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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):
1. Description of the patient: Age? Sex? Ethnicity? Marital Status? What precipitated hospitalization? Number of days in the hospital? Mental Status, etc.
2. Description of environmental setting where interaction took place. Explain the reasons for a supportive or non-supportive environment. (e.g. noise, distractions, light, temperature, etc.)
Course Number and Name
Course: NURS 223L
INTERPERSONAL PROCESS ANALYSIS TEMPLATE
Revision Date: Month, Year (i.e. February, 2010) Page 1
Page 1 of 3
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: |
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| Goal:
Verbal: Nonverbal: |
Verbal: Nonverbal: |
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| Goal:
Verbal: Nonverbal: |
Verbal: Nonverbal: |
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| Goal:
Verbal: Nonverbal: |
Verbal: Nonverbal: |
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| Goal:
Verbal: Nonverbal: |
Verbal: Nonverbal: |
INTERPERSONAL PROCESS ANALYSIS SUMMARY
1. 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?
2. How did you personally feel about the interaction? What would you change if you had to redo the interaction?
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