Harrison

Process Recording
Follow the PR Directions Sheet Carefully
DATE: 02/03/2016
Client Dx: Schizophrenia-Paranoia
Age: 65
Dialogue
N: Hello, My name is Marvin,
Im a student nurse from
KCC. How are you doing?
C: Im not doing good right
now.

N: What are making things

not good for you right now?
C: Im starving over here. They
said it is dinner time but
wheres the food? Im starving
to death over here.

Non Verbal
Communication
N: Sitting
upright next to
patient; eye
contact; smiling
C: brief eye
contact, facial
expression
displays emotion;
frequently looks
down, sitting in
recliner in the
reclined position.
N: Hands
together sitting
up and leaning
in, eye contact,
change facial
expression to
address concern
C: Eye contact,

Technique

Student
Feelings
(+)Introducto Happy,
ry statement confident
General lead

(+)Open
ended
question

Interested

Student Thoughts

T/
Analysis
N
Uh-oh, this patient
T 3. Most times I am
doesnt look too happy
confident when I speak to
right now.
clients. My feelings of
confidence affected my
interaction in a positive
manner because it allowed
me to initiate the
conversation without
thinking too hard. This
ultimately set the tone for
this meaningful
conversation.
I wonder, what is
T
wrong? I hope that this
patient tells me.

3. My thoughts and
feelings contributed to this
exchange in a positive
manner. My thoughts
allowed me to explore the
clients concerns. I tried to
make my nonverbal
communication congruent
to this by maintaining eye

Harrison
straight face with
brows slightly
lowered. Hands
are slightly
shaking resting on
abdomen. Raises
hands when
patient says,
Wheres the
food? Im
starving to death
over here.
N: What were you able to eat
today?
C: I had whatever they gave me
for breakfast and lunch. Then
they make me starve. They
starve me to death. Thats how
it works over here. They starve
you and we starve through the
winter.

N: Look around
unit towards
other members
and staff, then
initiates eye
contact with
client once
again. Opens up
hands.

contact, leaning in, and

changing my facial
expression from smiling
to more of a concerned
facial expression. I wanted
to tell the client that I am
listening and I am
concerned through my
nonverbal communication.

(+)Open
ended
question

Calm

2. The client expresses her

hunger so I tried to figure
out what she ate and the
last time she ate. I kept the
statement open but I could
have used another
therapeutic technique to
address her emotions
instead. If I used a
reflection of feeling, I
could have said, It
sounds like youre very
upset about that.

2. I used the therapeutic

skill of restatement. I
thought that it was
effective but I realize that

It wont be too long

before dinner is here.
Only 15 minutes more.
I wonder if she ate at
all today.

C: Discontinues
eye contact.
Hands slightly
shaking, resting
on abdomen,
reclined position.
N: They starve you?
C: Yeah, those guys they starve
you to death over here. But you

N: eye contact,
lean forward,
nodding

(+)Restateme Interested
nt

Some of those
statements like
starving through the
winter seem a little

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know what? Im still breathing.
Thats what my son tells me
every day, Mom when you
wake up in the morning
remember to be thankful that
you are alive and breathing
because tomorrow is never
promised.

N: Tell me more about your

children.
C: My son is a mechanic and he
collects antique cars. My
daughter is a veterinarian and
one day she is going to run her
own clinic. I miss my kids.

C: looking up
around unit,
points towards
nursing station to
clarify who she is
referring to.
Moves back into
resting position,
nodding head
movements, small
hand gestures,
eye contact
N: Direct eye
(+)Focus
contact,
statement
nodding, open
posture

C: Intermittent
eye contact; looks
away while
gathering
thoughts, small
hand gestures,
looks down when
she says, I miss
my kids.
N: When was the last time you N: Eye contact,
spoke with them?
nodding, slightly
repositions body
C: Never because they
to directly face
abandoned me. They gave up on client.
me. They dont call me or

(-)Close
ended
question.

delusional. I would
like to address her
concerns

it could have been

misinterpreted for a closed
ended question. One way I
could have changed this is
restate only the word that
I was trying to emphasize.
I could have just said,
They?.

Interested

I would like to know

more about your
family.

4. I noticed a change in
her nonverbal
communication when she
was talking about what
her son tells her. She made
direct eye contact once
she spoke about her son. It
made me feel like it was
something important to
her which allowed me to
give a response that would
let her express her
thoughts on her children.

Curious

I wonder if she still

talks to them or sees
them at all. I hope she
opens up about this.

5. This was a close ended

question because she
could answer this question
in one answer. A good
alternate response would
have been expression of

Harrison
anything because they left me
here. They abandoned me. It
makes me sad.

N: You feel sad because your

children left you here.
C: Yes, I dont know why they
left me here. Its terrible. Im
alone here and thats why you
got to watch your back over
here. They are out to get you. At
night they think Im sleeping
but I have to make sure that I
stay up in case someone tries to
do anything. Theyll wake you
up and put eye drops in your
eye.

C: Intermittent
eye contact.
Client would
make brief eye
contact and then
look down. Facial
expression
displays emotion
upon speaking of
children.
N: eye contact,
small hand
gestures,
nodding
C: looks down
when talking
about how her
children left her.
Makes eye
contact when
saying that you
got to watch your
back. Small
hand gestures,
makes fist and
squeezing motion

empathy. After she

expressed that she misses
her kids I could have said,
It must be hard for you to
be away from them.

(+)Reflection Empathetic
of feelings

T
Im glad shes
starting to open up.

4. I interpreted that my
clients nonverbal
communication skills
displayed expressions of
sadness. I used my
observations of these
nonverbal cues to respond
with reflection of feeling.
I thought that it was the
most appropriate
therapeutic technique to
use.

Harrison
N: So what youre saying is
that you dont get much sleep
at night because you have to
stay up in case something is
done to you.

N: Eye contact,
hand gestures,
open posture

(+)Paraphrasi Interested
ng

C: Yeah, they will put eye drops

in your eye but Ill tell you
what, this bird will keep
singing. They can put eye drops
in my eye to blind me all they
want but this bird wont stop
singing and thats for sure.

C: eye contact,
hand motions,
changes of facial
expression; points
finger towards
herself when
saying this bird
wont stop
singing.

N: What do you mean when

you say This bird will keep
singing.?

N: open posture, (+)Clarifying

eye contact, lean Question
forward,
nodding, breaks
eye contact to
look where client
is pointing

I wonder how much

sleep she gets per
night. Am I
understanding all of
this correctly?

C: Im saying they can do what

they want but I am going to
keep singing. They even took
away my ukulele but I keep
singing. Especially that guy
over there. He is bad news. He
started the initial pain I feel in
my body. He is one of the

C: points to one
of the other
patients on the
unit sitting at a

Interested

What exactly does

that mean?

3. I noticed that when I

tried to focus on her
feelings about her children
it wasnt too long until the
subject was changed and
directed towards watching
out for herself. She
verbally expressed that
she stays up at night
which made me think,
How much sleep does
she get?. My thoughts
contributed positively to
the interaction because it
allowed me to use the
therapeutic skill of
paraphrasing to explore
her sleeping habits while
at the same time address
her concerns of paranoia.
2. I used the therapeutic
communication skill of
clarification in this
exchange but I think that
maybe a refocus statement
would have been better. I
could have asked her to
tell me more about what
keeps her up at night to
address her sleeping
habits.

Harrison
troublemakers here.

table, shakes
head, eyes
focused on patient

N: How did that man make

trouble to you?

N: looking at
person that the
client is
addressing then
initiate eye
contact back on
client, lean
forward

T
(+)Open
ended
question.

Eager

C: He did. He is a doctor and he

created the pain I feel in my
body. He removed my
endocrinologist. And look now
hes sitting on my table over
there. Now I cant eat ever
again and now I am going to
C: facial
starve to death all thanks to him. expression
He did this to me.
displays emotion,
continues to point
towards patient at
table, shakes
head, hand
gestures

I wonder what that

guy did. He is literally
sitting down staring at
the table. I wonder if
its another delusion.

4. I interpreted that her

nonverbal communication
displayed some agitation
towards another patient.
Her expression made me
feel eager to find out
about factors that trigger
agitation. I responded with
an open ended question in
order for her to address
her concerns.

T
N: That sounds like it is very
stressful for you.

N: eye contact

C: Points directly
C: Yeah it is. Look at him.
at other patient,
Theyre all sitting on my table.
shakes head,
Now I am going to starve and
facial expression
look at him he is going to make displaying
me eat that cactus. Hey Im not emotion, waves
going to eat that cactus, Doctor. pointer finger side
You wont make me do
to side. Eyes
anything I dont want to do. I
focused on other

(+)Expressio
n of empathy

empathetic

Remember what
appropriate responses
are to those with
altered thought
processes are. The
response must be
therapeutic.

3. I thought that my
thoughts in this particular
exchange impacted my
interaction both positively
and negatively. I thought
that it affected it
positively because it made
me think about the best
response I can give to this
client in order for it to
remain therapeutic. It also

Harrison
am not going to eat that cactus
no matter what you tell me. He
really is bad news. Im telling
you, brother, I wont let him
make me eat that cactus.

patient and then

back towards me.

N: It sounds like you feel

angry about that.

N: direct eye
(+)Reflection Uncomforta
contact, open
of feeling
ble
posture. Break
eye contact again
to focus on
direction that
client is pointing
to. Initiates eye
contact again,
nodding

C: Of course I am! Thats what

he does to me. He upsets me. I
cant make him do that to me.
He is trouble and he is only one
of them. That one over there,
she is a trouble maker too I tell
you. Brother, just watch your
back because you never know.
You might get wiped out.

N: I hear that you are saying

that there are people who
make trouble to you or upset
you.

affected it in a negative
way because my thoughts
removed some of the
focus away from the client
and more towards myself.

T
She is really raising
her voice. Its a little
disruptive. I need to
redirect her to focus
on her emotions.

C: hand gestures,
pointing and
looking towards
another patient.
Regains eye
contact, folds
hands together
over abdomen
N: eye contact,
hand gestures,
nodding
C: eye contact,

(+)Paraphrasi
ng
Alert

4. My clients nonverbal
communication displayed
heightened expressions of
agitation. She was
pointing and raising her
voice and it made me feel
a little uncomfortable
because she was drawing
attention from people on
the unit. I tried to redirect
her by giving a reflection
of feeling to focus more
on the emotion instead of
the trigger.

T
I wonder what else or
who else agitates this
patient.

3. In this exchange my
thoughts affected this
interaction in a positive
manner because it
prompted me to use the

Harrison
C: Yes they do but I am still
small hand
breathing. You never know
gestures, small
thats why. You might wake up
head movements
and be ok and then the next day
you are dead. Tomorrow is
never promised. Thats why my
son tells me, Mom just be
thankful that you are breathing.

therapeutic skill of
paraphrasing. I wanted to
let her know that I am
listening to her concerns
but I also wanted to say it
in a way that could maybe
explore other factors that
agitate her.

T
N: Mhm
C: It is a daily struggle. Every
day I have to survive in this
place. They try to starve me to
death over here. Like now, they
say its dinner time but there is
no food. Theyre starving us to
death like how they do every
winter.

N: I think that dinner is on its

way right now. But that really
does sound like the struggle
you mentioned is hard for
you.
C: Thats what they always say.

N: eye contact,
nodding, lean
forward, open
posture

(+)Minimal
Encourager

Patient

I am here and I am
listening to you.

3. Since I used a minimal

encourager I wanted to
maximize my nonverbal
communication. I did this
by learning forward,
maintaining eye contact,
and keeping an open
posture. I noticed that
when I kept my posture
open and I leaned forward
she would share a little
more.

C: flat facial
expression,
breaks eye
contact, looks
towards nursing
station, hands
resting on chest
N: look towards
nursing station
to see if the food
arrived, then
maintain eye
contact, sitting
upright, open
posture.

T
(+)Expressio empathetic
n of Empathy

I hope that the food

arrives soon because
maybe her hunger is
adding to the
agitation.

3. I think that my thoughts

on this exchange affected
this interaction in a
negative manner because I
assumed that her hunger
was adding to the
agitation. My feelings of

Harrison
They say its on its way but it
never comes. All I want to do is
eat but I never get to. I always
have to fight for my life in this
place.

empathy helped me to use

the therapeutic
communication skill of
expression of empathy.

C: hand gestures,
facial expression
displays emotion,
intermittently
looks down.
Looks around unit

N
N: Well your food just got
here. I will help you open your
food and drinks so that you
can finally eat, but thanks for
talking to me.

N: smiling, stand
up, help open
food and
beverages for
client

C: Yeah finally, thank you

brother. I am starving.

C: sits up, grabs

utensils for food

No skill or
therapeutic
technique.

Happy

Im glad I had this

conversation and I am
also glad she can
finally eat. I hope I
was therapeutic. I need
to write all of this
down now. I hope I
can remember

5. My response in this
exchange was not
therapeutic but it was my
closing statement because
the nurse arrived with her
tray of food. I was happy
that this client took the
time to speak with me.

Cognitive Behavioral Model: In this process recording I quickly noticed that my patient had altered thought content. Her persecutory
thoughts made her feel paranoid. Her paranoia affected her behaviors and actions by displaying agitation towards others on the unit as
well as depriving herself of sleep at night. I tried to address these concerns along with others throughout this process recording. It was
a great learning experience.