PROCESS RECORDING: NURSE-PATIENT INTERACTION ORIENTATION PHASE (November 24, 2010; 2010; 6:00 PM) Nurse Verbal
“Hello! Good Afternoon po Sir R.C.”
Non - Verbal
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“Ako po si Marianne, 3rd year nursing student po ng Manila Doctors College. Ako po ang magiging student nurse niyo simula po ngayon hanggang December 14.”
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“Tuwing Monday to Wednesday nyo po kami makakasama simula ng 12 PM hanggang 8 PM”
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“Sir R.C. gusto ko pong malaman niyo na yung mga information pong makukuha ko galing sa inyo ay wala na po
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Therapeutic Communication Technique
PATIENT
Waves hand Smiles Maintains moderate eye contact Good and open posture In face to face position to the client. Moderate eye contact In face to face position to the client Good and open posture Leans forward Smiles Movement of hands Shake hands
Verbal
“Hello! Afternoon din.”
Non - Verbal
Good
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“Ako naman si R.C. Nagagalak kitang makilala”
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Moderate eye contact In face to face position to the client Good and open posture Smiles
No response
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Moderate eye contact In face to face position to the client Good and open posture Smiles
No response
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Waves hand Smiles Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Rationale
Giving recognition
It shows that the nurse recognizes the client as a person, an individual that gives the client fulfillment of his worthiness. In addition, it does not imply and hold the notion of value that is of being “good or bad”.
Giving information
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.
Establishing specifics of the relationship time, date, place and duration of meetings
Setting up the lucid boundaries of relationship time, date, place and duration of meetings clearly orients the patient when, where, and how will begin, go on and finally end.
Establishing confidentiality
To set up a means of respecting the patient’s right to keep private any information about his mental and physical health and related care. This also
akong pagsasabihan wala pong niyo.”
ibang hangga’t permiso
means allowing only those dealing with patient’s care to have access to the information that the patient divulges.
“Makikinig po ako sa mga sasabihin ninyo tsaka magbibigay din po kame ng mga activities na makakatulong sa inyo at makakapagbigay din ng kasiyahan” kasiyahan”
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“Kamusta kayo dito?
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naman
po
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“Maari mo po bang itanong kung ano po ba ang dahilan ng pamamalagi nyo dito?” dito?”
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Moderate eye contact In face to face position to the client Good and open posture Smiles
“Ok yun. Para naman maaliw kami.” kami.”
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Moderate eye contact In face to face position to the client Good and open posture Nodding Increased tone of voice
“Ayos ako.” ako.”
Moderate eye contact In face to face position to the client Good and open posture Slightly leaning forward
“Actually nandito lang ako for safe keeping. Ang case ko kasi love depression tapos gumamit din ako ng drugs e gusto ko agad maagapan kaya voluntary ako pumunta dito. Akala nga nila yung kapatid kong special yung papasok dito kasi nakaporma pa ako nun.” nun.”
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lang
naman
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Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Establishing trust
Building a trusting relationship with the patient facilitates a more reliable data collection because of the easier disclosure of information by the patient.
Broad openings
It allows the patient to take the initiative to introduce the topic. It also simplifies that the patient has the lead in the interaction and to think of an interesting topic for them.
General leads
This gives the patient an encouragement to continue on what he is saying. It also indicates that the nurse is listening and following what the patient is talking about without taking away the initiative for the interaction.
“Ano pong dahilan ng love depression nyo?” nyo?”
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No response
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“Ano na po ang nararamdaman nyo kay R ngayon?” ngayon?”
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Moderate eye contact In face to face position to the client Good and open posture
“Nagkaroon kasi kami ng problema ng girlfriend ko. Ang daming lies. Una, sabi nya single siya e hanggang sa naging close kami sinabi rin nya na may asawa siya for 2 years pero hiwalay na sila tapos may anak. E umuwi yung asawa galing Taiwan.”
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Moderate eye contact In face to face position to the client Good and open posture Nods
“Nakakatawa pa nga e. Kasi bumili ako sa tindahan tapos ako pa yung pinagtanungan nung lalaki kung saan nakatira si R. Tapos tinuro ko pa tapos yun pala yung asawa.” asawa.”
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Moderate eye contact In face to face position to the client Good and open posture
“Galit pero hindi ko yun masabi sa harap niya.” niya.”
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Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Exploring This means delving further into a subject or an idea. This also explores the patient to help them examine the issue more fully, not only superficially.
Silence
Encouraging expression
Provides limit to put clients actions, thoughts or feeling into words and shows place of interaction gives time to develop inside.
Helps the client appraise his own rather than accept the opinion of others.
siya?” “Nasaan po ba siya?”
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“Pwede ko po bang malaman sino po yung sila na tinutukoy nyo?”
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“Ah “Ah may anak po pala kayo?” kayo?”
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“Ano po yung ginagawa niyong paraan para mawala yung galit niyo kay R?” R?”
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Moderate eye contact In face to face position to the client Good and open posture Slightly leaning forward
sila.” “Nasa Bulacan na sila.”
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Moderate eye contact In face to face position to the client Good and open posture Movement of hands
“Si R at ang anak namin.” namin.” -
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Moderate eye contact In face to face position to the client Good and open posture Movement of hands
“Oo. Mag 1 year old na nga siya e. Baby girl.” girl.”
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Moderate eye contact In face to face position to the client Good and open posture
“Hinahayaan ko na lang. Lilipas din naman kasi yun. Ginagawa ko na lang ito para sa anak namin.” namin.”
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Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Exploring
Focusing
Restating
This means repeating the main idea expressed by the client. This lets the client know that he communicated the idea effectively. This also encourages the client to continue. In addition, if the client has been misunderstood, he can clarify his thoughts.
Formulating a plan of action
This means planning in advance what he might do in certain situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.
This means delving further into a subject or an idea. This also explores the patient to help them examine the issue more fully, not only superficially. This means concentrates on a single important point.
WORKING PHASE ( November 30, 2010; 6:00 PM) Nurse Verbal
“Hello po Sir R.C. R.C . Kamusta naman po kayo?” kayo?”
Non - Verbal
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“Napansin ko pong medyo matamlay po kayo ngayon.”
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“Paano niyo po nasabi na hindi naging maganda yung usapan niyo?” niyo?”
PATIENT
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Verbal
Non - Verbal
Waves hand Smiles Maintains moderate eye contact Good and open posture In face to face position to the client.
“Okay lang ako.”
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Moderate eye contact Good and open posture In face to face position to the client. Slightly leaning forward
“Medyo depressed kasi dinalaw ako ni R kasama yung anak naming pati parents ko. Hindi naging maganda yung usapan namin” namin”
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Moderate eye contact Good and open posture In face to face position to the client.
“Masyado pong mabilis yung pagbisita nila kaya uminit yung ulo ko. Tapos hindi pa kami makapagusap ng maayos kasi nandyan parents ko.” ko.”
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Waves hand Smiles Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Therapeutic Communication Communication Technique
Rationale
Giving recognition
It shows that the nurse recognizes the client as a person, an individual that gives the client fulfillment of her worthiness. In addition, it does not imply and hold the notion of value that is of being “good or bad”.
Making observations
This is verbalizing what the nurse perceives that sometimes patient cannot verbalize or make themselves understood or the patient may not be ready to talk.
General leads
This gives the patient an encouragement to continue on what he is saying. It also indicates that the nurse is listening and following what the patient is talking about without taking away the initiative for the interaction.
“Kumpara niyo po sa nakaraang dalaw nila sa inyo, gaano po katagal yung pinakamatagal nilang dalaw?” dalaw?”
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Moderate eye contact Good and open posture In face to face position to the client.
“Actually first dalaw nga nila yun e. 15 minutes nga lang sila.”
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“Ano pong dahilan at saglit lang sila bumisita sa inyo?” inyo?”
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Moderate eye contact Good and open posture In face to face position to the client.
“May aasikasikasuhin pa daw kasi si R. Ewan ko ba kung ano yun. Sa liga daw! Ang babaw noh? Halatang may kasalanan.” kasalanan.”
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“Ah ganun po ba?” ba?”
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Moderate eye contact Good and open posture In face to face position to the client.
“Oo. Tapos yung baby ko pa parang nagkatinginan pa kami tapos binuhat ko maya maya umiyak.” umiyak.”
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Moderate eye contact Good and open posture In face to face position to the client.
“Medyo kinabahan kasi first time kong nabuhat yung bata pero masarap yung feeling.” feeling.”
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“Ano po yung naramdaman niyo nung umiyak yung anak niyo?” niyo?”
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Maintains moderate eye contact Good and open posture In face to face position to the nurse. Maintains moderate eye contact Good and open posture In face to face position to the nurse. Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Encouraging comparison
Looking at similarities and differences.
Exploring
It explores the patient to help them examine the issue more fully, not only superficially.
Voicing doubt
Encouraging evaluation
This is expressing uncertainty about the reality of the patient’s perceptions which permits the patient to become aware that others do not necessarily perceive events in the same way like others or draw the same conclusion. The nurse will encourage the patient to re-evaluate what has happened. Helps the client appraise his own rather than accept the opinion of others.
“Natatandaan niyo po ba kailan nyo po binuhat yung anak niyo?”
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Moderate eye contact Good and open posture In face to face position to the client.
“Nung Sunday. November 28.” -
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
“Sa tingin niyo po ano po yung pwede niyong magawa pag labas niyo dito para mapalapit yung loob ng anak niyo sa inyo?” inyo?”
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Moderate eye contact Good and open posture In face to face position to the client.
“Paglabas ko dito aayusin ko buhay ko para sa baby ko. Mag-tatayo ako ng business tska aayusin ko yung relationship namin ni R in a casual way.” way.”
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
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Placing time or event in sequence
Assessing time frame and sequence of an event overtime.
Formulating a plan of This means planning in action advance what he might do in certain situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.
WORKING PHASE (December 1, 2010; 6:00 PM) Nurse Verbal
Non - Verbal
“Good afternoon po Sir R.C.” R.C.” -
na po kayo?” “Kamusta na po
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“Ah ganun po ba?”
PATIENT
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Verbal
Moderate eye contact Good and open posture In face to face position to the client. Smiles Waves
“Good Morning din.”
Moderate eye contact Good and open posture In face to face position to the client. Slightly leaning forward
“Medyo okay na ako. Kelangan ko na mag move on basta para sa baby ko ito.” ito.”
Moderate eye contact Good and open posture In face to face position to the client.
“Oo. Mas okay na siguro ng ganun.” ganun.”
Non - Verbal
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Maintains moderate eye contact Good and open posture In face to face position to the nurse. Smiles Nods
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Therapeutic Communication Communication Technique
Rationale
Giving recognition
It shows that the nurse recognizes the client as a person, an individual that gives the client fulfillment of his worthiness. In addition, it does not imply and hold the notion of value that is of being “good or bad”.
Broad openings
It allows the patient to take the initiative to introduce the topic. It also simplifies that the patient has the lead in the interaction and to think of an interesting topic.
Accepting
This gives the patient an encouragement to continue on what he is saying. It also indicates that the nurse is listening and following what the patient is talking about without taking away the initiative for the interaction.
“Maiba naman po tayo. Nasabi nyo po nung 1 st day natin na drug user po kayo. Sa papanong paraan niyo po natutunan mag drugs?” drugs?”
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“Kailan niyo po ba unang natikman yung drugs?” drugs?”
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“Saan niyo po ba unang nakuha iyon?” iyon?”
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“Tapos po?”
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Moderate eye contact Good and open posture In face to face position to the client.
“Dala ng curiosity nung kabataan at impluwensya nang mga kabarkada.” kabarkada.”
Moderate eye contact Good and open posture In face to face position to the client.
“15 yrs old pa lang ako nun. Hindi ko na natatandaan yung exact date.” date.”
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Moderate eye contact Good and open posture In face to face position to the client.
“Sa tito ko nakuha. Akala ko lang pagkain yun ng butete tapos bigla akong nilapitan ng barkada ko. Tinikman niya at sinabi niya na shabu nga daw yun. Tinikman ko din at dun na nagsimula.” nagsimula.”
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Moderate eye contact Good and open posture In face to face position to the client.
“Ilang buwan lang, pina rehab na ako ng parents ko. Pag labas ko, nagshabu pa din ako. Pero on and off naman.” naman.”
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Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse. Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
General leads
This gives the patient an encouragement to continue on what he is saying. It also indicates that the nurse is listening and following what the patient is talking about without taking away the initiative for the interaction.
Placing event in time and sequence
It helps both the nurse and the client to see relationship of events in perspective.
Exploring
General leads
It explores the patient to help them examine the issue more fully, not only superficially.
This gives the patient an encouragement to continue on what he is saying. It also indicates that the nurse is listening and following what the patient is talking about without taking away the initiative for the interaction.
“Bukod po sa shabu, ano pa po yung ibang drugs na ginamit nyo?” nyo?”
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“Ano pong pakiramdam pag gumagamit ng drugs?” drugs?”
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“Ano pong balak niyong pagka abalahan kapag kayo po ay pinagbigyan na makabalik sa inyo?” inyo?”
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Moderate eye contact Good and open posture In face to face position to the client
“Nagtry din ako ng marijuana pero alternate sila ng shabu.” shabu.”
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Moderate eye contact Good and open posture In face to face position to the client
“Paiba iba e. Madalas masaya na walang dahilan. Feeling ko nga para akong si James Bond laging tumitingin sa salamin. Minsan din malungkot.” malungkot.”
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Moderate eye contact Good and open posture In face to face position to the client
“Gusto kong magaral kahit vocational lang kasi ayoko na maging dependent sa parents ko at maranasan ulit yung mga nangyari sa buhay ko. Gagawa din ako ng business at aayusin ko ang pamilya ko.” ko.”
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Maintains moderate eye contact Good and open posture In face to face position to the nurse. Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Maintains moderate eye contact Good and open posture In face to face position to the nurse.
Exploring
Reflecting
It explores the patient to help them examine the issue more fully, not only superficially.
This directs the patient’s actions, thoughts and feelings back to the patient and encourage patient to recognize and accept his own feelings.
This means planning in Formulating a plan of advance what he might do action in certain situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.
TERMINATION PHASE (December 13-14, 2010; 6 PM) Nurse Verbal
“Good R.C.” R.C.”
Afternoon
PATIENT Non - Verbal
Sir -
“Kamusta po kayo?”
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“Tulad po nang aming binanggit nung unang araw ng nakasalamuha namin kayo, ang ating huling araw ay December 14 which is today.” today.”
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Verbal
Moderate eye contact Good and open posture In face to face position to the client. Smiles Waves
“Good Afternoon din.”
Moderate eye contact Good and open posture In face to face position to the client. Slightly leaning forward
“Ok lang naman.”
Moderate eye contact Good and open posture In face to face position to the client.
“Ah oo nga pala.”
Non - Verbal
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Moderate eye contact Good and open posture In face to face position to the nurse. Smiles Nods
Moderate eye contact Good and open posture In face to face position to the nurse. Smiles
Moderate eye contact Good and open posture In face to face position to the nurse. Decreased tone of voice
Therapeutic Communication Communication Technique
Rationale
Giving recognition
It shows that the nurse recognizes the client as a person, an individual that gives the client fulfillment of her worthiness. In addition, it does not imply and hold the notion of value that is of being “good or bad”.
Broad openings
It allows the patient to take the initiative to introduce the topic. It also simplifies that the patient has the lead in the interaction and to think of an interesting topic for them.
Giving information
Informing the client of the facts increases her knowledge about the topic and what to expect on the interaction. It also builds trust with the client.
“Sa nakalipas na apat na linggo heto na po yung nagawa natin: naglaro, nagexercise, nagkakwentuhan, nagdrawing, nagtahi ng wallet, gumawa ng picture frame, kumain, at iba pa.” pa.”
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“At sa mga nakaraan po nating pag-uusap, napag-usapan po natin ang ilang mga bagay tungkol sa inyong nakaraan.”
Moderate eye contact Good and open posture In face to face position to the client.
No response
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Moderate eye contact Good and open posture In face to face position to the client
No response
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Moderate eye contact Good and open posture In face to face position to the nurse. Nods
Moderate eye contact Good and open posture In face to face position to the nurse. Nods
Summarizing
This is organizing and summing up which has gone before and seeks to bring out the important points of discussion and to increase awareness and understanding of both participants. It omits irrelevant and organizes the pertinent aspects of interaction. It allows both patient and the nurse to depart with the same ideas and provide a sense of closure at the completion of each discussion. This is more effective with movements of hands, moderate eye contact and good and open posture.
Summarizing
This is organizing and summing up which has gone before and seeks to bring out the important points of discussion and to increase awareness and understanding of both participants. It omits irrelevant and organizes the pertinent aspects of interaction. It allows both
patient and the nurse to depart with the same ideas and provide a sense of closure at the completion of each discussion. This is more effective with movements of hands, moderate eye contact and good and open posture.
“Nasabi po ninyo sa mga pag-uusap natin na talagang nalulungkot kayo at naguguluhan kayo sa sitwasyon niyo ni R. Nabanggit niyo rin na nabitin kayo sa bisita nila dito nung nakaraang linggo. Nasabi niyo rin po na namimis niyo na po ang anak niyo kaya gusto niyo na makalabas. Naikwento niyo rin po sa akin paano niyo po nakuha yung drugs. Nai-share niyo din po sa akin yung mga plano niyong gawin sa oras na makalabas po kayo.”
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Moderate eye contact Good and open posture In face to face position to the client Movement of the hands
“Oo. Iyon nga ang mga napag-usapan napag-usapan natin.”
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Moderate eye contact Good and open posture In face to face position to the nurse Nods
Summarizing
This is organizing and summing up which has gone before and seeks to bring out the important points of discussion and to increase awareness and understanding of both participants. It omits irrelevant and organizes the pertinent aspects of interaction. It allows both patient and the nurse to depart with the same ideas and provide a sense of closure at the completion of each discussion. This is more effective with movements of hands, moderate eye contact and good and open posture.
“May iba pa po ba kayong gusting sabihin?”
Moderate eye contact Good and open posture In face to face position to the client
“Wala na Marianne.”
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“Kung ganun po, maraming salamat po Sir R.C. sa tiwala pong ibinigay ninyo sa amin, sa cooperation at sa maganda po ninyong pagtanggap. Merry Christmas. Good bye po. Ingat po kayo parati.” parati.”
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Moderate eye contact Good and open posture In face to face position to the client Smiles Waves
“Merry Christmas din. Salamat sayo Marianne at sa mga kaklase mo. Mag ingat rin kayo. Bye.” Bye.”
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Moderate eye contact Good and open posture In face to face position to the nurse Smiles
Moderate eye contact Good and open posture In face to face position to the nurse. Smiles Waves
Encouraging description of perception
Giving recognition
Asking for patient to describe feelings, perceptions, and views of their situations. To understand the client, the nurse must see things from her perspective. It shows that the nurse recognizes the client as a person, an individual that gives the client fulfillment of her worthiness.