Video Process Recording and Analysis Guidelines: 50 points Video Process Recording is a recording and written account of an interaction between a pair of students who enact a nurse/patient interview and video record the interaction. Students will complete the video recording before the first week of their rotation. Scheduling with the TA will be done in class. After completing the recording, you can either view your recording for the written write up in one of three ways: 1) N drive in the NLC; 2) burned CD or 3) download on to your personal jump drive. **The total time limit for each recording will be 10 minutes.** Psychiatric Nurse Role will consist of starting to establish the therapeutic relationship in order to help the patient identify any problems or issues and proceed to help the patient identify a plan to begin to work on identified issues. The Nursing Role should emphasize helping the patient explore the patient s perception of the problem, not how the nurse thinks the patient should fix the problem. Patient Role will consist of demonstrating through their behaviors and verbal/non-verbal communication the signs and symptoms of their psychiatric disorder based on DSM-IV-TR criteria. The patient should also be prepared to discuss a problem that they will disclose for the nurse to address. The student playing the patient role will give the nurse some feedback in the following areas: What therapeutic factors were evident (genuineness, empathy and positive regard)? Which pieces of the communication made them feel better? Which pieces of the conversation made them feel discomfort? Preparation: View the Nursing Communication Skills Vignettes found on Learning Suite This learning activity will help to increase your understanding of the different communication skills and how they can be used effectively in order communicate therapeutically with your patients. Video Process Recording Paper: (50 points): A two- three paged typed paper will be prepared according to the following format: 1. Preparation: Write a comment indicating that you watched the Nursing Communication Vignettes. 2. Identification of the psychiatric disorder of the patient using DSM criteria. 3. Communication skills and therapeutic techniques utilized. State each technique used and give an example of the use of each technique. Refer to the Therapeutic Communication Skills Reference Sheet for a list of commonly employed skills. 4. Identify your areas of strength and weakness in your communication skills.
Therapeutic Communication Skills Reference Sheet Factors observed: Genuineness Empathy Positive Regard Therapeutic Communication Techniques Observed: Using silence Accepting Giving Recognition Offering Self Offering General leads Giving Broad Openings Placing events in time or sequence Making observations Encouraging comparison Restating Reflecting Focusing Exploring Giving Information Seeking clarification Presenting Reality Voicing Doubt Seeking consensual validation Encouraging evaluation Attempting to translate into feelings Suggesting collaboration Summarizing Encouraging Formulation of a Plan of Action Paraphrasing Open-Ended Questions Close-Ended Questions Encouragers Verbalizing the Implied Encourage description of perception (Varcarolis & Halter, 2010, p. 179-183) Non therapeutic Techniques Observed: Giving premature advice Falsely reassuring Asking why questions Giving approval: agreeing Changing the subject (Varcarolis & Halter, p. 184-185) Non verbal behavior observed Body behaviors Voice related Minimizing feelings Making value judgments Asking excessive questions Disapproving: disagreeing Excessive closed ended questions Facial expressions Physiological responses Defense Mechanisms Resistance Observed Transference or Counter Transference Issues Varcarolis, E. M. & Halter, M.J. (2010). Foundations of Psychiatric Mental Health Nursing: A Clinical Approach (6 th ed.). St. Louis, MO: Saunders Elsevier.
NAME Video Process Recording Analysis Possible Points Students Points 1. Preparation: Written statement that Nursing Communication Skills Vignettes were viewed. 5 2. Provide a written paragraph describing the symptoms displayed by your patient and identify the probably psychiatric diagnosis/diagnoses. List the DSM criteria for the diagnosis/diagnoses as listed in your textbook. 3. Written bullet point list of each therapeutic communication skills and techniques, both verbal and non-verbal, which were used during the conversation. Provide a direct quote as an example for each communication technique. Utilize Therapeutic Communication Skills Reference Sheet or textbook. 10 15 4. Written bullet point lists of identified communication skills that were ineffective or non-therapeutic. Discuss how you would change those communication skills. What could you have done instead to make that part of the conversation more therapeutic? 10 5. Oral discussion of communication skills that were used effectively and not effectively in the conversation. Address the therapeutic factors (genuineness, empathy and positive regard). 10 Total 50
Feedback for Students after Role Play Scenarios: 1. Respond to the student s ability to listen were they attentive? Did their posture and mannerisms indicate interest in the client? When not, offer suggestions. 2. Respond to the student s ability to stay on track with the client. Did the student explore issues, or jump all over the place? If they jumped around, demonstrate how they can ask follow-up questions or exploratory statements. 3. How did the interaction make you feel? Did the student make you feel significant and your issue important? (Genuineness, empathy, positive regard demonstrated). 4. What did the student do particularly well?
Scenario #1: Anxiety disorder and Depression Video Process Recording Scenarios N462 Patient Role 21 year old university student who comes from a well-known family. Struggling with daily alcohol use to deal with anxiety symptoms. Not sleeping, struggling with classes. Anxious in social settings with panic attacks. You have been isolating more with decreased attendance at church and other social functions. Hospitalized after a suicide attempt with carbon monoxide. Fears that anxiety will never go away and you will never be able to perform in school or in a relationship to meet your goals. Adamant that you do not want anyone to know about being in hospital. Support system: Parents on church mission. One sister, who you use to be close to, but since she got married, she has not had time for you. Drifted away from friends and has not called them in a long time. Medication: Never been on medication, concern about being a Prozac girl Goal: To get anxiety under control so that you can return to school and talk with other people Resistance Tactics: Refocus conversation on confidentiality and fears that nurse will disclose to others about your situation just like a friend who blabbed to everyone about a secret crush you had and how humiliated you felt. Minimize alcohol abuse. Scenario #2: Depression 28 year old mother of 3 (ages, 2, 4, 8) who is hospitalized after a suicide attempt (overdose on Tylenol and alcohol). You are despondent about your ability to care for your children because you are not receiving any support. Depression symptoms: sad, low energy, feeling overwhelmed, poor sleep, hopeless and helpless. Support system: Married x 8 years. Husband works. Stay at home mom. Feels distanced from husband and does not feel like he helps out enough at home. LDS religion but attends irregularly. Medication: Never been on meds before and you have some fears about side effects. Goal: Get some relief from depression symptoms and get some help with caring for children Resistance tactics: Minimize alcohol abuse, blaming problems on husband
Scenario #3: Schizophrenia 35 year old male with Schizophrenia with belief that you are handing out flyers on campus as the first step to becoming enrolled at BYU, which you call the School of the Prophets. You believe that you have a special message to tell the prophet. Voices at night are bothersome in that you are being rebuked for not fulfilling your mission. Thoughts are speeded up and it is difficult to stay on task Support system: Lives with girlfriend/recently moved to Utah County Medication: Only want meds for the voices and to slow down thoughts. Previous bad experience with side effects. Goal: Want some help for voices at night and to slow down thoughts Resistance tactics: Ask questions about nurse s religious belief/ comment on nurses physical appearance transference. Scenario #4 Bipolar Disorder Client role: 32 year old female with 15 year history of Bipolar Disorder Manic. Mother of 4 children. Since your husband lost his job, you could not afford your medications. You stopped y our meds and within 4 weeks you started to experience manic symptoms: no need for sleep, mind racing, started lots of projects. Husband started to complain about not being able to keep the house clean and organized. Ran up credit card debit $10,000 in 2 weeks. You got in an argument with your husband that turned physical with the police being called. Domestic violence charges are pending. Support system: Married x 12 years. Relationship has been supportive until this last manic episode. Husband is angry with you for stopping your meds without telling him and embarrassed about the legal charges. Parents and 1 sister have been supportive. You have had several friends for many years. Medication: Likes the medication, but misses the high moods. Goal: Get back on medication and try to repair relationship with husband. You are concerned about legal charges being dropped. Resistance: Minimize symptoms and legal and relationship implications.
VIDEO TAPED ROLE PLAY-Scenarios N293 #1- You are taking care of an older adult in the nursing home. She is 96 years old and is recovering from a hip fracture. She had raised a large family and has been a widow for more than 20 years. Other than her hip fracture, she is relatively healthy. When you enter her room one afternoon she seems very depressed and looks as though she is crying. You don t know much about what is going on. Using the skills we have learned in lab, try to open up communication and respond empathetically. #2- You are a registered nurse working in a nursing home. Upon arrival to work today, you are asked to admit Mr. Daniel Jones, an 86 year old patient with terminal lung cancer. Mr. Jones has made it clear that he will not be pursuing treatment for his cancer. As part of the admissions procedures, you are required to ask Mr. Jones about Do Not Resuscitate and Do Not Intubate orders. Using the skills we learned in lab, discuss the options for his Code status. #3- Your patient has been diagnosed with Diabetes for a long time. You notice that his blood glucose levels have been high. You find him often eating candy or other sweet and not monitoring it with insulin. He often makes comments that it doesn t really matter what his blood sugar is, as long as he is feeling good. You read in his chart a comment made that he doesn t really care about changing his life for Diabetes because he s going to die anyway. Using the skills we learned in lab, confront the patient about managing his diabetes. #4- Mr. Lines is a difficult patient. On this encounter, you pop out his pills out of the blister pack into his med cup and he refuses them because he says he is in a lot of pain. Pain level is 8 out of 10, this is most likely because he refuses to take pain medication as he thinks drugs are for the weak and those who are addicts. Using the skills we learned in lab, respond while maintaining your role as caregiver who is concerned about his pain level. #5 Jessica is a 27 yr old married woman with two children that has been involved in a paragliding accident. She has lost sensation from the waist down from a spinal cord injury. The neurologist just informed him that he is going to be a paraplegic. The doctor has just left the room and informed the patient that you will be providing further information regarding what it means (self-catheterization, bowel care, wheel chair, etc ) Using the skills from lab, provide information to the patient while showing empathy, respect, warmth, etc.