Download - DASAR-DASAR KOMUNIKASI 2003
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
TERBUKA
DIRI SENDIRI
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ORAN
G L A
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Ti
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BUTA
TERSEMBUNYI TIDAK DIKETAHUI
[ JOSEPH LUFT & HARRY INGHAM ] [ PENYINGKAPAN DIRI ]
TIDAK DIKETAHUI
KIATKIAT JENDELA JOHARYDIRI SENDIRI
Tidak tahu Tahu
ORAN
G L A
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Tahu
Ti
dak
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BUTA
[ JOSEPH LUFT & HARRY INGHAM ] [ PENYINGKAPAN DIRI ]
TERSEMBUNYI
TERBUKA
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.