FORMAT ANALISIS PROSES INTERAKSI

Inisial klien : Nama mahaisswa :

Status interaksi P-K : Tanggal :
Lingkungan : Jam :
Deskripsi klien : Ruangan :
Tujuan (berorientasi pd K):

Analisa berpusat pd Analisa berpusat pd

Komunikasi verbal Komunikasi non verbal Rasional
Perawat Klien
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
P:................................................................. P:........................................................................……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
K:................................................................ K:....................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ........................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ............................................................ ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
.................................................................... ...................................................................... ……………………….. ……………………….. ………………………..
Kesan Perawat:
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………