THERAPEUTIC COMMUNICATION
Communication in nursing is called therapeutic communication, in this case the communication made by a nurse at the time of nursing intervention must be able to provide therapeutic efficacy for the patient's healing process. Therefore, a nurse must increase the knowledge and application of therapeutic communication skills so that patient needs and satisfaction can be met. Northouse (1998) defines therapeutic communication as the ability or skill of nurses to help clients adapt to stress, overcome psychological disorders and learn how to relate to others. Stuart GW (1998) states that therapeutic communication is an interpersonal relationship between nurses and clients, In this relationship the nurse and client gain a shared learning experience in order to improve the client's emotional experience. While S. Sundeen (1990) states that the therapeutic relationship is a cooperative relationship characterized by the exchange of behavior, feelings, thoughts and experiences in fostering a therapeutic intimate relationship.
From some of the definitions above, it can be understood that therapeutic communication is communication that has therapeutic meaning for clients and is carried out by nurses ( helpers ) to help clients achieve adaptive and positive conditions.
B. Function
It has been mentioned earlier that the communication carried out by nurses is a tiered communication. Each level of communication has the following functions: Intrapersonal communication is used for thinking, learning, contemplating, increasing motivation, introspection . Interpersonal communication is used to improve interpersonal relationships, explore data or problems, offer ideas, give and receive information. Public Communication affects people, conveys information, conveys general (public) orders or prohibitions.
C. Purpose
Therapeutic communication aims to develop the client's personality towards a more positive or adaptive direction and is directed at the client's growth which includes:
1. Self-realization, self-acceptance and increased self-respect.
Through therapeutic communication, it is hoped that changes will occur in the client. Clients who suffer from chronic or terminal illnesses generally experience changes in themselves, they are unable to accept their existence, experience impaired self-image, decrease self-esteem, feel insignificant and ultimately feel hopeless and depressed.
2. The ability to build interpersonal relationships that are not superficial and interdependent with others.
Through therapeutic communication, clients learn how to accept and be accepted by others. With open, honest communication and accepting clients as they are, nurses will be able to improve the client's ability to build trusting relationships (Hibdon, 2000). Rogers (1974) in Abraham and Shanley (1997) suggests that the deep relationship used in the interaction process between nurses and clients is an area for expressing needs, solving problems and improving coping skills.
3. Improved function and ability to satisfy needs and achieve realistic goals.
Sometimes clients set their ideals or goals too high without measuring their abilities. Taylor, Lilis and La Mone (1997) suggest that individuals who feel that their reality is close to their ideal self have high self-esteem, while individuals who feel that their reality is far from their ideal will feel inferior.
4. A clear sense of personal identity and increased self-integrity .
Clients with personal identity disorder usually lack self-confidence and experience low self-esteem. Through therapeutic communication, nurses are expected to be able to help clients improve their integrity and clear self-identity.
D. Therapeutic Communication Techniques
Every client is not the same, therefore it is necessary to apply the technique
communicate differently. The following communication techniques, especially
use of references from Shives (1994), Stuart & Sundeen (1950) and Wilson &
Kneisl (1920), namely:
1. Listening attentively
Attempts to listen to the client convey non-verbal messages that the nurse
attention to client needs and problems. Full listening
Attention is an attempt to understand all verbal and non-verbal messages
2. Focusing
This method is carried out with the aim of limiting the discussion material so that
more specific and understandable. Nurses shouldn't cut off the conversation
client when conveying important issues, unless the conversation
continue without new information.
Example: "This seems important, we'll talk more about it later".
3. Delivering the results of observations
Nurses need to provide feedback to clients by stating the results
observations, so that it can be seen whether the message was received correctly.
The nurse describes the impression made by the client's non-verbal cues.
Delivering the nurse's observations often makes the client communicate
clearer without having to increase focus or clarify the message.
Example: – “You seem anxious”.
– “ Do you feel uneasy when you……”
4. Offer information
This additional information allows a better understanding for the client
to his situation. Providing additional information is education
health for clients. In addition, this will increase the client's confidence in
nurse. If there is information that is covered by the doctor, the nurse needs to
clarify the reason. Nurses should not give advice to
client when providing information, but facilitates the client to make
decision.
5. Diam
Silence provides an opportunity for nurses and clients to organize
his mind. Using the silent method requires skill and determination
time, otherwise it will cause a bad feeling. Shut Up
allows clients to communicate with themselves,
organize their thoughts, and process information. Silence allows clients
to communicate with himself, organize his thoughts, and
process information. Silence is especially useful when the client has to take
decision.
6. Summarizing
Summarizing is the repetition of main ideas that have been communicated verbally
short. The ono method is useful for helping the topics that have been discussed
before moving on to the next conversation. Summarizing the conversation
helps nurses repeat important aspects of their interactions, so that
can continue the conversation with related topics.
Example: – “For several hours, you and I have been talking about…”
7. Giving awards
Greet the client by name, show awareness
about the changes that occur respect the client as a whole person
who has rights and responsibilities for himself as an individual.
The award should not be a burden for him, in the sense of the word
don't let the client try hard and do everything for the sake of
get praise or approval for his actions. And neither
meant to state that this was “good” and otherwise “bad”.
Need to say "When the client achieves something real, then the nurse can say so."
Example: - "Good morning Mother." Or "Assalmualaikum"
- "I noticed that you had combed your hair."
In Islamic teachings, giving greetings and appreciation reflects akhlah
commendable, because it means praying for others to get grace from Allah
S.W.T. Greetings show how much nurses care about others by
be friendly and friendly.
8. Offer yourself
The client may not be ready to communicate verbally with others
or the client is unable to make himself understood. Often nurses
only offer his presence, a sense of interest, this communication technique must
done selflessly.
Example: – “I want you to feel calm and comfortable”
9. Give the client an opportunity to start a conversation.
Provide opportunities for clients to take the initiative in choosing a topic
talks. Let clients who feel doubtful and uncertain about
role in this interaction the nurse can stimulate him to
took the initiative and felt that he was expected to open up
talks.
Example: – “Is there something you want to talk about?”
– “What are you thinking?”
– “Where do you want to start this conversation?”
10. Advise to continue the conversation
This technique encourages the client to direct most of the conversation
which indicates that the client is following what is being
discussed and interested in what will be discussed next. Nurse
seeks to interpret rather than direct the discussion/talk
Example: – “…..go on…..!”
– “…..and then….?
– “ Tell me about that….”
11. Placing events on a regular basis will help nurses and clients to
see it in perspective.
Continuation of an event on a regular basis will help both the nurse and the client
to see it in perspective. Continuation of an event
regularly will help the nurse and client to see what's next
as a result of the first event. The plane will be able to determine the pattern
interpersonal difficulties and provide data about the experience
satisfying and meaningful to the client in meeting his needs.
Example: – “What happened before and after
– “When did this incident occur
12. Encourage the client to describe his perception
If the nurse wants to understand the client, then she must see everything
actually from the client's perspective. Clients should feel free to
describe their perceptions to nurses. When telling his experience,
Nurses should be aware of the emergence of symptoms of anxiety.
Example: - "Find me how you feel when you are about to."
operated on”
- "What is going on"
13. Reflection
“Reflection encourages clients to express and accept ideas and
feeling like a part of himself. When a client asks what
should he think and do or feel then the nurse can answer:
"What do you think?" or “How are you feeling?”. Therefore
The nurse indicates that the client's opinion is valuable and that the client
have the right to be able to do that, then he will think
that he is a human being who has the capacity and ability
as an integrated individual and not as part of another.
Example: K: “Do you think I should tell the doctor?”
Q: “Do you think you should say it?”
K: “My husband hasn't come to visit me in a long time, that
don't call me, if he comes I don't want to talk
with him.
P: “This makes you angry”
E . Characteristics of Therapeutic Communication
There are three basic things that characterize therapeutic communication, namely as follows: (Arwani, 2003: 54).
1. Sincere (Genuiness)
All negative feelings that the patient has must be accepted and an individual approach with verbal and non-verbal will provide assistance to the patient to communicate his condition appropriately.
2. Empathy ( Empathy )
It is an honest attitude in accepting the patient's condition. Be objective in assessing the patient's condition and not overdo it.
3. Warm ( Warmth )
The warmth and permissiveness given are expected by the patient to be able to give and realize his ideas without fear, so that the patient can express his feelings more deeply.
F. Phases in therapeutic communication
1. Orientation : In this phase the relationship that occurs is still shallow and the communication that occurs is extracting information between nurses and patients. This phase is characterized by five main activities, namely testing , building trust , identification of problems and goals , clarification of roles and contract formation .
2. Work ( Work In this phase nurses are required to work hard to meet the goals set in the orientation phase. Work with the patient to discuss issues that are hindering goal attainment. This phase consists of two main activities, namely integrating the communication process with treatment actions and building a supportive atmosphere for the change process.
3. Completion ( Termination ): In this phase the nurse encourages the patient to provide an assessment of the goals that have been achieved, so that the goals achieved are mutually beneficial and satisfying conditions. Activities in this phase are assessment of goal achievement and separation (Arwani, 2003 61).
G. Communication inhibiting factors
Factors that hinder therapeutic communication are (Indrawati, 2003: 21): Development, Perception, Values, Socio-cultural background, Emotions, Gender, Knowledge, Roles and relationships, Environment, Distance, Self-Image, Physical Condition.
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