Interpersonal Process Analysis (IPA) Discussion

Introduction

Interpersonal Process Analysis (IPA) is a way to identify patterns in student and patient communication. It is not an intake assessment nor question and answer session but a time to listen and demonstrate caring concern, and a time to recognize and identify a patient’s emerging feelings. IPA is a written record of a segment of the nurse-patient conversation that reflects as closely as possible the verbal, non-verbal, coping, and defense mechanisms utilized during the interaction. IPA has some disadvantages because it relies on memory and is subject to distortions, however, it can be a useful tool for identifying communication patterns. The purpose of the conversation is to give an opportunity to identify and practice communication strategies correctly. Note that the goal is not to solve the patient’s problems but to explore and use interactive therapeutic communication.

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The student selects goals prior to the interactions that are realistic and measurable. Topics include such areas as behavioral issues (triggers like getting angry when called or made to feel “stupid”), replacing negative with positive coping mechanisms (reframing), identification of feelings (hungry, angry, lonely, tired, happy, etc.), plans for discharge, presence/absence delusions/hallucinations, etc. Therapeutic Communication demonstrates the use of mostly broad open-ended questions, clarification, confronting, reflecting, empathy, immediacy, focusing, etc. Identify the techniques used with rationales for use, and the effect of these techniques. Read and follow guidelines (template and rubric) and chapters on therapeutic communication. Is the patient able to answer? Are responses congruent with your statements?

Instructions

Select a patient to participate. Do not use a “script” for this interaction. Listen and respond to the patient without taking notes. Taking notes is distracting for both the student and the patient and the patient may resent or misunderstand the student’s intent or feel like a project. Write out and analyze a segment of the nurse-patient interaction using quotation marks around what both you and the patient said. Identify non-verbal actions such as body position changes, mood/affect changes, or conversation factors (looking down when discussing an uncomfortable subject). Describe the environmental setting where the interaction took place – did they contribute to a therapeutic (ease of conversation) or non-therapeutic setting (too cold, smoky, etc.). The interpretation sections will be completed later because these sections take time and reflection. Utilize ATI or the textbook for communication and defense/coping strategies.

The selected interaction is based upon the parts of the conversation most meaningful or therapeutic. Allow the interaction to flow, documented so that the Instructor can easily follow the content. As soon as the interaction is completed, thank the patient and excuse yourself. Begin to write the conversation verbatim (word for word) to the best of your recollection. Document both parties’ non-verbal behaviors. During documentation, insert information about any discontinuity, i.e. “patient needed to get ready for group therapy;” “patient left to use the bathroom;” or “we agreed to meet up directly after group.” If the student continues a conversation later and wishes to include parts of both conversations, identify the change or time lapse. (Always account for how an interaction ended when it is unplanned and abrupt, i.e., “patient stood up and said he didn’t want to talk about this anymore.”)

Interpersonal Process Analysis (IPA) Discussion

Steps:

Complete the patient demographic information and the environmental setting. (Was the setting conducive to talking?). In the patient description section, the patient should be described in such a way that no one can identify him or her (first and last initials only). Never use patient’s name in your papers.
Include grooming, affect, posture, and mood.
Quote both sides of the conversation and the non-verbal information. Verbal communication is concerned with the spoken word, including inflection and tone of voice. Non-verbal communication is concerned with gestures, body movements, posture and other unspoken forms of relaying ideas and feelings.
Identify student thoughts and feelings during the interaction. For example, “I was feeling nervous and scared. He had attempted suicide and I didn’t know if what I said would hurt him.” Focus on what is happening to you and the patient that has communication value.
The rest of the template will be completed later with time to analyze. Once all columns are complete, the student will have gained insight needed to look back and decide if the technique was therapeutic or non-therapeutic. If the patient responded favorably, yet a non-therapeutic statement was used such as closed statements (“why did you do that?”), document what could have been said that was more therapeutic. For example, I could have said, “Tell me more about what happened.”
The ability to look back and analyze conversation errors/ non-therapeutic responses is as valuable as providing therapeutic responses during the conversation and can provide insight into what is customarily used in your conversations.
Complete the type of communication techniques used and identify whether therapeutic or non-therapeutic. (Therapeutic communication is defined as a face-to-face process of interacting, focusing on advancing the patient’s physical and emotional well-being, and is used to support or inform.)
Identify coping or defense mechanisms the patient probably used in this interaction and whether these were adaptive or maladaptive.
Evaluate the effectiveness of this interaction.

Evaluate the goals. Are the responses relevant to the goal?
Did the patient initiate the conversation or did you?
Did you or the patient change the subject due to discomfort with the topic (like self-harm or abuse)? Did the patient answer you, look away, or hesitate?
Were only meaningless/social topics discussed (football teams, music, food, etc.)? Did you use closed communications, and if so was it because the patient was not cognitively communicative (Alzheimer, stroke, or dementia patient)? What communication techniques were used the most?
Is there congruence between the verbal and nonverbal communications?
Interpret behaviors. These relate to the perception of meaning behind the words.
Identify feelings involved. When possible, document the reasoning behind the feelings.
Identify and evaluate themes and strategies.
What did the communication mean to you and the patient? If you were to redo this interaction, what would you change?

These assignments are typed. Extra pages/rows may be added as needed for the conversation. Include a reference page in APA form.
Interpersonal Process Analysis (IPA) Discussion

REV 5/2017

INTERPERSONAL PROCESS ANALYSIS

Student: Date:

Clinical Instructor:

Name (initials only): Unit:

Current Legal Status (Vol., 5150, 5250, 30 day, T-Con, LPS-Conservatorship):

Multiaxial Diagnostic System: Axis I (Clinical Disorder):

Axis II (Personality Disorder / Mental Retardation):

Axis III (General Medical Conditions):

Axis IV (Psychosocial and Environmental Problems):

Axis V (Global Assessment of Functioning Scale):

Description of the patient: Age? Sex? Ethnicity? Marital Status? What precipitated hospitalization? Number of days in the hospital? Mental Status, etc.

Description of environmental setting where interaction took place. Explain the reasons for a supportive or non-supportive environment. (e. noise, distractions, light, temperature, etc.)

INTERPERSONAL PROCESS ANALYSIS

NAME: DATE:

Student:

· Verbal (quotes) and Nonverbal Communication (behavior, tone of voice, eye contact, mannerisms, etc.)

· Document at least 5 interactions

· Goal for each interaction (realistic and measurable)

Patient:

Verbal (quotes) and Nonverbal Communication (behavior, tone of voice, eye contact, mannerisms, etc.)

Communication Techniques

· Identify communication technique used then define your communication techniques

· Was the communication therapeutic or non- therapeutic?

· Which defense and coping mechanisms didthe patient use? Rationale based on your patient.

Critique and Analysis

(effective or not effective? Could have said…) Document your thoughts and feelings during the interaction.

Was your goal met?

Goal:

Verbal:

Nonverbal:

Verbal: Nonverbal:

Goal:

Verbal:

Nonverbal:

Verbal: Nonverbal:

Goal:

Verbal:

Nonverbal:

Verbal: Nonverbal:

Goal:

Verbal:

Nonverbal:

Verbal: Nonverbal:

Goal:

Verbal:

Nonverbal:

Verbal: Nonverbal:

INTERPERSONAL PROCESS ANALYSIS SUMMARY

Evaluation: After analyzing the interaction, provide a description on how the interaction progressed. Identify the reasons for successful process or unsuccessful process. What did you learn from the interaction with your patient?

How did you personally feel about the interaction? What would you change if you had to redo the interaction?

INTERPERSONAL PROCESS ANALYSIS RUBRIC

Program Learning Outcome #7: Utilize effective communication to interact with patients, families, and the interdisciplinary health team.

Course Learning Outcome #3: Initiate therapeutic nurse-client relationship then analyze verbal and non-verbal interactions, defense mechanisms, and coping mechanisms.

Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcome.

CRITERIA	4 (Exceeds Expectations)	3 (Meets Expectations)	2 (Approaching Expectations)	1-0 (Does Not Meet Expectations)	Score
Environment Description	Clearly and accurately describes the environment with clear detail of where the interaction took place.	Adequately describes the environment with adequate detail where the interaction took place.	Vaguely describes the environment with some detail regarding where the interaction took place.	Lack description of the environment and presents no detail of where the interaction took place.
Client Description	Clearly and accurately describes the client’s description in detail.	Adequately describes the client’s description with adequate detail.	Vaguely describes the client’ description with some detail.	Lack description of the client and presents no detail.
Communication Goals	Clearly and accurately identifies realistic and measurable communication goals.	Adequately identifies realistic and measurable communication goals.	Vaguely identifies realistic and measurable communication goals.	Fails to identify to identify realistic and measurable communication goals.
Student Communication	Clearly and accurately identifies all verbal and non-verbal communications.	Adequately identifies verbal and non-verbal communications.	Vaguely identifies some, but not all of the verbal and non-verbal communications.	Fails to identify either the verbal and non-verbal communications.

CRITERIA	4 (Exceeds Expectations)	3 (Meets Expectations)	2 (Approaching Expectations)	1-0 (Does Not Meet Expectations)	Score
Client Communication	Clearly and accurately identifies all verbal and non-verbal communications.	Adequately identifies client’s verbal and non- verbal communications.	Vaguely identifies some but not all of the client’s verbal and non-verbal communications.	Fails to identify either client’s verbal and non- verbal communications.
Communication Techniques	Clearly and accurately identifies therapeutic and non-therapeutic communication techniques. Consistently able to explain the rationale for using selected techniques.	Progressively identifies therapeutic and non- therapeutic communication techniques. Progressively able to explain majority of the rationale for using selected techniques.	Vaguely identifies some, but not all therapeutic and non- therapeutic communication techniques. Able to explain some of the rationale for using selected techniques.	Fails to identify any of the therapeutic and non- therapeutic communication techniques used. Fails to explain the rationale for using the selected communication techniques.	X 2
Defense Mechanism	Clearly and accurately identifies client’s defense mechanisms.	Progressively identifies client’s defense mechanisms.	Vaguely identifies some but not all defense mechanisms.	Fails to identify client’s defense mechanisms.	X2
Coping Mechanism	Clearly and accurately identifies client’s coping mechanisms.	Progressively identifies client’s coping mechanisms.	Vaguely identifies some but not all coping mechanisms.	Fails to identify client’s coping mechanisms.	X2
Critique and Analysis	Clearly and accurately interprets if the communication technique was effective or not. Clearly interpretation of thoughts and feelings regarding statements.	Progressively interprets if the communication technique was effective or not. Identifies interpretation of thoughts and feelings regarding statements.	Vaguely interprets if the communication technique was effective or not. Vague interpretation of thoughts and feelings regarding statements.	Fails to interpret if the communication technique was effective or not. Lack justification of one’s analysis and interpretation of feelings regarding his or her statements.	X2
CRITERIA	4 (Exceeds Expectations)	3 (Meets Expectations)	2 (Approaching Expectations)	1-0 (Does Not Meet Expectations)	Score
Evaluation	Expresses clear and precise point of view. Responds strongly regarding personal feelings regarding the interaction.	Progressively expresses own point of view and own personal feelings during the interaction.	Difficulty expressing own point of view, vague response regarding personal feelings during the interaction.	Fails to clearly express own point of view and describe personal feelings during the interaction.	X2
General Organization	Accurate APA format, appropriate citations and references. No spelling or grammar errors.	Adequate APA format. Minimal citations and references are appropriate. Few spelling or grammar errors.	Numerous APA format errors, inaccurate citations and references. Few spelling and grammar errors.	Fails to utilize APA format. No citations or references included numerous spelling and grammar errors.
Total					/64 = %

STUDENT SIGNATURE: DATE:

INSTRUCTOR SIGNATURE: DATE:

COMMENTS: _______

Interpersonal Process Analysis (IPA) Discussion