained from the process recoding and how they might assist in developing therapeutic communication skills.

SOME PRACTICAL CONSIDERATIONS:

Process recordings should be done as soon as possible after the interview so that the recording will be as accurate and complete as possible.

Recording a client interview is very time consuming. Students should plan ahead to be sure they have sufficient time to complete the Process Recording.

Process recordings are a learning tool to assist you in developing therapeutic communication skills.

Process Recording Template: Available on Canvas under week 8. Use the template to complete assignment and upload here. Process recording should be typed using the template


 

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