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
(the student)
1) SN: Goodmorning, are
you (patient name).
Non-Verbal Communication
-We are both sitting in chairs in
front of the tv. I am using
SOLAR technique
2) SN: I was wondering if
you would talk with me
this morning, would that
be okay?
Non-Verbal Communication
-I am still using SOLAR and pt
appears relaxed
3) SN: How did you sleep
last night?
Non-Verbal Communication
-I am still using SOLAR and pt
appears relaxed.
4) SN: Could you tell me a
little about what brought
you into the hospital?
Non-Verbal Communication
-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*
INTERVIEWEE
(the patient)
Pt: Yes thats me.
Pt: Oh sure, that is fine with
me.
.
Pt: Not too bad at all, I got
pretty good sleep last night.
Pt: It was my health. I
wasnt healthy at home.
IDENTIFY ANALYSIS OF THE
COMMUNICATION INTERACTION
(Was the technique effective? Why
TECHNIQUES or why not?
Was there anything else that could
have been explored?
What were the major themes?)
1) Close Ended Question 1) Opening my communication
with the patient in this manner
allows me to establish a
positive rapport with the
patient.
2) Broad opening
2) This statement allowed the
patient to feel that they were
making the decision to talk
with me and not that I was
pressuring them into
conversation. Also allowing
for a positive rapport to
continue to be established.
3) Broad opening 3) This technique was effective
because it showed the patient
that I was interested and
engaged in communicating
with them.
4) This technique was effective
4) Offering a general because it allowed the patient
lead therapeutic to explain to me why they
communication were at the hospital.
5) SN: So you said your
health brought you into
the hospital, could you
tell me more about that?
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.
6) SN: Where exactly
where you living before
you came here?
Non-Verbal Communication
-Still sitting at the table as the
patient eats breakfast, in SOLAR.
Pt still relaxed and opened to
communicating.
7) SN: Do you think that
environment was causing
you stress? Or making
you feel anxious and
depressed?
Non-Verbal Communication
-Still sitting at the table as the
patient eats breakfast, in SOLAR.
Pt still relaxed and opened to
communicating.
8) SN: Are you feeling
depressed or having any
anxiety today?
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
thoughts of hurting
yourself or hurting
others?
Pt: I just couldnt take
where I was living any
longer. It wasnt a good
place for to try and stay off
drugs at.
Pt: I was living with my
boyfriend at his house. He
also lives with his mother
and she makes it hard to
want to stay there. I dont
want to go back there when I
leave
Pt: Definitely. I was
anxious and stressed all the
time.
Pt: No not at all. I feel
great today.
Pt: No Im not.
5) Restating/exploring 5) This technique was effective
therapeutic because it got the patient to
communication begin to elaborate in more
detail their reason for being in
the hospital.
6) Requesting and 6) This technique was effective
explanation because it allowed the patient
therapeutic to communicate in better
communication detail their story.
7) Risk
assessment/exploring 7) This technique was effective
therapeutic because it allowed the patient
communication to explain how their past
living situation was effecting
their mood.
8) Requesting an
8) This technique was effective it
explanation
allowed the pt to explain to
therapeutic
me their current state of
communication
anxiety and depression.
9) This technique was effective
9) Risk Assessment
because it assessed the
therapeutic
patients current
communication
suicidal/homicidal thoughts.
10) SN: Where is it you plan
to go when you leave
here?
Non-Verbal Communication
-Sitting at the table as patient eats
breakfast. Sitting in SOLAR.
Patient is relaxed and open to
communicating.
11) SN: Where does your
daughter live at?
Non-Verbal Communication
-Sitting at the table as pt wats
breakfast. Sitting in SOLAR. Pt
is relaxed and open to
communication.
12) SN: You said you are
currently drug free. What
kind of drugs were you
on?
Pt: Im gonna go live with
one of my daughters and my
grand-babies.
Pt: She lives in Tennessee.
Two other of my daughters
live there and so does my
only son. Im really excited
to go there. We used to not
get along very well because I
was on drugs, but now that
Im clean we get along better
and I think it will be better
for me there.
Pt: Cocaine. But I had to
stop for my health. I dont
want to ever do it again. I
feel a lot better now.
10) Exploring/requesting 10) This technique was effective.
and explanation It allowed the patient to tell
therapeutic me what their plan for housing
communication is after living the hospital.
11) This was a closed ended
11) Closed Ended question however, because the
question pt is so willing to offer
information I got more about
her future living environment.
12) This technique was effective
12) Restating/exploring because it allowed the patient
therapeutic technique
to tell me about their previous
history with substance abuse.

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