4.1. Explain adequately when can we say that communication has been effective.
The communication has been effective when the meaning of a message is identified accurately. Communication is effective once it implies that the message is understood by both sender and receiver. Remember that there are two forms of communication, verbal and non-verbal, which we must be carefully assess. Be cautious specially the non-verbal, which includes messages sent and received by means of signs, facial expression, posture, gestures, gait, groans and other body movements. It is important to understand that communication is more than simply talking to people or giving information. Just as people learn in different ways, people absorb communication in a variety of ways. So, it is important to ensure that the “style” of communication is varied to ensure that everyone will understand the message. Make sure that, as often as possible, your communication is “two way”. There must be an opportunity for questions, discussion and clarification of the key issues. The procedure of communication is dynamic concept and not a stationary. It takes presence of mind and courage to face people with the power to prove what we want to convey through communication. A communication can be said successful only if we are able to convince people for whatever we wanted to convey. Depending on the environment and circumstances the effectiveness of speech changes. It is therefore a dynamic interaction both affecting and being affected by many variables. It is a basic social process required for the growth and development of individuals, groups, society and people specially in the nursing profession as we communicate with our patient.
4.2. Describe briefly but clearly what is a therapeutic communication.
Therapeutic communication is an interpersonal meaningful interaction between a nurse and a patient with a certain purpose or goal to be attained, specifically fitted to the needs of the patient to promote an effective exchange of information and the focus is on our patient’s needs and concerns. Therapeutic communication has defined rules and guiding implementation and prescribes interpersonal boundaries. The communication takes place within health care settings and interactions usually are time limited. Each person’s role, abilities and boundaries are clearly recognizable both by the nurse and the patient. This is important to remember because some patient and nurses would like to allow a satisfying relationship to extent beyond goal achievement.
Barlund recognized that choosing the right communication strategy to meet the unique needs of each situation is the art of nursing. Therapeutic communication aren’t simply communicating, it is a powerful tool for the improvement of patient’s status and health-related concerns.
4.3. Give at least 5 therapeutic communication techniques that you actually used in your NPI then cite an excerpt from your NPI where it took place. Explain acceptable reasons for using each.
Giving recognition – According to Videbeck, greeting the patient by name has made all show that the nurse recognizes the patient as a person, as an individual. Trust is built in the nurse-client relationship when the nurse exhibits friendliness, caring, interest.
Nurse: “Magandang Hapon sa iyo, Arabit!”
Patient: “Magandang Hapon din po.”
Nurse: “Aba! Natapos mo ang mga gawain mo ngayon sa tamang oras. Nakapag-ahit ka ng bigote mo at malinis kang tingnan.”
Patient: “Siyempre ma’am eh alam ko mag-uusap tayo ngayon kaya tinapos ko na lahat ng mga gawain ko sa ward. Pero mamaya po ma’am magma-mop pa po ako ng sahig.”
Acknowledging or noting efforts of the patient is therapeutic. Such recognition does not carry the notion of value, that is, of being “good” or “bad”. I used this kind of therapeutic communication to show that my patient is worthy and with dignity. I want to make my patient feel that he is a human being who has the need to be accepted and recognized just like other people. I do believe that to be a successful psychiatric nurse, I need to have a philosophical outlook which recognizes the wholeness of the person and also is aware of the worthy of every human whoever he is, rich or poor, or whatever condition he is going through. This involves the ability to see the client as a person and not to dehumanize the person by ignoring that they can do something good.
Silence – Videbeck defined silence as absence of verbal communication, which provides time for the patient to put thoughts or feelings into words, regain composure or continue talking.
I used silence when I asked something about my patient’s experience with his uncle who mistreated him during the time my patient was in crisis (as claimed by the patient when he draw his uncle and told that he suffer from the hand of that person). My patient paused and didn’t say anything that time so I used silence to give him time to answer me. It took 3 minutes for us to be silent. During that time, I never say anything but I continue to maintain eye contact to let my patient feel that I convey interest. I think this is beneficial since I also take note his non-verbal cues while in silent moment. Silence gives my patient time to organize his thoughts or focus on issues that are most important.
Broad openings – allowing my patient to set the direction of the conversation and introduce a topic.
Nurse: “Saan mo gustong mag-umpisa tayo? Mayroon ka bang topic na gusto mo pag-usapan natin?
Patient: “Ikaw po Ma’am, kahit ano… tungkol ba sa akin, Ma’am?” “Gusto ko pag-usapan ang aking mga magulang, ang tatay ko at ang nanay ko.”
It make explicit that the patient has the lead in the interaction. I used broad opening to stimulate him to take the initiative. The focus the conversation is directly on the patient and communicate to him/her that I am interested in his concern.
General Leads - Indicates to the patient that you have understood what he said and using neutral expressions to encourage continued talking by the client.
Nurse: Sige, ipagpatuloy mo, nakikinig ako….
I used this technique since my patient suddenly stops while telling his story. I thought that he might suddenly feel uncomfortable in the topic so to encourage him to continue, I used this technique.
Presenting reality – Videbeck defined this as telling which is real.
Patient: Alam mo palagi ko napapaganipan ang mga diwata at mga babaeng nagsasayaw.” “Kahit gising na ako nakikita ko pa rin.” “Nakikita mo ba? Totoo ang mga diwata.”
Nurse: “Wala akong nakikitang mga diwata.”
I presented reality since my patient is seeing fairies, which indicates that he is misinterpreting reality or hallucinating. So, in that moment, I tell him what is real and what I perceived but not arguing with my patient and I didn’t say that his perception is wrong. My intention is to give my patient an alternative thought to consider as what Videbeck explained the rationale to her book.
4.4. Try to recall specific nursing situations in the NPI whereby honest mistake you have used non- therapeutic communication techniques. Identify at least 5 non-therapeutic communication techniques and explain each briefly what makes it non-therapeutic.
The non-therapeutic I have done were advising, agreeing, testing, challenging and rejecting.
Advising – I once gave a piece of advice to my patient when he asks me what to do to make him feel good. I should let my patient to identify and I should be there to encourage him and help. It not just to see by my patient that as his nurse, I am the only one who knows better and thus I hinder my patient to think of his own and not helping my patient to be self-reliant and learn making decisions knowing that I will not be forever with my patient.
Agreeing – I sometimes agree with my patient by saying “Tama ka.” I think this is non-therapeutic by letting my patient feel that he is right and he might feel that he is confident since I agree with him and no way for him to analyzes if there is something wrong.
Testing – I become non-therapeutic when I said “Alam mo ba kung anong klaseng hospital ito?” I pretended that my patient is unknowledgeable and force him to answer. It is still not helping my patient that I might hurt his feelings.
Challenging – I commit this when I said “Paano mo naman nasabi iyon?” It’s like I’m demanding something just to let my patient to prove that what he is saying is true. I just making my patient to defend and force his mind to think and think of answers to prove something.
Rejecting – I think this is my biggest mistake when I said “ok, tama na. Bumalik ka na muna sa ward mo at magpahinga.” I am so sad because I stop our conversation and put my patient back to his ward. I did it because my patient is hallucinating and saying irrelevant things. But still it is not therapeutic.
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