Thesis on psychodynmic traits in adherence to therapeutic communication skills

7/31/2019 Thesis on psychodynmic traits in adherence to therapeutic communication skills

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Rationale

Are you okay? Little did we know that these words means so much to the

patients we are interacting with every day. Today, one of the most critical

components of the health care delivery process is the interaction between the care

provider and the bereaved individuals, nurses especially in hospital settings try to

lessen the pain or mend on the emotions that the patient is dealing with, it requires a

great deal of sensitivity and a good knowledge in regarding with the techniques or

traits we are about to use.,

Communication is a process by which information is given from one person to

another either directly in face-to-face meetings or indirectly. It involves intrapersonal

and interpersonal exchanges. (King, 1981). Communication can be defined as the

pro cess of transmitting messages and interpreting meaning. (Wilson and others,

1995) with therapeutic communication, the sender, or nurse seeks to illicit a

response from the receiver, the patient that is beneficial to the patients mental and

physical health.

In addition, nurses interaction with various people in the course of their

profession. Hence, high aptitude in communication helps the nurse maintain balance

and effective relationships within the entire sphere of professional practice and help

meet legal, ethical and clinical standards of care. Failure to effectively communicate

causes serious difficulty especially to these pediatric patients where the value of trust

is still undeveloped, for nurses these may lead to increase liability and threatens

professional credibility.

Moreover, it is necessary to build therapeutic communication for this journey.

Nurses give therapeutic communication to people under stress: clients, families and


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colleagues. They function as client advocates and as members of interdisciplinary

teams who may have different ideas about priorities for care (Potter and Perry,

2005). Therapeutic communication can be very effective in dealing with troubled

children. Establishing a therapeutic relationship is one of the most important

responsibilities of the nurse when working with clients. Communication is the means

by which a therapeutic relationship is initiated, maintained, and terminated.

However, it should be noted that gaining expertise in communication as in any

aspect of nursing, requires both understanding of the communication process and

reflection about ones communication expertise as a nurse (Guipando, 1983).

On the other hand, therapeutic communication is n important asset of a nurse,

most especially to the Filipino nurses. According to some experts, Filipino nurses are

much sought out inn communicating with and caring for patients. Thus there is

indeed a need for nursing students to develop their therapeutic communication skills.

Therapeutic communication is an interpersonal interaction between the nurse

and the client during which the nurse focuses on the clients specific needs to

promote an effective exchange of information. Skilled use of therapeutic

communication techniques helps the nurse understand and empathize with the

clients experience. All nurses need skills in therapeutic communication to effectively

apply the nursing process and to meet the standard of care of their clients.

Therapeutic communication must be enhanced and practiced constantly as it is an

integral part of the health care delivery especially in the ward with pediatric patients

where patients cannot comprehend facts about health immediately nor can they

read. However, only nurses who are well trained with therapeutic communication can

most of the time gain their trust and reach the minds of the patients.


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Although along with therapeutic communication, we also have the nontherapeutic

communication which nurses should recognize so that they would know what not to

do during their exposure on the ward, the researchers considers the therapeutic

communication in relation to this study.

A common misconception by students learning the art of therapeutic

communication is that they always must be ready with questions the instant the client

has finished speaking. Hence, they are constantly thinking ahead regarding the next

question rather than actively listening to what the patient is saying. The result can be

that the nurse does not understand the clients concerns, and the conversation is

vague, superficial, frustrating and irritating most especially to pediatric patients who

have lesser patience in dealing with this kind of conversation. Through this study this

kind of misconception can be changed and corrected.

As a whole, this study deal with the therapeutic communication skills of third

year nursing students as they communicate with their pediatric patients. It aims to

show the various therapeutic communication skills utilized by junior student nurses

as well as the perception of the parents of the patients on the level of competence of

the student nurses in applying their skills in the ward. The researchers also intend to

use the result of this investigation as an eye opener for everyone in the college of

nursing in the importance of developing strategies that will help the students to

further improve their quality of care and therapeutic relationship despite the toil in

dealing with pediatric patients by way of therapeutic communication.


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Theoretical Background

This study is anchored on the Goal Attainment Theory of Imogene King which

states that, a personal relationship is the vehicle for the delivery of nursing care,

which she defines as a dynamic interpersonal process in which the nurse and client

are affected by each others behaviour, as well as by the health care system. The

nurses goal is to use communication to assist the client in re -establishing or

maintaining a positive adaptation to the environment (Williams, 2004).

This conceptual model was developed by Imogene King for nursing in the mid1960s with the idea that human beings are open systems interacting with the

environment. Kings work is considered a conceptual model because it comprises

both a conceptual framework and a theory.

The central focus of Kings framework is man as a dynamic human being

whose perceptions of objects, persons, and events influence his behaviour, socialinteraction, and health. Kings conceptual framework includes three interacting

systems with each system having its own distinct group of concepts and

characteristics. These systems include personal systems, interpersonal systems,

and social systems. Kings basic assumption maintained that nursing is a process

that involves caring for human beings with health being the ultimate goal. The three

systems that constitute Kings conceptual framework provided the basis for the

development of her theory of Goal Attainment.

The personal system that King speaks of refers to the individual. The

concepts within the personal system and fundamental in understanding human

beings are perception, self, body image, growth and development, time, and space.

King viewed perception as the most important variable because perception


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influences behaviour. King summarized the connections among the concepts in the

following statement: An individuals grow and develop through the life span,

experiences with changes in structure and function of their bodies over time

influence their perceptions of self.

Interpersonal systems involve individuals interacting with one another. King

refers to two individuals interacting as dyads, three individuals as triads, and four or

more individuals as small or large groups. The concepts associated with

interpersonal systems are interaction, transaction, communication, role and stress.

The interactions and transactions that occur between the nurse and the client, or the

dyad, represent an example of an interpersonal system. Communication between

the nurse and the client can be classified as verbal or nonverbal. Verbal exchanges

include both spoken and written communication, while nonverbal communication

includes such things as appearance, distance facial expression, posture and touch.

The third and final interacting system in kings model is the social system.

Social systems are groups of people within the community or the society that share

common goals, interest, and values. Social systems provide a framework for social

interaction and relationships, and establish rules of behavior and courses of action.

Examples of social system include the family, the school and the church. It is within

these organizations that the individuals beliefs, attitudes, values and customs are

formed. The concepts that king identified as relating to social systems are

organization, authority, power, status and decision making. The relationship

between these three systems led to kings theory of goal attainment.


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The conceptual framework of the interpersonal system had the greatest

influence on the development of this theory. King state d, Although personal systems

and social systems influence quality of care, the major elements in theory goal

attainment are discovered in the interpersonal systems in which two people, who are

usually strangers, come together in a health care organization to help and to be

helped to maintain a state of health that permits functioning in roles. King believes

that interactions between the nurse and the client lead to transactions that result in

goal attainment. Furthermore, king proposes that through mutual goal setting and

goal attainment, transactions result in enhanced growth and development for the

client. King used ten major concepts from the personal and interpersonal system to

support the theory of Goal attainment. Those concepts include human interactions,

perception, communication, role, stress, time, space, growth and development, and

transactions. To capture the essence of these interrelated concepts, king states that

nurse and client interactions are characterized by verbal and nonverbal

communication, in which information is exchanged and interpreted; by transactions,

in which values, needs, and wants of each member of the dyad are shared; by

perceptions of nurse and client and the situation; by self in role of client and self in

role of nurse; and by stressors influencing each person and the situation in time and

space.

Kings Theory is supported by Videbecks concept of communication which

states that communication is far more complex than a message sent in a straight line

between a sender and receiver. It is a process that involves give and take between

the participants. Verbal and nonverbal messages are transmitted back and forth

between sender and receiver. For example a patient can be silent while a nurse is

explaining the effect of the medication given, however, the patient may be


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communicating a response to the nurses message by body stance, facial

expression, and eye contact (or lack of it). The receiver perceives and interprets the

message and then provides feedback on the message was received. The sender

then has information on what the receiver has heard and how he or she responded

to the message and, on this basis, can decide whether to continue the

communication and, if so, how to proceed.

The nurse should use words that are clear as possible when speaking to the

client so that the client can understand the message. The nurse should be aware

that anxious people lose cognitive processing skills the higher the anxiety, the less

the ability to process concepts so the nurse uses concrete messages are important

for accurate information exchange. In a concrete message, the words are explicit

and need no interpretation (www.rno.org) .

The nurse can use many therapeutic techniques to interact with clients. The

choice of technique depends on the intent of the interaction and the clients ability to

communicate verbally. Overall, it is the nurse who selects the technique that will

facilitate the interaction (Weitzel, et.al., 1983).

Here below, are some effective techniques to promote therapeutic communication

(Videbeck, 2004):

THERAPEUTIC

COMMUNICATION

INTERPRETATION

ACCEPTING

Indicates reception; indicates that the nurse thenurse has heard and followed the clients train of thought. It does not indicate agreement but is not

judgmental.
http://www.rno.org/http://www.rno.org/


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BROAD OPENINGSIt makes explicit that the client has the lead for interaction. For the client who is hesitant abouttalking, broad openings may stimulate him or her to take the initiative.

ENCOURAGING DESCRIPTION

OF PERCEPTIONSTo understand the client, the nurse must seethings from his perspective. Encouraging theclient to describe ideas fully may relieve thetension the client is feeling.

EXPLORINGIt helps client examine issues more carefullywhen topics are given superficially. Any problemor concern is better understood if explored indepth.

GENERAL LEADSUsing neutral expressions to encourage patientsto continue talking. It indicates that the nurse islistening and following what the client is sayingwithout taking the initiative for interaction.

GIVING INFORMATIONProviding information that will help patients makebetter choices. Informing the client of factsincreases his knowledge about a topic or lets theclient know what to expect.

OFFERING SELFMaking self-available and showing interest andconcern. The nurse can offer his presence,interest and desire to understand.

SEEKING INFORMATION Asking patient to restate, elaborate, or giveexamples of ideas or feelings to seek clarificationof what is unclear. The nurse should seekclarification throughout the interactions with theclient.

SUGGESTING

COLLABORATION

The nurse seeks to offer a relationship in whichthe client can identify problems in living withothers, grow emotionally, and improve the abilityto form satisfactory relationships.


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SUMMARIZINGReviewing the main points of discussions andmaking appropriate conclusions. It allows bothclient and nurse to depart with the same ideasand provides a sense of closure at the end of

discussion.

In contrast, there are many nontherapeutic techniques that the nurse should

avoid. These responses cut off the communication and make it more difficult for the

interaction to continue. Responses such as Everything will work out or Maybe

tomorrow will be a better da y may be intended to comfort the client2, but instead

may impede the communication process. Asking Why questions (in an effort to gain

information) may be perceived as criticism by the client, conveying a negative

judgment from the nurse. Many of these responses are common in social interaction.

Therefore, it takes practice for the nurse to avoid making these types of comments

(Videbeck, 2011).

Gaining expertise in communications in any aspect of Nursing requires both

an understanding of the communicati on process and reflection about ones

communication experiences as a nurse. Nurses who have developed good critical

thinking skills make the best communicators. They are able to draw upon theoretical

knowledge with what has been learned through personal experience. They can

interpret messages received from others, analyse their content, make inference

about their meaning, evaluate their effect, explain rationale for communication

techniques used, and self-examine personal communication skills (Guipando, 1983).

Based on a theory known as the Five Factor Model, there are essentially five

overriding personality traits. This list of personality traits are the dominant factors that

shape all our personalities and encompass the more subtle individual traits. This


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article gives a personality traits list and examines each of the big five and how they

may affect how your child relates to the rest of the world. The Big Five Personality

Traits of a child (1.) Conscientiousness. The conscientious child is organized and

disciplined. You can recognize this in how kids keep their toys, color, and complete

school work. The conscientious child to shows self-discipline and prefers planned

activities over spontaneous behaviour. This trait is associated with a strong

performance and a high level of commitment. Of all the personality characteristics,

this one is associated with great students and professionals later in life. (2).

Agreeableness. The agreeable child is friendly and pleasant to be around. His

relationships will be mostly strong. He has tendency toward compassion and

cooperation. He will rarely be suspicious or antagonistic with others. This child is a

social creature, and gets energy from being around other kids and adults. This is the

kid who gets along with everyone . You just have to watch out that he isnt taken

advantage of. (3.) Neuroticism. The neurotic child is a worrier. Shes often anxious

and her emotions can fluctuate quite a bit. She is vulnerable to experience

unpleasant emotions such as anger and anxiety easily. This is sometimes referred to

as emotional instability. Watch for signs of depression and sadness during the teen

years. Although this trait is inborn, parents can help alleviate stress by providing and

communicating a safe and stable environment. This personality trait often leads to

physical ailments. (4.) Openness. The open child is your daredevil. She loves

adventures and trying new things and is very insightful and imaginative. This is the

child who entertains you with wise-beyond-her-years one liners and stunning

creativity. She appreciates art and unusual ideas. She is not afraid to take risks and

therefore may not take your parental advice either. (5.) Extraversion. The extraverted

child is assertive, talkative, and loves to be the center of attention. Hes got a lot of


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energy and optimism. He has a tendency to seek stimulation and the company of

others. While he may prefer not to be alone, he can become overwhelmed if this trait

is allowed to go unchecked. Extraverts actually need time alone

(http://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-

Your-Child) .

In addition, related to Kings theory. Republic Act No. 9173. Section 28.

Scope of Nursing. - A person shall be deemed to be practicing nursing within the

meaning of this Act when he/she singly or in collaboration with another, initiates and

performs nursing services to individuals, families and communities in any health care

setting. It includes, but not limited to, nursing care during conception, labor, delivery,

infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old

age. As independent practitioners, nurses are primarily responsible for the promotion

of health and prevention of illness. Members of the health team, nurses shall

collaborate with other health care providers for the curative, preventive, and

rehabilitative aspects of care, restoration of health, alleviation of suffering, and when

recovery is not possible, towards a peaceful death. It shall be the duty of the nurse

to:

(a) Provide nursing care through the utilization of the nursing process. Nursing care

includes, but not limited to, traditional and innovative approaches, therapeutic use of

self, executing health care techniques and procedures, essential primary health care,

comfort measures, health teachings, and administration of written prescription for

treatment, therapies, oral topical and parenteral medications, internal examination

during labor in the absence of antenatal bleeding and delivery. In case of suturing of

perineal laceration, special training shall be provided according to protocol

established; (b) establish linkages with community resources and coordination with
http://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-Your-Childhttp://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-Your-Childhttp://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-Your-Childhttp://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-Your-Childhttp://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-in-Your-Child


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the health team; (c) Provide health education to individuals, families and

communities; (d) Teach, guide and supervise students in nursing education

programs including the administration of nursing services in varied settings such as

hospitals and clinics; undertake consultation services; engage in such activities that

require the utilization of knowledge and decision-making skills of a registered nurse;

and (e) Undertake nursing and health human resource development training and

research, which shall include, but not limited to, the development of advance nursing

practice; Provided, That this section shall not apply to nursing students who perform

nursing functions under the direct supervision of a qualified faculty: Provided, further,

That in the practice of nursing in all settings, the nurse is duty-bound to observe the

Code of Ethics for nurses and uphold the standards of safe nursing practice. The

nurse is required to maintain competence by continual learning through continuing

professional education to be provided by the accredited professional organization or

any recognized professional nursing organization: Provided, finally, that the program

and activity for the continuing professional education shall be submitted to and

approved by the Board (www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002) .

Section 29. Qualification of Nursing Service Administrators. - A person occupying

supervisory or managerial positions requiring knowledge of nursing must:

(a) Be a good registered nurse in the Philippines. (b) Have at least two 2 years

experience in general nursing service administration; (c) Possess a degree of

Bachelors of Science in Nursing, with at least nine 9 units in management and

administration courses at the graduate level; and (d) Be a member of good standing

of the accredited professional organization of nurses;

Provided, that a person occupying the position of chief nurse or director of nursing

service shall, in addition to the foregoing qualifications, possess:
http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002


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(1) At least five years of experience in a supervisory or managerial position in

nursing and (2) A master's degree major in nursing; Provided, further, That for

primary hospitals, the maximum academic qualifications and experiences for a chief

nurse shall be as specified in subsections (a), (b), and (c) of this section: Provided,

furthermore, That for chief nurses in the public health nursing shall be given priority.

Provided, even further, That for chief nurses in military hospitals, priority shall be

given to those who have finished a master's degree in nursing and the completion of

the General Staff Course (GSC): Provided, finally, That those occupying such

positions before the effectivity of this Act shall be given a period of five (5) years

within which to qualify (www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002) .

According to Dr. Gail Porrier of the University of Louisiana at Lafayette,

nurses are routinely called upon to use their therapeutic communication skills, written

and verbal, for the following purposes: to promote consistent quality care; maintain

continuity of care; to provide evidence of critical thinking that accompanies; the

utilization of the nursing process; to establish accountability for care; to develop

nurse-patient and nurse-other health care provider relationships.

It should be pointed out that failing to communicate effectively with the patient

from the first could actually destroy the delicate nurse-patient relationship together.

The first few seconds of the nurse-patient interaction with either establish or destroy

trust. And if the nurse loses trust of the patient, it is difficult to regain it (Oxtoby,

2005).

Poor one-on-one communication can even be dangerous. It can lead to

misdiagnosis or even medication errors. If the patient does not disclose to the nurse
http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002


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misinterprets what the patient is saying, it can be potentially life threatening (Oxtoby,

2005).

Indeed, being able to communicate clearly with a patient is a challenge in the

health care environment. Hence, the researchers conducted this study to ascertain

the verbal and non-verbal communications skills of the junior student nurses in the

hope of contributing recommendations as to how the student nurses enhance their

skills.


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Goal attainment theory

By: Imogene King

Parents or guardian of the pediatric

patients

Level of perception to the

therapeutic communication

Enhancement of the therapeutic

communication skills of the nursingstudents

Republic Act No. 9173

An act providing for a moreresponsive nursing profession,

repealing for the purpose of theRepublic Act No. 7164 other known

as the Philippine nursing act of

1991 and for other purposes

Figure 1

THEORITICAL CONCEPTUAL FRAMEWORK OF THE STUDY


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THE PROBLEM

Statement of the Problem

The purpose of this study is to determine if the nursing students are capable

of implementing the necessary therapeutic communication towards pediatric

patients.

Specifically, this study seeks to answer the following questions:

1. What are the demographic profile of the respondents in terms of:

a. Age;

b. Gender;

c. Civil status;

d. Religion;

e. Educational attainment; and

f. Economic status?

2. What are the perception of the respondents in the therapeutic communication

implemented by nursing students of Holy Name University:

a. Accepting;

b. Broad opening;

c. Consensual validation;

d. Encouraging comparison;


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e. Encouraging description of perceptions;

f. Encouraging expression;

g. Exploring;

h. Formulating a plan of action;

i. General leads;

j. Giving information;

3. Is there any significant correlation between the demographic profile of the

respondents and their perception in the therapeutic communication

implemented by the nursing students of Holy Name University?

Statement of the Hypotheses

1. There is no relationship between the demographic profile of the

respondents and their perception in the therapeutic communication

implemented by the nursing students of Holy Name University.

Significance of the Study

This research would be beneficial to the following:

Student nurses. The result of this research would increase their awareness in

developing the quality of care they give and their therapeutic relationship with

pediatric patients by way of communication.

Clinical instructors. The study would furnish them knowledge of the

communicative proficiency of their students who are sent to practice and help the


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students exploit authenticity, confidence and responsiveness while employing

therapeutic communications to pediatric patients.

School administrators. This study anticipates to motivate the clinical

instructors to use new approach in helping the students progress their therapeutic

communication skill activities such as hospital and community health exposure

where their therapeutic communicating abilities to be tested and polished.

Scope and limitations

This study focus on the therapeutic communication skills of the nursing

students enrolled in Holy Name University and how these affect the patients

perception of the student nurses communication competence.

The number of respondents is limited to only thirty. The questionnaires given to them

were self-made and these were given during the free time of the researchers and

within one week of hospitalization of the respondents.

The results of this study primarily presented the therapeutic communication

skills commonly used by the student nurse in the pediatric ward.

RESEARCH METHODOLOGY

Research Design

This particular study employed the descriptive method of research. The

collection of data was facilitated through the use of self-made questionnaires

distributed to the patient respondents.


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Research Environment

The research environment was the Governor Celestino Gallares Memorial

Hospital located in Miguel Parras Steet, Tagbilaran City. It is only a ten minute- ride

from the Josef Freinademetz Building, Dampas Campus,Janssen Heights.

The building has various wards namely: OPD, under five clinics, Emergency

Room, Obstetrics, Operating Room, Delivery Room, Medical 1, Medical 11, Surgical

1, Surgical 11, Pedia 1, Pedia 11 and Neonatal Intensive Care Unit. The latter eleven

of these were the wards assignment of patients respondents.

Research Respondents

The research respondents were the parents/guardians of the paediatric

patients at GCGMH particularly at the Pediatric Ward.

Although the study maybe conducted on pediatric ward, the researchers

opted to have parents or guardians as research participants of the study, so that

biases will be avoided.

There were approximately thirty respondents. The type of sampling used were

T-test sampling and also the questionnaires given to them were self made and these

were given during the free time of the researchers with the scope of one week of

hospitalization of the respondents.

Research instruments

The researchers made use of self-made questionnaire. The questionnaire

which is used, aims to obtain data that provide significant information on ht following

objectives: First part, the respondents demographic profile in terms of age, gender,


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religion, educational attainment, economic status. Second part, the perception of the

respondents in the therapeutic communication implemented by the level 3 nursing

students of HOLY NAME UNIVERSITY.

Third part is there any significant correlation between the demographic profile

of the respondents and their perception in the therapeutic communication

implemented by level 3 nursing students.

Research procedure

Each researcher was held responsible for the distribution and collection of

data. In response to the distribution of questionnaire, a formal letter was sent to

GCGMHS chief of hospital, Dr. Nenita Moraga Po requesting access to patients to

conduct the survey, but before the distribution of questionnaire was done

researchers first made a research proposal and had it approved by the adviser.

In order to maintain anonymity and to avoid bias, the researchers did not

require the patients to give their names. Propriety was strictly observed during the

gathering of data. Upon the completion of the answers were carefully tallied,

interpreted and submitted to the statistician. Then data was further analysed.

Treatment of Data

T- test was used to attain the statistical data in this study.

Where:

X1 = mean of the first sample


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X2 = mean of the second sample

n1 = sample size of the first sample

n2 = sample size of the second sample

S p = pooled standard deviation

And;

( ) ( )


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DEFINITION OF TERMS

The study applied terms, which improved understanding in the light of the

current study, are herein defined as follows.

Implementation.

A method or a design of doing something.

Communication .

the activity of conveying information.

Therapeutic communication.

a process in which the nurse consciously influences a client or helps the clientto a better understanding through verbal or nonverbal communication.

Documents

Thesis on psychodynmic traits in adherence to therapeutic communication skills