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INTERACTION PROCESS ANALYSIS (IPA)

Students Name: Holly Stelter Clients Name:_____M.P.___________

Interview Date: 3/22/2017____________

I. PURPOSE OF THE SESSION: List three goals for your patient for the day of the IPA.

1. My patient will verbalize her support system during my shift (700-1200).

2. My patient will verbalize her goals after being discharged during my shift (700-1200)

3. During my shift (700-1200) my patient will verbalize a positive coping method learned during her
admission.

II. EXPECTATIONS OF THE SESSION: List three goals for yourself during this interaction.

1. During my interaction with my patient I will use 6 verbal responses that are purposeful and
therapeutic.

2. During my interaction with my patient I will avoid using closed ended questions.

3. During my interaction with my patient I will give support to the patient and show empathy.

II. OBSERVATION: Include observations related to the patient and the unit environment.

1. My patient was sitting with 2 other patients in front of the TV when I arrived on the floor.

2. My patients appearance was appropriate and clean; she was dressed in hospital clothes with what
appeared to be her own long sleeved shirt underneath.

3. The unit was overall calm during my shift. Several patients did not come out of their rooms onto the
unit but those who did were very cooperative with the students.

Many patients with psychiatric disorders have difficulty communicating. A process recording
(IPA) assists the new psychiatric nursing student to record the verbatim interaction after the
conversation takes place with an assigned patient then identify and analyze symbolic meanings,
themes and techniques and blocks in therapeutic communication ( Boyd, 146-152)
III. CONTENT:
INTERVIEWER INTERVIEWEE IDENTIFY ANALYSIS OF THE
COMMUNICATION INTERACTION
(the student) (the patient) (Was the technique effective? Why
TECHNIQUES or why not?
Was there anything else that could
have been explored?
What were the major themes?)

1) SN: Goodmorning, are


Pt: Yes thats me. 1) Close Ended Question 1) Opening my communication
you (patient name).
with the patient in this manner
allows me to establish a
Non-Verbal Communication positive rapport with the
-We are both sitting in chairs in patient.
front of the tv. I am using
SOLAR technique

2) SN: I was wondering if Pt: Oh sure, that is fine with 2) Broad opening
you would talk with me 2) This statement allowed the
me.
this morning, would that patient to feel that they were
be okay? making the decision to talk
with me and not that I was
pressuring them into
Non-Verbal Communication
conversation. Also allowing
-I am still using SOLAR and pt .
for a positive rapport to
appears relaxed continue to be established.

3) SN: How did you sleep


last night?
Pt: Not too bad at all, I got 3) Broad opening 3) This technique was effective
pretty good sleep last night.
because it showed the patient
Non-Verbal Communication
that I was interested and
-I am still using SOLAR and pt engaged in communicating
appears relaxed.
with them.

4) SN: Could you tell me a


little about what brought
you into the hospital? Pt: It was my health. I 4) This technique was effective
4) Offering a general because it allowed the patient
wasnt healthy at home.
lead therapeutic to explain to me why they
Non-Verbal Communication communication were at the hospital.
-I am still using SOLAR. Pt still
relaxed and became very open to
talking about their
hospitalization.

*pt began running off into


with the communication and it
became therapeutic for about
15 minutes*
5) SN: So you said your Pt: I just couldnt take 5) Restating/exploring 5) This technique was effective
health brought you into where I was living any therapeutic because it got the patient to
the hospital, could you longer. It wasnt a good communication begin to elaborate in more
tell me more about that? place for to try and stay off detail their reason for being in
drugs at. the hospital.
Non-Verbal Communication
-I am still using SOLAR. Our
location has moved from in front
of the TV to a table while the pt
eats breakfast. The pt is still calm
and relaxed. Opened to
communicating with me.

Pt: I was living with my 6) Requesting and 6) This technique was effective
6) SN: Where exactly boyfriend at his house. He explanation because it allowed the patient
where you living before also lives with his mother therapeutic to communicate in better
you came here? and she makes it hard to communication detail their story.
want to stay there. I dont
Non-Verbal Communication want to go back there when I
-Still sitting at the table as the
leave
patient eats breakfast, in SOLAR.
Pt still relaxed and opened to
communicating.

Pt: Definitely. I was 7) Risk


7) SN: Do you think that assessment/exploring 7) This technique was effective
anxious and stressed all the
environment was causing therapeutic because it allowed the patient
time.
you stress? Or making communication to explain how their past
you feel anxious and living situation was effecting
depressed? their mood.

Non-Verbal Communication
-Still sitting at the table as the
patient eats breakfast, in SOLAR.
Pt still relaxed and opened to
communicating.

8) Requesting an
8) SN: Are you feeling Pt: No not at all. I feel 8) This technique was effective it
explanation
depressed or having any great today. allowed the pt to explain to
therapeutic
anxiety today? me their current state of
communication
anxiety and depression.
Non-Verbal Communication
-Still sitting at the table as the
patient eats breakfast, in SOLAR.
Pt still relaxed and opened to
communicating.

9) SN: Are you having any Pt: No Im not. 9) This technique was effective
9) Risk Assessment
thoughts of hurting because it assessed the
therapeutic
yourself or hurting patients current
communication
others? suicidal/homicidal thoughts.
10) SN: Where is it you plan Pt: Im gonna go live with 10) Exploring/requesting 10) This technique was effective.
to go when you leave one of my daughters and my and explanation It allowed the patient to tell
here? grand-babies. therapeutic me what their plan for housing
communication is after living the hospital.
Non-Verbal Communication
-Sitting at the table as patient eats
breakfast. Sitting in SOLAR.
Patient is relaxed and open to
communicating.
Pt: She lives in Tennessee. 11) This was a closed ended
Two other of my daughters 11) Closed Ended question however, because the
11) SN: Where does your
live there and so does my question pt is so willing to offer
daughter live at?
only son. Im really excited information I got more about
to go there. We used to not her future living environment.
Non-Verbal Communication get along very well because I
-Sitting at the table as pt wats was on drugs, but now that
breakfast. Sitting in SOLAR. Pt Im clean we get along better
is relaxed and open to and I think it will be better
communication.
for me there.
12) This technique was effective
12) SN: You said you are 12) Restating/exploring because it allowed the patient
Pt: Cocaine. But I had to therapeutic technique
currently drug free. What to tell me about their previous
stop for my health. I dont
kind of drugs were you history with substance abuse.
want to ever do it again. I
on?
feel a lot better now.

Non-Verbal Communication
-Sitting at the table as pt eats
breakfast. Sitting in SOLAR. Pt
is relaxed and open to
communication.
13) This technique was effective
13) SN: Since you are now 13) Focusing/exploring because it allowed the pt to
Pt: Oh yes. My kids will be
clean on drugs and going therapeutic technique identify a positive support
a great support system. They
to live with your system for themselves after
were there with me when I
daughter, do you think they leave the hospital.
was really bad on the drugs
you will have a support
and they have always wanted
system in this new
me to quit. And I will be
environment?
spending lots of time with
my grand-babies and I dont
Non-Verbal Communication want to be on drugs with
-Sitting at the table as pt eats them.
breakfast. Sitting in SOLAR. Pt
is relaxed and open to
communication.
14) This technique was effective
because recognizing the
14) SN: I bet that will be Pt: I know, I cant wait! I;m
14) Recognizing patients excitement about their
exciting to be in a new really looking forward to the
therapeutic new environment help end the
environment with your change.
communication conversation on positive note.
family who is going to
support you.
IV. IMPRESSIONS/ASSESSMENT: 1) What did you observe throughout the session -- behavior and
affect; 2) was the behavior/affect appropriate, explain; 3) how does this behavior/affect fit with what you
know about the clients past behavior/affect; and 4) identify the major themes/issues that emerged.

1) Throughout the session with my pt there were several things I observed. She was calm and in a
relaxed posture throughout the entire conversation. She did not make a lot of eye contact during
our conversation which could be indicative of some underlying emotional issues going on. Her
facial expression was animated and she was dressed neatly and appropriately.
2) The patients behavior was appropriate for her diagnosis. She is diagnosed with schizoaffective
disorder. Although she denied any depression (0/10) or anxiety (0/10), she did come into the
hospital expressing signs of depression.
3) Based on reading the chart of the pt and getting shift report on her, this behavior does seem both
normal and new/different. It was stated to me that on other visited to the hospital the patient is
always pleasant and cooperative, however she is usually SAP. She was still pleasant and
cooperative but she is now negative for drugs which is a positive improvement for the pt.
4) The major theme/issue that I noticed had played a large role in the patients stress at home was her
living situation before coming to the hospital. She was living with her boyfriend and his mother
which she said was causing her a lot of stress.

V. USE OF PROFESSIONAL SELF: Choose two significant interventions you made: 1) identify/describe; 2) what
was your impression of your effectiveness; and 3) what would you change.

I think a significant intervention I used was seeking clarification about her support system. The pt had mentioned
that she wanted to find a new living situation when she left the hospital, so I took the opportunity to get clarification
on where, if anywhere, the pt was looking to go after their discharge. Once she said she was looking to go to her
daughters, I further asked her if she felt this would be a good supportive environment for her staying sober and drug
free. My impression is that her children moved away due to her long struggle with substance abuse and that her
previous living situation was causing her unneeded stress in her life. She really seems motivated to stay clean and
recognizes that her current living situation is going to be a struggle for her to stay clean. If I had to change anything,
I would ask for better explanation on her relationships with her kids and why she started doing drugs in the first
place. I think the technique was effective.

VI. PLANS: (Brief statement of your plans for the next session, long range goals, short range goals that are relevant
for this client.)

My plans for next session would be to get the pt to further elaborate on their current living situation and why exactly
they do not want to go back to it. Also what about the pt boyfriends mom caused so much stress because that
seemed to be the major reason she no longer wanted to live with her boyfriend. My long term goal for the pt would
be to remain substance free and attend NA classes. My short term goals for the pt were that she would verbalize her
support system during my shift (700-1200), verbalize her goals for being discharged during my shift (700-1200),
and to verbalize a positive coping method learned during her admission.

VII. ISSUES, QUESTIONS OR PROBLEMS: Include issues of diversity, value dilemmas, counter-transference
etc.

Issues that my pt are facing are both past and present situations. I believe that her history of drug abuse could have a
lot to do with her diagnosis of schizoaffective. I do believe there is way more to it than just her drug use, I really
feel that there is more from her past we did not discuss in this session that are culprits to her diagnosis. As positive
as it is that the patient has goals to improve her environment, I question how much will truly happen and if shes
discussed with her children her plans to move in with them. The patient is on SSI so he has limited income and
making such a huge move can become costly. It was positive that she identified her current situation as not being
conducive to her bettering her life, I just question what the follow through will be. It was really easy to communicate
with the pt through out the shift. At times she would run off and go off topic while talking but I could easily rain her
back in and bring things back to therapeutic talk.

VIII. EVALUATE THE OVERALL EFFECTIVENESS OF THIS INTERACTION: Relate this back to the
goals you established for you and the patient.

I think that my conversation with the pt was effective. Even though at times I had to rein her in and bring her back
to therapeutic talk, she always remained open and willing to share information with me. She did not seem guarded,
and was willing to express how she was feeling. I did accomplish some of my goals with the patient. She
verbalized that her support system was her children living in Tennessee. She verbalized that her goal for after
discharge was to move in with her children in Tennessee. The only goal I did not accomplish was the patient
expression a positive coping mechanism she learned during her admission. I do wish I would of further pressed for
information on how much her children knew of her plans to move in with them. I do have some concern that even
though the pt has great goals that due to her mental illness diagnosis, she may not fulfill her goals once discharged
from the hospital. In my future conversations I plan to continue working on my therapeutic technique while
communicating.

References:

Townsend, M.C. (n.d.). Psychiatric Mental Health Nursing, 8th edition. F.A. Davis Company.