Ns. Heni Dwi Windarwati, M.Kep.Sp.Jiwa

DefinitionCommunication

Antai-Otong (2003) The transmission of feelings, attitudes, ideas and

behaviours from one person to another.

Therapeutic CommunicationAntai-Otong (2003)

A healing or currative dialogue between people

Factors that direct communication patternsAttitudeTrustEmpathyLanguageCulturePerception and observationSelf concept and self esteemAnxiety and stressPersonal space

Theories About The NURSE-CLIENT Relationship

Peplau’s theorySix roles

The stranger respect, interest, acceptance

The resource helping the consumer

The teacher help educate the client

The Leader help the client follower contribute to and participate

The surrogate help the client resolve interpersonal problems

The counselor help integrate reality and the client emotional responses

to illness

Travelbee’s theoryHuman to human relationship allows the nurse

to help clients and their families cope with illness and find meaning in the experience

King’s theoryInteracting personalInteracting interpersonalInteracting social systems

message

response

Sender (encoder)

Receiver (decoder)

Wants to convey

message

Listener perceives what sender is

saying

Feedback allows sender to validate or

correct messages

Sensory channel

Element of the Therapeutic Relationship

Personal Qualities

Self awarenessClarification of valuesExploration of feelingsRole modelingAltruismEthics and responsibility

Facilitative Commmunicatio

nVerbal behaviorNonverbal behaviorAnalysis of problemsTherapeutic techniques

+Responsive Dimensions

GeniunenessRespectEmpathyConcreteness

Action Dimensions

ConfrontasiImmediacySelf disclosureCatharsisRole Playing

+Therapeutic

ImpasesResistanceTransferenceCountertransferenceBoundary violations

Therapeutic Outcome

For patientFor societyFor nurse

Elements affecting the nurse’s ability to be

therapeutic

A. Personal Qualities1. Self awareness

Goal: to achive authentic , open and personal communication

Component: Psychological:

emotions, motivation, self concept, personality Physical:

Body sensation, body image, physical potential Environment

Sociocultural environment, relationships with others, knowledge of the relationship between humans and nature.

Philosophical Sense of life having meaning

Increasing self awareness Johari Window

KIATKIAT JENDELA JOHARY

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[ JOSEPH LUFT & HARRY INGHAM ] [ PENYINGKAPAN DIRI ]

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2. Clarification of values

Steps in the value clarification process

3. Exploration of feelingsNurse should be open to, aware of , and in

control of their feelings so that they can be used to help patient

4. Serving as Role ModelThe power of role models in molding socially

Adaptive Maladaptive

5. AltruismConcern for the welfare of othersChanging social conditions to meet heman

welfare needs.

6. Ethics and responsibilityInvolves knowing limitation and strengths and

being accountable for patient.

Phases of the relationship

B. Facilitative Communication All behavior is communication and all

communication affects behavior Communication is the vehicle used to

establish a therapeutic relationship Communication is the mean by which people

influence the behavior of another, leading to the successful outcome of nursing intervention

Communication is the relationshi itself becouse without it, a therapeutic nurse-patient relationship is impossible.

1. Verbal Communication Spoken Written

2. Non Verbal Communication Types:

Vocal cues: qualities of speech Action cues: body movement Object cues: dress, furnishings, possessions Space: intimate space, personal space, social

consultative space and public space Touch : involves both personal space and action

3. Analysis of Problems Transactional analysis model

4. Therapeutic techniques Listening Broad opening Restating Clarification Reflection Focusing Sharing perseptions Theme identification Silence Humor Informing Suggesting

C. Responsive Dimensions1. Genuineness/ Kesejatian

Pengiriman pesan pada orang lain tentang gambaran diri kita yang sebenarnya (Smith, 1992)

Dapat ditunjukkan dengan adanya kesamaan antara vebal dan non verbal (kongkruen)

Lawannya inkongruen

Kesejatian perawat Keuntungan untuk klien Berbicara dengan sungguh-

sungguh dan tanpa menyakiti

Mengekspresikan apa yang dia pikirkan, perasaan, pengalaman saat ini

Menunjukkan kesopanan Menunjukkan keterbukaan

Merasa bebas utk mengekspresikan pikiran dan emosi mereka yang sesungguhnya

Mengembangkan perasaan percaya pada perawat

Menyediakan informasi dimana meraka dapat menggunakannya

Merasa atmosfer rileks Menikmati iklim kesejatian

2. RespectKesediaan untuk bekerja dengan klienMenunjukkan siap sediaKetertarikan pada masalah klienMemahami keunikanMelakukan pendekatan penyelesaian masalah

3. EmpathyKemampuan menempatkan diri kita pada posisi orang lain, serta memahami bagaimana perasaan orang lain dan apa yang menyebabkan reaksi mereka tanpa emosi kita terlarut dalam emosi orang lain (Smith, 1992)

Aspek-aspek Empati (Smith, 1992)Aspek Mental

Kemampuan melihat dunia orang lain dengan menggunakan paradigma orang tersebut

Memahami orang lain secara emosional dan intelektualAspek Verbal

Kemampuan mengungkapkan secra verbal pemahaman terhadap perasaan dan alasan reaksi emosi klien

Memerlukan keakuratan, kejelasan, dan kealamiahanAspek Non Verbal

Diperlukan kemampuan menunjukkan empati dengan kehangatan dan kesejatian

4. ConcretenessPerawat mempunyai terminologi spesifik dan

bukan abstrak pada saat diskusi dengan klien mengenai perasaan, pengalaman, dan tingkah lakunya

Fungsi: mempertahankan respon perawat terhadap perasaan klien, penjelasan dengan akurat tentang masalah akan mendorong klien memikirkan masalah yang spesifik

D. Action Dimensions1. Confrontation

Expression by nurse of perceived discrepancies in the patient behavior.

Three categories of confrntation Discrepancies between the patient expression of what he is (self-

concept) and what he wants to be (self ideal) Discrepancies between the patient’s verbal self –expression and

non verbal behavior Discrepancies between the patient’s expressed experience of

himself and the nerse’ experince of him Required high levels of empathy and respect

2. Immediacy Focusing on the current interaction of the nurse and the

patient in relationship Sensitivity to the patient’ feeling and a willingness to deal

with these feelings rather than ignore them

3. Self disclosure Subjectively true, personal statements about

the self, intentionally revealed to another person

Criteria for self disclosure To model and educate To foster the theraeutic alliance To validate reality To encourage the patiens’s autonomy

4. Catharsis The patient is encouraged to talk about things

that are most bothersome

5. Role playing Patient acts out a particular situation to

increase insight into human relations and enhance the ability to see a situation from another point of view; it also allows the patient to experiment with new behaviors in safe environment.

E. Therapeutik Imphasses1. Resistance

The patient’s reluctance or avoidance of verbalizing or experiencing troubling aspects of oneself

2. Transference Pemindahan pikiran, perasaan dan tingkah

laku yg berhubungan dengan signifficant others dari masa kanak-kanak seseorang kedalam hubungan saat ini.(More & Fine cit. Boyd & Nihart, 1998)

3. Counter transferenceReaksi perawat thd klien yg berdasar pd kebutuhan,

konflik, masalah dan pandangan mengenai dunia yg tdk disadari perawat dan sgt mempengaruhi hubungan perawat klien (Boyd & Nihart, 1998)

4. Boundary ViolationJika perawat berusaha memenuhi kebutuhan pribadi

dgn klien.Menjadikan hubungan tdk terapeutikTerjadi pada saat perawat melampaui batas

hubungan yg terapeutik dan membina hubungan sosial, ekonomi atau personal dgn klien.