Therapeutic Communication

[verivici]

I'm currently doing a mental health rotation in hospital for clinical this semester. I was wondering if anyone had any tips for how to comprehensively asses the mental status of a patient therapeutically? My instructor is a little eccentric and hard to follow at times, and as a result is not very helpful in my journey of developing my therapeutic communication skills. I have an idea of what to ask but I always feel so awkward because I feel like it turns into an interview and not a conversation. When I try to talk to my patients more conversationally though I feel like its too social and I feel like I am not being as professional as I should be because I am not solely focusing on my patient and their symptoms. Is this just something that will go away as I gain more experience?

[nurseprnRN, BSN, RN]

open-ended is the only way you'll get more than "yes" or "no" to questions, and yes-no questions only reflect your idea of what there is to ask and answer. open-ended is the way to go. if you want great interviewing info, listen to terry gross on fresh air on npr-- i learned so much from her.

never be afraid of silence. sometimes, especially in psych, you have to wait a long time before they trust you enough to speak, and sometimes it takes people a really long time to formulate a complete sentence. i've had patients who suddenly start speaking after i just sit quietly with them for ten or fifteen minutes, or longer. try that.

[klone, MSN, RN]

My instructor is a little eccentric and hard to follow at times,

A psych nursing instructor?? That can't be!

[chevyv, BSN, RN]

I really let my pts talk. Most of them don't get people to just listen to them. When I have a conversation with a more difficult pt, I try to ask questions that can be answered by the pt. A lot of times, the thought process just isn't there and if it is, it can leave in a quick minute. I'm lucky because I get to know my pts well so I can tell if they are having a tough day. Many pts will tell you flat out they are upset. Seeing that you can usually tell, I will answer quite honestly, "Yep, you do look upset, want to talk about it?" Most say no and then go on and on about why they're upset.

Sometimes they are paranoid, I reassure. I have peeked under beds for monsters, prayed over mattresses that 'big mean dogs' keep tearing up, and even checked on pts who ask me to every 5 minutes for 30 minutes. Once a person can feel that you care, they will open up a bit more. Always be respectful and if your in a hurry, don't let it show. Nobody likes being timed.

You may only get one question in or you may hit a good topic and have someone telling you their life story. I have talked about cool green cars and found out a mountain of information about a pts childhood, parents, siblings, when they started having troubles etc. Sometimes it's good to have a way around the medical type questions we have to ask as students if we make it a bit more like we're interested in their whole life. I hope this helps. I too am a psych nurse so I'm probably a bit off with my advice

[verivici]

I hope this helps. I too am a psych nurse so I'm probably a bit off with my advice

No, that was the reassurance I needed to hear, thank you!! I guess what I'm struggling with is feeling like I'm hovering over my patients and prying too much. I know how important it is to learn about the sressors in their life, however I feel like thoose can be such personal things. I know if I were the patient I'd feel awkward answering such personal questions. It's kinda funny how I have no problem asking someone when their last BM was, but I hate asking about how they feel about the stressors on their life. I can see myself growing as a nurse, but it just seems like such a slow process haha.

[mindlor]

Am I allowed to tell on myself and say that every IPA I ever wrote was fictional? LOL