INTERACTION PROCESS ANALYSIS (IPA)

Student’s Name: Celeste Cavanaugh Client’s Name: D.D.

Interview Date: February 9, 2018

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

1. PT will identify two coping skills she uses.

2. PT will describe her discharge plans.

3. PT will participate in group therapy.

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

1. I will be able to use therapeutic communication techniques with the PT effectively.

2. I will be able to have a calm conversation with the PT without any upsets.

3. I will help PT to understand her diagnosis.

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

My first observation of my PT, was walking into the group therapy room. There were two women sitting in
that room watching the morning news. One looked calm and subdued; the other, very anxious. My PT turned out to
be the calm one. She looked up at me and my classmate curiously as we walked in the room. She began talking to
us immediately after our instructor introduced us to her. The overall environment of that room was calm after the
other woman left. The rest of the floor was also calm, considering all the SN’s talking to the PT’s.

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
(the student)
SN: Hi, my name is Celeste. I
am a Youngstown State
Nursing student. Would it be
alright if I sat and talked to
you?
SN: That’s great that you’re
doing better. Can you tell me
what brought you here?
SN: Tell me what happened
that brought you to the
hospital.
SN: When you say you felt
like superwoman, describe to
me what that feels like.
SN: Tell me some of the
things that you were doing
when you felt like
superwoman.
INTERVIEWEE
COMMUNICATION
(the patient)
TECHNIQUES
PT: Yes, that would be okay.
I am actually doing much
better since when I got here.
PT: Yes, what would you
Closed Ended Question
like to know?
PT: Well, I was feeling like
Open Ended Question
superwoman the day before I
got to the hospital. I don’t
remember what happened
that I needed to go to the
hospital. I just remember
waking up at Northside. And
then after a little while at
Northside, they told me I had
to come here.
PT: It feels like I can do
anything, and I was so
happy. I don’t know what
happened because I was
doing so good and then next
thing I know it, I’m in the
hospital.
.
PT: I’d rather not. I don’t
really remember much other
than I was really happy.
IDENTIFY ANALYSIS OF THE
INTERACTION
(Was the technique effective?
Why or why not?
Was there anything else that could
have been explored?
What were the major themes?)
This was an effective technique in
Offering Self introducing myself to the PT and
telling the PT who I am and what I
want to do.
This was effective because of the
way the PT replied, but it could
have very easily been not effective
if the PT would not have added her
own question.
This was effective because the PT
broadened the topic and explained
to me what happened that brought
her to the hospital.
This was effective because I went
Exploring
further with this subject without
causing the PT any stress.
This was not effective because I
was pushing the PT too hard for
answers. I should have noticed
Probing that the PT was upset about the
situation and did not want to talk
about that subject anymore.

SN: I understand, we can
move on from that topic.
SN: So, you said earlier that
you were at Northside
Hospital.
SN: I see, go on.
SN: So, when you’re stressed,
or having a bad time, what do
you do to relax?
SN: Do I understand correctly
that you said you don’t have
anybody?
SN: [Nodding]
PT: Thank you.
PT: Yes, but they wanted me
to come here because I was
hallucinating.
PT: I was hearing and
talking to God.
PT: I get lonely a lot. I
don’t have anybody, so I like
to go to the library and play
on the computer. Its’s too
expensive to have one of my
own, so I just go to the
library. And I like to watch
television. And I like to stay
healthy, so I play my wii
sports games.
PT: Yes, I don’t have any
family where I live, and I got
divorced a long time ago.
We never had kids. I got
pregnant once but we were
both doing drugs and the
baby didn’t survive.
PT: It was a good thing, I
think. The baby wouldn’t
have been healthy.
[PT stopped making eye
contact with SN]
This was effective because I
Accepting voiced to the PT that we did not
have to continue to talk about the
subject she was uncomfortable
with.
This was effective because the PT
Offering General Leads continued from my statement that I
provided.
Offering General Leads This was effective because the PT
continued form my statement that I
provided.
This was effective because I
Formulating a plan of related to the PT that the
Action hallucinations may be stressful and
asked the PT to recognize some
things to decrease the PT stress
levels.
This was effective because the PT
Seeking Clarification and
clarified what I was asking.
Validation
This was effective because it
Using Silence
allowed the PT to think about what
had happened to her baby because
of her actions.

SN: I noticed after you shared
about your miscarriage, you
stopped making eye contact
with me.
SN: Okay, I think it’s just
about time for breakfast, so
we can take a break. I’ll be
around until this afternoon, so
if you’d like to talk some
more, I will be on the floor.
PT: I feel guilty about a lot
of things that happened in
my marriage. [continued to
make no eye contact]
PT: Okay, thanks.
This was effective because the PT
Making Observations recognized that she stopped
making eye contact and explained
why.
This was effective because I let the
Offering self PT take a break from talking when
she started to get upset and let her
know that I’d be around if she
wanted to talk anymore.
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 client’s past behavior/affect; and 4) identify the major themes/issues that
emerged.

Throughout my session I observed my patient’s behavior and affect to be appropriate for what she
was talking about. When she was talking about feeling like superwoman, she was smiling and using hand
motions while she was talking. When she was talking about something sad, like her miscarriage, she
wouldn’t make eye contact with me and was fiddling her hands together. Overall, her behavior was
appropriate based on her past history of depression and bipolar. The major themes or issues that emerged
was what brought the patient to the hospital and her miscarriage.

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.

The first significant intervention I made was making myself available to the patient. I introduced myself at
the beginning of the conversation, told her who I was, what I wanted to do, and asked her if that was okay. I thought
I was very effective because she opened right up to me and asked what I wanted to talk about. I would change what
I first began to talk about. I started right off talking about what lead up to her hospitalization; I should have started
to get to know her personality and then asked about her hospitalization. That would have created a better rapport
with my patient.
The second significant intervention I made was when I switched topics when I noticed my patient begin to
feel uncomfortable talking about her mania. I continued to ask her about her mania, using the term “superwoman”
because that is how she described how she felt when she was manic. I was effective in obtaining answers, but I was
not effective in creating a trusting relationship with my patient; I was probing, and I should have not asked so many
questions right off the bat.

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

For my next session with the patient, I would start off broader. I would ask more about the patient and
what she likes to do, rather than immediately ask why she was in the hospital. A short-range goal for my patient
would be to have a discharge plan. I would like to talk to her about her diagnosis and help her to understand it
better. Along with understanding her diagnosis, I would like to also teach her about her medications for her illness
and the importance of complying with her medication regimen. A long-term goal for this patient would be to
discover a support system. She does not have any family or friends, so I would recommend to her: going to
Alcoholics or Narcotics Anonymous and discovering a support system with people who know how she feels and
understand what she has been through.

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

My patient is a divorced woman with no children, no family, and no friends. She has no support system, so
that is the biggest issue for her. Because she has no support system, she social isolates herself and goes days without
leaving her apartment and talking to another human being. My patient is also unemployed, so that is another reason
why she can go days without leaving the apartment. Also, my patient is healthy to a fault. She is so strict about her
eating habits, that she is not getting the proper diet that she needs.
 VIII. EVALUATE THE OVERALL EFFECTIVENESS OF THIS INTERACTION: Relate this back to the
goals you established for you and the patient.

The overall effectiveness of this interaction went very well. The three goals I set for my patient were: to
identify two coping skills she uses, describe her discharge plan, and that the patient will participate in group therapy.
My patient identified more than two coping skills she uses, and although it was not part of our conversation, she did
participate in group therapy. We did not, however, talk about her discharge plan. The three goals I set for myself
were: I will be able to use therapeutic communication techniques with my patient effectively, I will be able to have a
calm conversation with my patient without any upsets, and I will help the patient to understand her diagnosis. I do
think I used many therapeutic communication techniques with my patient effectively and I did have a calm
conversation with my patient. I did not, however, talk to my patient about her diagnosis.

References:

Townsend, M, C. (2015). Psychiatric Mental Health Nursing: Concepts of Care in Evidence- Based
Practice (8th Edition). Philadelphia. F.A. Davis.