Process Recording

Kelsy Dannenberg
Kapiolani Community College

Please type & print on only one side of paper. Completed PR must be submitted to your clinical instructor with a cover sheet
and a blank grading sheet in a folder.
Process Recording Template
Follow the PR Directions Sheet Carefully
Date: September 9, 2016
Clients Dx: Mood Disorder NOS R/O MDD, Panic Disorder without Agoraphobia, Social Anxiety Disorder
Age: 14
LOS: 9 days
Dialogue

Non Verbal
Communication

Technique

Student
Feelings

Student
Thoughts

(To group during

psychoeducation
teaching)
Hello, my name is
Kelsy. Im a student
nurse at Kapiolani
Community College.
(After activity, one on
one time with patient)
Tell me what
brought you here?
I tried to commit
suicide.

Eye contact with

patients, scanned
the patients, looked
at each of them.
Eye contact with
patient.
Appropriate
posture. Hands on
lap, legs planted on
floor, positioned as
if open to
conversation
(remained in this
position for full
conversation).

Introductory
statement.

Anxious,
worried,
stressed.

T/
N
T

Are they going

to participate in
this activity?
T

Open ended
statement.
General lead.

Hopeful.

Good start, good

start.

Analysis
3. I feel like my
nonverbal
communication had a
positive effect on the
group. My eye
contact led to more
involvement with the
patients.
3. My nonverbal
communication may
have impacted the
interview negatively.
I think the eye
contact was a little
too strong for the
patient. And the way
my body was
positioned wasnt
casual. I feel like I
may have looked a

Tell me more about

that.

Eye contact with the

ground.

I had a plan to
overdose on pills. I
looked up the lethal
dose online which is
3200, and my mom had
800 pills. So I was
going to take 10 of
those. Which is 8000,
so I wouldve been
dead for sure.
Are you having any
Head nod yes.
of those suicidal
thoughts today?
No.

Open ended
statement.
Focusing
statement.

Determined.

I got this, just go

with the flow.

Wow, good
memory if she
could remember
those numbers.

Closed ended
question.

Scared.

Closed ended
question.

Concerned.

Is there that
much
information
online about
suicide?
Good! If she had
said yes, I
wouldve done a
TM-33 on her.

Continued eye
contact with the
ground.

Will you tell the staff Maintained eye

if you start to have
contact.
those thoughts?

Please say yes.

little awkward which

may have led her the
patient feeling
awkward.
4. I felt like the
patient didnt want to
talk to me because of
her eye contact with
the ground and not
with me.

2. I feel like the jump

from the last
statement to this
question was a little
bumpy. I probably
could have made the
conversation
smoother by
connecting her plan
to that day. Maybe
saying, Have you
had any thoughts of
overdosing today?
3. If she had said no,
it mightve been
difficult for me to

Yes.
Whens the last time
youve had suicidal
thoughts?
When I was at my
moms house, last
Sunday.
And how often do
you get these
thoughts?
They come once in a
while. But only for a
short amount of time.
Maybe like 20 minutes
or an hour.
They usually come
when Im at my moms
house.
And how does your
moms house affect
your suicidal
thoughts?
Its just not good
there. Its not
beneficial.

Maintained eye
contact.

Closed ended
question.

Head nod.

Closed ended
question.

Confused.

Possible trigger?

Open ended
question.

Confused.

What happens at
her moms
house?

Continued eye
contact with the
ground.

proceed. I might have

wanted to ask why
not, which is a TC
error.
2. I shouldve asked
how she felt on the
unit. If she felt safe,
scared, etc. These can
positively or
negatively affect her
suicidal thoughts.
3. I was confused on
how her moms house
could affect her SI.
Was there someone
there, was it the
location?? I think this
influenced the
conversation in a
positive way because
it created a desire to
investigate more.
2. I shouldve asked,
In what ways does
your moms house
affect. because it
may have made it
easier for her to
answer. Its more
specific rather than
how I asked.

In what ways?
Like I would just stay
in my room all day and
not come out, and not
eat dinner. Its different
when Im with my
dad.
Go on.

Head tilt towards

side, as in
confusion.

Open ended
question.
Clarifying
question.

Head nod

Minimal
encourager.

Well I like my dad.

Hand gestures while
And my step mom. I
speaking.
get along with them
and we have fun
together. Him and my
mom had a nasty
divorce a few years
ago, and she kicked
him out. He was
homeless and I didnt
get to see or talk to him
for a year. He was also
an alcoholic. But hes
been sober for 5
years.
Your dad must be
Eye contact.
very important to
you.
He is. He was recently
diagnosed with
multiple sclerosis in
the brain and spine. So

Open ended
statement.

Confused.

Stuck.
Helpless.

Where do I go
from here?

Empathetic.

Thats sad. I
cant imagine
going through
that while being

3. If I had asked, in
what ways, as stated
in the previous block,
I couldve avoided
this pass all together
and couldve got to
the point quicker.

4. Patient started
speaking with her
hands which made
me feel like she was
excited about this
topic. This affected
my response because
it was encouraging.
This was the most she
moved during the
interview and made
me feel like she
wanted to talk.

3. My feelings and
thoughts could have
negatively impacted
our conversation. My
dad is very important
to me and if I wasnt
focused on the
conversation, I

Im scared Im not
going to have much
time left with him.
It sounds like you
feel scared and
fearful.
I am. And worried.
Like why do I need to
be here. Im going to
residential and I dont
want to go. I think its
unnecessary.
Unnecessary?
Because I think if I
can work with my
psychiatrist on Maui
for a few years, I can
be stable. I have been
depressed since I was 3
and I have a lot of
anxiety. If I could deal
with it this long, then
why should I have to
stay here?
So you dont feel like
you need to stay here
because you think you
can be stable at home
by working with your
psychiatrist?

stuck at Kahi.
Minimal eye contact
with SN.

Reflection of
feelings.

Maintained eye
contact.

Restatement.

Unwanted.

mightve jumped to
conclusions.

I must sound
like a therapist.

4. There was almost

no eye contact
between the patient
and I. I felt like I was
unwanted and that the
patient didnt want to
talk to me.

Is she bored?

4. The patients eye

contact with her
hands made me feel
like she didnt want
to talk to me even
more. This negatively
impacted our
interaction because I
felt like she was
bored with me.

4. The patients
nonverbal head nod
was a positive
contribution to the
interview because it
assured me that I had
understood what was

Eye contact with

hands and
fingernails.

Paraphrasing.

Head nod yes.

What do you think is Maintained eye

expected from you so contact.
that you can be
discharged?
Im not sure. My
therapist doesnt share
any information with
me.
I see. Lets talk more Silence.
about your anxiety.
How does that change
your day to day life?

Open ended
question.

Nothing? At
all??
Communication
error- change of
topic.

Stuck.

Did I just change N

the subject? I
think I did.
Me too! I have a
hard time falling
asleep and
staying asleep.
Do I have an
anxiety
disorder??

Its annoying. I get

panic attacks
sometimes. I dont
sleep much. Maybe 4
hours of sleep a night.
And I have a hard time
falling asleep. I also
get up early.
I dont have that many Head nod.
friends either because
its a social anxiety. I
only had a few friends
in 6th grade and its the
same way now.
Whens the last time Eye contact.
youve had a panic
attack?

said correctly. This

affected my response
by allowing me to dig
deeper.

Closed ended
question.

Not surprised. It T
must be
overwhelming to
go to a new

1 & 5. Rephrase:
You mentioned
having a lot of
anxiety. Lets talk
more about that.

3. My feelings could
have negatively
affected

When I came here.

So you have been
depressed since you
were 3 and you have
social anxiety with
panic attacks. How do
you usually cope with
everything?
I like to go to the
beach with my friend.
Or play video games.
Its different here
because I cant do any
of those.
How do you cope on
the unit?

Paraphrasing.
Summarizing.
Open ended
question.

Stuck.

Looks at the clock.

Looks everywhere
but towards SN.

Open ended
question.

Pressured.

Maintain eye
contact.

Closed ended
question.

Unmotivated.
Bored.

place with a
bunch of
strangers.
Okay Im stuck
again. Lets go
over what weve
discussed so far.

2. Before this pass, I

could have asked
about her symptoms
when she gets a panic
attack. That way I
wouldve been able
to link her
manifestations to the
ones in the DSM or
other textbooks.

Does she not

want to talk to
me anymore?

Me either.

4. The patients
nonverbal actions
made me feel
uncomfortable
because I was
convinced she didnt
want to talk anymore.
I felt pressured and
wasnt sure where to
carry the
conversation.
3. My feelings
negatively impacted
the conversation
because I was
unmotivated to

Eye contact with

SN.

With music. Or stress

balls. Or journaling.

Do you enjoy
journaling?
Not really. I want to
go to med school after

I graduate. A doctors
without borders.

That is an awesome
career and I wish you
the best of luck with
it. Is there anything
else you want to talk
about today?
No.

continue. I felt
pressured and
unwanted because of
the patients lack of
eye contact and looks
towards the clock.
Smile.

Closed ended
question.

Relieved.

I am so stuck
and I have no
idea what else to
say. I think she
doesnt want to
talk to me
anymore. Did I
gather enough
information?

This patient was having many thoughts that clearly influenced her feelings, and I think a lot of it
stems from her dad. He was constantly on her mind since him and her mom recently divorced
and he was kicked out of the house and had to live on the streets. He was also recently diagnosed
with a debilitative illness, and he has a hx of alcohol abuse and a dx of depression. Because of
these things, this patient is constantly thinking about her dad which led her to feel sad, worried,
and possibly frustrated that she had to be admitted. She also had feelings of anger towards her
mother because shes the one who kicked the dad out and filed for divorce.
With these feelings or sadness and anger, the patient was lead to take action. She would
not come out of her room at her moms house and had the thought of committing suicide. She
researched how much of a certain pill it would take to overdose. However, before she devoted to
taking action, she came forward with her plan, which led to her admission at Kahi.
During the interview, there was minimal eye contact. Working backwards, I think her
behavior of no eye contact was brought about by her feelings of boredom and reluctance to talk
with me for however long we talked. These feelings may have come from her thoughts of other
activities shed rather do, and possibly her thoughts of having to repeat what shes already said
several time to her therapist and other medical professionals.