School of Health Sciences – College of Nursing
Bayombong, Nueva Vizcaya

Nurse-Patient Interaction Form
I. Introduction

II. Objectives

III. Setting

IV. Nurse Patient Interaction

(Sample) Nurse & Patient References (Patient’s home has limited space with beer bottles scattered on the floor. He avoids eye contact, always looking at the floor, double checks the camera to ensure that his face is not shown) Interpretation Analysis

(Unconfirmed Alcoholic)

Patient uses alcohol frequently, without even bothering to hide it.

(Carl Roger’s Humanistic Psychology)

Posited that the origin of problems for many people is that display themselves to be not valuable and unworthy of being loved

N: Good morning po, ako po si Karen Analyn Pait, isa po akong student nars. Nandito po ako para kumustahin ang sitwasyon niyo. Huwag po kayong mag-alala, anumang pag-uusapan natin ay confidential at hindi malalaman ng iba.(Maintaining eye Contact)

Establishing Rapport Active Listening Maintaining Eye Contact Conveying Interest and Concern

Therapeutic use of self, it includes use of therapeutic communication techniques

(Explain the implications of the 4th stage according to KublerRoss)

Kubler-Ross Model Stage 4-Depression

3. Group’s Goal and Objectives 5. C. Demographical Data. Learning Insights VI. Documentation PLT COLLEGE. Biographical Data History (Attach the Psychiatric Report Evaluation Tool) Psychodevelopmental History According to: Sigmund Freud Erik Erikson Jean Piaget Lawrence Kohlberg 6. Sx/s. Title Page Acknowledgement Table of Contents Introduction A. Brief Introduction of the Mental Disorder/s (Etiology. Chapter 3 (Psychopathophysiology) . School of Health Sciences – College of Nursing Bayombong. B. DSM IV classification. Chapter 1 (Patient’s Profile) A. 2. 4. INC. Chapter 2 (Assessment) Mental Status Examination (Attach the Psychiatric Report Evaluation Tool) Assessment for Special Children (Patients below 18 years old) Gordon’s Functional Health Pattern of Assessment Attach also other tools for evaluation 7. Nueva Vizcaya Psychiatric and Mental Health Nursing Counselling Portfolio Format 1.V. Medical & Nursing Management. Reason for choosing the case) B.

Collaborative Educative 9. Dx. Institutions/People Concerned) 12. Recommendation (To the Client.- Narrative & Schematic 8. Family. Bibliography A. Mechanism of Action Responsibilities Side Effects Adverse Effects Indications Contraindications Nursing Considerations Chapter 6 (Activities)include also your documentation 1st Week of December 1st and 2nd Week of January rd 3 and 4th Week of January st 1 Week of February 2nd and 3rd Week of February th 4 Week of February 1st Week of March 2nd Week of March 3rd Week of March Self Awareness Activity History Taking with NPI Form Assessment with NPI Form Continuation of NPI Form Intervention Phase Termination Phase Group Evaluation Completion of Output Submission (Monday Chapter 7 (Summary and Recommendations) A.Actual/Potential Meds Drug Generic Name Brand Name Classification Dosage Frequency Availability Route 10. Cues Nsg. Chapter 4 (Nursing Care Plan) 1 Actual. STO: Within a day LTO: Beyond 1 day Diagnostics Therapeutics . Books B. Cues Obj. Summary of Findings B.Dependent . Week 1 Week 2-3 Week 4-5 Week 6 Week 7-8 Week 9 Week 10 Week 11 Week 12 11. Diagnosis Objectives Nursing Action Rationale Subj. Chapter 5 (Drug Study). 1 Potential Assessment Explanation of the Problem Elaboration of your Nsg.Independent . Newspapers/Journals/ Magazines .

Electronic Sources 13. Appendices A. others 12 Coupon Bond Size: Long Spacing: 1. Original Copy of Forms. Attendance Sheet from Week 1-12 F.5 Margins: 1 Bottom. Communication Letter B. 1 top. Budget (Week 1-12) E. 1 ½ Left Orientation: Portrait .C. Others (Health Teaching Plan. Individual Learning Feedback Diary G. 1 Right. etc) Portfolio Specifications: Font: Calibri Font Sizes: Headings/ Title 14/16. Unpublished Sources D. Ecomap C. Other Photo Documentations D.

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