NURSE-PATIENT INTERACTION

I. PATIENT PROFILE
Name: Sarah Dada
Age: (not mentioned)
Gender: Female
Civil Status: Married
Diagnosis: Depression

II. SCENARIO
The interaction took place in the morning, inside of Dr. Jad’s clinic, where Sarah, the patient is
seated in front of Dr. Jad. The environment is an area/ room that provides privacy because only the
doctor and the patient is around. Sarah is seated on a chair, as well as Dr. Jad with a table between
them.

III. NURSE-PATIENT INTERACTION

Therapeutic
Mental Health
Patient Communication Analysis of Behavior
Worker
Techniques Used
*Doctor Jad opens *Sarah steps inside
the door for Sarah* the room*
 It shows that the nurse recognizes
“Good morning, I’m “Good morning  Giving recognition
the client as a person, an
Dr. Jad, I will be doctor.”  Giving information individual that gives the client
seeing you today.” fulfillment of his worthiness. This
makes the client feel respected
and comfortable.
 Informing the client of the facts
increases his knowledge about the
topic and what to expect on the
interaction. It also builds trust
with the client.

*Doctor Jad shakes *Sarah shakes the  Non-verbal therapeutic

Sarah’s hand* doctor’s hand* techniques such as hand shakes
are important because this
*Doctor points to a *Sarah sits down* gesture may make the client feel
welcomed and comfortable.
chair where Sarah
could sit*

*Doctor sits down

on the chair in front
of her*

“Can you please tell

 Open-ended
me your name?” “Sarah Dada.” questions  Oftentimes, open-ended
questions are regarded as non-
therapeutic, especially if it
answerable by yes or no. But in
this case, since Sarah is being
asked her name, it can
be therapeutic.

“Tell me, Sarah.  Broad openings

What is troubling  Broad openings allow the patient
you?” “I don’t know what’s to take the initiative to introduce
wrong with me. All the topic and talk more. It also
my body aches. My allows patient to explain more
about what he/she is feeling. For
head, my stomach, Sarah, she has explained what she
my knees. And has been feeling and her
sometimes I have a experiences. During the
strange tingling interaction, the patient showed
sensation in my left little to no emotions and she kept
looking down. Signs of flat affect
cheek.” has also been witnessed. These
signs are commonly seen in
patients experiencing depression.

 Exploring  This means delving further into a

“Is there anything subject or an idea. This also
else bothering you?” “I’m worried it might explores the patient to help them
examine the issue more fully, not
be cancer. I am not
only superficially. Sarah, the
eating well. And I’ve patient, has also stated that she
lost about 5 kg this has lost weight and appetite. This
month.” may put her at risk for nutritional
imbalance as she has not been
eating well. To add, depression is
also a common factor for patients
who has eating disorders such as
anorexia nervosa.

“I can see you are  Making  Acknowledging what the patient is

worried.” observations/ feeling may help them to delve
acknowledgement further and may help them realize
that there is something wrong.
This may also help them feel that
they are not alone and that they
 are being listened to. Listening
intently is important, especially
for patients who have mental
health problems as they tend to
feel as though no one cares and
tend to also self-blame.

“Do you mind if I ask  General leads

a few questions, to  This gives the patient an
encouragement to continue on
better understand what he is saying. It also indicates
what you’re going that the nurse is listening and
through?” following what the patient is
“No, not at all.” talking about without taking away
the initiative for the interaction.
By asking if the patient is willing to
answer, the nurse makes the
patient feel respected and that
he/she has a say in the
interaction. The patient is also
being very participative by being
open to answering the doctor’s
further questions.

“Do you have any  Focusing

medical illness?”  Focusing is a technique used to
“No.” concentrate on a single important
point. And in this case, the patient
is being asked about the
conditions she has. This is an
important question to be asked
because, by knowing so, we are
*Sarah shakes her able to know her history, the
head. * symptoms that she may present
and the possible risks for her
condition. But in Sarah’s case, she
“And I don’t take did not have any medical illnesses.
any medications.”
 Silence
*Sarah pauses and  Provides limit to put clients’
actions, thoughts or feeling into
continues* words and shows place of
interaction. Silence gives time for
“I was fine until one patient to form thought and
month ago.” continue expressing herself.

“How did all of this

start one month “Well, I don’t know if  Focusing is a technique used to
ago?” it is related but 3  Focusing concentrate on a single important
 Encouraging point. And in this case, the patient
months ago, my is being asked about how her
husband lost his job expression
symptoms started presenting. This
and we had to move technique also encourages her to
in with my in-laws.” express some more. Sarah was a
bit confused in the beginning but
she remained participative by
narrating to the doctor what she
*Sarah looks up, as if remembered. During this point of
trying to remember* the interaction, Sarah showed
signs of being forgetful. She has
also verbalized that she has been
forgetting things lately. To note,
*Doctor provides forgetfulness is also a known
silence, looking at symptom of depression.
Sarah and writing “No!”  Silence
down notes. *  Provides limit to put clients’
actions, thoughts or feeling into
words and shows place of
interaction. Silence gives time for
*Doctor provides *Sarah corrects
patient to form thought and
silence, maintaining herself. * continue expressing herself.
eye contact*
 Silence
“I think it was 5  Provides limit to put clients’
actions, thoughts or feeling into
months ago.” words and shows place of
interaction. Silence gives time for
*Doctor provides patient to form thought and
silence, allowing “I don’t know what continue expressing herself.
Sarah to continue is happening. I keep  Encouraging
expression  Helps the client appraise his own
speaking. * on forgetting rather than accept the opinion of
things.” others. The patient also complies
well and continues verbalizing.
*Sarah goes back to
her initial thought*

“Anyway, they are  In this part of the interaction,

nice people. But Sarah verbalizes about how they
their house is small moved from their home to their
and I have 3 in-laws’. This indicates that Sarah
has had a hard time adjusting and
children. I work all was not able to cope up well with
day long and I’m not the changes happening around
eating well. I am also her. She also expresses her
very worried about worries towards her husband, this
my husband. He is indicates that Sarah is also having
a social problem and lack of
having a hard time money to sustain the family’s
*Doctor provides finding a job. Before needs, which is a very common
silence, allowing I knew it, I was not cause of depression.
Sarah to continue eating well, or  Silence
speaking. * sleeping well and  Provides limit to put clients’
 started having pain actions, thoughts or feeling into
all over my body.” words and shows place of
interaction. Silence gives time for
patient to form thought and
*Sarah explains with continue expressing herself. To
hand gestures as if add with silence, the doctor also
explaining what had maintained moderate eye-contact
happened. * and open posture. This non-verbal
technique allows patient to feel
comfortable in disclosing
“Besides pain, have *Sarah looks at the information.
you noticed anything Doctor*
else?”
 Encouraging
 Helps the client appraise his own
expression rather than accept the opinion of
others. The patient also complies
“Like bleeding or well and continues verbalizing.
cough or fever for “Like what?” The patient is also being
example.” participative by seeking
clarification from the doctor.
 Giving  Informing the client of the facts
information increases her knowledge about
*Sarah shakes her the topic and what to expect on
head. * the interaction. It also builds trust
“You said that the with the client.
pain is all over your “No. Nothing like
body. Does it hurt that.”
more in any specific  Restating
area?”  Exploring  Restating what the client has said
*Sarah hums*  Encouraging allows the client to feel heard and
understood. This helps them feel
expression
acknowledged and their feelings
“No. It comes and respected. Exploring has also been
goes. Especially used because this allows both the
when I get angry doctor and patient to delve
with my children. I further and for the patient to
express some more of his/ her
feel like my head is
thoughts and experiences. Due to
going to explode and this, Sarah was able to verbalize
my hands start that she feels much more pain
shaking.” when she’s upset. The pain that
*Doctor hums* she experiences is a common
occurrence in people with
depression. This condition is
“Hmm, okay.” called psychosomatic pain. This
refers to a pain that is aggravated
“So, the pain gets by emotional stressors. This
worse when you are happens due to the hormonal
imbalance that is happening to
angry. Are you often the body.
angry lately?”  Restating
 General leads  Restating what the client has said
*Sarah cries silently* allows the client to feel heard and
 Encouraging understood.
expression
  This gives the patient an
encouragement to continue on
what he is saying. It also indicates
*Doctor nods* that the nurse is listening and
following what the patient is
talking about without taking away
“Only at my children. the initiative for the interaction.
I feel so bad. I don’t
 Sarah stated that she feels guilty
know what is as she is always angry with her
happening with me. I children. She stated that she
was never like that!” understands that children are like
*Doctor nods, urging that, however, she could not
Sarah to continue* “They are children, control it. Sudden bursts of anger
and constantly being guilty are
of course. They want common symptoms among
to play and run depressed patients.
around. My little girl
is only one. I hardly  She has also stated that she could
feed and clean her. I not do her motherly duties. That
having been said, Sarah is also at
don’t talk to her or
risk for impaired role and
play with her impaired parenting due to her
anymore! condition. She has also been doing
poorly in terms of her routine
“Not only that!” activities or ADLs and feels guilty
because of it.

“Sarah continues. I
am not cooking or
cleaning the house
either!”
 People who suffer from
depression cries a lot because
*Sarah cries* they are easily triggered by things.
Depression crying is understood
to be a form of self-soothing; as
“Sorry if I am such, it regulates emotion,
induces a state of calm, and might
crying.”
improve mood. With the crying
also comes the apologies. People
*Sarah inhales with depression often feel guilty
“I can see how much deeply* about a lot of things, even if it’s
this is affecting you. not their fault. They also tend to
self-blame.
Would you like to
tell me more about  It shows that the nurse recognizes
it?”  Giving the client as a person, an
recognition individual that gives the client
“I don’t mean to get  General leads fulfillment of his worthiness. This
makes the client feel respected
angry with them but
and comfortable.
I just can’t control it.  This gives the patient an
I feel so bad. Then I encouragement to continue on
start crying and what he is saying. It also indicates
blaming myself.” that the nurse is listening and
following what the patient is
 talking about without taking away
“No need to the initiative for the interaction.
apologize. It is fine
to cry here!”

“Are you crying a lot
lately?”
“Almost every day! I
feel that my heart is
“When you are so heavy. Anything
upset, what can make me cry.”
comforts you?”
“My husband tries
to help me but
nothing really works.
I feel like nothing
can really get me out
of this sadness.”
*Sarah pauses and
continues*
“When I think about
the future, I feel like
I have no hope!”
“Can you explain to
me what you mean
when you say ‘I have
no hope’?”
 Accepting
 Accepting means that you
acknowledge the patient as a
person and that you respect their
feelings. This also assures them
that what they feel is valid and
that it’s okay to feel them.
 Focusing
 Focusing is a technique used to
concentrate on a single important
point. And in this case, the doctor
is also slowly trying to make Sarah
see that there is something wrong
in random crying spells by asking
her focused questions.
 Focusing
 Focusing is a technique used to
concentrate on a single important
point. And in this case, the doctor
is also slowly trying to make Sarah
see that there is something wrong
in random crying spells by asking
her focused questions. The
patient’s answer also indicates
that her husband is a great
support system to her, which is
 Offering Silence very important for her to have
due to her condition. However,
she stills feel guilt. The patient has
also stated feelings of
hopelessness, which is also a
common occurrence when a
person is depressed.
 Seeking
clarifications

“I keep thinking of
all the bad things
that happened to
me in the past. I
don’t seem to be
able to enjoy  Offering silence
anything.”
 *Sarah pauses and
continues*

“I wonder how this is

going to be better in
the future.”

*Sarah pauses and

continues*

“I don’t know if
there is a future.”
*Doctor breathes
deeply and
verbalizes. *
 Exploring
“Sometimes, when a
person goes through
such a hard time,
she might think that
it would be easier to
die. Are you thinking
about that?”

“I do wish
sometimes to sleep
and never wake up
but I would never
end my own life.”

*Sarah inhales
deeply and shakily*

“It is against my
religion and who
would take care of
my children?”

*Sarah frowns*  Focusing

“Do you often wish
that you’d never
wake up?”

“No, not really.”

*Sarah continues*
 “It is just that
sometimes, it gets
hard to handle.”

“I don’t know how I

would be able to
manage if it wasn’t
for my husband.”
 Restating
“So, your husband is *Sarah looks down*  Seeking
an important clarifications
support for you?”

“Yes.”

*Sarah continues*

“He is a good man. I

don’t know how he
can stand me these
days. I’m sure no  Active listening
“Besides your one else would!”  Focusing
husband, is there
any other person
that you feel can
give you support?”

“My family! But they

live far from here. I
was telling my
husband that I
would like to take
the children and go  Focusing
to my parents for a
“Would that be while.”
possible?”

“I think so. But I  General leads

haven’t given it
“Sarah, did you talk much thought.”
with anyone about
what you are going
through?”
 *Sarah shakes her
head*  Reflecting

“Sarah, what do you “No.”

think is happening
with you?”

“I don’t know. I
heard on the radio
the other day that if
you feel tired and
you lose weight, it  Reflecting
might be cancer. So,
“Do you have any I came to see you.”
other explanation
for what is
happening to you?”
 Encouraging
description of
“Is there anything “No.” perception
else that you would
like to share with
me?”

“No, that’s about it.,  Giving

doctor. What do you information
“We will discuss that think I have?”
soon.”

*Doctor continues*  General leads

 Exploring
“If you don’t mind, I
still have a few
questions to ask,
then I will do a
physical exam, and
afterwards we will
talk. Is that okay
with you?”
 Focusing

“Do you drink “Sure.”

alcohol?"
 *Sarah gasps and  Giving
becomes defensive* recognition

*Doctor apologizes* “No, of course not!”

“Sorry! I didn’t mean

to offend you.”

*Doctor explains  Giving

further* information

“It is just a routine

question that we ask  Giving
everyone.” *Sarah looks down* information

“I have to ask you

more routine  Exploring
questions as well.” *Sarah looks at the  Focusing
doctor*
“Do you use any
medication to calm
yourself?” *Sarah sighs*
 Exploring
 Focusing
“No! I don’t like
“Okay, one last medication at all!”
question. You
mentioned that you
have a one-year-old
baby. Do you
breastfeed her?

*Sarah frowns and

shakes her head*

“No.”
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 Sources/ References:

[CITATION Riv21 \l 1033 ]

[ CITATION Eli18 \l 1033 ]