Importance of Process Recording in Nursing - Case Study Example

Running Head: PROCESS RECORDING Process Recording 1 Brief history or scenario and description of setting (5 points): This interview was conducted with an 83 year old high school teacher in her home so that she was comfortable in her own chair. The interview took place in the morning with the hope that this would be a good period of the day that allowed for relaxed interaction. What I said and did (verbal and nonverbal communication). (15 points) My thoughts and feelings. (10 points) What the client said and did. (10 points) Identification of the phases of the interaction communication. (10 points) Labeling of therapeutic and nontherapeutic communication techniques (10 points) Records rationale for each technique. For each nontherapeutic technique used, provide an example of a therapeutic technique that could replace the nontherapeutic communication technique. (15 points) Note: This fourth column is most important. You are expected to critically analyze your communication based upon the communication theory. Therefore, you should cite references. I looked over my notes, and prepared for the meeting. Stepping up to the door, I knocked and waited patiently expecting it to take some time for her to answer. T: Will she be able to understand the purpose of this process? F: Cautious Preinteraction Phase – During this phase it was essential to prepare for the conversation through reviewing notes and thinking about the questions that I would ask. Hello, Mrs. ______. We spoke earlier about you helping me with a project for school? All I need is to just open up a conversation with you about anything you would like to talk about. (smiles) This would be a private conversation with only my professor having access to the notes. It doesn’t have to take too long. Is that still ok with you? T: I am concerned that she will be too personal or not talk about anything at all. I am more concerned she forgot about my coming over, but she has not. F: Mildly Anxious “Of Course, come in, come in” (with enthusiasm) Orientation Phase Introductions were made and through reminding her of a previous discussion that arranged for the meeting, the arrangement was verified as still acceptable to her for the project. Confidentiality She was reminded that the process would be confidential. This is just practice for my career so that I can learn how to listen better. You can talk about anything you would like to talk about, and I will just be taking notes. Ok? T: I realize that I am talking too much F: Mildly embarrassed as I look down. (smiles and nods) Orientation Phase Continued .According to Antai-Otong (2008) the orientation phase can be considered the infrastructure of the relationship between the client and the nurse. What would you like to talk about? T: I smile, but I am afraid that it shows my anxiety. F: Fear (she laughs a little) Oh, I can talk about many things, but I guess I would like to talk about teaching. Introduction Phase Client is given the opportunity to be in control of the conversation from the beginning. What was teaching like for you? T: I feel good about the topic and my response F: Comfort I don’t know what it was like I guess, but I didn’t always enjoy it. Beginning of Working Phase fail. What about teaching do you want to talk about then? T: Although I thought my last question was reasonable, it wasn’t a good way to converse. This feels better F:Mildy anxious Well, I guess how angry it made me some of the time. Beginning of Working Phase Broad Opening: Allows the client to have control over the direction of the interview (Basavanthappa, 2004). (nods) Tell me about your anger. T: I am focused on her now, this topic of anger unexpected. F: Interested Well, my time of teaching is over and I feel like I missed something. I feel like…. Reflection (therapeutic)– Reflection is a technique of repeating the core concept indicated by the client in order to allow them to expand on that idea (Basavanthappa, 2004). . You feel like? T: I am wondering if this topic is over my skill level and I am uncomfortable F: Concerned I feel like I was supposed to accomplish more while I was teaching and that somewhere I missed some opportunity to make a bigger difference. Reflection (therapeutic)– Reflection is a technique of repeating the core concept indicated by the client in order to allow them to expand on that idea (repeated use) (Basavanthappa, 2004). (nods) So you feel like there should have been something more? T: Feeling a little sad and overwhelmed by the topic F: Sudden sorrow, somewhat unexplained. I just think there is more to teaching than just going to class each day and reciting what we are told to teach. I wish I had found something more important to teach to my students…something profound. Paraphrasing (therapeutic): This sends feedback back so that the client sees you are listening (Basavanthappa, 2004). Conveying Acceptance: Shows that one not only understands, but accepts the premise of the conversation. What kind of message do you wish you could have given them? T: Not sure where this is leading, so I am a little nervous F: Uncomfortable again (laughs a little)oh, I don’t know. How not to mess it all up? (She grows quiet) Focusing: directing the topic towards a more focused concept in order to help the client (Basayanthappa, 2004) – but this time it failed, but caused confusion. Life? You mean? [Silence] T: I want to interpret this for her, but she should direct how it goes…am I messing this up? F: Oddly annoyed Sort of. I wish there was a way to get people to see how to live right and make it all work. It just seems that while I taught them math and literature, I never taught them how to live right. Clarifying: Helping the client to focus in on the topic through clarifying what they may mean (Basayanthappa, 2004). Silence: Allowing for an open communication channel to exist that the client may choose to fill, without interruption or too much input from the interviewer (Basayanthappa, 2004). (smiles) Life is a big subject though. (more silence) T: Still feeling annoyed..not at the client, but at something about the topic. F: Annoyed Well, it’s just that it seems that so many have failed careers, marriages, lives, really. I just wish there was a way to teach how to live well. Clarifying: Helping the client to focus in on the topic through clarifying what they may mean (repeated technique) (Basayanthappa, 2004). You seem frustrated by this, but was that your responsibility? T: Feeling more in control for a moment F: Superior…which is bad Shouldn’t it have been? I prepare them for learning more academically, but when they leave me what do they know about life…did, what did they know. Stating Observations: Putting observations about behavior into the therapeutic conversation. Clarifying. (again) Well, ok, what did they know? (silence) T: I feel suddenly focused on the problem F: on track Honestly, I don’t know… (smiles) As I said, I don’t know exactly what I missed, but I feel like I missed something Restatement: Restating what they have said in order to encourage reflection (Basayanthappa, 2004). (nodding) I feel like you have something to talk more about, but you haven’t clarified it. You know there is something you wish was different about how you did things, but you are unsure what exactly you would have done. The time for this is up, but I find what you think about this topic is interesting. Is there anything else you would like to say before we conclude? T: I wish there was more time. F: Concern I don’t know if I really knew I felt this way. Regret can be a terrible thing, I guess. Termination Phase Summarizing: Provides an overview of the discussion. Acknowledgement of the client’s participation. (smiles) There is always more time as long as you are alive…Thank you for talking with me. T: Biting my tongue on this one..didn’t mean to comment. F: Disappointment (smiles) That is true. Thanks for talking with me. Opinion: This was not a good thing to have given an opinion. It takes the focus off the feelings of the client. Summary Evaluation The conversation that I had with the woman who was a teacher during her career went very differently than was expected. It seems that the woman had some regrets that she was waiting to express to someone and she took this opportunity to express them. That she could feel comfortable enough to talk about how she felt was a good sign that the interview seemed to go well between us. As she discussed the topic she was not really sure how she should discuss her feelings, but she began to open up at first. The concept of regret was clearly emerging as she began to grow wistful about her experiences as a teacher. Her ability to discuss this topic showed that the discussion was taking place in what seemed to be a safe environment and allowed her to open up about her feelings about what she had accomplished. The parts of the conversation that went well were in the therapeutic practices of silence, clarification, and reflection. She was allowed to be in control so she could direct the conversation, the silence allowing for her to expand upon her thoughts about her feelings of anger and regret. As a listener, it was important to reflect back to her what she was saying, helping her to clarify her thoughts and paraphrasing when necessary in order to fully explore the topic and allow her room to discuss her feelings. In repeating what she said back to her, it allowed her to hear her own words and to help find interpretations about what she was trying to convey during the interview. Paraphrasing is feedback that will allow the patient to know that the listener is hearing what is being said, as well as acknowledging the beliefs and feelings of the patient (Basavanthappa, 2004). A big mistake at the end of the interview was in giving my opinion on what she could consider when thinking about the past. Giving an opinion, according to Basavanthappa (2004), is one way in which to interrupt the work that a patient is doing about a topic. Opinions are not a good way to work with people when in a therapeutic session. As well, I found that my own feelings about the topic were impeding my listening capabilities. I do not know why portions of her conversation made me feel annoyed and almost angry, but what she said was affecting my own feelings. I did not find her annoying, or her topic to be annoying, but for some reason I felt annoyed about something she was saying. It may be that I was reflecting her feelings through my own, adopting what she was feeling into my own emotions. I was frustrated for her and felt her grief at not accomplishing what she desires to accomplish. At one point I felt superior during the conversation as if I understood her completely and could keep her on point. This was a mistake as I worked towards getting to the root of the issue. I led her, to an extent, and this is not always the way to provide therapeutic support. It is possible that when I inserted the idea of teaching about life into the conversation, I took too much control. As I reflect on the conversation, it seems as soon as I said what she may have been angry about; her ability to communicate about it was stalled. I may have put up a communication barrier, stopping her from being able to express her own feelings and in the process of trying to focus the conversation, it may have been stunted from my making assumptions. This conversation was an interesting experience in trying to keep a focused conversation while maintaining objectivity about the experience. In reflecting on my own behaviors, it is clear that I inserted too much of my own beliefs into the topic. At the time it seemed that the conversation was client directed, but it might be that I directed too much of the direction of the talk. In looking back on how the interview was conducted, it might be said that I was not focused on the patient, but on my own capacity to understand the ideas she was presenting. I find that the process of working on this type of communications is necessary as I see that it is not as easy to accomplish as it might appear. References Antai-Otong, D. (2008). Nurse-Client Communication: A Life Span Approach. New York: Jones & Bartlet. Basavanthappa, B. T. (2004). Fundamentals of nursing. New Delhi: Jaypee Brothers. Read More