THE CPE VERBATIM TOOL

Name of Student Nurse:

Date of Visit: Date of Write-up:
Initials of Patient: Verbatim #:
Nursing Unit: Length of Visit

THE VERBATIM WRITE-UP OF PASTORAL CONVERSATIONS.

I. KNOWN FACTS (Note three-inch margin for the supervisor’s comments.)

1. Summarize here what factual information you have learned about the
person before the conversation.
2. Describe the person, situation and occasion for the interview; giving such
data as person’s age, marital status, religious affiliation, length of stay in
hospital, diagnosis, etc.

II. OBSERVATIONS (Such observations are clues as to how to proceed.)

1. What do you find at the beginning of the visit?

2. Observe the room and arrangement of its contents. Note the appearance
of the person, e.g., posture and gestures, attitudes, nervous mannerisms,
etc.
3. Record your first impression of the patient, the room and other
observations you may regard pertinent.

III. ASSUMPTIONS FROM OBSERVATION AND YOUR FEELINGS GOING

INTO THE CONVERSATION (Did you feel comfortable, angry, or how as you began?)

IV. PURPOSE/FOCUS (State what you hope to learn about yourself, ministry, etc.)
Why are you choosing to present this verbatim?

V. THE PASTORAL VISIT/ VERBATIM:

Here, give a verbatim account of what took place, not only the
conversation but also incidents, embarrassments, pauses, interruptions
and such details as they occurred during the visit. (Reserve all interpretations and
judgments for the analysis.)

1. The pastoral role usually prevents taking notes during the conversation,
but immediately afterward one may jot down a stream of key words in
shorthand sequence.
2. Then, at first opportunity, type the visit as verbatim as possible.
3. Put each speech in a separate paragraph led in by the initial of the one
speaking.
4. Nonverbal communications should also be noted (in parentheses.)
VI. ANALYSIS

The purpose of this is to help you understand the dynamics present

in the patient and your relationship with him /her in order that you may
minister more effectively as a Nurse Chaplain. Arrange the ANALYSIS in five
numbered paragraphs. Do not omit any part.

1. The Patient
To guide your analysis of the patient, the following maybe helpful:
a. Person in General:
i. How do you understand what’s going on in the person? Note
association of ideas, repetition, hidden implications,
unconscious revelations, etc.
ii. State insights gained and interpretations that occur to you
regarding the person.

b. Theological concern:
i. What is the quality of his faith in God?
ii. How is this faith related to his present situation?
iii. How does this faith affect your relationship to him/her?
iv. What is his /her growing edge?

c. Psychological concerns:
i. What is his/ her level of emotional maturity?
ii. What could be his/ her present major psychological needs,
conflicts?
iii. To what extent does he/she recognize them?
iv. How do these needs affect your relationship?
v. How is his/ her psychological pattern related to his faith in
God?

d. Sociological concern:
i. What is the relationship of the patient to his family, friends,
and community and hospital staff considering his / her
cultural, economic and political background?
ii. How is this sociological pattern related to his /her faith in
God?
2. The Nurse Chaplain:
a. Criticize your own responses.
b. How do you understand what went on in you and your responses?
c. How well have you listened?
d. Note how you responded from your feelings.
e. Note the feelings the person stimulated in you.
f. Attempt to understand your own emotional and religious reactions
and involvements.
g. What did you consider your role to be with the patient?
 h. How did you feel during the visit?
i. Note where and how you did a good job in ministering to the person
j. Note your struggle areas and what you might have done better.
k. What methods you might use next time or again.

3. Interpersonal Dynamics:
a. Characterize the manner in which the two (or more) of you related.
b. How did the person stimulate you to respond?
c. How did your responses stimulate the person and in what way?

4. Theological Implications:
a. Were there any explicit theological statements made?
b. What were the implicit theological understandings expressed in the
session (i.e., God as wrathful judge, understanding of forgiveness
and/or grace, view of the human condition, etc.)?
c. How did this interview relate to your theology?

5. Future Goals and Chart Note:

a. What are your future goals for involvement with the person, or with
others who might be helpful to him or her?
b. Next appointment, if any, or plan for follow up.
c. What did you write in your chart note and why?

NOTE: In write-ups never use actual names of persons or places. Use initials or
fictitious names.