Counseling Assessment Checklist - Adherence
Counseling Assessment Checklist: VCT
for Nurses
Facility: ________________________
Mentee: ________________________ Date: ______________
Mentor: ________________________ Visit #: ___ out of_____
|Counseling Skills and Techniques |Check off ( |
|Establishes Therapeutic Relationship and Supportive Environment |
|Creates comfortable external environment | |
|Uses culturally appropriate greeting gestures that convey respect and caring | |
|Offers seat (if available) | |
|Uses appropriate body language and tone of voice | |
|Provides comfortable, trusting atmosphere for patients to ask questions | |
|Responds to questions and concerns appropriately | |
|Addresses concerns based on the patient’s priorities | |
|Begins with less intimidating or less sensitive issues | |
|Maintains patient privacy and confidentiality | |
|Uses Active Listening |
|Looks at patient when speaking; maintains eye contact | |
|Has attentive body language and facial expressions | |
|Maintains continuous eye contact | |
|Uses occasional nonverbal gestures, such as nods or touch, to acknowledge patient | |
|Uses verbal cues such as “yes” or “OK” | |
|Uses Effective Questioning |
|Uses open-ended questions to elicit information | |
|Asks relevant questions | |
|Waits for answers rather than speaking immediately | |
|Reflects statements back to patient for confirmation | |
|Summarizes Information |
|Takes time to summarize information obtained from patient | |
|Checks with patient to ensure understanding of important concerns and issues | |
|Messages |
|Gives positive messages | |
|Provides factual information to the patient without judgment | |
|Guides patient to prioritize concerns | |
|Helps patient identify steps of action for identified concerns | |
|Helps patient identify strengths and resources | |
|Empathizes with Patient |
|Comments on patient’s challenges and strengths | |
|Exhibits balance between detachment and closeness | |
|HIV Pre- and Posttest Counseling |Check off ( |
|Pretest Counseling Checklist |
|Introduces self | |
|Asks patient to introduce self | |
|Assures patient of confidentiality | |
|Lets client know that some personal questions may be asked, but this is only to help counsel the client more | |
|effectively | |
|Asks patient why s/he came to voluntary counseling and training (VCT) center today | |
|Asks patient about what s/he knows about HIV and how it is transmitted | |
|Assesses risk profile of patient | |
|Asks whether sexually active and, if yes, number of partners | |
|Asks about previous history of sexually transmitted infections (STIs) | |
|Asks about history of blood transfusion(s) | |
|Asks whether partner and/or children are HIV-infected | |
|Asks patient whether s/he feels s/he is at risk for HIV infection | |
|Creates risk-reduction plan | |
|Reminds patient of prevention (ABC strategy): | |
|Abstinence | |
|Being faithful to one partner | |
|Condom use | |
|Determines HIV-status of client and partner(s) | |
|Explains the actual HIV test | |
|It is a blood test that detects antibodies | |
|The significance of a “window period” | |
|The significance of an HIV-positive test | |
|The significance of an HIV-negative test | |
|Makes appropriate referrals for patient | |
|Directs patient to lab for blood test | |
|Sets up follow-up appointment for results | |
|Posttest Counseling Checklist |
|Introduces self to patient | |
|Asks patient to introduce self | |
|Assures patient of confidentiality | |
|Reviews briefly information discussed during pretest counseling: | |
|What is an HIV-antibody test | |
|What are the possible results and their implications | |
|Assesses patient’s readiness for results | |
|Gives the results in a simple and clear manner | |
|Gives the patient time to reflect on the results | |
|If Negative: |
|Helps patient understand that HIV was not detected at this time; however, since the patient could be in the | |
|window period, recommends a second test in 3 to 6 months | |
|Emphasizes the need to engage in non-risky behavior to prevent his/her exposure to HIV infection; reminds | |
|patient of ABC prevention strategy | |
|If Positive: |
|Explains the difference between being HIV-infected and having AIDS | |
|Reminds patient about the modes of transmission | |
|Reminds patient of the need for safe sex to prevent further transmission: condoms for all sexual intercourse | |
|Explains the non-transmission modes of contact (e.g., hugging, kissing, shaking hands, casual contact) | |
|Explains that antiretroviral therapy (ART) is available at the ART Center if patient is eligible | |
|Explains the CD4 count—a special blood test that needs to be done first to determine whether the patient needs | |
|treatment now or later | |
|Talks about disclosure and partner notification and a strategy to bring partner(s) in for testing | |
|Discusses the importance of sharing the result with a trusted friend or family member | |
|Gives information about support groups and/or other community resources | |
|Asks patient whether s/he has any further questions | |
|Refers to HIV clinic for baseline blood tests and HIV clinic appointment | |
Brief evaluation of strengths (including what skills improved since last evaluation):
Recommendations to improve mentee’s practice (mark recommendations agreed upon for next visit):
Examples of information you shared or skills you demonstrated that were intended to improve the mentee’s practice:
Mentor’s signature: _____________________________________________
Mentee’s signature: ______________________________________________
Date: __________________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- child family development programs scaled family
- assessment in counseling
- draft national options counseling standards
- visitation assessment and planning
- counseling assessment checklist adherence
- competencies in professional counseling
- introduction
- initial health assessment and behavioral risk assessment
- family counseling i
- troy university
Related searches
- marriage counseling assessment questions
- couples counseling assessment tools
- couples counseling assessment form
- career counseling assessment tools
- free couples counseling assessment forms
- free counseling assessment tools
- counseling assessment tools for children
- counseling assessment sample
- family counseling assessment form
- counseling assessment tool
- types of counseling assessment tools
- counseling assessment tools free printable