Date: 09/18/2016

Dx: SI, major depression disorder

Age: 15 year old
LOS: 2 days

PROCESS RECODING

Dialogue

Non Verbal
Communica
tion

Technique

Hi, Im Van. Im a KCC

student nurse. Ill be in
the unit until 1 pm
today. Im going to
interview you for about
5-10 minutes. Tell me
what bought you in
here?
I started drinking again
and my foster mom drove
me here.

Seated on
opposite to
the client,
making eye
contact.

Introductor
y /General
lead
statement

Started drinking
again?

Curious
face

Stude
nt
Feelin
gs
Worry

Student
Thoughts

T/N

Analysis

I worry if he is
willing to talk
to me.

I have practice the

introduction so many times.
I feel it come out very easily
and flow now.

Curiou
s

I wonder what
did he do
after drinking
that his foster
mom had to

1. It seems like a good start

as he seems confortable
and openly talked about his
drinking.
2. He might have done

Client seated
comfortably,
looked at me
then moved
his eyes
down on the
floor
Restateme
nt

bring him in
here.

I used to drink alcohol

before. I was sober for
two years.
Uh huh.

Took a deep
breath.

I get depressed when I

think about my biological
mom so I drink again.

Unease,
closed his
eyes for a
brief moment
Look at
client
sincerely
and show
interest
Holding his
head like he
feeling pain

Tell me about your

depressed feeling with
you mom?
My biological mom has
bipolar. She could be very
violent. My dad has to put
a temporary restrain on
her sometimes.
That must be hard for
you.

Maintain
eye contact
without
judgment

Concern
and

something very bad that his

foster mom brought him in.
Thus, I wanted to him to
talk more about it.

Minimal
encouragin
g

Shock

Oh boy, he is
only 15. When
did he start
drinking?

I wanted him to keep talking

so I did not interrupt his
feeling and thought with a
question.

Open focus
statement

Relief

Oh great, he
opens up to
me another
issue

I think this was an

appropriate question to
explore his feeling about his
mom.

Empathic
statement

Empat
hic

That is
horrifying for

I wanted the client know

that I was listening to him

It is hard. She gets so

violent that she hurts my
dad and I, so one day my
dad drove me to the
police. I told the police
about my mom. The
police contacted CPS.
They removed my brother
and I from home. We lived
in a shelter then I moved
in to live with my foster
mom in August.
You sounded sad.

empathic
look
Eye contact
and nodded
to agree with
writers
statement,
look sad

Empathic
look

a child.

Hes been
through a lot.

closely and understand his

feeling

Reflecting
feeling

Sad

Client is depressed with her

mom. I wanted him to focus
on his feeling.

Open focus
question

Concer His mom must T

n
be still
aggressive
with him.

I saw that the root of him

feeling depressed is from his
mom. Thus, I want to stay
on this problem.

I am sad when think of my Nod

mom or see my parents.
What happened when
you see your parents?

Concern
look

My mom was aggressive

and my dad blamed me
for telling the police about
my mom so that my
brother and I were moved

Sad look,
speech in a
monotone
voice

from home.
You said, he was the
one drove you to the
police after you was
hurt, right?

Check out
client
behaviors

Yes he drove me to the

police. But now he blames
me for losing my bother.

Look at me in
the eyes
convincingly
then look
down again
after that

How often do you see

your parents?

Silent a
moment,
Thinking
faces

Clarify
statement

Confus
ed

Closed
Anxiou
question/
s
Not
focusing on
clients
feeling/
Communic
ation error

What am I
missing?

I was confused and

uncertain. I wondered if the
client was being honest.
Thus I want to clarify with
the client if he said it earlier.

It seems to
get more
complicated.

1. Now this question doesnt

sound relevant to me. It
doesnt matter how often he
visits them; he is depressed.
2. Alternative statement to
focus on clients feeling
about problem:
What do you think about
you dad saying its your fault
for him losing your
brother?
3. He seems honest. But
Im still confused about
what made his dad took him
to the police station after

the mother hurt them and

now blaming him for losing
his soon. I should have
asked question to clear up
the missing part. But I was
anxious and didnt think of
it.
I see them every
Deeply
weekend. I supposed to
breath,
move back in with them in looked down
October.
unease
I hear you saying that
feel depressed about
your mom is violent to
you, your dad is
blaming you, and you
concern about moving
back home in October,
is that right?

Maintain
eye contact

Yes.

Look sad

You mention that your

foster mother brought
you here. Tell me what

Silent a bit

Paraphrasi
ng

Inappropria
tely
change

Worry

Stuck

I hope he
wont be mad
at me for
bringing up
sad feelings
about his
parents.

What should I
ask her next?

I was trying to verify if I

heard him right.
2. I think could have follow
up with the next question,
Did you talked anyone
about the violence of the
visit? This could help
identified if he talks about
him concern about unsafe
environment at home.

1. I was preoccupied with an

idea that conflicts might
have rise between them

foster mom say or

think about your
drinking behavior?

topic

after he drank. I was

thinking it could help client
see that his drinking and
related behaviors affect
others and himself.
2. I could have focus on
exploring his coping skills
regarding about depression.
3. Alternative statement:
What do you do when you
have stress or having a
concern?

Communic
ation error

She didnt know because

she was asleep when I got
home. She only found out
when she checked my
texts. She supposed to
check my text for safety.
She got mad at first then
we talked about I got
depressed about mom
parents so she
understands.

Look sad

What do you think

about your drinking?

Nods

I feel bad because I hid

the bottle of alcohol in the

Took a deep
breath

Open ended
focus
statement

Relief

Well, Im glad
they talked it
out. So, why
he is here?

I think this is an appropriate

question to ask in this
situation to assess his moral
development level.

house. Her 8-year-old

daughter could have
found it and drank it. That
was how I started to drink
at 9 when I found the
bottle of alcohol in my
house. I feel bad and
depressed so thought of
killing myself. I feel
unsafe and talk to my
foster mom and told her
to drive me here.
Do you think of killing
yourself or having a
plan now?

Stay calm,
look at
client for
nonverbal
cues, look
at his feet

Sometimes I thought of it.

I dont think of killing
myself now and I dont
have a plan for it.

Calm, remain
his eyes on
the floor

Please let your nurse

or the staffs know if

Insisted
face

Close
ended
question

Shock

Drink at 9
years old?

Concer He doesnt
n
want kill

1. I was shock when he said

he started to drink at 9.
However, I turned my focus
on suicide ideation.
2. It was a close end
question but it is necessary
to ask for considering safety
measurement.

1. Verbal contract is
necessary because first

you ever have a

suicidal thought or a
plan for hurting
yourself or you feeling
so they can help you.

himself now
but he till
think of it
which is bad.

I will.

Nod

Tell me what have you

learned here which will
help you after
discharge?

Maintain
eye contact

Open
ended
question

Happy

Im glad this
question pops
up in my
mind.

priority is patient safety.

2. It also is better if I
assessed any pervious
suicide attempts and the
mean he used so we can
prevent his access to it.

1. I learned this question

from the professor and
when it popped up I used it
right away.
2. It is important to assess
client coping skills such as
what he is going to do to
deal with emotional stress,
crisis at home.

Talk my feeling out will

help me. I will talk to my
psychiatrist when I feel
unsafe and or depressed.

Intermittent
eyes contact

Ok, What else can you

do?

Nods,
encouragin
g look

I will also talk to my

Silent a bit,

Open focus
statement

Happy

Im happy
that you learn
to talk your
feeling out.

I try to have the client think

about other solution besides
talking to a psychiatrist as
he/ she may not always
available.

friends or someone I live

with. I like to draw. I will
draw when I feel
depressed.
Do you take any
medication?

Maintain
eye contact

I stopped taking
medication since April.

Sad

It is important to take
your medications as
ordered to manage the
symptoms you may
have.

Eye contact

My mom was not well and

we kept missing the
appointments. I dont
have any medications
now because I dont have
a prescription. I will need
to contact my psychiatrist
for medications.

Closed
ended
statement

Happy

Thats a good
strategy.
Drawing could
help reduce
stress.

Concer Med
n
incompliance
is a big
problem.

1. Alternatives statement:
Tell me about any
medication you are taking?
2. This question is necessary
to assess clients knowledge
and med compliance.

So today we discussed
about your depressed
feeling with your mom
violence and your dad
blamed you for the loss
of your bother. We
also discussed about
your feeling about
hiding alcohol inside
the house. You also
mentioned that you
have intermittent
thought of killing
yourself and agreed to
inform the nurse when
you think of it or have
a plan for it. You stated
that you will call your
psychiatrist for help
and talk your feeling
out to people and you
will draw when you
feel depressed. You
dont take medication
now but you will
contact psychiatrist for
a prescription.

Smile,
maintain
eye
contact,
hand
gestures

Yes.
Ok. Thats it for today.

Nods

Summarizi
ng
statement

Uncert
ain

Did I ask all

the necessary
questions

1. I think there are still

questions that I should have
asked at beginning.
2. Look back at the
conversation; I realized the
client was blaming others
for his drinking behaviors. 3.
Suggestions for
improvement: Tell me any
of your behaviors at home
contribute to you parents
actions toward you? Asking
questions that help client to
links his behaviors to the
problems so that he can find
a solution for the problem.

Thank you for your

time and cooperation.
Ill be around in the
unit until 1pm today. If
you want to talk about
something please dont
hesitate to do so.
Ok