Date: 1/20/16

Client Dx: Bipolar Mania

Age: 45
LOS: 3 days
Dialogue
Hows it going. My name is
Anthony. Im a student
nurse. Ill be here till 11:30.
Hows it, Im (patients
name).
Would you like to go on the
patio to talk story?

Pts Non Verbal

Communication
I approached
patient with a smile
and maintained eye
contact.
Standing upright with
a welcoming face.
Eye contact, holding
hands in front of
body

Communication
Student
Technique
Feelings
Introductory
Curious
Statement

Closed
Question

So how has hospitalization

been so far?
Good, I feel ready to go
home now. I been here for
the time I was supposed to
and finally my doctor got the
dosage right.

Eye contact, body

facing to the right of
me, legs crossed,
hands on arm rest.

What do you mean when

you say your doctor didnt

Eye contact, open

posture, hands in

T/N

Analysis

My first impression
is this patient seems
cool. I would like to
know more about this
patient.

(3) I performed my AIDET

with a positive attitude and
smile. I feel I made good
first impression on the
patient by showing I am
friendly.

Curious

I dont get a negative

vibe from the way he
is speaking. I would
like to know his
story.

Excited

My patient is easy to
talk to. It seems like
this conversation will
go smoothly.

I hope this patient

doesnt start talking

Yeah sure.
Standing upright, eye
contact, hands at side.
Eye contact, open
Open General
posture, hands in
Lead
lap

Student Thoughts

Open Clarifying Nervous

Question

(2) I should have used a

closed statement instead of
setting myself up to get
rejected.
(5) Lets go on the patio to
talk story.
(3) I had trouble with the
children my first clinical. I
asked for help from my
instructor and followed her
technique to allow patients
to open up. It felt great to
see how a simple technique
can be so effective.

(3) This is where I noticed

the grandiose statements

get the dosage right?

Well, first off, I came here
because I needed help. I
messed up. I shouldnt have
smoked that dope, but I did
and started having the urge to
kill anyone who got in my
way. When I got admitted,
the doc didnt give me the
right dose. I needed the dose
I usually get, but he gave me
a baby dose. Thats why I
havent been sleeping as
much. Im an elite athlete.
My body can metabolize
things quickly. He just had to
up the dose cause Im a
bigger guy.
That must have been very
frustrating not getting the
correct dosage for your
medication. But it looks like
youre satisfied with your
treatment.
Yeah, now that my meds are
right I feel fine. My friend
came in yesterday and helped

lap, nodding head to

acknowledge I am
listening

about homicidal
things.

and linked it with the

patients diagnosis. I was
careful not to smirk or
laugh when he was
speaking highly of himself.
I did not want to be trapped
in an uncomfortable
situation.

Eye contact, as
patient answers
question, goes from
original position, to
shifting in chair,
eventually sitting at
the edge of his seat
and using hand
gestures. Slightly
elevates voice during
answer.

Eye contact, open

posture, hands in
lap, nodding head to
acknowledge I am
listening.
Eye contact, from
original position,
begins shifting in
chair and using hand

(4) I felt this patient would

begin on a tangential flow
of thought because he
started to get agitated. I felt
I would offer empathy to
show I was listening.

Expression of
Empathy
Reflection of
Feeling

Impressed

Im impressed the
patient is motivated
to be productive and
not want to go back
to his previous way
of living. I should
have stayed silent
after the expression
of empathy.

(2) Should have not said

anything after medication
to allow pt. to respond.
(5) That must have been
very frustrating not getting
the correct dosage for your
medication.

me write a list of my
objective I need to complete
when I get out. My first
mission is to visit my doctor
and refill my daily meds. Im
gonna try hard to stay
straight. I dont want to go
through that again.
Go through that again?
I dont want to get that
feeling of wanting to kill
people. I cant go to jail
again. And I got too many
things I gotta get done. Take
a look at the list I made. I
need to get started on that
like yesterday.

What kind of things you

got on the list?
I got things to do, ideas on
how to make money, people I
gotta talk to, its like my
calander. I dont have one so
this is my check off list.

gestures during
answer. Shakes head
toward end of answer.

Eye contact, open

Restatement
posture, hands in
lap. Nodding head
to acknowledge I am
listening.
Eye contact, shifting
in chair, hand
gestures when
speaking. Turns chair
to be in open posture
with me. Shows me a
paper.
Eye contact, open
posture, hands in
lap.
Eye contact, open
posture, use of hand
gestures when
speaking.

Open General
Lead

Impressed

The friend of this

patient must have
been very convincing
to get the patient this
motivated.

(4) I am gaining confidence

in my therapeutic
communication skills now
that he opened his posture
towards me.

Interested

Lets see the ideas he

got.

(3) Im not sure if he has

actual plans or this is his
grandiose statements.

(After I take a look at the

list, I point to an objective)
What does this one mean?
Thats an app that Im gonna
use get some real money for
my other plan. Im gonna
have to hustle if I want to
start on the other stuff on that
list.
So youll start selling stuff
with the app to get some
money. Then when you
have enough money, youll
invest in your next
objective. Is that what you
mean?

Well yeah thats the plan for

now. I gotta file all the
paperwork to get a patent for
the damn thing and draw up
some plans. But its hard
when I got all my friends in
Waikiki blowing up my
phone trying to kick it.
What happens when you

Eye contact, open

posture, hands in
lap. After showed
the list, leaned
forward and
pointed.
Eye contact, open
posture, using hand
gestures as he
explains his plan.
Eye contact, open
posture, hands in
lap.

Open General
Lead

Interested

Im interested with
T
his objectives. He has
the motivation, but I
would like to know
his plan.

(2) Maybe I should have

offered silence.

Paraphrase
Check Out

Curious

I would like to know

what he thinks of his
friends.

(4) It seems like he does

not like the idea of hanging
out with his friends since
he shook his head when
speaking about them. This
prompted me to explore
more about his relationship
with his friends.

Open General

Understand

I have the same

(3) I understand where hes

Eye contact, open

posture, using hand
gestures while he
speaks. Shakes head
in no manner
while he talks about
friends in Waikiki.

Eye contact, open

(3) I was interested about

how he planned to make
money.

and your friends kick it?

(Pt. starts laughing
excessively) Deep down, I
really wanna go to Waikiki.
Its my hearts desire. The
things me and my friends do
are crazy, but thats what
makes it so fun. Thats the
reason I ended up in here.
The only thing stopping me
is when I look at the list, I
know I cant cross anything
off if I go to Waikiki. Well,
except maybe buy a carton of
stoges and a bottle of jack.
Actually, I should cross those
off cause I cant be spending
my start up money like that.
It sounds like you feel very
motivated.
Hell yeah. I got too many
money making ideas I need
to start. I cant waste
anymore time in here or out
there wasting it in jail or
hitting the pipe. Im not
gonna let down my friend.

posture, hands in
lap.

Lead

ing

problem with my
friends. Its tough to
balance my
relationship with my
friends and school.

Reflection of
Feeling

Surprised

Its surprising to hear

that he has a drive to
do well for himself.

Eye contact, open

posture, patient shifts
in chair as he laughs,
uses hand gestures as
he speaks about
friends. Leans over
and looks at the list,
crossing out
objectives.

Eye contact, open

posture, hands in
lap.
Eye contact, open
posture, use of hand
gestures when
speaking, shakes
head in no manner
when speaking about

coming from. Its tough to

manage responsibilities
with friends. Now that
were older, everyone has
different schedules.

(3) I would like to know

more about what caused
him to be this driven.
Perhaps I should talk about
the relationship with his
friend who helped him
make the list.

jail and the pipe.

Tell me more about the

friend who helped you
write the list.

Eye contact, open

posture, hands in
lap.

Me and (Patient stated

friends name) go way back.
We used to be cruising at
Waikiki everyday trying to
hustle. We both started
smoking dope at the same
time and got into all kinds of
trouble.
What kind of trouble?

Eye contact, open

posture, shift
occasionally in seat,
use of hand gestures
when speaking about
friend. Smiling when
speaking about
friend.
Eye contact, open
posture, hands in
lap, leaning slightly
forward.

One time we were at a

friends house for a party. It
was only me and him high as
f***. We seen the neighbor
leave her house and knew
there was money there. We
broke in the house, but set off
the alarm. We ended up
running. My friend who
threw the party knew it was
us and Im pretty sure he was
the one who called the cops

Eye contact, open

posture, began
shifting in seat and
using hand gestures
when speaking.

Focusing
Statement

Interested

Open Clarifying Interested

Question

I would like to know

more about the friend
who helped him.

(3) I was interested in the

relationship with his friend.
I figured that this friend
would be really close.

Both of them must

have been desperate
to get money if they
broke into a house.

(2) I shouldnt have asked

this question and moved to
another question about his
relationship with his friend.
This question just opened
the conversation to a crazy
story that I didnt have
time for.

on us. Had to lay low for a

while. Couple weeks later,
we met a guy and started
running for him. We were
making good money but my
friend got pinched, but he
never snitched on me. (Pt.
begins laughing) Let me add
rapper to the list of
objectives.
That must have been tough
seeing your friend get
caught.
It was. I stopped slanging
and using. But this New
Years Eve I couldnt say no
cause everyone was passing
the pipe around. I ended up
smoking the load and dont
know how long I stayed up.
(Nurse opens door and
states that the patient is
being discharged.)
Well, looks like you got a
busy day ahead of you.
Yeah, my mission objectives
are my first priority. But first

Eye contact, open

posture, hands in
lap

Expression of
Empathy

Thankful

Its great that he was

nice enough to share
this much of his
personal life.

(3) Meth is such a

damaging drug on the
person and their social life.
Im glad the patient was
able to share this story.

Closed
Statement

Inspired

Thats awesome that

he has the motivation
to get better. The
question is will he
avoid going to
Waikiki.

(2) I feel like the

conversation could have
been a little smoother. I
should try to slow down
the conversation next time.
I need to have a set list of
what kind of information I
want before I speak with

Looking down at
first, then made eye
contact, open posture,
hands in lap.

I turn to nurse to
acknowledge that I
will wrap up my
conversation. Eye
contact, open
posture, hands in
lap.

things first, gotta visit my

doctor to get some meds.

Eye contact, open

posture, hands on
armrest.

Hey (patients name), I just

wanted to say thank you for Eye contact, smiling,
your time and patience
standing and
speaking with me.
reaching out hand
for handshake.
No way brah. Im the one
Upright posture.
who should be thanking you.
I cant stand talking to these
Eye contact, smiling,
crazy people or the nurses
standing and
and doctors here. Ill be fine
acknowledging
when I get out. I got a
handshake.
mission to do.

the patient.
(3) I hope he does what he
has been saying this whole
time. Its great to see
patients trying to get better
for themselves.

Cognitive Behavior Model: My patient had some grandiose thoughts, but he also had some actual ambitious thoughts about making
money and staying out of trouble. My patient definitely felt driven to do well for himself after he got discharged. My patient wrote a
to-do list to stay busy after he was discharged.