PsychNrsg Im groping! How do i make process recording?

Soon-to-be-NurseJess · Dec 1, 2005

We only had to do one process recording thank goodness...they are kind of tedious. In telling you this, I'm assuming my teacher used a universal form of process recording.

The first page had client initials, client age, client diagnoses, a pt profile (42 yr old black male with history of blah blah blah. The client has attempted suicide twice in the past 2 years blah blah. Client also has a drinking problem blah blah), and the pt's medications and why he/she is taking them.

The next pages include every word from the conversation you have with the patient. You're not going to remember exactly, but try to remember most of what you said. The whole point of a process recording is to determine how well of a therapeutic communicator you are and what you should improve. You list every statement you made, and then the patient's response to those statements. then after all that you list the pt's nonverbal communication during each statement (crying, rolling eyes, scared expression, no eye contact, etc) and the nurses thoughts and feelings regarding each statement.

Lastly we did an analysis of the entire conversation. For each nursestatement-patientresponse we had to list what kind of therapeutic communication technique we used (reflecting, exploring, open-ended questions) whether it was a good one or a bad one and if it was bad why we shouldn't have said it that way.

Hope that was helpful :nurse:

Cute_CNA, CNA · Dec 1, 2005

hotmaleRN, nice name, lol! :rotfl:

Daytonite, BSN, RN · Dec 2, 2005

What I did when I had to do these in school was I carried a small tape recorder in my pocket. I asked the patient if it was OK if I taped any conversation between us and why I was doing this. The tape recorded just fine. Out of sight, out of mind with regard to the patient speaking freely. I wanted to record the conversation because our process recordings had to be 30 minute conversations. How much of what you and the patient specificallly say to each other do you think you are going to remember verbatim? If you try to take notes while you are talking, it's likely that a psych patient is going to get ticked off at you. When I would play the conversation back and start setting up and formatting the paper I would be turning in to my instructor I was shocked at some of the things I had said back to the patient. It was good from the viewpoint that part of the idea of the process recording is that you are analyzing the effectiveness of your therapeutic communication. You will find that you will have said things to the patient that did not fit the mold of being therapeutic responses. That's OK because the whole idea is to learn from your mistakes with these things. Your grade will depend on how good you are at recognizing your errors and then developing an alternative response you should have made which would have been better. This is the whole idea behind doing them. By taping, you are pretty much guaranteeing that the report you turn in is going to be long. However, it is going to be much more accurate than if you try to recall the conversation from your memory.

Have fun! Most of us, particularly in BSN programs, had to do them too. :icon_smil

hotmaleRN2b · Dec 3, 2005

Thanks, it was abit of a help... I was hoping i could get a step by step process here.:) What i feel so idiot about is the communication process itself. THe nurse-patient interaction stuff... Everytime im talking to my patient i feel like im always running out of words to say. I give a lot of broad openings and then ended up being cut by the pt by saying "whatever you want" "we can talk about anything" those stuff... I got frustrated

Daytonite, BSN, RN · Dec 3, 2005

Oh, I see what you are needing. Well, it's been 15 years since I've done one of these and I don't have any saved. What I do remember about them was that we had several classes on therapeutic communication with patients. We were given handouts that listed and named the various therapeutic responses you made in response to patient's statements. Were you given some sort of journal articles to look at regarding this, or given references to look up to get this kind of information. I don't know that you'll find it in any nursing textbooks. Perhaps some other people who are currently in school and are reading this will know.

Anyway, the way I remember ours being set up was to make a number of columns. Column One was what the patient said (verbatim) and Column Two was our answer to the patient (verbatim). These two columns were pretty much like reading a script. Many students run out of words when talking with patients. It's probably smartest to have a conversation that is focused on, perhaps, getting some specific information from the patient, or some little patient teaching thing. For a psych patient you might want to talk with them about the medications they are taking and kind of interview them as to how they organize the medications at home, any kind of side effects they have with them, and how they feel about whether or not they are working for them. If the patient is in a psych facility focus your conversation around why they were admitted. Kind of do a Review of Symptoms with them along with a medical history.

It's typical to feel like you're always running out of words to say. That is because you have your assignment in the back of your mind. You are also just learning about therapeutic communication so it's very, very new to you. This is another reason why I carried the recorder in my pocket. I actually did record conversations without telling the patients, especially when I realized I had engaged them in a conversation that was flowing very well. It was very easy to click the recorder on without them knowing it. It's wasn't kosher, I know, but I was able to get a couple of good conversations to chose from out of it. The alternative is to just make up the whole paper you turn in. There were students in my class that did that. What I learned, however, was that my instructors seemed very satisfied with my struggle doing these, especially when I sat with them at a one on one session and we discussed what I had turned in to them. This expression of my frustration and the fact that they saw how I was struggling to work with these techniques is exactly what they were expecting from me. Now, your instructors might be different, but this was the experience I had. However, if you look at this as a learning experience, there really is a lot about talking with patients that you will learn from doing process recordings. Most people don't understand what open ended questions are. I didn't. I do now, however. And, after many years of practice I know that I can glean more information from a patient using an open ended question than, say, a yes/no one. You might want to sit down and practice talking with someone you know about something they've been involved in or done to help you out with this. A relative or friend is more likely to sit patiently while you consult your notes on how to phrase questions to put to them. It really would be a good way to practice this stuff. The big major focus by my instructors was not on all the wrong responses I gave to the patient, but my own recognition as I was writing up the process recording of how I could have responded in a more therapeutic way. Then, of course, we had to identify these things and reference them to literature on it. Counselors and clinical psych people spend a great deal of time perfecting these techniques. You are not going to be expert at them right now and I doubt very much that your instructors expect that of you at this point. Correcting years and years of our communication patterns starts with a recognition of what we are doing that doesn't fit the therapeutic communication mold. Next, comes a realization of what we should have done. The process recording is an exercise designed to help you with that.

Is this any kind of help for you?

VickyRN, MSN, DNP, RN · Dec 3, 2005

The following are some excellent resources concerning process recordings, therapeutic communications, and the psychiatric nurse role:

http://www.uri.edu/nursing/schmieding/orlando/uses/uses.htm (actual process recording format, similar to what Daytonite described)

http://www.msu.edu/~saintarn/409/process_recording_form.htm (another process recording template)

http://nursing.msu.edu/downloads/fall2002/NUR412.doc (process recording template, page 21)

http://www.ivcc.edu/abel/outlinenotes_1210.htm

http://www.nurselearn.com/test_tx_comm.htm

http://servercc.oakton.edu/~mikey/103sdlp.html

http://www.lmunet.edu/academics/undergrad/nursing/Spring05NURS/NURS115_Unit_II.doc

http://www.ivcc.edu/abel/outlinenotes_1210.htm

VickyRN, MSN, DNP, RN · Dec 3, 2005

This is another reason why I carried the recorder in my pocket. I actually did record conversations without telling the patients, especially when I realized I had engaged them in a conversation that was flowing very well. It was very easy to click the recorder on without them knowing it. It's wasn't kosher, I know, but I was able to get a couple of good conversations to chose from out of it. The alternative is to just make up the whole paper you turn in. There were students in my class that did that.

This was an overall excellent post; however I do take exception to these two suggestions. Recording a patient's conversation without his or her express knowledge or prior approval is a serious violation of patient rights, nursing code of ethics, and most facility policies. Making up a paper is also unprofessional behavior and a breach of ethics. In fact, both are so serious, that, if discovered, the student would be immediately dismissed from most nursing programs.

http://www.nursingworld.org/ethics/ecode.htm

Daytonite, BSN, RN · Dec 4, 2005

Recording a patient's conversation without his or her express knowledge or prior approval is a serious violation of patient rights, nursing code of ethics, and most facility policies. Making up a paper is also unprofessional behavior and a breach of ethics. In fact, both are so serious, that, if discovered, the student would be immediately dismissed from most nursing programs.

Uh-oh! I guess I ought to try to redeem myself here, Teach. I really did ask the patients for permission to record their conversations, most of the time. We were told that we had the option of taping our conversations as long as we got the patient's permission. I was aware that if I hadn't asked and gotten permission, it was unethical and I was wrong when I did it. I promise that all the coversations either got erased or ended up in the trash. So for anyone who is reading this and contemplating doing something similar, it's the wrong way to approach this. And, I was never one of the people who made up any parts of my process recordings. I struggled with process recordings a lot because the idea of therapeutic communication was very new to me and I did not understand it very well at the time. But I struggled through doing them and discovered I was making a lot of mistakes when speaking with patients while doing them. It was a great source of frustration to me at the time. Many of my fellow students thought they were rediculous, but I understood that this was a skill that could only make my interactions with patients more meaningful. That was over 15 years ago when I was in my BSN program. As the years have gone by, I've found that continually working on this skill has really made a difference in my practice with patients and co-workers.