Therapeutic Communication Papers

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FOREWORD

Thank God we pray to God Almighty khadirat. His mercy and His grace so that
we can complete paper of this group. We realize there are still many shortcomings in the writing
of this paper are certainly far from perfection. Therefore our group is always open to any
suggestions and constructive criticism to the perfection of our work further.
The completion of this paper can not be separated from the share assistance. For
that we would like to thank all those who helped, either directly or indirectly.
Finally, hopefully donation charities all these parties got rewarded from Him. And
hopefully this paper can increase the knowledge of our group in particular and society in general
science lovers.

Pare Pare, January 15, 2013

composer
 TABLE OF CONTENTS

Foreword .................................................................................................. i
table of contents ....................................................................................... ii
CHAPTER I INTRODUCTION
1.1 Background ...................................................................................... 1
1.2 Problem Formulation ......................................................................... 1
1.3 Objectives .......................................................................................... 1

CHAPTER II DISCUSSION
2.1 Definition of Therapeutic Communication ........................................ 2
Phase-Phase 2.3 Therapeutic Communication ......................................... 4
2.3 Therapeutic Communication Engineering-Engineering .................. 9
2.4 Factors Therapeutic Communication ................................................. 14
2.5 Therapeutic Communication Processes in Nursing ........................... 16

CHAPTER III CLOSING

3.1 Conclusion 19
3.2 Suggestion 19

BIBLIOGRAPHY ................................................................................ 20
 CHAPTER 1
PRELIMINARY

1.1 BACKGROUND
Communication is a process that is very special and meaningful relationships. At the
nursing profession communication becomes more meaningful because it is the main method of
implementing the nursing process. Science experiences to help others require special skills and a
great social concern (Abdalati, 1989).
For that nurses require special skills and social concerns include intellectual skills, and
interpersonal tehnical which is reflected in the behavior of "caring" or affection / love (Johnson,
1989) in communicating with others.
Nurses who have the skills to communicate therapeutic not only be easy to establish a
relationship of trust with clients, preventing legal issues, provide professional satisfaction in
nursing services and improve the image of the nursing profession as well as the image of the
hospital, but the most important is their knowledge to provide aid to fellow human beings.
In this paper will be discussed on the definition of communication includes "therapeutic
use of self" and "helping relationship" for nursing practice, attitudes and techniques as well as
the dimensions of the relationship of therapeutic communication.

1.2 FORMULATION OF THE PROBLEM

1. What is the communication terapiutik?
2. What are the phases in communication terapiutik?
3. What are the techniques of communication terapiutik?
4. How terapiutik communication process in nursing?

1.3 PURPOSE OF PAPERS

1. Equipping nurses at the time of going to indent the action to the patient
2. In order for nurses and patients good communication
3. Help patients to clarify and reduce the burden of feelings and thoughts and could take action to
change the situation when the patient believes in the things needed.
4. Reducing doubt, help in things take action effective and maintain the strength of his ego.
 CHAPTER II
DISCUSSION

2.1 UNDERSTANDING COMMUNICATION THERAPEUTIC

Therapeutic communication is a shared experience between nurses client that aims to
resolve client issues that affect patient behavior. Therapeutic nurse client relationship is a shared
learning experience and experience using a variety of communication techniques in order to
change the client's behavior in a positive direction as optimally as possible. To implement an
effective therapeutic communication nurse must have enough skill and understanding about him.
Very appropriate communication theory in nursing practice (Stuart and Sundeen, 1987, p.
111) because:
1. Communication is a way to build a therapeutic relationship. In the process of communication
takes delivery of information and exchange of feelings and thoughts.
2. Communication intention is influencing the behavior of others. Means, success depends on the
communication of nursing interventions for the nursing process aimed at changing behavior in
achieving the level of normal health.
3. Communication is related. Relations therapeutic nurse and client can not be achieved without
communication.
In Therapeutic relationships with clients, nurses need to know the process of
communication and communication skills to help clients solve the problem.
Elements that must exist in the communication process is the sender of the message, the
recipient of the message, media and feedback. All senders and recipients of individual behavior
is communication will inform the effects on behavior. The message conveyed can be verbal and
nonverbal. Playing is how to communicate and relate well with children clients.
Nurses can convey nonverbally or assessing, among others: Vocal; tone, quality, hard ato
soft, speed, all of which describe the emotional atmosphere.
1. Movement; reflex, posture, facial expressions, repetitive motions, or other movements. Special
movements and facial expressions can be interpreted as a mood.
2. The distance (space)
Distance in communicating with others portray intimacy.
3. Touch: said to be very important, but need to consider the cultural aspects and habits.
 So that nurses can play an effective role in the therapeutic she must analyze himself: self-
awareness clarification of values, feelings and being able to be a model that is responsible. A
nurse will be able to know the condition of the client if there is no ability to appreciate the
uniqueness of the client.
Therapeutic communication can not take place itself, but must be planned, consideration
and done professionally. The first time nurses perform therapeutic communication
communication process is generally brief, awkward, false and made-buat.hal like this would be
more helpful to perceive each patient relationship for their chance to achieve a positive human
relations that will facilitate the achievement therapeutic purposes.

2.2 PHASE - PHASE COMMUNICATION THERAPEUTIC

1. Preparation Phase (Prainteraksi)
Preparation or prainteraksi important before interacting with clients (Christina, et al,
2002). At this stage the nurse explore feelings and identify advantages and disadvantages. At this
stage the nurse is also looking for information about a client. Then the nurse to design a strategy
for the first meeting with a client. This phase should be done by a nurse to understand her,
overcome anxiety, and assured him that he is ready to interact with clients (Pham, 2005).
The duties of nurses at this stage include:
a. Explore the feelings, hopes and anxieties. Prior to interact with clients, nurses need to examine
his own feelings (Stuart, GW in Syriac, 2005). What feelings arise in connection with interaction
to be performed. Are there any feelings of anxiety? What is worry? (Suryani, 2005).
b. Analyze the strengths and kelemanhan own. This activity is very important to keep the nurse is
able to overcome his weaknesses to the fullest when interacting with clients. For example, a
nurse might have the power capable of starting a conversation and sensitive to the feelings of
others, this situation may be used nurses to make it easier to open talks with clients and build a
trusting relationship (Pham, 2005).
c. Collecting data on the client. This activity is also very important for the nurse to know
information about the client to understand the client. At least the nurse can know the identity of
the client that can be used at the start of the interaction (Pham, 2005).
d. Planning the first meeting with a client. Nurses need to plan the first meeting with a client. It
planned include when, where, and what strategies will be carried out for the first meeting (Pham,
2005).

2.stage Introduction
Introduction of the activities carried out during this first meeting or contact with clients
(Christina, et al, 2002). At the time acquainted, nurses should introduce themselves first to the
client (Brammer in Syriac, 2005). By introducing itself means nurses have to be open on the
client and is expected to encourage the client to open itself (Pham, 2005). The purpose of this
phase is to validate the accuracy of the data and plans that have been made with the current state
of the client, and to evaluate the results of past actions (Stuart, GW in Syriac, 2005).

The duties of nurses at this stage include:

a. Foster mutual trust, indicate acceptance, and open communication. Trusting relationship is the
key of success of the therapeutic relationship (Stuart, GW in Syriac, 2005), due to the absence of
mutual trust is not likely to happen openness between the two sides. Coachee relationship is not
static, it can change depending on the circumstances (Grace, J in Suryani 2005). Therefore, to
maintain or build a trusting relationship nurse must be open, honest, sincere, accept what their
clients, keeping promises, and appreciate the client (Pham, 2005).
b. Formulating the contract on the client (Christina, et al, 2002). This contract is very important to
ensure the continuity of an interaction (Barammer in Syriac, 2005). At the time of formulating
the contract nurses also need to explain or clarify the roles of nurses and clients in order to avoid
misunderstanding the client to the presence of a nurse. In addition, to avoid raising expectations
too high from the client to the nurse because nurses for clients regard as a god helper versatile
and omniscient (Gerald, D in Syriac, 2005). Nurses need to emphasize that the nurse only help,
while the strength and desire to change present in the client's own (Pham, 2005).
c. Digging thoughts and feelings as well as to identify the client's problem. At this stage the nurse
encourages clients to express their feelings. By providing an open question, nurses are expected
to encourage the client to express his thoughts and feelings so as to identify the client's problem.
d. formulate the goals with the client. Nurses need to formulate goals for the interaction with the
client without the client's involvement may be difficult goal to attain. This objective was
formulated after the client identified.
Orientation phase, this phase is carried out at the beginning of each meeting the second and
so on, the purpose of this phase is to validate the accuracy of the data, plans have been made
with the current state of the client, and then evaluate the results of action. Generally associated
with things that have to do with a client (Cristina, et al, 2002).

3. Work Phase
This work phase is the core stage of the overall process of therapeutic communication
(Stuart, GW in Syriac, 2005). At this stage, the nurse and the client work together to address the
problems faced by the client. At the stage of this work demanded of nurses in encouraging the
client's ability to uncover feelings and thoughts. Nurses are also required to have a sensitivity
and a high level of analysis for the presence of changes in the client's verbal and nonverbal
responses.
At this stage, the nurse needs to do active listening because the duty nurse at the stage of
this work aims to solve the client's problem. Through active listening, the nurse helps clients to
define problems, how to solve this problem, and evaluate how or alternative solutions to
problems have been.
Nurses are also expected to conclude his conversation with the client. This concludes
technique is an attempt to consolidate and affirm the important things in the conversation, and
helped nurse-client have the same thoughts and ideas (Murray, B & Judth in Syriac, 2005). The
aim is to help the client conclude technique dig into things that are important and emotional
themes (Fontaine & Fletcner in Syriac, 2005)
4. Phase Termination
Termination is the end of a meeting with a client nurse (Christina, et al, 2002). This stage
is divided into two temporary termination and a termination end (Stuart, GW in Syriac, 2005).
terminations while is the end of each meeting of the nurse-client, after the termination of
temporary nurses will meet again with the client at the time the final ditentukan.Terminasi occur
if the nurse has completed the nursing process as a whole.
 The duties of nurses at this stage include:
a. Evaluating the achievement of the objectives of the interactions that have been implemented.
This evaluation also called objective evaluation. In the evaluation, the nurse should not be
impressed testing the ability of the client, but should impress just repeat or concluded.
b. Perform subjective evaluation. Subjective evaluation done by asking the client's feelings after
interacting with nurses. Nurses need to know how the client's feelings after interacting with the
nurse. Does the client feel that this interaction can reduce anxiety? Do clients feel that the
interaction of any use? Or whether the interaction was actually raises new problems for clients.
c. Agreeing on the follow-up of the interaction that has been done. This action is also referred to as
homework for clients. Follow-up given should be relevant to the interaction would do next. For
example, at the end of the clients already understand the interaction of several alternatives to
overcome anger. So to follow up nurse might ask the client to try one of these alternatives.
d. Making a contract for the next meeting. Important contract made so that there is agreement
between the nurse and the client to the next meeting. Contracts are made, including the time,
place, and purpose of the interaction.
Stuart GW (1998) in the Syriac (2005), states that the nurse-client termination process is
an important aspect in nursing care, so that if it is not done by a nurse, then regression and
anxiety can occur again on the client. The emergence of such a response is strongly influenced
by the ability of nurses to open, empathetic and responsive to the needs of clients on the
implementation of the previous stage.

2.3 THERAPEUTIC TECHNIQUES-TECHNICAL COMMUNICATION

1. Asking
Inquiry (questioning) is a technique that can encourage clients to express their feelings and
thoughts. The following techniques are often used in the orientation phase.
a. Facilitative Questions and nonfasilitatif
Question facilitative (facilitative question) occurs if the time to ask the nurse sensitive to the
thoughts and feelings and are directly related to the client's problem, while questions
nonfasilitatif (nonfacilitative question) is a question that is not effective because it gives you a
question that does not focus on the problem or talk, is threatened and seemed less understanding
of the client (Gerald, D in Syriac, 2005).
b. Open and closed questions
Open question (an open question) is used as the nurses need answers that many of the clients.
With open questions, the nurse is able to encourage clients to express himself (Antai-Otong in
Syriac, 2005).
Question closed (closed question) is used when nurses need answers short.

c. Quantity inapropriate question

Inapropriate quantity less question that is the question both in terms of the number of questions,
which resulted in a confused client answered. Too many questions is an inappropriate action
because it creates confusion client to answer (Long, L in Syriac, 2005).

d. Quality inapropriate question

Quality inapropriate question is a question which is not good given to the client and usually
begins with the word "why" (why). Why this question is not considered appropriate because:

1) Impressed interrogating, so the client feels as if intimidated (Sturat, GW in Syriac, 2005). This
could hamper the openness of the client to the nurse.

2) Will not be able to dig the feeling of the actual client because the client mengiring why question
to answer in a rational or reasoned out of an act or situation, rather than how her feelings towards
events (Gerald, D in Syriac, 2005).

2. Listen
Listening (listening) is the main basis in therapeutic communication (Keliat, Budi Anna,
1992). Listening is an active process (Gerald, D in Syriac, 2005) and the receipt of information
as well as a review of a person's reaction to a received message (Hubson, S in Syriac, 2005).
During listening, the nurse must follow read what the client attentively. Nurses
respond appropriately and not interrupting client. Show me the attention that nurses have the
time to listen (Purwanto, Heri, 1994).

3. Repeat
 Repeating (restarting) are the main ideas expressed repeat clients. Useful to strengthen the
expression of the client and gives an indication of nurses follow a conversation client (Keliat,
Budi Anna, 1992). Restarting (repetition) is a strategy that supports listening (Pham, 2005).

4. Clarification
Clarification (clarification) is reiterated ideas or thoughts were not clear client or ask the
client to explain the meaning of that expression (Gerald, D in Syriac, 2005).
At the time of clarification, the nurse should not interpret what the client says, also can not
add information (Gerald, D in Syriac, 2005). When the nurse interpret client talks, the
assessment will be based on the views and feelings. The main focus is on feelings clarification,
because understanding of the client's feelings are very important in understanding the client.
5. Reflection
Reflection (Reflection) is steered back ideas, feelings, questions, and the contents of the
conversation to the client. It is used to validate the notion nurse about what was said client and
emphasize empathy, interest, and respect for the client (Antai-Otong in Syriac, 2005).
Reflection techniques consist of: (Keliat, Budi Anna, 1992)
a. Reflection vision, which validates what is heard. Clarification of the expressed ideas clients with
the understanding nurses.
b. Reflection of feeling, which responds to the client's feelings against the contents of the
conversation, so that the client is aware of and feelings.
The point is to:
a. Knowing and accepting ideas and feelings.
b. Proofread.
c. Giving more details.
Disadvantages are:
a. Repeat too often and the same.
b. Can lead to anger, irritation and frustration

6. Focus
Focus (focusing) aims to provide an opportunity for clients to discuss the core issues and
direct client communication to goal achievement (Stuart, GW in Syriac, 2005). Thus it would
 avoid the conversation without direction and replacement of the subject. Things to consider in
mengguanakan this method is to try to not be hung up when clients deliver important issue
(Pham, 2005).
7. silent
Technics silent (silence) is used to give the client a chance to answer questions before a
nurse. Silence will provide the opportunity for nurses and clients to organize their own thoughts
(Stuart & Sundeen in Syriac, 2005). This technique gives the client time to think and live, slow
the tempo of interaction, while nurses expressed support, understanding, and acceptance. Silence
also allows the client to communicate with itself and is useful when the client must take a
decision (Pham, 2005).

8. Giving information
Provide additional information (informing) is a client health education measures. This
technique is very helpful in teaching health or education to clients about aspects that are relevant
to clients with personal care and healing. Information given to clients must be able to provide
insight and understanding of the issues facing clients as well as assist in providing alternative
solutions to problems (Pham, 2005).

9. Conclude
Summing (summerizing) is the communication techniques that help clients explore the
important points of the nurse-client interaction. This technique helps the nurse and the client to
have the same thoughts and ideas while ending the meeting. The main points of the review
concluded that the communication has been done (Murray, B & Judith in Syriac, 2005).
The benefits of concluding among other things: (Suryani, 2005)
a. Focusing on relevant topics.
b. Helping nurses in repeating the main aspects of the interaction.
c. Helping clients to feel that nurses understand his feelings.
d. Helping clients to be able to repeat the information and make additions or corrections to
previous information.
10. Changing Perspective
 The technique changed the way (refarming) is used to provide another point of view so that
the client does not see anything or problems of any negative aspects (Gerald, D in Syriac, 2005).
This technique is very bermanfaan especially when clients were thinking negative about
something, or looking at things from the negative side. A nurse sometimes give less precise
response when a client expresses a problem, for example, states: "exactly what you think it's not
as bad as what happened". Reframing will make the client is able to see what happened on the
positive side (Gerald, D in Syriac, 2005) thus enabling clients to make better planning in dealing
with her problems.

11. Exploration
Exploration aims to find or explore further or deeper problems experienced by clients
(Antai-Otong in Syriac, 2005) so that these problems can be overcome. This technique is useful
in the working stage to get a detailed picture of the problems experienced by the client.

12. dividing Perception

Stuart GW (1998) in the Syriac (2005) states, divides perception (sharing peception) is
asking the opinion of the nurses clients feel or think. This technique is used when nurses feel or
see no difference between people are responding verbal and nonverbal responses of clients.

13. identify themes

Nurses must be responsive to the story told by the client and should be able to manangkap
theme of the entire talks. The point is to increase the understanding and explore important issues
(Stuart & Sadeen in Syriac, 2005). This technique is very useful in the early stages of work to
focus the discussion at the beginning of a problem that actually felt client.

14. joke
Humor can have multiple functions in the therapeutic relationship. Florence Nightingale in
Anonymous (1999) in the Syriac (2005) has never said a bitter experience very well handled
with humor. Humor can increase mental awareness and creativity, as well as lowering blood
pressure and pulse.
In some humor of the following conditions may be done:
a. By the time the client is experiencing mild to moderate anxiety, humor might reduce client
anxiety.
b. If relevant and consistent with the client's social culture.
c. Help clients cope with the problem more effectively.

15. Giving Praise

Giving Praise (reinforcement) is a psychological advantage gained clients when interacting
with nurses. Reinforcement useful for improving self-esteem and strengthen client behavior
(Gerald, D in Syriac, 2005). Reniforcement be expressed in words or through nonverbal cues.
2.4 THERAPEUTIC COMMUNICATION FACTORS
Factor - the limiting factor in the process of Therapeutic communication is: (Purwanto, Heri,
1994)
a. The ability of different interpretations.
b. Observations / interpretation are different because of past experience.
c. One-way communication.
d. Different interests
e. Guarantees the impossible
f. Tell what should be done to the patient
g. Discuss matters of a personal nature
h. Demanding proof, challenges as well as an explanation of the patient regarding his actions
i. Criticizes the sufferer feeling
j. Stop / change the subject
k. Too much talk is supposed to listen.
l. Shows the nature of tired, pessimistic.

Communication inhibiting factors: (Kariyoso, 1994)

a. Skills are lacking in communicating
b. Lack of proper attitude
c. Lack of knowledge
d. Lack of understanding of the social system
e. Unwarranted prejudice
f. Physical distance, communication becomes less smoothly when the distance between the
communicators with receptors apart
g. There is no perception
h. Indera damaged
i. Speaking excessive
j. Dominating the conversation, and so forth

Factors that affect communication (Suryani, 2005)

a) Credibility
Credibility (credibility) there and the effect on the source or communicator. The credibility of
communication greatly affects the success of the communication process, because it affects the
confidence Tertiary target or communication to the message sent.
b) The contents of the message
The message should contain helpful content for the target. The results will be better
communication if the message content beneficial for the target.
c) Compliance with the interests of the target
Compliance with the interests of the target (context) there and play a role in the message. The
message conveyed should relate to the interests of the target.
d) Clarity
Clarity (clarity) there and play a role in the message. Clarity of the message conveyed is very
influential on the success of communication.
e) Continuity and consistency
Continuity and consistency (continuity and consistency) contained in the message. Messages to
be conveyed should be consistent and sustainable.
f) Channel
Channel (channel) there and play a role in the media. The media used must be adapted to the
message to be conveyed.
g) target capability
 Target capability (capability of the audience) are communicant. In the message, the
communicator must take into account the ability of the target to receive messages.
h) Psychological (Grace, J in Syriac, 2005)
Such as attitude, life experiences, motivation, personality, and concepts.
i) Social (Ellis, Gates & Kenwarthy in Syriac, 2005)
j) Such as age, gender, social class, ethnicity, language, power, and social roles.
2.5 COMMUNICATION PROCESS IN THERAPEUTIC TREATMENTS
1. The communication process: (Mubarak, Wahid Iqbal, et al, 2007)
a. Reference, a stimulus that motivates a person to communicate with others. Can be the
experience, ideas or actions.
b. Sender / source / encorder, also called the communicator. Either individuals or groups.
c. Message / news, information transmitted. Can be words, gestures or facial expressions.
d. Media / channel, the means chosen shipper to deliver the message to the recipient / target.
e. Reception / target / decoder, to whom the message was intended.
f. Feedback / feedback / response, reaction from the target to the message sent.

2. Therapeutic communication in Nursing.

a. Assessment (Purwanto, Heri, 1994)
1) Determine the person's ability to process information.
2) Evaluating data about the patient's mental status to determine the limits of intervention.
3) Evaluating the patient's ability to communicate verbally.
4) Observe what happens to the patient at this time.
5) Identify the level of development of the patient so that the interaction is expected to be realistic.
6) Determining whether the patient shows verbal and nonverbal attitude accordingly.
7) Assess the patient's level of anxiety that can mengantisifasi necessary intervention.

b. Nursing Diagnosis (Potter & Perry, 1999)

1) A written analysis of the assessment invention.
2) Health team planning sessions.
3) Discussions with clients and families to determine the method of implementation.
4) Make referrals.

c. Plan objectives (Purwanto, Heri, 1994)

1) Written care plan (Potter & Perry, 1999).
2) Helping patients to meet their own needs.
3) Helping patients to receive experience I've ever felt.
4) Increasing self-esteem of the patient.
5) Provide support for their changing environment.
6) Nurses and patients agreed to communicate more openly.

d. Implementation (Purwanto, Heri, 1994)

1) Introduce yourself to the patient.
2) Started dangan patient interaction.
3) Helping patients to describe their personal experience.
4) Advise the patient to be able to express feelings needs.
5) Use communication to increase the self-esteem of the patient.

e. Evaluation (Purwanto, Heri, 1994)

1) Patients can develop the ability to assess and meet their own needs.
2) Communication becomes clearer, more open and focused on the problem.
3) Help create an environment that can reduce the level of anxiety.
 CHAPTER III
COVER

3.1 CONCLUSION
1. The ability to apply therapeutic communication techniques requires practice and sensitivity and
sharpness feeling, because communication takes place not in ability but in the dimension values,
time and space that influence the success of communication seen through the therapeutic impact
for the client and also satisfaction for nurses.
2. Communication will also provide a therapeutic effect when in use is considered attitude and
therapeutic communication techniques. Another thing that is worth noting is that the dimensions
of the relationship. This dimension is a supporting factor that is very influential in developing
therapeutic touch capability.

3.2 SUGGESTION
1. Serving clients in the nurse should always communicate with the client for approval action that
will be done.
2. In communicating with clients nurse should use language that is easily understood by the client
so that no misunderstanding of communication.
3. Nurses in their profession should always uphold the ethics of nursing.
 BIBLIOGRAPHY

Into, Ermawati.2009. Nursing Communication Handbook. Jakarta: Trans

Media Info
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