Student Name: Brittany Thompson Brief Information about this Client: 32 year old female diagnosed with depression but being evaluated for possible schizophrenia Student Goals For this interaction: To therapeutically communicate with the patient and build a trusting relationship Setting/Time: 6South of UAB Psychiatric Ward, mid morning snack
Nurse Communication (Verbal & Non Verbal) Client Communication (Verbal & Non Verbal) Nurses Thoughts & Feelings Related to the Interaction Analysis of the Interaction (Effectiveness, Technique, Name & Rationale) Alternate or Revised Response 1. (I approach the client when I notice she has been sitting alone most of the morning and avoids communication with others. After asking if I could join her at their table and introductions, I started asking questions)
What brought you to the unit?
My husband brought me here because he is worried about me Apprehensive at first because the patient seemed so closed off, but relieved that she didnt seem to mind me asking personal questions. Therapeutic and effective because it gave me an opportunity to see how the patient came to the unit from their prospective, not just what was written in the chart. Do you mind if I ask you what brought you to the hospital? 2. Why is it that your husband is worried?
He thinks that I might try and hurt myself or one of our sons
(She then breaks eye contact and stares at the table) Interested to learn about the relationship with her husband and what occurred for him to bring her to the hospital Non-therapeutic because I think the patient felt shamed because of the way I worded the question. I should have avoided asking why What is it that was worrying your husband? 3. Have you thought about hurting yourself or your sons?
No but I do need help, my medications are not working for my depression I believe that she does not have any intention to hurt anyone (including herself) but she does seem very depressed. Therapeutic and effective because it is direct and clear, which is the best way to ask about suicidal thoughts. Have you ever thought of harming yourself in any way? 4. What has been going on that you do not think your medication has been working for your depression?
Well, the last time I was in the hospital they diagnosed me with postpartum depression, but I did Interested to continue the conversation to learn more about the patients condition Therapeutic and effective because the patient was able to cognitively describe why their previous treatment may Can you tell me more about your medication not working to treat your depression? Nurse Communication (Verbal & Non Verbal) Client Communication (Verbal & Non Verbal) Nurses Thoughts & Feelings Related to the Interaction Analysis of the Interaction (Effectiveness, Technique, Name & Rationale) Alternate or Revised Response not tell them that I was hearing voices. I thought the medication might make the voices go away, but they have gotten worse. not have been sufficient 5. Are you still hearing voices or seeing things that are not real?
Yes, I only knew that you were real because I saw you talking to my nurse a minute ago. I really felt sorry for her at this point in the conversation because I could see that she was struggling to determine reality. Therapeutic and effective. The patient was able to talk about their hallucinations and I got some insight to what the patient must be experiencing. How long have you been hearing voices? 6. What were the voices saying?
The patient described how the voices were telling her things in the middle of the night like if you go to sleep I will smother you with your pillow I gained a new understanding of a story I heard from her nurse when I arrived on the unit. The nurse told me that the previous night the patient hid in her closet because she was afraid of the male tech that was checking on her. When I first heard that it sounded crazy, but after talking to the patient I can see how having violent hallucinations at night in a strange place would be terrifying. Therapeutic and effective. I used this open-ended question to determine the extent of his hallucinations and she was able to elaborate on them. Can you tell me what the voices were saying to you? Nurse Communication (Verbal & Non Verbal) Client Communication (Verbal & Non Verbal) Nurses Thoughts & Feelings Related to the Interaction Analysis of the Interaction (Effectiveness, Technique, Name & Rationale) Alternate or Revised Response 7. Are you going to tell the doctors about the voices that you have been hearing? Yes, I have never told them because I thought they would keep me here and away from my sons, but I just really want the voices to go away, and if they can help me then I will. Glad to hear that she is willing to talk to the doctors about her hallucinations so that she can start to get treatment that can help her. Therapeutic because the patient is moving towards agreeing to a treatment plan that can help her. Have you told the doctors about the hallucinations you have experienced?