LEVEL

SEKOLAH TINGGI ILMU KESEHATAN

DOKUMEN: BAGIAN :
PANTI RAPIH YOGYAKARTA
FORMULIR
JUDUL FORMAT STRATEGI PELAKSANAAN KOMUNIKASI KODE
: :
TERAPEUTIK
TANGGAL DIKELUARKAN :
AREA : INSTITUSI STIKes Panti Rapih Yogyakarta
NO. REVISI :

FORMAT

STRATEGI PELAKSANAAN KOMUNIKASI THERAPEUTIK

A. PROSES KEPERAWATAN
1. DESKRIPSI KONDISI KLIEN
.............................................................................................................................
.............................................................................................................................
.........
2. DIAGNOSA KEPERAWATAN
.............................................................................................................................
.............................................................................................................................
.........

3. TUJUAN INTERAKSI
.............................................................................................................................
.............................................................................................................................
.........

4. TINDAKAN KEPERAWATAN
.............................................................................................................................
.............................................................................................................................
.........

B. STRATEGI KOMUNIKASI DALAM PELAKSANAAN TINDAKAN

KEPERAWATAN

1. FASE ORIENTASI
a. SALAM TERAPEUTIK
....................................................................................................................
....................................................................................................................
.........
b. EVALUASI/VALIDASI
....................................................................................................................
....................................................................................................................
...........................

c. KONTRAK :
1) TOPIK
.......................................................................................................

2) WAKTU
.......................................................................................................
3) TEMPAT
......................................................................................................
 LEVEL
SEKOLAH TINGGI ILMU KESEHATAN
DOKUMEN: BAGIAN :
PANTI RAPIH YOGYAKARTA
FORMULIR
JUDUL FORMAT STRATEGI PELAKSANAAN KOMUNIKASI KODE
: :
TERAPEUTIK
TANGGAL DIKELUARKAN :
AREA : INSTITUSI STIKes Panti Rapih Yogyakarta
NO. REVISI :

2. FASE KERJA : (langkah-langkah tindakan keperawatan)

..........................................................................................................................
..........................................................................................................................
( verbatim )

3. FASE TERMINASI

a. EVALUASI RESPON KLIEN TERHADAP TINDAKAN KEPERAWATAN

1). EVALUASI SUBJEKTIF
........................................................................................................................
........................................................................................................................
.........

2). EVALUASI OBJEKTIF

........................................................................................................................
........................................................................................................................
...........................

b. RENCANA TINDAK LANJUT (hal yang perlu dilatih/dikerjakan klien sesuai

dengan hasil tindakan keperawatan yang telah dilakukan)
..............................................................................................................................
..............................................................................................................................
.........

c. KONTRAK YANG AKAN DATANG

1).TOPIK.....................................................................................................

2).WAKTU..................................................................................................

3).TEMPAT.................................................................................................