Calimlim,Kim Regino.

PROCESS RECORDING NO.2

PHASE: Orientation Working Phase Termination Phase

OBJECTIVE (S): To gain rapport of patient, establish trust , self-care and to terminate nurse-client relationship

PATIENTS PROFILE:

Name: B.K Age: 67 Pavillion:

HISTORY OF HOSPITALIZATION:

Admitted at 60 years old, male client, separated, College Graduate , from Mandaluyong City ,wearing a t shirt and pants with flip flops, ambulatory, accompanied by
NurseX, calm, manageable noted the auditory hallucinations, talking to self with complaints of Sleep Pattern Disturbance, easily being irritable,

PRESENT DIAGNOSIS:

Schizo Affective.

Prior to interview, the nurse has already reviewed the chart of the patient particularly the reason of confinement.

COMMUNICATION
NURSE
(Subjective/Objective cues)
Good morning, Betty! (smiling) I am Kim
Regino M.Calimlim a Student Nurse from
Lyceum North Western University i am
your nurse for 8 am to 1pm until Friday
our stay here is until Oct 27, 2017. Our
activity is only for 15 minutes, until 10:30
to 10:45 everyday.
Betty How is your day? Can I ask the
reason how you were admitted here in
Sunshine.com
Ok Betty Thank you for the information.
Thats it for today because the time is up
and I have told you that we have 15
minutes to have our introduction.
DAY 1 (Orientation Phase)
Patient
(Subjective/Objective cues)
Nice meeting you kim (smiling back)
I was Brought here before with a different
diagnosis snd for the third time they
brought me here again. Because I have a
new diagnosis my new psychiatrist
diagnose me with schizo affective
Ok kim thanks for your time, see you
tomorrow (smiling)
INFERENCE
COMMUNICATION TECHNIQUE
Greets the patient and mentoring the
patients name; and explanation of
purpose for the interaction; establishing a
contract of the nurse-patient relationship
Placing bounderies on the relationship;
establishing confidentiality
Giving Information
ANALYSIS OF NURSES RESPONSE
Connotes respect and recognition of the
patient. Patient has idea of what to
expect.
There are important parameters that the
nurse should establish for the patient so
the patient would feel safe and would
know what to expect. Establishing
confidentiality is a patients right.
Informing the client of facts increases his
or her knowledge about a topic to let the
client know what to expect
Calimlim,Kim Regino M.

PROCESS RECORDING NO.2

PHASE: Orientation Working Phase Termination Phase

Schizo Affective

OBJECTIVE (S): To gain rapport of patient, establish trust , self-care and to terminate nurse-client relationship

PATIENTS PROFILE:

Name: B.K Age: 67 Pavillion:

HISTORY OF HOSPITALIZATION:

Admitted at 60 years old, male client, separated, College Graduate , from Mandaluyong City ,wearing a t shirt and pants with flip flops, ambulatory, accompanied by
NurseX, calm, manageable noted the auditory hallucinations, talking to self with complaints of Sleep Pattern Disturbance, easily being irritable,

PRESENT DIAGNOSIS:

Prior to interview, the nurse has already reviewed the chart of the patient particularly the reason of confinement.

COMMUNICATION
NURSE
(Subjective/Objective cues)
Hows Your Day Betty.
What foods do you like to eat?
What kind of process foods bettty?
I see Betty so you prefer shawarma?
Sandwiches and Pancits that are
prepared by food stands.
Ok Betty I understand I will take note
that you dont like process foods the time
is up betty its time to return to your
room I will talk to you again tomorrow.
(touching the patient)
DAY 2 (Working Phase)
Patient
(Subjective/Objective cues)
Its good I like it when its not raining
because I can walk outside .
I like to pancit and Spanish foods while
drinking wine I dont like to eat process
foods .
The ones that they make in the factory I
dont like it.
Pancit? I like Pancit yes I can eat
sandwiches its ok its up to you if youre
gonna buy me one.
Ok Kim I hope you will attend the
Halloween Party. See you tomorrow
INFERENCE
COMMUNICATION TECHNIQUE ANALYSIS OF NURSES RESPONSE
Broad openings Shows that the patient has the lead in the
interaction.
Exploring Exploring can help them examine the
issue more fully.
Seeking information/clarification It helps the patient to articulate.
Seeking Information/Clarification It helps the patient to articulate.
Restating/Clarification, touching It helps the patient to articulate and
touching the patient can be comforting
and supportive when its welcome and
permitted.