Communicating

Effectively with
Clients Experiencing
Chronic Condition
EIN III
Group 4 Class A3
Presentations,12 May 2016

Member of Group
Aida Fitriyah
Anisa Ramadani
Anjar Ani
M Daud Al Abror
Elok Damayanti
Nabila Rida Puspita Sari
Dewi Fathur Rosyida
Lyntar Ghendis Larasati

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Chronic condition is defined as a medical condition or a health

problem that related to the symptom, disorder, or disability and in
need of treatment and care management for a long time ( 3
months), (WHO, 2015).
Fact : More than 50 % of the world lives with chronic disease
(WHO,2015)
Chronic conditions described as a disease that runs long and
probably also cannot be cured.

Chronic condition is a human health condition or disease that is

persistent or otherwise long-lasting in its effects or a disease that
comes with time. The term chronic is often applied when the course
of the disease lasts for more than three months. Common chronic
diseases include arthritis, asthma , cancer , COPD , diabetes and
viral diseases such as hepatitis C and HIV/AIDS .

The typical characteristics of a chronic disease that lasts a long

time often cause problems in the management of the treatment and
care of clients. Chronic conditions gave psychosocial cultural and
economic impact for clients and the families. Psychological and
emotional reactions on different acute and chronic conditions.
These reactions generally occurred not only during the initial
incident but also a recurrent symptoms occur. (AIHW,2010)

Factors that affect the adaptability of clients and families with

chronic conditions are :
The patient's Personality
before having a disease
The patient's Attitude in solving
problems and facing grief
(grief) before having the
disease
The situation when the disease
appears (Genesis) and the
impact of lifestyle changes that
occur suddenly

The concept of families and

individuals in the face of stress
Patient's lifestyle and family
before
Experience with previous
disease

The Phase Loss on Chronic Disease:

1. Phase of denial
The first reaction of individuals who experience loss is shock, not
understand, or deny the fact that the loss actually occurs.
2. Phase of Anger
This phase at the start of the incidence of awareness of the fact
that the occurrence of the loss. usually he shows aggressive
behavior, talk roughly, refused treatment, and accused the
nurses or doctors.

3. Phase of Bargaining
If the individual was able to express his anger intensified, then
he will advance to the bargaining phase to praying of god
4. Phase of Depression
In this phase, Client often show an attitude such as withdraw,
unwilling to talk, sometimes acted as a Client who is very good
and according to or with the expression that States of despair, a
feeling of worthlessness
5. Phase of Acceptance
This phase associated with the reorganization of the feeling of
loss. If the individual can start these phases and enter the phase
of peace or the acceptance, then he will be able to end the
grieving process and overcome feelings of loss in completed

Communication is
The most important aspect that health profesionals have to
master
Weatheraw, N (1998)

80% of patients complaints arise from a breakdown in

communication
Towies, BMJ 1998. 301-4

Communication is a transaction between two or more people, with

all participants having an active role in the process. Communication
is the process of sharing information, thoughts and feelings between
people through speaking, writing or body language. According
Department of Health London, (2012) Effective communication takes
place only when the listener clearly understands the message that
the speaker intended to send. The key effective communication are
respect, frequency, focus, calm, and engagement.

Nurses provide the freedom for clients and respect all of the client's decision to
create a therapeutic relationship. Hospital services are inseperable from the
role of communication. In every phase of the nursing process.
Stages of communication in nursing include (Dept of Health RI
Pusdiknas,1995) :

How to communicate with chronic condition ??

Verbal
and
Non-Verbal

(Bukley Herth, quoted from Potter Perry 2004 and 2010).

Verbal
Verbal communication is in expressing their feelings verbally
or written. It should be considered :
Simplicity : the sentence used to be simple, easy to
understand, concise and clear.
Clarity : communication that is in use there is are similarities
between the stated or dictated by movement of the face and
body.
Timely and relevant: sensitive to the needs of clients

Non-Verbal
Non-verbal communication is cam be seen from facial
expressions, body movements and postures. It should be
comsidered:
1. Posture and gait
2. Expressions
3. Hand gesture

1. Posture and gait: posture and gait can know a persons

mood and condition. The upright posture, active and
purposeful way passage means the person feel comfortable
and secure both physically and emotionall.

2. Expressions: on the face, especially the eyes, the

muscles around the eyes and mouth can determine how the
expression of someone example : happy, sad, angry,
disappointed, embarrassed and scared others.

3. Hand gestures to communicate all kinds of feelings

The obstacle of communicate in client with

chronic diseases and in a state of terminal
can cause response bio-psycho-socialspiritual is lost response.
(Bukley Herth, quoted from Potter Perry 2004 and 2010)

Phase of Denial
Denial is the first reaction of the individual is lost when subjected
shock. Physical reactions that occur in the phase of denial is
fatigued, weak, pale, nausea, diarrhea, respiratory disorders, rapid
heartbeat, crying, anxiety and dont know what to do. The above
reaction quickly end up in a few minutes until a few years. At this
point we can use the techniques of communication :
Always located near the client
Maintain eye contact
Listen to what the client expressed
Communicate topics/thoughts that are well thought out client

Phase of Anger
This phase at the start of the incidence of awareness of the fact that
the occurrence of the loss. usually he shows aggressive behavior,
talk roughly, refused treatment, and accused the nurses or doctors.
Physical response that often occur in this phase, among others, face
red, rapid pulse, anxiety, insomnia, hand clenched. At this point we
can use the techniques of communication:
Listening: a nurse trying patiently to hear anything that was said to
be client
Assist in providing health education on the compliance with aspects
of well-being or independence of the client
Communicate to clients about what she thinks and the expectation
Help clients discuss things reach major topics and keep the
communication goals are achieved

Phase of Bargening
If the individual was able to express his anger intensified,
then he will advance to the bargaining phase to beg mercy
of god. This response is often expressed with the words "if
only this occurrence can be delay, then I will
always pray". in the process of grieving is a natural in a
family, then statements like this often come across "if
only the pain is not my son.
In this phase, the nurse needs to hear his complaints and
encourages client to be able to speak because it will
reduce the guilt and fear
Ask the client what they want

Phase of Depression
In this phase, Client often show an attitude among others
withdrew, unwilling to talk, sometimes acted as a Client
who is very good and according to or with the expression
that States of despair, a feeling of worthlessness.
Physical symptoms that are often on the show was
refusing to eat, insomnia, and fatigue.
Nurse have to do in this phase is: always present nearby
and listen to what is complained of by the Client. It would
be better if to communicate non-verbally is sitting quietly
beside him and observing non-verbal reactions of Client
that foster a sense of security for Client.

Phase of Acceptance
This phase associated with the reorganization of the
feeling of loss. If the individual can start these phases
and enter the phase of peace or the acceptance, then he
will be able to end the grieving process and overcome
feelings of loss in completed. But if the individual stays in
one phase and not up to the acceptance phase.
If you have lost more difficult for him to get in on the
reception phase. We have to do in this phase is: give a
sense of family and friends that the client had received
his condition and need to be involved as optimal as
possible in the treatment program and was able to help
himself the extent of his ability.

The strategies set the stage for collaboration between

the nurse and client (Boxer and Susan, 2005) :

Set a shared agenda

The critical step of setting an agenda for the visit is frequently overlooked.
The nurse may have a clear idea of what should be discussed but often
does not share this information with the client. Setting an agenda allows
important topics to be laid out at the beginning of the visit. Agenda setting
can start by asking, example : Mrs. Jones, what would you like to discuss
today? The client and the nurse then decide together which issues take
priority.

Ask-tell-ask
This strategy provides a structure for the Nurse to tailor information to the
clients needs by
1. asking the client what he or she already knows or wants to know about
his or her illness,
2. telling the client what he or she needs to know and
3. asking or ascertaining whether the client understands the information or
has additional questions

Assess Readiness to Change

Clients will differ in their readiness to change their health habits even if they
are well informed about the importance of such changes. (See Stages of
change, for behavior change to take place, the individual must feel that the
change is important (motivation) and feel capable of making the change
(selfefficacy).

Set self- Managements Goals

Nurses and other staff members can help clients identify incremental changes in
health behavior that are realistic for them to achieve. Goals should follow the

SLAM acronym:
Specific: If a clients goal is to exercise more, the nurse should encourage
the client to commit to exercise by specifying what type of exercise he or
she will do, how often and how long. The more specific the plan, the more
likely the client will follow it.
For example, a specific exercise plan would be to walk three times a week
with my husband for 20 minutes.
the plan was effective.

Next

Limited: The goal should be limited to no more than a few weeks. It may be
too overwhelming for clients to conceive of sustaining these changes over
the long term. Goals can be continued or modified at the next visit.
Achievable: It is not reasonable for a sedentary client to commit to a daily
five-mile run, but it may be achievable for that same client to commit to
walking around the block three times a week. Success with an achievable
goal can lead to greater confidence and motivation to tackle more ambitious
goals down the road.
Measurable: The goal should be measurable so the client and Nurse can
determine whether

Close the loop

Closing the loop means asking the client to repeat the important
points and instructions to ensure correct understanding. Having the
client verbalize key instructions allows the nurse to correct
misunderstandings before they become errors. If a Nurse only has
time to employ one of the five strategies, this one is a good choice

Thank You