Psychiatric Interpersonal Process Analysis Worksheet

Course: NURS 223L INTERPERSONAL PROCESS ANALYSIS TEMPLATE Student: Date: Clinical Instructor: Name (initials only): Unit: Current Legal Status (Vol., 5150, 5250, 30 day, T-Con, LPS-Conservatorship): Multiaxial Diagnostic System: Axis I (Clinical Disorder): Axis II (Personality Disorder / Mental Retardation): Axis III (General Medical Conditions): Axis IV (Psychosocial and Environmental Problems): Axis V (Global Assessment of Functioning Scale): 1. Description of the patient: Age? Sex? Ethnicity? Marital Status? What precipitated hospitalization? Number of days in the hospital? Mental Status, etc. 2. Description of environmental setting where interaction took place. Explain the reasons for a supportive or non-supportive environment. (e.g. noise, distractions, light, temperature, etc.) Page 1 of 3 Course: NURS 223L INTERPERSONAL PROCESS ANALYSIS TEMPLATE INTERPERSONAL PROCESS ANALYSIS NAME: Student: • Verbal (quotes) and Nonverbal Communication (behavior, tone of voice, eye contact, mannerisms, etc.) • Document at least 5 interactions • Goal for each interaction (realistic and measurable) DATE: Patient: Communication Techniques Verbal (quotes) and • Identify communication technique Nonverbal Communication used then define your communication (behavior, tone of voice, eye techniques contact, mannerisms, etc.) • Was the communication therapeutic or non- therapeutic? • Which defense and coping mechanisms didthe patient use? Rationale based on your patient. Goal: Verbal: Nonverbal: Verbal: Nonverbal: Goal: Verbal: Nonverbal: Verbal: Nonverbal: Goal: Verbal: Nonverbal: Verbal: Nonverbal: Goal: Verbal: Nonverbal: Verbal: Nonverbal: Goal: Verbal: Nonverbal: Verbal: Nonverbal: Page 2 of 3 Critique and Analysis (effective or not effective? Could have said…) Document your thoughts and feelings during the interaction. Was your goal met? Course: NURS 223L INTERPERSONAL PROCESS ANALYSIS TEMPLATE INTERPERSONAL PROCESS ANALYSIS SUMMARY 1. Evaluation: After analyzing the interaction, provide a description on how the interaction progressed. Identify the reasons for successful process or unsuccessful process. What did you learn from the interaction with your patient? 2. How did you personally feel about the interaction? What would you change if you had to redo the interaction? Page 3 of 3 Patient Description: 49 Y O single Caucasian male with multiple past PMH hospitalizations, admitted through ED, secondary to increasing depression with suicidal ideation (SI), and alcohol abuse. Patient lives alone, has no daytime structure. Highest level of education is high school. Past social history indicates possible sexual abuse. Patient currently denies SI but has had past attempts using knives; details regarding these attempts are unclear. Patient denies any legal history of violent/criminal behaviors. Admitting Assessment Data & Mental Status Examination (MSE): Patient appears older than stated age of 49. He is heavy set with fair grooming. Mild psychomotor retardation noted. Maintains eye contact, though at times is staring intently and seems preoccupied. Concentration is poor. Mood is reported as depressed and anxious. Affect is odd, anxious and constricted in range. Speech halting at times. Thought process significant for thought blocking. Denies any visual or auditory hallucinations. No delusions elicited. He currently denies suicidal ideation or homicidal ideation. Judgment and insight are fair. History of Present Illness (HPI): This is one of multiple hospitalizations for this man who has a diagnosis of schizoaffective disorder. The patient has a history of alcohol dependence and this intensified after his friend recently died. Also, the patient’s father died last year on the patient’s birthday, of prostate cancer. The patient himself was diagnosed with lymphoma in 2010 and underwent biopsy of axillary lymph nodes in 2010; resolved but he states this is contributory to his increasing depression and SI. He admits to increased drinking of “about 6 beers a day and some vodka”. He reports having blackouts. He denies any change in weight or appetite. He reports his concentration is poor, sleep is decreased. He reports his mood as depressed and he says he feels overwhelmed. The client self-admitted to the ED because of feeling unsafe, but upon admission to the unit he denies SI. He also denies symptoms of psychosis, although he appears preoccupied and guarded during the interview. He appears to have some thought blocking, but when questioned, reports he is “trying to concentrate”. No history of withdrawal seizures or DTs. Patient has been admitted for substance abuse numerous times, at several locations. Psychiatric Interpersonal Process Analysis Worksheet

Risperidone (Risperdal) 3 mg PO BID Divalproex sodium (Depakote) 1000mg PO QHS Fluoxetine (Prozac) 60mg PO QHS Thiamine (Vitamin B1) 100 mg PO BID Magnesium oxide 400mg PO BID Folic acid (Folvite) 1 mg PO QD Chlordiazepoxide (Librium) 25MG PO TID Case #2 78-year-old patient airlifted from his small first nations community to the closest trauma center after involvement in motor vehicle accident, where he sustained multiple fractures and traumatic brain injury. Luckily, impairment of cognitive and psychosocial functions was only temporary, and the patient returned to nearbaseline after several months of intensive care. While a good deal of his physical health was able to be restored, the team diagnosed CHF, diabetes, dementia, and masses that were suspected to be malignant. In addition, upon discharge the patient will likely be required to use a walker, and pursue intense physiotherapy due to the severity of fractures to his hip and legs. While being treated at the trauma center awaiting discharge, the patient suffered an acute mental health event, and was transferred to the Mental Health Centre 10 minutes from the current hospital for further assessment and treatment. Upon admission, the team at the Mental Health Centre had difficulty obtaining informed consent from this patient; partially due to English being the patient’s second language, but also because of the patient’s differing perception of mental health and well-being. In addition, the patient’s capacity to consent to treatment was questioned due to a recently diagnosed dementia. Fortunately, a translator from the same community was available to facilitate this process. The patient was successfully treated, and discharge was planned. Placement in long-term care (LTC) was suggested along with follow-up with local mental health resources. While planning discharge, it was discovered that the patient was unsure how he would get home. He was airlifted to the trauma center (300kms from his community), did not have the ability to drive, and lacked funds for a bus or other transportation ticket. Furthermore, no family existed to assist. In addition, the Social Worker planning discharge discovered that no permanent mental health resources exist in the patient’s home community. Instead, two nurses, and two crisis workers are deployed on 6-day rotations from the closest city. As well, the nearest LTC home is 220km away, and the patient refuses to leave his home community. If discharged back to his home community, you know that there is a high likelihood that he will not receive the mental health support he needs, and that there is additional physical risk to him now that he requires a walker. Thiamine (Vitamin B1) 100 mg PO BID Magnesium oxide 400mg PO BID Folic acid (Folvite) 1 mg PO QD Donepezil 5 mg PO QHS Ativan 0.5 MG PO Q 4 Hrs. PRN for Agitation Glipizide 5MG PO QD Case #3 A 30-year-old female who is 37 weeks pregnant is admitted under a “Form 3” to inpatient psychiatry for acute psychosis, severe substance abuse, and uttering death threats about her unborn child. (A Form 3 allows the patient to be held for up to two weeks.) After being re-assessed by Psychiatry, progress notes indicate that the patient is “legally competent”. Some of the nursing staff have voiced that they disagree and that she is not always capable of making informed consent decisions related to hers elf and/or her fetus. Several days into her admission, the patient begins to experience mild contractions. Psychiatric Interpersonal Process Analysis Worksheet

The staff have many questions: W hat is the birthing plan? Can patient consent to one? How will patient rights be protected? How will the OB GYN and Nursing Staff be protected? How will the baby be protected? OBGYN states she wants patient to consent to caesarian section (C/S), as it is felt this is safest for the patient, the unborn baby and the staff involved. At a visit on day 4 of admission, Social Work feels that the patient now wants to protect her unborn baby from harm. In addition, they believe that it would be a great time to have an open conversation about plan of care with the patient. The OBGYN and SW visited the patient to ensure she was able to understand, and the OBGYN determined at this time that the patient was capable to provide consent. The patient decided to sign for caesarian section, if necessary. At this point, the team and patient made the decision to investigate who the substitute decision-maker would be, should the patient again lose capacity. Joint decision makers were found, in the patient’s parents, who were listed as next of kin. They were asked to jointly make/agree upon a plan of care for both their daughter and their unborn grandchild. The patient remained on inpatient psychiatry unit until the baby was born two weeks later, by caesarian section. Multivitamin 1 tab PO QD Folic Acid 1mg PO QD …Psychiatric Interpersonal Process Analysis Worksheet