• PROCESS RECORDING

• Is a method in which a nurse and student nurses record all the communication, both
verbal and non-verbal, spoken and observed during his or her interview with the patient.

• PURPOSES OF A PROCESS RECORDING

• To provide means for self-evaluation of verbal and non-verbal communication pattern and
its effect on the client.
• To improve the quality of therapeutic nurse patient relationship
• To asses the nurse to plan, structure and evaluate the interaction on a conscious rather
than intuitive level
• To help the nurse identify the thoughts and feelings in relation to self and others
• To help increase the ability to identify problems and gain skills in solving them
• PROCESS RECORDING SAMPLE FORM
• Name of student: _______Group no.: __Agency: NCMH Area of assignment: Pav. 14
• Name of client (initial only): _______Age: _____Sex: _____Race: ______
• Phase of interaction: Orientation Phase Date of NPI: Feb. 14, 2021 Medical diagnosis:
Bipolar Disorder Type 1, manic episode

• Objectives of the interaction:

• 1. To establish rapport and gain patient’s trust
• 2. To gather patient’s medical and psychiatric history
• 3. To assess patient’s psychosocial problems and mental health status
• GENERAL DESCRIPTION OF THE CLIENT: (GUIDED BY MSE)
• Patient is male, is of regular body built, has an average height, stands about 160cm
and weighs 76kg. He was clad in clean blue hospital suit, wearing a green clean
rubber slipper which he claimed it was given by her mother and the color green is
his favorite. He was also observed to have just taken a bath because his short hair
was wet but was well comb. In general, the client is observed o have a good
personal hygiene.
 Nurse Patient
Verbal Non-Verbal Communication Verbal Non-Verbal
Communication Communication techniques used Communication Communication Analysis
and Rationale

Seated in the Giving Good morning! Seated in the The patient is

Good morning Mr. bench in a relax recognition. This opposite bench aloof, shy and
Cruz. posture, directly is to facing the student does not
facing the patient, acknowledge the nurse with maintain eye
leaning forward patient and crossed arms and to eye
toward the patient establish legs. Looked contact. He is
while maintaining rapport down the floor responsive to
eye contact with and glance at the queries but
him. student nurse provided
once in awhile limited
but not directly information to
through her eyes questions
being asked.
• EVALUATION OF THE OUTCOME OF THE GOALS:
• _______________________________________________________________________
_______________________________________________________________________
________
Establishing a therapeutic relationship is one of the most important
responsibilities of the nurse when working with clients.

Communication is the means by which a therapeutic relationship is

initiated, maintained, and terminated.
 NURSE-PATIENT RELATIONSHIP

A therapeutic nurse patient relationship is defined as

a helping relationship that is based on mutual trust,
respect, nurturing, being sensitive to self and others
and assisting with gratification of your patient’s
physical, emotional and spiritual needs through your
knowledge and skills.
THERAPEUTIC RELATIONSHIP

- Is a helping relationship between the nurse and a client focusing on meeting

the needs the of client.
> Patient centered
> Professional relationship
> Goal directed
> Time bounded
> Structured – planned and follows a sequence
- Establishing
- Maintaining,
- Terminating
 ROLES OF THE NURSE IN A THERAPEUTIC RELATIONSHIP
• TEACHER - The nurse teaches the client new methods of coping and solving
problems. He or she may instruct about the medication regimen and available
community resources.
• CAREGIVER – The nurse implements therapeutic relationship to build trust, explore
feelings, assist the client in problem solving, and help the client meet
psychosocial needs.
• ADVOCATE - The nurse informs the client and then supports him or her in whatever
decision he or she makes and acting on the client’s behalf when he or she cannot
do so.
• PARENT SURROGATE –The nurse provides personal care such as feeding or bathing
 TRUST

Key factor in establishing a

therapeutic relationship towards
recovery process
 Accepting
Behavior
A caring action on the client’s well
being such as, sensitivity, comforting,
attentive listening , honesty and non-
judgmental acceptance
NURSE-PATIENT RELATIONSHIP (NPR) TO MEET
Using oneself as a tool in the development of nurse-patient
relationship (NPR) to meet clients’ emotional needs and
resolve client’s health needs
• It requires: EARS
• E- empathy
• A- awareness of self
• R- respect
• S- self disclosure
DEVELOPING HELPING RELATIONSHIPS
•1. Listen attentively.
• 2. Help to identify what the patient is feeling
• 3. Put yourself in the patient’s shoes
• 4. Be honest, genuine and credible
• 5. Use your ingenuity.
• 6. Maintain client confidentiality.
• 7. Know your role and your limitations
• 8. Be aware of cultural differences
PHASES OF NURSE-PATIENT RELATIONSHIP
• PRE-ORIENTATION PHASE
• It begins before the client first contact with the
patient. The nurse gathers information. Such
information may include the client’s name,
address, age, medical and social history. The
nurse should consider her personal strength
and limitation when working with the client and
in any area that might signal difficulty because
of past experiences
• 1. Self- awareness.
• 2. Data gathering
ORIENTATION ( ESTABLISHING)
The nurse establishes a relationship , develop
- Nurse responsibilities
trust and respect , setting goals, and security - Arrive on time
within the nurse–client relationship
1. Establish trust – consistent, congruent,
- End on time
honest, keeping promises, show genuine - Maintain confidentiality
interest and respect - Document sessions (recording
2. Establish contract process)
- time, place and length of session - Assess client level of anxiety
- Duration
- Prepare client for termination
and separation of the
- Purpose of the meeting relationship
- Client responsibilities 3. Beginning assessment and
- Nurse responsibilities identify problems to work with the
patient
3. Set boundaries of the relationship
WORKING (MAINTAINING)
3. Facilitate behavioral changes
1. The nurse works with the
3.1. Examine feelings and responses
client on the resolution of
his identified problem while 3.2. Develop a better coping skills
maintaining the nurse – 3.3. Promote a positive self concept
patient relationship 3.4. Develop independency
2. Identifies issues or 3.5. Exploring perception of reality
concerns causing problems 4 . Evaluation and redefining goals as
appropriate
TERMINATION (TERMINATING/ SEPARATING)
- The nurse summarizes with the clients his progress of the
relationship and assessing the client’s ability to handle
situations independently
1. Assess client emotional stability
2. Identify and deal with separation issues
3. Encourage client to discuss feelings about the termination
4. Do not promise the client that the relationship will be continued
5. Refer and transfer client to other support system
BARRIERS TO THERAPEUTIC RELATIONSHIP
(Candy TRIES)
C – COUNTERTRANSFERENCE I – INAPPROPRIATE BOUNDARIES
- Nurse transfers feelings to client of a
significant person in her life - Relationship should be maintained
T – TRANSFERENCE within the NPR
- Client transfers feelings to nurse of a E – ENCOURAGE DEPENDENCY
significant person in her life
R - RESISTANCE AND AVOIDANCE - Encourage independency
- Development of ambivalent feelings S – SYMPATHY
for self-exploration or self-disclosure
- Empathize