Retno Lestari

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 Pernahkah kamu mendapatkan kritik dari teman
dalam 1 situasi?

Bagaimana reaksi kamu?

Apakah kamu berharap tidak ada dalam situasi

itu?

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 Pertukaran informasi melalui pesan yang dikirim
dan diterima oleh dua orang atau
lebih(Timby, 2005)

Proses mengirim dan menerima pesan yang

disampaikan melalui simbol, kata2, tanda2,
bahasa tubuh atau lainnya (Smith, Duell, &
Martin, 2004)

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 Verbal
Verbal
7%

Tone
Tone
38%
Nonverbal 55%

Nonverbal
Ekspresi wajah
Bahasa tubuh
Kontak mata

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Face talks

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 Nurse-client relationship - Therapeutic
Relationship-

Client-centered

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 PURPOSES OF THERAPEUTIC
COMMUNICATION

Developing a therapeutic relationships

Building trust
Exploring clients feelings and thoughts
Facilitating personal growth and
behavioral change
Providing support and comfort

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 2 MAIN PRINCIPLES IN
COMMUNICATION

CLARITY means that the meaning of

message is accurately understood by both
parties
CONTINUITY promotes connection
among ideas and the feelings, events or
themes conveyed in those ideas

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CRITERIA OF SUCCESSFUL
COMMUNICATION:

FEEDBACK there should be an accurate

return response
APPROPRIATENESS response should be
relevant
EFFICIENCY message and questions
should be clear, easy, simple and
concrete

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 Attitude
Trust

Empati

Bahasa

Budaya

Persepsi dan observasi

Konsep diri dan harga diri

Cemas dan stres

Personal space
 Teori Peplau
Six roles
Pihak lain
menghormati, memperhatikan, menerima
Sumber
Membantu klien
Pendidik
Mendidik klien
Pemimpin
Bantu klien u/partisipasi
Fasilitator
Membantu klien selesaikan masalah interpersonal
Konselor
Bantu klien menghadapi respon emosional pd
penyakit
 Teori Travelbee
Hubungan antara manusiaperawat bantu
klien dan keluarganya untuk mempunyai
koping adaptif thd penyakit

Teori King
Interaksi individu

Interaksi interpersonal

Interaksi sosial
Sender (encoder) Receiver (decoder)

Wants to convey Listener perceives

message what sender is saying

Sensory channel

message

response

Feedback allows
sender to validate or
correct messages
 Kualitas personal
Kesadaran diri
Klarifikasi nilai
Explorasi perasaan
Role modeling
Dimensi Respon
Altruism
Kesejatian
Etik dan tanggung jawab
Menghormati
Empati
+ Konkrit Therapeutic Impasse
Resistance
Fasilitasi Komunikasi Transference
Verbal Countertransference
Nonverbal
Analisa masalah
+
Dimensi Tindakan
Boundary violations

Tehnik Terapeutik
Konfrontasi
Kesegeraan
Keterbukaan
Catharsis
Role Playing
Therapeutic
Outcome
For patient
For society
For nurse
1. Kesadaran Diri
Tuj: u/ mencapai komunikasi yg terbuka, personal dan
akurat
Komponen:
Psikologi:
emosi, motivasi, konsep diri, kepribadian
Fisik:
Gambaran diri, potensi fisik
Lingkungan
Lingkungan sosiobudaya, hubungan dgn orla
Filosofi
Arti kehidupan

Meningkatkan kesadaran diri Johari Window

 KIAT JENDELA JOHARY
DIRI SENDIRI
[ JOSEPH LUFT & HARRY INGHAM ]
[ PENYINGKAPAN DIRI ] Tahu Tidak tahu

TERBUKA BUTA

TIDAK
TERSEMBUNYI
DIKETAHUI
3 prinsip dari Johari Window yaitu :

Perubahan satu kuadran akan mempengaruhi

kuadran yang lain.
Jika kuadran 1 yang paling kecil, berarti
komunikasinya buruk atau kesadaran dirinya
kurang.
Kuadran 1 paling besar pada individu yang
mempunyai kesadaran diri yang tinggi.

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 KIAT JENDELA JOHARY
DIRI SENDIRI
[ JOSEPH LUFT & HARRY INGHAM ]
[ PENYINGKAPAN DIRI ] Tahu Tidak tahu

TERBUKA BUTA

TIDAK
TERSEMBUNYI DIKETAHUI
2. Klarifikasi Nilai
Tahapan Klarifikasi Nilai

Freely
CHOOSING From Alternatives
After thoughtful consideration of the consequences
of each alternative

Cherishing, being happy with the

PRIZING choice
Willing to affirm the choice publicly

Doing something with the choice

ACTING Repeatedly, in some pattern of life
3. Eksplorasi perasaan
Perawatbersikap terbuka, sadar dan dapat
mengontrol perasaan diri saat berinteraksi dgn
klien

4. Menjadi Role Model

Kekuatan role models
Adaptif

Maladaptif
5. Altruism
Memperhatikan kesejahteraan orla

6. Etik dan tanggung jawab

Akuntabilitas thd klien.
Pre interaction phase

Introductory or orientation
phase

Working phase

Termination Phase
 Semua perilaku merupakan komunikasi dan
semua komunikasi mempengaruhi perilaku
Komunikasi merupakan alat u/ membina hubungan
terapeutik
Komunikasi dapat mempengaruhi perilaku orla
Komunikasi merupakan hubungan interpersonal itu
sendiri, tanpa hal tsb, hubungan terapeutik
perawat-klien tidak mungkin terjadi
1. Komunikasi Verbal
Lisan
Tertulis

2. Komunikasi Non Verbal

Jenis:
Vokal : Kualitas bicara
Tindakan: bahasa tubuh
Objek: pakaian, kepemilikan
Space: intimate space, personal space, social
consultative space and public space
Sentuhan : personal space dan tindakan
3. Analisis Masalah

4. Tehnik Terapeutik
Mendengarkan
Broad opening
Restating
Klarifikasi
Refleksi
Focusing
Sharing pendapat
Silence
Humor
Informing
Suggesting
Active Listening
Being attentive to what the client is
saying, verbally and non- verbally. Sit
facing the client, open posture, lean
toward the client, eye contact, and
relax.

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The Art of Active Listening

a non-intrusive way of sharing a patient's thoughts

and feelings.
hear what the patient is saying, repeat what
you heard, and then check with the patient to
make sure the reflection is correct.
In a more complete listening response, you don't
just listen to the words, you try to reflect the
feeling or intent behind the words.

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Typical Dialogue:

Patient: I'm very frightened about the procedure

tomorrow.
Nurse: Oh, you'll be fine. The doctor does
hundreds of these every year.

Active Listening Response:

Patient: I'm very frightened about the procedure

tomorrow.
Nurse: So, you're frightened about the procedure.
Can you say more about what's so frightening for
you?
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 Offering Selfmaking one self available and
showing interest and concern
Ill stay here with you for a while
I have a hour to spend with you

Acceptingindicating that the nurse has heard

and is willing to hear what client has to say
Nurse: Yes Nodding.
I follow what you said.
It is OK to tell me.
I understand

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 Broad openingsusing open ended
questions that provide opportunity for
client to introduce a topic
Whats been happening in your life?
Where do you want us to begin?

Focusingconcentrating on a single,
important point
This point seems worth looking at more
closely

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 Using Silence-refraining from the verbal
comments while conveying and attitude of care
and interest toward the patient
nurse says nothing but continues to maintain
eye contact and convey interest
Sitting or walking with the patient who is unable
or willing to communicate with words.

Offering General leadsGiving encouragement

for patient to continue verbalization
And then?
Continue.
Go on
Tell me about it
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 Restating-repeating exact words of patient so he is
reminded of what he has said or known that he is heard
P: I cant sleep
N: you cant sleep?
P Do you think I should tell my husband what
happened?
N Do you think you should tell you husband?

Seeking Clarification-Making an effort to have the

patient clarify comments that are vague, which have a
meaning that is not understood or which have been
spoken softly or quickly.
P -Im crazy
N-What do you mean you are crazy
P I cant sleep. I stay awake all night
N You have difficulty sleeping? 32
 Exploring encourage patient to dig deeper
into topic.
Tell me more about that?
Would you discuss that more fully?

Giving information Giving patient facts and

specific information that is needed
My name is.
Im taking you to the treatment room

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 Presenting Reality Indicating to the patient
which is real when he is misinterpreting reality
Ex: P -Eggs are flying saucer
N Eggs are food to be eaten

Summarizing -Reviewing main points and

conclusions
Ex: Lets see, so far you have said
During the last 30 mins that we discussed

Use open ended questions introducing an

idea and let the patient respond.
Ex: What are you feeling right now
Trust means.
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 Making observation -Verbalizing what the
nurse perceives
Ex: You appear tense
Ive notice that youre biting your lips

Giving recognition by acknowledging

behavioral changes or indicating awareness
Ex: Youve comb your hair today
Greeting the patient Good morning

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 Encouraging comparison requesting the
patient to describe similarities and differences
about thoughts, feelings, and situation or to
appraise the way his life experiences have
affected him
You said your feelings have change. Please
tell me in what way?
How was this meeting differ from
yesterday?

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NON-THERAPEUTIC COMMUNICATION
False Reassurance/ Agreement attempting
to dispel the patients anxiety by implying that
there is no cause to worry. Often this technique
is more comforting to the nurse than it is helpful
to the patient.
Everything will be alright
Dont worry soon youll be okay

Overloading-talking rapidly, chaining topics too

often and asking for more information than can
be absorbed at one time.
What is you name? I see you like sports,
where do you live?
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 Value Judgements Giving ones own
opinion, evaluating moralizing or implying
ones value by using word such as bad, nice,
right, wrong, etc.
You shouldnt do that, thats wrong

Incongruence sending verbal and non

verbal messages that contradicts to one
another.
The nurse tells to the patient Id like to
spend time with you and then walk away

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 Invalidation ignoring or denying anothers
presence, thoughts or feelings
Client: How are you?
Nurse: I cant talk right now, Im busy.

Changing topic-introducing new topic

inappropriately
Ex: P I really want to die
N Your mother did not visit you this week?

Advising telling the client what to do, giving

opinions or making decisions for the client.
Ex: I think you should?
If I were you
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1. 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 Merasa bebas utk
sungguh-sungguh dan mengekspresikan pikiran
tanpa menyakiti dan emosi mereka yang
Mengekspresikan apa sesungguhnya
yang dia pikirkan, Mengembangkan
perasaan, pengalaman perasaan percaya pada
saat ini perawat
Menunjukkan kesopanan Menyediakan informasi
Menunjukkan dimana meraka dapat
keterbukaan menggunakannya
Merasa atmosfer rileks
Menikmati iklim
kesejatian
2. Menghormati
Kesediaan untuk bekerja dengan klien
Menunjukkan siap sedia

Ketertarikan pada masalah klien

Memahami keunikan

Melakukan pendekatan penyelesaian masalah

3. Empathy
Kemampuan 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
intelektual
Aspek Verbal
Kemampuan mengungkapkan secra verbal
pemahaman terhadap perasaan dan alasan reaksi
emosi klien
Memerlukan keakuratan, kejelasan, dan kealamiahan
Aspek Non Verbal
Diperlukan kemampuan menunjukkan empati dengan
kehangatan dan kesejatian
4. Kongkrit
Perawat 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
1. Konfrontasi
Expresi perawat o/k perbedaan persepsi thd
perilaku klien
3 jenis konfrontasi:
Beda antara ekspresi klien thd dirinya
(Konsep diri) dan apa yang diinginkannya
(Ideal diri)
Beda antara ekspresi verbal klien dan
perilaku klien
Beda antara ekspresi klien thd apa yg
dirasakannya dengan pengalaman perawat
selama merawat klien
Membutuhkan sikap empati dan menghormati
yang tinggi
2. Kesegeraan
Fokus pd hubungan interaksi perawat-klien saat
ini
Sensitif thd perasaan klien

3. Keterbukaan
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 patienss 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.
1. Resistance
The patients reluctance or avoidance of
verbalizing or experiencing troubling aspects of
oneself

2. Transference
Pemindahan pikiran, perasaan dan tingkah laku
yg berhubungan dengan significant others dari
masa kanak-kanak seseorang kedalam
hubungan saat ini.(More & Fine cit. Boyd &
Nihart, 1998)
3. Counter transference
Reaksi 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 Violation
Jika perawat berusaha memenuhi kebutuhan pribadi
dgn klien.
Menjadikan hubungan tdk terapeutik
Terjadi pada saat perawat melampaui batas hubungan
yg terapeutik dan membina hubungan sosial, ekonomi
atau personal dgn klien.
The patient feels distraught after being given a life-threatening
diagnosis.
Nurse: "Mr. Roberts, it seems that you are feeling sad. That
would be totally natural given your diagnosis. Would
'sad' be the right word for what you're feeling inside
right now?

Patient: "Sure I'm sad." Pause. "But that's not the worst of it."
Long pause. "I'm really worried about my family. About
my wife. I don't know how she's going to take this.

Nurse: "So there's sadness, but more, there's a lot of worry

there. And the worry is about how your wife is going to
take this news.

Patient: "I don't know how she can take this." (He's close to
tears.)
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Nurse: "I understand that you're really worried about
your wife. Can you set that whole worried
feeling at a little distance from you so you can
breath?

Patient: "Yeah, it's right next to me.

Nurse: "Let's spend a little time with this just keeping

that feeling company. (Pause) If you listened to
that worried feeling, what might it tell you?

Patient: (Pause.) "I'm scared to tell her by myself. It

would help if her sister was there. She always
takes things better when Susan's with her.

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Nurse: "You'd be a little less worried if your wife's
sister was there in the house with you when
you tell her.

Patient: "Yeah. She could take it better." Pause. "I'd

feel better.

Nurse: "So, I guess we have a little plan here.

You're going to call your wife's sister, and
have her in the house with you when you
tell her about your news, right?

Patient: "Right. That makes it a lot easier."

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