Komunikasi dalam

Manajemen Keperawatan

Mona Saparwati

11/22/2021 1
 BAHAN DISKUSI

 MASALAH KOMUNIKASI

 INTERPROFESIONAL RELATIONSHIP

 KOMUNIKASI TERAPEUTIK
2. MASALAH KOMUNIKASI
.
Ineffective team communication
is frequently at the root of
medical error

129
421
gagalfailures
komunikasi
)

Communication
Communication failures
failures in
in the
the operating
operating room:
room: an
an observational
observational classification
classification of
of recurrent
recurrent types
types and
and effects.
effects.
Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober
Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E. E.
KURANG KOMUNIKASI VERBAL

5 % waktu perawat berkomunikasi verbal

Kesadaran pasien
Banyak tindakan fisik

(Baker & Meley, 2007)

 KEGAGALAN KOMUNIKASI DI OR
 WAKTU TIDAK TEPAT : 45.7 %
 ISI TIDAK AKURAT : 35.7 %
 TIDAK MENYELESAIKAN MASALAH : 24.0 %
 PELAKU KOMUNIKASI (KEY PERSON) : 20.9 %
TIDAK TERLIBAT

36.4% MENGAKIBATKAN
 inefficiency
 team tension
 resource waste
 workaround
 delay
 patient inconvenience
 procedural error
 THE HARM PRODUCED
BY INEFFECTIVE HANDOVER

 WRONG TREATMENT
 DELAY IN MEDICAL DIAGNOSIS
 LIFE-THREATENING ADVERCE EVENT
 PATIENT COMPLAINTS
 INCREASES HEALTH CARE EXPENDITURE
 INCREASED HOSPITAL LENGTH OF STAY
 POLA KOMUNIKASI YANG
PALING SERING DI OR

69.24% dari 2074 komunikasi

face to face
 KOORDINASI ALAT : 38.7 %
 PERSIAPAN PASIEN : 25.7 %
 STAFFING : 18.8 %
 ROOM ASSIGNMENT : 10.7 %
 JADUAL & JADUAL ULANG : 6.2 %

Journal of Nursing Administration, 2004 Feb; 34 (2): 93-100

Improving operating room coordination: communication pattern assessment.
Moss J, Xiao Y.
AKIBAT 12 JAM KERJA PER 24 JAM

 Drawsiness

 Kewaspadaan menurun

 20 % tertidur

 25 % melakukan satu kesalahan

> dari 12 jam: melakukan dua kesalahan

(Linda, dkk, 2006)

POST TRAUMATIC STRESS DISORDER
(PTSD)

 25 % perawat critical care

 14 % perawat umum

(Mealer, et all, 2007)

KOMUNIKASI PADA KONSUMEN
70 % PENYEBAB MASALAH

Rekomendasi dari:
AORN (ASSOCIATION OF PERIOPERATIVE RN)

 I-SBAR
I PASS THE BATON
 FIVE-Ps
 PACE
3. INTERPROFESIONAL
RELATIONSHIP

.
 Types of Teams

 Multidisciplinary

 Interdisciplinary

 Transdisciplinary
 Interprofessional Teams
 An interprofessional team is made up of
members of different professions and
positions

 Individuals bring to the team the specialised

knowledge, skills, methods and attitudes of
their disciplines

 Members integrate their observations, bodies

of expertise and spheres of decision making
to coordinate, collaborate, and communicate
to optimise client care
 Health Care Stereotypes

Nursing
Medicine
Physiotherapists
Occupational Therapists
Speech Pathologists
Pharmacists
Dentists
Collaborative Skills for Teamwork

 Cooperation
 Assertiveness
 Responsibility
 Communication
 Autonomy
 Coordination
 IS B A R
I
• Introduction
• Situation
S

B
• Background

A
• Assessment
• Recommendation
R
I PASS THE BATON

18
 I PASS THE BATON
I - Introduction: Introduce yourself
P - Patient: Name: identifiers, age, sex location
A - Assessment: “The problem” procedure etc.
so far in the process
S - Situation: Current status/Circumstances,
uncertainty, recent changes
S - Safety concerns: Critical lab values/reports;
threats, pitfalls and alerts
19
 I PASS THE BATON

B - background: Co-morbidities,
previous episodes, current meds, family
A - actions: What are the actions to be taken
and brief rational
T - Timing: Level of urgency, explicit timing,
prioritization of actions
O - Ownership: Who is responsible
(person/team) including patient/family
N - Next: What happens next? Anticipated
changes? Contingencies

20
 “5-Ps”
 Ensures proper information is passed during patient
transfers or provider shifts change.

 Use the 5 Ps:

◦ Patient
◦ Plan
◦ Purpose
◦ Problems
◦ Precautions

 After instituting guidelines with the behavior-based

expectations, Sentara Health experienced a
21%
Quality increase
for All Americans: in effective
Celebrating Success, handoffs.
Gary Yates, Sentara Healthcare. Panel 1—Promising Quality Improvement Initiatives: Reports From the Field. AHRQ Summit—Improving Health Care
Measuring Progress, Moving Forward ; 2004.
21
 PACE
• PATIENT / PROBLEM
P

A
• ASSESSMENT / ACTION

• CONTINUING / CHANGE
C

E
• EVALUATION
 FIVE Ps
P
• PATIENT
P
• PLAN
P
• PURPOSE
P
• PROBLEM
p
• PRECAUTION
• PHYSICIAN (ASSIGNT TO COORDINATE)
Ps
Interprofessional practice is reaching
out beyond the team
 4.
KOMUNIKASI TERAPEUTIK
PERAWAT - KLIEN
.
Akses Perawatan & Kesinambungan
Hand Over Hand Over

1. Pulang ke
IGD / URI Rumah
URJ Ruangan - Ruangan 2. Rujuk YanKes

Hand Over
Hak Pasien & Keluarga (HPK)

SPO Penerimaan Pasien Baru

Tim Yang
Hak / Merawat:
Orientasi
Kewajiban Dokter, Perawat,
Ahli Gizi dll
Asesmen & Perawatan Pasien

STANDAR ASESMEN
KELUHAN UTAMA/ALASAN MASUK DIAGNOSIS/MASALAH

ASKEP/ASMED & PENDIDIKAN KES

PASIEN KELUARGA

KOLABORASI
DOKTER/PERAWAT TIM KES LAIN: AHLI GIZI, FARMASI DLL
 Komunikasi Terapeutik

 SIKAP PROFESIONAL
◦ Kemampuan Intelektual
◦ Kemampuan Teknikal
◦ Kemampuan Interpersonal (komunikasi)

 KOMUNIKASI:
◦ Perawat Kesehatan - Klien
◦ Perawat Kesehatan - Keluarga
◦ Perawat -Tim Kesehatan

11/22/2021 29
KOMUNIKASI-PERAWAT

1 • PERAWAT - PASIEN

2 • PERAWAT - KELUARGA

3 • PERAWAT - TIM KESEHATAN

KOMUNIKASI-PENUNJANG

1 • TENAGA KES- PASIEN

2 • TENAGA KES- KELUARGA

3 • TENAGA KES- TIM KESEHATAN

 LATIHAN
 PERAWAT
◦ TULISKAN 10 DIAGNOSIS KEPERAWATAN YANG
PALING SERING DITEMUKAN

 DOKTER
◦ TULISKAN 10 DIAGNOSIS MEDIK YANG PALING
SERING DITEMUKAN

 TENAGA KES PENUNJANG DAN MANAJEMEN

◦ TULIAKAN 10 KEGIATAN YANG PALING SERING
DILAKUKAN BERHUBUNGAN DENGAN ORANG LAIN
 Komunikasi-Terapeutik
 Proses:
◦ Belajar & Berpengalaman bersama

 Alat:
◦ Diri provider
◦ Teknik pendekatan

 Tujuan:
◦ Membangun relasi
◦ Memberi Informasi/meningkatkan kesadaran
◦ Meningkatkan kemampuan menyelesaikan
masalah kesehatan 11/22/2021 33
PRASARAT KOMUNIKASI

 Sikap Positif
 Peduli Terhadap Pelanggan
 Budaya Melayani
 Memberi Rasa Percaya
 Mampu mendapatkan Informasi
 Melakukan Interaksi
20/05/2003 34
 3.
KOMUNIKASI
PERAWAT - DOKTER

11/22/2021 35
 ISBAR
I
• Introduction
• Situation
S

B
• Background

A
• Assessment
• Recommendation
R
Introduction

 State your name and unit

 I am calling about
(patient name)

37
 INTRODUKSI
 Via Tel:
◦ Selamat pagi
◦ Saya Budi, perawat ruang E
◦ Saya mau melaporkan pasien Sofian

 Visit Dokter
◦ Selamat pagi
◦ Ini pasien Sofian, dan saya yang
merawat

11/22/2021 38
Situation
•
Patient age
• Gender
• Pre-op diagnosis
• Procedure
• Mental status
pre-procedure
• Patient stable/unstable

39
 SITUASI/KONDISI PASIEN

 Hari ini Sofian panas tinggi

11/22/2021 40
Background
• Pertinent medical history
• Allergies
• Sensory Impairment
• Family location
• Religion/culture
• Interpreter required
• Valuables deposition
41
 LATAR BELAKANG

 Pasien
ini masuk tadi pagi,
dengan panas dirumah sudah 2
hari

11/22/2021 42
Assessment
•Vitals
• Isolation required
• Skin
• Risk factors
• Issues I am concerned
about

43
 ASESMEN YG SUDAH
DILAKUKAN

 TTV nya: Khusus suhunya 39

11/22/2021 44
Recommendation/Request

•
Specific care required
immediately or soon

• Priority areas
⁻ Pain control
⁻ IV pump
⁻ Family communication
45
 REKOMENDASI

 Dok,mungkin pasien memerlukan

obat penurun panas

11/22/2021 46
 CONTOH ISBAR: HIPERTERMI
 I: Selamat siang saya perawat Budi yang
merawat pasien Sofyan. Saya ingin
menyampaikan kondisi Ps Sofyan
 S: Sofyan panasnya tinggi, tindakan kep
sudah dilakukan: pakaian dan selimut tipis,
minum banyak dan kompres air hangat
 B: Dia masuk tadi pagi dan sudah dua hari
panas di rumah
 A: asesmen yang sudah dilakukan: Sh: 39,
N: 84, R: 24, T: 130/70
 R: Dok, sepertinya Sofyan memerlukan obat
penurun panas
11/22/2021 47
SELAMAT
MENCOBA

11/22/2021 48