NURS 416~ Mental Health Nursing
Interpersonal Process Recording (IPR)
Student Name:
Location (describe environment):
Date/Time (duration of interaction):

CLIENT INFORMATION:
Identifying Information (use XX or XY only):
Age:
Appearance:
Brief Information about this client:
HX:
1) Mental health conditions (past/current):
2) Mental Health (current or prior treatments):
3) Major medical conditions (past/current):
4) Past Medical/Surgical HX:
DSM- DX:

Student Goal for this Interaction:

PROCESS RECORDING:
Student Nurse Communication
(Verbal & Non-Verbal): Client Communication
(Verbal & Non-Verbal): Student Nurse’s Thoughts & Feelings R/T Interaction: Analysis of the Interaction (Effectiveness, name & rationale of therapeutic/non-therapeutic communications: Alternate and Revised Response (what could have been said, what may have been more appropriate?)

*Please see table 9.2 and 9.3 in Foundation’s Text for: Therapeutic & Nontherapeutic Communication Techniques. Table 9-4 for an example.
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NTERPERSONAL PROCESS RECORDING (IPR) TEMPLATE

Student Name: [insert your name]
Location: [describe the environment where the interaction took place]
Date/Time: [include the date and duration of the interaction]

CLIENT INFORMATION:
Identifying Information: XX/XY (protect client privacy)
Age: [insert age]
Appearance: [provide a brief description]
Brief Information about this client: [provide a brief overview of the client’s mental health status and relevant background information]

HX:

Mental health conditions (past/current): [include any relevant mental health conditions]
Mental Health (current or prior treatments): [describe any treatments or therapies the client has received]
Major medical conditions (past/current): [include any relevant medical conditions]
Past Medical/Surgical HX: [provide any relevant medical or surgical history]
DSM-DX: [if applicable, include the client’s DSM diagnosis]
Student Goal for this Interaction: [describe the objective of the interaction from the student’s perspective]

PROCESS RECORDING:
Student Nurse Communication (Verbal & Non-Verbal):
[describe your own verbal and non-verbal communication during the interaction]

Client Communication (Verbal & Non-Verbal):
[describe the client’s verbal and non-verbal communication during the interaction]

Student Nurse’s Thoughts & Feelings R/T Interaction:
[describe your thoughts and emotions during the interaction, including any challenges or successes you experienced]

Analysis of the Interaction (Effectiveness, Name & Rationale of Therapeutic/Non-Therapeutic Communications):
[analyze the interaction and describe any therapeutic or non-therapeutic communication techniques used, including their effectiveness and rationale]

Alternate and Revised Response (What Could Have Been Said, What May Have Been More Appropriate?):
[provide an alternate or revised response to the interaction, explaining what could have been said and what may have been more appropriate]

*Please refer to Table 9.2 and 9.3 in Foundation’s Text for Therapeutic & Non-Therapeutic Communication Techniques, and Table 9-4 for an example.