THERAPEUTIC COMMUNICATION OF DEGENERATIVE PATIENTS

A.Definition
The American Nurses Association’s Corrections Nursing: Scope and Standards of
Practice states that nurses are patient advocates and maintain a therapeutic and professional
nurse–patient relationship with appropriate professional role boundaries. To provide quality
health care for patients in correctional settings, nurses must be able to communicate with
patients, other health care providers, correctional staff and outside providers.

Therapeutic communication is defined as the face-to-face process of interacting that

focuses on advancing the physical and emotional well-being of a patient. Nurses use
therapeutic communication techniques to provide support and information to patients. It may
be necessary to use a variety of techniques to accomplish nursing goals in communicating
with a patient (see list of common therapeutic communication techniques).

The process of aging is a process that converts healthy adults become brittle
accompanied by declining reserves almost all physiological systems and be accompanied by
increased susceptibility to disease and kematian.1 others argue that aging is a process of
gradual disappearance of the network's ability to repair itself / replace and maintain normal
structure and function, so that it can not survive (including infection) and ability to repair
damage suffered. Thus human beings will progressively lose resistance to infection and will
more and more distortion metabolic and structural referred to as "Degenerative Diseases,"
which would eventually lead us to face the end of life with episodes terminal dramatic such as
stroke, myocardial infarction, coma asidotik, cancer metastases, and so on. The definition of
communication is "A process of delivering the thoughts or information of a person to another
person in a certain way so that the other person understands very well what is meant by the
transmitter of thoughts or information". (Komaruddin, 1994; Schermerhorn, Hunt & Osborn,
1994; Koontz & Weihrich, 1988)
The goal of effective communication between physicians and patients is to direct the
process of extracting disease history more accurately for doctors, providing more support to
patients, thus more effective and efficient for both (Kurtz, 1998).
B.Therapeutic communication techniques

Using Silence

At times, it’s useful to not speak at all. Deliberate silence can give both nurses and patients an
opportunity to think through and process what comes next in the conversation. It may give
patients the time and space they need to broach a new topic. Nurses should always let patients
break the silence.

Accepting

Sometimes it’s necessary to acknowledge what patients say and affirm that they’ve been
heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply
make eye contact and say “Yes, I understand.” Patients who feel their nurses are listening to
them and taking them seriously are more likely to be receptive to care.

Giving Recognition

Recognition acknowledges a patient’s behavior and highlights it without giving an overt

compliment. A compliment can sometimes be taken as condescending, especially when it
concerns a routine task like making the bed. However, saying something like “I noticed you
took all of your medications” draws attention to the action and encourages it without requiring
a compliment.

Offering Self

Hospital stays can be lonely, stressful times; when nurses offer their time, it shows they value
patients and that someone is willing to give them time and attention. Offering to stay for
lunch, watch a TV show, or simply sit with patients for a while can help boost their mood.

Giving Broad Openings

Therapeutic communication is often most effective when patients direct the flow of
conversation and decide what to talk about. To that end, giving patients a broad opening such
as “What’s on your mind today?” or “What would you like to talk about?” can be a good way
to allow patients an opportunity to discuss what’s on their mind.

Active Listening

By using nonverbal and verbal cues such as nodding and saying “I see,” nurses can encourage
patients to continue talking. Active listening involves showing interest in what patients have
to say, acknowledging that you’re listening and understanding, and engaging with them
throughout the conversation. Nurses can offer general leads such as “What happened next?”
to guide the conversation or propel it forward.
Seeking Clarification

Similar to active listening, asking patients for clarification when they say something
confusing or ambiguous is important. Saying something like “I’m not sure I understand. Can
you explain it to me?” helps nurses ensure they understand what’s actually being said and can
help patients process their ideas more thoroughly.

Placing the Event in Time or Sequence

Asking questions about when certain events occurred in relation to other events can help
patients (and nurses) get a clearer sense of the whole picture. It forces patients to think about
the sequence of events and may prompt them to remember something they otherwise
wouldn’t.

Making Observations

Observations about the appearance, demeanor, or behavior of patients can help draw attention
to areas that might pose a problem for them. Observing that they look tired may prompt
patients to explain why they haven’t been getting much sleep lately; making an observation
that they haven’t been eating much may lead to the discovery of a new symptom.

Encouraging Descriptions of Perception

For patients experiencing sensory issues or hallucinations, it can be helpful to ask about them
in an encouraging, non-judgmental way. Phrases like “What do you hear now?” or “What
does that look like to you?” give patients a prompt to explain what they’re perceiving without
casting their perceptions in a negative light.

Encouraging Comparisons

Often, patients can draw upon experience to deal with current problems. By encouraging them
to make comparisons, nurses can help patients discover solutions to their problems.

Summarizing

It’s frequently useful for nurses to summarize what patients have said after the fact. This
demonstrates to patients that the nurse was listening and allows the nurse to document
conversations. Ending a summary with a phrase like “Does that sound correct?” gives patients
explicit permission to make corrections if they’re necessary.
Reflecting

Patients often ask nurses for advice about what they should do about particular problems or in
specific situations. Nurses can ask patients what they think they should do, which encourages
patients to be accountable for their own actions and helps them come up with solutions
themselves.

Focusing

Sometimes during a conversation, patients mention something particularly important. When

this happens, nurses can focus on their statement, prompting patients to discuss it further.
Patients don’t always have an objective perspective on what is relevant to their case; as
impartial observers, nurses can more easily pick out the topics to focus on.

Confronting

Nurses should only apply this technique after they have established trust. It can be vital to the
care of patients to disagree with them, present them with reality, or challenge their
assumptions. Confrontation, when used correctly, can help patients break destructive routines
or understand the state of their situation.

Voicing Doubt

Voicing doubt can be a gentler way to call attention to the incorrect or delusional ideas and
perceptions of patients. By expressing doubt, nurses can force patients to examine their
assumptions.

Offering Hope and Humor

Because hospitals can be stressful places for patients, sharing hope that they can persevere
through their current situation and lightening the mood with humor can help nurses establish
rapport quickly. This technique can keep patients in a more positive state of mind.
C. Communication with degenerative patients
Communication can be disrupted because the normal calling process and unclear
communication can cause the entire treatment to fail so effective communication with
degenerative patients is necessary. Effective communication can occur if previously we know
the background and condition of degenerative patients. Conditions and backgrounds that need
to be known in degenerative patients:
 Physical changes
Some physical changes in the degenerative can affect communication such as hearing
loss, reduced visual acuity and changes in speech and articulation. This change in speech
ability can be observed from sound changes to vibrating, weak, harsh and difficult to
understand.

 Psychological changes
Major psychological changes that affect the communication include slowdown / loss
of memory and the ability to catch information more slowly. The most common memory loss
is short-term memory which results in degenerative patients struggling to recall recent events.
Both of these cause the slow process of communication and discourage young people from
talking to the degenerative.
 Status Changes and Social Roles Social changes
Such as retirement from work that result in loss of income and changes in status can
affect psychic condition especially the degenerative self-esteem, especially for power-oriented
groups will be lost because of old, unproductive and incompetent. The above can affect
willingness and reluctance to communicate. The sense of loss, grief and separation from
family and friends can lead to anxiety, depression, irritability and agitation that affect the
ability to communicate
 Background
The political and socio-economic conditions of their time with us are different. Some have
experienced shortcomings or disadvantages and received low formal education. Such
conditions will cause their ideology and vision may not be able to understand and accept.
This will affect the communication. To get it there are some things we must pay
attention and we do that is:
1. Allocate more time for degenerative patients
Research shows that older patients are less likely to capture information than younger
patients who are likely to be nervous or less focused. This resulted in the need for additional
time for the degenerative patient. If doctors look busy and lack interest, they will feel it so that
communication becomes ineffective.
2. Avoid interference
The patient wants to feel that the doctor is taking the time for him and they are
considered important. Research shows that if doctors give undivided attention for 60 minutes
will give the impression of how meaningful time is with them. We should pay attention to the
patients as long as they come to visit and if possible reduce visual and hearing disturbances
such as other people or noisy / noisy atmosphere.

3. Sit face to face

Some degenerative patients have hearing and vision problems and reading the doctor's
lips movement is essential to receive information correctly. Sitting in front of him may be
able to reduce the disturbance. This action gives the impression that what the doctor will tell
them and what they tell the doctor is something important. Several studies have shown that
patient adherence to treatment increases after doctors provide information about their illness
with face-to-face contact with patients.
4. Keep eye contact
Eye contact is one form of direct and important nonverbal communication. Eye
contact shows the patient that you care about him and they can trust you. Maintaining eye
contact provides a comfortable and positive atmosphere that can make the patient open and
willing to additional information.
5. Listen
The most frequent patient complaint about the doctor is that they are not listening.
Good communication depends on our awareness to actually hear what the patient is saying to
us without interrupting. Some problems related to non-compliance can be reduced in a simple
way by providing time to hear what the patient is saying.
6. Speak slowly, clearly and loudly enough
The pace of speech that the degenerative can digest is slower than the young. So the
speed of speech when conveying information can have a profound effect on how much
information can be retrieved, digested and remembered by degenerative patients. Do not push
patients continuously with instructions. Speak clearly and loud enough to be heard but do not
shout.
7. Use short, simple words and phrases
Simplifying information and how to speak so it is easier to understand is one of the
best ways to ensure that patients will follow our instructions. Do not use medical or technical
terms that are hard to understand. Do not assume that the patient understands in basic medical
terms. Make sure that we use familiar words to the patient.
 8. Focus on one topic at a meeting
Information overload will confuse the patient. To avoid it, give a long and detailed
explanation to the patient. Try to provide information in the form of an outline, which can
lead us to explain important information in the stages. For example first talk about heart,
second talk about blood pressure, third talk about blood pressure treatment.
9. Simplify the instructions and write in sequence
When giving instructions to patients, avoid complicated and confusing ones. Therefore
write down the basic instruction sequences and easy to follow.
10. Use cards, models or drawings
Visual aids will help the patient to know better about his condition and treatment.
11. Often summarize and repeat the information on the most important part
When we discuss the most important points with the patient, ask him to repeat our
statement or instruction. If after hearing what the patient says the doctor concludes that he has
not understood our statement and instructions, simple repetition can be done because
repetition will add memory.
11. Give the patient one chance to ask questions
As the doctor explains about the treatment and gives you all the necessary
information, give it a chance to ask. This will lead them to reveal some of the insights they
have and through their questions doctors can determine if they fully understand the
instructions and information the doctor gives.

https://online.rivier.edu/therapeutic-communication-techniques/