COMMUNICATION

CHAPTER IV THERAPEUTIC COMMUNICATION PRACTICES

BASED ON AGE AND SOCIAL LEVELS
PRELIMINARY

Currently you are studying the chapter of therapeutic communication practice by age level
and social level. This chapter will discuss how to practice therapeutic communication at
various ages and social levels. Practices are designed in the nursing laboratory using case
and patient models or carried out in real situations in families / groups. Students are
encouraged to carry out communication strategies (SP), show therapeutic attitudes and
apply therapeutic communication techniques in certain situations in accordance with the
patient model cases that have been prepared in advance. The model patient will play the
role of a sick person or a person who needs services to visualize conditions that are similar
to the real situation. For practice in the field will be carried out in families or groups, namely
students are encouraged to communicate in real situations. Before practicing interaction
and communication, students must prepare themselves by creating a therapeutic
communication strategy implementation (SP) scenario according to the phases of
relationship / communication that will be used when they interact or communicate with
patients.

It has been explained that communication in nursing activities is the most basic thing and
becomes the main work tool for nurses. For 24 hours continuously, the nurse is with the
patient and in every activity uses communication to provide nursing services / care. Mastery
of therapeutic communication in nursing practice will enable you to practice quality nursing.
The ability of nurses to apply communication strategies at various levels of age (infants,
children, adolescents, adults, and elderly) and social levels (family / group), is useful for the
self-development of nurses and patients while undergoing treatment in the hospital. This is
important because patients who are hospitalized will experience many problems and
changes in psychological responses due to the disease and its treatment.

After studying this chapter, it is hoped that you will be able to develop communication
implementation strategies (SP) and practice them at various age levels (infants, children,
adolescents, adults, and the elderly) and social levels (family / groups) using attitudes and
therapeutic communication techniques. according to the phases of the nurse-patient
therapeutic relationship.

The focus of discussion in Chapter IV is how students practice therapeutic communication

based on age and social levels which are divided into three practices as follows.

 Practice 1: Therapeutic Communication Practices in Infants, Children, and

Adolescents

 Practice 2: Therapeutic Communication Practice in Adults and the Elderly (Elderly)

 Practice 3: Therapeutic Communication Practices in Families / Groups

 This chapter takes the form of practical instructions which are important to use
when you are trying to practice or demonstrate communication and interaction with
patients as individuals at various levels of age, family or group. This chapter contains
practical instructions that will be presented based on the steps in communicating
and interacting so that it will provide experiences for you in communicating and
interacting with patients.

The things that you must prepare before practicing are as follows.

1. Understand the learning objectives as targets to be achieved.

2. Study the available cases and make sure you understand.
3. Creating interaction / communication scenarios based on cases provided according
to the phases of the relationship / communication starting from the pre-interaction,
orientation, work, and termination phases.
4. Prepare a model patient who will play the role of a patient according to the case and
scenario.
5. Do the recommended exercises.
6. Practice / demonstrate communication according to the scenario that has been
made.
7. Write down any difficulties you have and discuss them with a friend or tutor.

We hope that you will be able to follow the overall practice in this chapter well.
HAPPY LEARNING AND SUCCESS FOR YOU.

Practice: 1
Therapeutic Communication Practices in Infants, Children and
Adolescents
Before joining this practice, make sure that you understand the basic concepts of
communication and therapeutic communication in Chapter I and understand how they can
be applied to communicating with infants, children, and adolescents in Chapter II.
After learning Practice 1, it is hoped that you will be able to develop a communication
implementation strategy (SP) and practice it at various age levels (infants, children, and
adolescents). Practice 1 will provide you with experiences on how to interact and
communicate with infant, child, and adolescent patients using strategies and
communication techniques appropriate to their level of development.

After studying Practice 1, hopefully you will

1. develop communication strategy implementation (SP) and practice it on infant /

child patients by using communication strategies and techniques according to the
characteristics of infant / child development.
2. develop communication strategy implementation (SP) and practice it in adolescent
patients using communication strategies and techniques according to the
characteristics of adolescent development.

Description (Theory)

Humans communicate throughout their life span; from the time the baby is in the mother's
womb to the elderly and even before death. Since in the womb, the baby has
communicated with his mother and the people around him. The communication that is
carried out by the baby in the womb is nonverbal communication in the form of kicks in the
mother's stomach, or doing regular movements at certain times.

Infants, children and adolescents are age groups that have special characteristics in
communicating. Remember that babies or children whose speech skills are not yet
developed, communicate with those around them by crying, babbling, gesturing by moving
their bodies / feet, emotional expressions reflected in facial expressions, and crying or
hiding faces. In children whose speech skills have developed, communication is carried out
verbally and nonverbally. In adolescents, their communication is well developed, so they
need a logical and rational explanation when talking to them.

There are 2 techniques used when communicating with children, namely verbal and
nonverbal techniques.

1. Verbal techniques that are often used are storytelling (story telling), bibliotherapy,
mentioning wishes, and playing or games.
2. Commonly used nonverbal techniques are writing and drawing.

In addition, what nurses need to pay attention to when communicating with children
is maintaining voice intonation, distraction, eye contact, body posture, and
maintaining physical distance, and touch.

 "Caution: Don't touch children and avoid physical contact with children if they
don't know you."

 "Fostering a trusting relationship with children can increase a child's sense of

security."
 In adolescents, the development of communication is shown by the ability to discuss
or argue. The cognitive development pattern has begun to think conceptually
considering this period is the transition period for children to become adults.
Teenagers often reflect on their lives, which is about the future which is reflected in
communication.

Following are the therapeutic attitudes that nurses must develop when interacting
and communicating with adolescents.

1. Be a good listener and give them the opportunity to

express his feelings, thoughts and attitudes.

2. Invite teenagers to discuss feelings, thoughts and attitudes.

3. Don't interrupt the conversation and don't comment or respond

excessive when adolescents show emotional attitudes, then our attitude is to give
support for all the problems faced by adolescents and help to solve them by
discussing them.

4. Nurses or other adults should be able to be friends for teenagers, a place to share
stories of joy and sorrow.
5. Sitting with teenagers, hugging, hugging, chatting, and chatting with them and often
having meals together.

Meanwhile, the atmosphere that nurses must pay attention to support

Effective communication during interaction and communication with adolescents is mutual

respect, mutual respect, mutual trust, and mutual openness.
 Make youths as adult friends.

 Don't be condescending and give them the opportunity to express their opinion openly.

Exercise 1: Communication Practices in Children

Case Illustration

A 5-year-old girl is admitted to the hospital with a diagnosis abdominal thypus. Based on
physical examination, it was found that the child's temperature was 380 C, was sweating a
lot and sometimes vomiting. Children always want to move and play. The child said he was
afraid of being injected and did not want to be in the hospital. The patient is planned for
intra vina therapy (IV-line therapy) to maintain balance (balance) fluids and drug
administration.

Duty:

 Form small groups (3-4 people).

  Define their respective roles as: child (patient model), mother and father (model)
and the role of the nurse.

 Use the SP communication format.

 Discuss scenario SP communication conversations according to communication

phases.

 Practice SP communication that has been created by role playing according to

each role.

 Do it role play alternately and each member must have served as a nurse.

A. PREPARATION

1. Tools and Materials (Materials)

1. Case
2. SP communication format
3. SP communication scenario
4. Observation instrument
5. Model patient
6. Prepare a tool (game) that can be used as a medium for playing and
diversifying children, for example stethoscope toys or other objects that are
the child's favourite.
2. Environmental Preparation
1. Design the environment /setting a place for interaction (appropriate setting
location in the case, e.g., a treatment room, clinic, consultation room, or
home).
2. Set up a safe environment and involve parents to feel safe for children.
3. The division of roles
1. Form groups
2. Defining roles: patient models, mother models, and nurse role models.

c. Determineobserver to observe communication practices carried out by the perpetrators

of the practice using checklist communication.

4. Development of Conversation Scenarios (according to Format)

1. Orientation Phase
2. Work Phase
3. Termination Phase

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient Condition:

A 5-year-old girl patient was admitted to the hospital with the diagnosis abdominal thypus.

Physical examination temperature 380 C, sweat a lot and sometimes vomit. The child always
wants to move and play outside the room, is afraid of getting injections, and doesn't want to
be in the hospital.

Patient planned therapy intra vina (IV-line therapy) to maintain balance (balance) fluids and
drug administration.

Nursing Diagnosis:

 Risk of complications (bleeding, perforation)

Nursing Plan:

1. Resting the patient on the bed (bedrest).

2. Perform an IV insertion line and give fluids / drugs according to therapy.

Purpose:

 There were no complications, the patient was cooperative during the treatment.

SP Communications

Orientation Phase

Therapeutic greeting: “Hello, dear, good morning. I'm Mrs. Tri. Can you shake your sister? "
(while providing game tools for diversion)

Evaluation and validation: “You are so beautiful sister, how are you? The toys are good, do
you like them? "

Contract: “Brother while sleeping here, yes. Waiting for father and mother. I will attach this
tool to my sister's hand, assisted by my mother, is that okay? Just for a little while, yes, so
that my sister gets better quickly”.

Work Phase (Write down the words according to the goals and plans to be achieved /
carried out)

Nurse: “Before the appliance is installed, let's pray together with father and mother,
hopefully the device will not hurt the younger siblings and we will receive a quick recovery.
Bismillah ".

Patient: (Child response)

Nurse: “Are you ready? Come on, here we go, shall we. Can you borrow his hand for a
moment?

Clean it up first. It hurts a little, yes, honey. Is your sister feeling pain? "

Patient: (Child response: cry or scream)

Nurse: "There you go, the equipment has been installed Is it hurt or not? For a while, let this
tool be clinging in your hand, yes. Little brother is a great kid because he dares to have a
tool in your hand. This tool can be used as a means to accelerate the recovery of younger
siblings so that the younger siblings can quickly go home and return to school”.

Patient: (Child response)

Nurse: “Okay, my job is done. Your younger siblings can play while lying on the bed. It's
better not to get out of bed first, so you can get well soon”.

Patient: (Child response)

Termination Phase

Subjective / objective evaluation: "How does it feel after putting the device in hand?"

Follow-up plan: “I will come regularly to make sure that the equipment is kept in place and
therapy can be carried out as planned”.
Upcoming contract: "In thirty minutes I'll be back to see that the device in your sister's hand
is safe and you don't feel any pain."

B. IMPLEMENTATION

1. Take turns playing roles using SP communication to children using the example
above.
2. During the process of playing the role of a nurse, observer make observations using
the therapeutic communication observation format, give an objective assessment
and convey the results after completing the exercise role play.

C. EVALUATION (POST-IMPLEMENTATION)

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask for team members to improve your skills in interaction and communication.
4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate the communication practices that you have done, use the assessment format
provided.

Calculate the score you got, are you satisfied with the results achieved? Repeat if your
assessment is still lacking.

Ability Communication Skills = Frequency / Number of items X 100%

Exercise 2: Communication Practices in Youth:

Case Illustration:

A 15-year-old teenager accompanied by his mother came to the hospital for consultation.
The parents said that recently their child cried a lot, couldn't sleep well and often woke up
at night. Children say they cannot concentrate on learning, are lazy to go to school and feel
ashamed because they have failed. This situation occurs after the child loses competition
with his friends.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each: child (patient model), mother (model) and the role of
the nurse.

 Use the SP communication format.

 Discuss scenario SP communication conversations according to communication

phases.

 Practice SP communication that has been created by role playing according to

each role.

 Do it role play alternately and each member must have served as a nurse.

1. Preparation

1. Tools and Materials (Materials)

1) Case

2) SP communication format
 3) SP communication scenario

4) observation instruments

5) Patient model

2. Environmental Preparation
Design environment /setting a place for interaction (appropriate setting location in
the case, e.g., a treatment room, clinic, consultation room, or home).
3. The division of roles

1) Forming groups

2) Determine the role: patient model, mother model, and nurse role, as
wellobserver.

4. Conversation scenario development - SP communication (according to format)

1) Orientation Phase

2) Work Phase

3) Termination Phase

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient Condition:

Teenagers aged 15 years, the main complaint is often crying, not sleeping well and often
waking up at night. Children say they cannot concentrate on learning, are lazy to go to
school and feel ashamed because they have failed. This situation occurs after the child loses
competition with his friends.

Nursing Problems:

Crisis situation

Purpose: clients are able to overcome the crisis that occurs and behavior effectively

Nursing Plan:

1. Identify problems that occur with the client

 2. Listen to the patient's feelings

SP Communications

Orientation Phase

Therapeutic greeting: “Good morning. I'm Mrs. Tri” (reaching out to shake hands).

Evaluation and validation: “How are you? How are you feeling this morning? I saw my
sister's eyes looked red and swollen, how did she sleep last night? "

Contract: “According to the agreement, now we will identify the crisis that happened to the
younger sibling. Where are you going? "

"Okay, just the place in the room, the time is 10-15 minutes. Ready?"

Work Phase: (Write down words according to the goals and plans to be achieved / carried
out)

Nurse: "Well, according to the agreement we will discuss the problems that your sister is
facing".

Patient: (Response)
Nurse: "Try to explain what happened so that the sister feels sad and has trouble sleeping".

Patient: "I have failed, I am stupid, I am ashamed of everything that happened to me".

Nurse: "Try to explain what made you feel like a failure and stupid!"

Patient: “I am stupid because I can't be the champion in the competition”.

Nurse: (Pause, nods), "What do you want?"

Patient: "I want to make mama proud if I become a champion".
Nurse: “I understand how you feel. Every problem has a solution. Mama will be very proud if
you are able to rise up and become a strong person. "" You are not alone. Make failure a
valuable teacher. Failure is delayed success".
Patient: (Silent)
Nurse: "Look at mama, she really hopes you get up and be a tough child".
Patient: (Looking at his mother)
Nurse: "Look at mama and smile for mama". "You have to promise to get back up, study
harder, for a better tomorrow".
Patient: (Hugs his mother) "I'm sorry, I promise to get back up and learn better".

Termination Phase:
Subjective / objective evaluation: "How do you feel now?" "Try to mention the problem that
happened again?" "I'm glad to see that you can smile".

Follow-up plan: “From now on you must prepare yourself again to learn better. Write down
your plans for the next 1 week”.

Upcoming contract: “Tomorrow I ask you to come back here to show me your plans in the
next week. See you tomorrow, huh. Good afternoon".

2. Implementation

a. Take turns playing roles using SP communication to adolescents according to the example
above.

b. During the process of playing the role of a nurse, observer make observations using the
therapeutic communication observation format, give an objective assessment and convey
the results after completing the exercise role play.

3. Evaluation (Post Implementation)

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask team members for input to improve your skills in interaction and
communication.
4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate the communication practices that you have done, use the assessment format
(observation) provided. Calculate the score you got. Are you satisfied with the results
achieved? Repeat if your assessment is still lacking.

Communication Skills Ability = frequency / Number of items x 100%

SUMMARY

1) Communicating with children requires special techniques so that the relationship

can take place properly in accordance with the child's development. In general, there
are two communication techniques used in children, namely verbal and nonverbal
communication techniques.

2) Use favorite play equipment as a medium of distraction for paediatric patients.

3) The development of communication in children has different and specific

characteristics at each level of development.
 4) Use a moderate tone, soft, and not pushy. Get permission before touching the
child or touching the things the child likes.

5) Always use the SP communication format when designing communication

scenarios and use communication observation sheets to assess success.

6) Always use the SP communication format when designing communication

scenarios and use the communication observation sheet to assess success.

7) At school age and adolescence, they have been able to understand

communication through simple explanations. Parents should be able to be friends
with teenagers, invite them to discuss if the teenager seems to have problems.

8) Use therapeutic communication techniques (as per Chapter I).

9) Recognize adolescent problems as early as possible and immediately provide

assistance if adolescents have difficulties.

10) Don't leave teens alone in solving their problems.

Practice: 2
Therapeutic Communication Practices in Adults and the Elderly
Before joining this practice, ensure that you understand the basic concepts of
communication and therapeutic communication in Chapter 1 and understand how they
apply to communication in adults and the elderly in Chapter IV.

After studying Practice 2, it is hoped that you will be able to develop a communication
implementation strategy (SP) and practice it in the adult and elderly age group. Practice 2
will provide you with experiences on how to interact and communicate with adult and
elderly patients using strategies and communication techniques appropriate to their level of
development.

After studying Practice 1, hopefully you will

 1. developing communication implementation strategies (SP) and practicing them in
adult patients using communication strategies and techniques according to adult
developmental characteristics.
2. developing communication implementation strategies (SP) and practicing them in
elderly patients using communication strategies and techniques according to the
developmental characteristics of the elderly.

Practice 2 will provide you with experiences on how to interact and communicate with
adult / elderly patients using therapeutic communication strategies and techniques
appropriate to the characteristics of an adult or elderly person.

Description (Theory)

Communication is carried out throughout the life span. Communication to infants, children
and adolescents is very different in approach when we communicate with adults or the
elderly. Erikson (1985) in Stuart & Sundeen (1998) explains that in adults there is
psychosocial development, namely intimacy vs isolation. Adults, including the elderly,
already have certain attitudes, certain knowledge, sometimes even that attitude has
remained in them for a long time, so it is not easy to change them. In the elderly, this
condition is getting stronger because they already have a strong belief in their thoughts,
attitudes and behaviour. At this time, adults / elderly people have their own ways of
communicating with other people.

The following review specific psychological attitudes in adults / elderly about

communication.

1. Adults / seniors communicate based on their own knowledge / experience.

2. Communicating with adults / seniors must involve feelings and thoughts.
3. Attitude of nurses.
4. Communication is the result of cooperation between humans who share
experiences, mutually express their reactions and responses to a problem.

Meanwhile, therapeutic communication techniques that are important for nurses to use
according to Mundakir (2006) are assertiveness, responsiveness, focus, support,
clarification, patience, and sincerity. In elderly patients, in addition to the psychological
characteristics that must be recognized, nurses must also pay attention to the physical,
psychological or social changes that occur as a result of the aging process. Hearing, vision
and memory decline will greatly affect communication, and this must be considered by
nurses.

An atmosphere of communication with the elderly that can support the achievement of
goals that you must pay attention to is an atmosphere of mutual respect, mutual respect,
mutual trust, and openness. Verbal and nonverbal communication is a form of
communication that must support one another. As with communication in children,
nonverbal behaviour is just as important in adults as in the elderly. Facial expressions, body
movements and tone of voice give signals about the emotional status of adults and the
elderly.
"Adults and the elderly have persistent knowledge, experience, attitudes, and skills that are
difficult to change in a short time."

"Motivating and empowering the knowledge / experience and attitudes that you already
have are important for communicating with adults / seniors"

Exercise 1: Adult Communication Practice

Case Illustration

A 68-year-old female patient was admitted to the hospital with inflammation of the liver
(liver). Based on the physical examination, the body temperature was 380 C, sweating a lot,
sometimes nausea and vomiting. Palpation palpable enlarged liver. The patient said that the
doctor's diagnosis was wrong, "The doctor misdiagnosed, it is impossible for me to be sick
like that because I always take care of my health". The patient refused treatment and did
not want to be treated. The patient is sure that he is well and does not need treatment and
medication.

Duty:

 Form small groups (3-4 people).

 Define the roles of each as: adult patient (model patient), influential family
(model) and role of nurse.

 Use the SP communication format.

 Discuss scenario SP communication conversations according to the stages / phases

of communication.

 Practice SP communication that has been created by role playing according to

each role.

 Do it role play alternately, and each member must have served as a nurse.

A. PREPARATION

1. Tools and Materials

1. Case
2. SP communication format
3. SP communication scenario
4. Observation instrument
5. Model patient
6. Environment (according to location settings: treatment room, clinic,
consultation room, or home).
2. Environmental Preparation
 Design environment /setting a place for interaction (appropriate setting location in
the case, e.g., a treatment room, clinic, consultation room, or home).

3. The division of roles

1. Form groups.
2. Defining roles: patient models, mother models, and nurse roles.
3. Specify observer.
4. Conversation Scenario Development (according to Format)
1. Orientation phase
2. Work phase
3. Termination phase.

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

The patient, Mrs. Sofi, aged 68 years, was admitted to the hospital (MRS) with inflammation
of the liver (liver). Based on the physical examination, the body temperature was 380 C,
sweating a lot, sometimes nausea and vomiting. Palpation palpable enlarged liver. The
patient said that the doctor's diagnosis was wrong, "The doctor misdiagnosed, it is
impossible for me to be sick like that because I always take care of my health". The patient
refused treatment and did not want to be treated. The patient is sure that he is well and
does not need treatment and medication.

Nursing Diagnosis / Problems:

Denial (Denial)

Nursing Plan:

1. Rest the patient on the bed (bedrest).

2. Improve patient understanding of their health.
3. Discuss the problems faced and the process of therapy while in the hospital (RS).

Purpose:

The patient accepts the pain and is cooperative during treatment and medication.

SP Communications

Orientation Phase

Therapeutic greetings:

Nurse: “Good morning. I'm Mrs. Tri. Is it true that I am with Mrs. Sofi? " (come closer to the
patient and reach out to shake hands).
Patient shook the nurse's hand and said “good morning”.
Evaluation and Validation:

Nurse: “How are you, Mother? How do you feel today? You seem tired? "

Patient: "I am in good health, no need to worry about me".

Nurse: Smiling while holding the patient's hand.

Contract:

Nurse: "Mother, I want to discuss maternal health issues so that your condition is better
than now".

Patient: “Yes, but is it true that I am not sick? I am always healthy”.

Nurse: (smile). "We'll discuss later. The time is only 15 minutes, okay?

Where do you want a comfortable place? "Fine here huh".

Work Phase: (Write down the words according to the goals and plans to be achieved /
carried out)

Nurse: “I hope that in the meantime, mom will first rest for a few days in the hospital. Limit
your activities and don't be too tired ”.

Patient: "I'm fine ... why should I rest? I can't just sit around like this. I am used to doing
activities and social tasks in society”.

Nurse: "I really understand your activities and I am very proud of your activities, who are
always enthusiastic."

Patient: (listening)

Nurse: "Mothers also have to understand that every human being has limited abilities and
strengths (waiting for the patient's response)".

Nurse: "I want to know, what is the reason for the family to bring mother to this hospital?"

Patient: “I have fever, nausea, vomiting and frequent flatulence. But it is normal, no need to
go to the hospital to be healed”.

Nurse: "Then, what worries the family so that the mother is sent to the hospital?"

Patient: "I vomited vomiting and my body was weak then passed out for a while."
Nurse: "In your opinion, if you faint, does it mean that your body is still strong or has
decreased in strength?"

Patient: "Yes, it means that my body is not able to do it, does that mean I have to rest?"

Nurse: "According to you, you need to rest or not?"

Patient: “How long should I rest? If you're in this hospital, don't you stay long? "

Nurse: "The length of time or not the treatment depends on the mother herself." "If the
mother is cooperative during treatment, follows the recommendations and undergoes
therapy according to the program, hopefully it will not take you long to be in the hospital."

Patient: "Well I am willing to follow the recommendations of nurses and doctors, and will
follow the therapy process well".

Nurse: “Thank you, you have made the best decision for you. Get well soon".

Termination Phase:

Subjective / objective evaluation: "How do you feel now?" "Now explain why you have to
rest for a while!"

Follow-up plan: "I hope you can be cooperative while being treated. The mother must rest
and not have much activity, eat according to the diet provided, and take medication
regularly”.

Upcoming contract: “In one hour I'll be back to make sure that you finish your meal and take
your medicine according to the program. See you later, huh. Good afternoon".

B. IMPLEMENTATION

1. Take turns role playing using SP communication in adults using the scenario
according to the example above.
2. During the process of playing the role of a nurse, observer make observations using a
therapeutic communication observation format, and provide an objective
assessment.
3. Convey the results after practical(nurse) finished doing role play.

C. EVALUATION (POST-IMPLEMENTATION)

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask for team members to improve your skills in interaction and communication.
 4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate the communication practices that you have done, use the assessment format
provided. Calculate the score you got, are you satisfied with the results achieved? Repeat if
your assessment is still lacking.

Communication Skills Ability = frequency / Number of items x 100%

Exercise 2: Communication Practice in Elderly Patients

Case Illustration:

An elderly patient, 78 years old, was taken by the family to the hospital because he could
not sleep and was angry. The family said the elderly patient accused her children of hiding
her sticks and favourite belongings.

Duty:

1. Form small groups (3-4 people).

2. Discuss the SP communication conversation scenario according to the stages /
phases of communication as an example (Use the SP communication format as an
example).
3. Practice SP communication that has been created by role playing according to each
role.
4. Do it role play alternately and each member must have served as a nurse.
5. Determine the roles of each as: elderly patient (model patient), influential family
(model) and role of nurse.
6. Practice is carried out according to the following practical stages:

A. PREPARATION

1. Tools and Materials (Materials)

1. Case
2. SP communication format
3. SP communication scenario
4. Observation instrument
5. Model patient
2. Environmental preparation

Design environment /setting a place for interaction (appropriate setting location in

the case (e.g., treatment room, clinic, consultation room, or home).
 3. The division of roles
1. 1) Forming groups.
2. 2) Determine the role: patient model, mother model, and nurse role as
wellobserver.

4. Development of conversation scenarios - SP communication (according to format to be

discussed in groups)

1) Orientation phase

2) Work phase

3) The termination phase.

B. IMPLEMENTATION

1. Take turns playing roles using SP communication that the group has developed
based on the illustration of the elderly case in Exercise 2 above.
2. During the process of playing the role of a nurse, observer make observations using
the therapeutic communication observation format, give an objective assessment
and convey the results after completing the exercise role play.

C. POST-IMPLEMENTATION EVALUATION

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask for team members to improve your skills in interaction and communication.
4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate the communication practices that you have done, use the assessment format
(observation) provided. Calculate the score you got, are you satisfied with the results
achieved? Repeat if your assessment is still lacking.

Communication Skills Ability frequency = x 100% Number of items

SUMMARY
 1) Adult to elderly communication is difficult and requires a special approach.
Knowledge that he considers correct is not easily replaced by new knowledge so that
adults and elderly people cannot be taught anything new.

2) In communicating with adults / the elderly, knowledge of typical attitudes in the

elderly is required. Use the feelings and thoughts of adults / seniors, work together
to solve problems and provide opportunities for the elderly to share experiences and
respond to these experiences themselves.

3) Communicating with adults / seniors requires an atmosphere of mutual respect,

mutual respect, mutual trust, and mutual openness.

4) Delivery of direct messages without intermediaries, mutual influence and

influence, direct reciprocal communication, and carried out continuously, not static,
and always dynamic.

5) Difficulty in communicating in the elderly is caused by reduced function of the

communication organs and cognitive changes that affect the level of intelligence,
learning ability, memory power, and client motivation.

Practice: 3
Therapeutic Communication Practices in Families / Groups
Before taking Practice 3, make sure that you understand the concepts of therapeutic
communication in families and groups in Chapter IV and understand how they apply to
communication.

After learning Practice 3 it is hoped that you will be able to develop a communication
implementation strategy (SP) and practice it in your family and group. Practice 3 will provide
you with experiences on how to interact and communicate with families or groups in the
community using communication strategies and techniques according to their
characteristics.

After learning Practice 3, hopefully you will

1. develop a communication strategy (SP) and practice it in families using

communication strategies and techniques in the context of health promotion,
2. develop a communication strategy (SP) and practice it in groups using
communication strategies and techniques in the context of health promotion.

Description (Theory)

Humans communicate in all walks of life, whether in families, groups, or communities. The
ability to communicate within the family or group in the community is very important as a
health practitioner in order to improve (promote) and prevent (prevent) health problems in
the community.
This chapter is useful in helping students prepare themselves as health / nursing personnel
in carrying out health promotion efforts to improve the health status of families and groups
in society.

How is therapeutic communication applied to families and groups? 1. Application of

Therapeutic Communication Strategies in Families and Groups
communicating in a family / group is not easy, communicators must have strategic ways as
an effort to achieve communication goals. The following are efforts to improve
communication within the family / group.

1. Mutual understanding between group members, in order to know what kind of

communication he should do for the sake of smooth communication.
2. Group leaders can properly organize each member of the group so that the
communication process between group members can develop properly.
3. Communicate clearly, politely, and according to applicable ethics, so that group
members don't misunderstand and offend each other.
4. Mutual respect for other group members.
5. Don't interrupt other people's conversations.
6. Always pay attention to the person you are talking to.
7. Give a kind, supportive, and non-offensive response when someone asks you to talk.

2. Factors Affecting Group Communication

1. Group size, effective groups have members that are neither too small nor too
large.
2. Group goals. Goals that have been mutually agreed upon will be easy to
achieve because all members have the same goals. Unite goals in groups,
minimize individualism that can interfere with the achievement of common
goals.
3. The cohesiveness of group members is important because it shows the
strength and cohesiveness of the group to achieve common goals.
4. Communication network (networking) is needed to get opportunities to
achieve common goals.
5. Group leadership needs a leader who can protect all members, is impartial
and accommodating so that it can increase group cohesiveness.

3. Health Promotion

Health promotion is a science and art to help people make their lifestyle optimally
healthy, namely a balance of physical, emotional, social, spiritual and intellectual health.
This is not just a lifestyle change, but is related to environmental changes that are
expected to be more supportive of making healthy decisions. Lifestyle changes can be
facilitated through the incorporation of creating a supportive environment, changing
behaviour and raising awareness.
Health promotion is the process of enabling people to increase control over and improve
their health (WHO, 1984). Meanwhile, the Ottawa Charter (1986) explained that health
promotion is a process to increase people's ability to control and improve their health. This
activity is carried out to achieve a healthy state so that it is hoped that each person or group
must be able to identify and realize aspirations, be able to meet needs and change or
control the environment.

The form of health promotion can be done through health education, disease prevention,
and health protection. To do this, it is necessary to master the understanding of
communication and communication strategies in the group in order to achieve maximum
results. In order to achieve optimal results in changing behaviour, the things that need to be
prepared by nurses are to provide and prepare promotional work tools including proposals
for health promotion activities and media in the form of leaflet, flipcharts, modules, and
other relevant resources. Fostering a trusting relationship is essential so that health
promotion goals can achieve optimal results.

Exercise 1: Communication Practices in Families

Case Illustration

Mr. Bani's family, 55 years old, consists of 5 people, consisting of his wife and 3 children.
Currently the family is experiencing health problems. His wife and child suffer from
pulmonary tuberculosis. You plan to do prevention and health promotion to prevent the
spread of the problem to other family members.

Duty:

 Form small groups of 4 people.

 Perform the division of duties / roles as a nurse for 1 person, family (father,
mother, and child), and observer 1 person.

 Make it up leaflet/ flipchart / poster.

 Discuss the SP Communications conversation scenario according to the stages /

phases of communication.

 Practice SP communication that has been made.

 Conduct guided counselling by instructors / tutors.

A. PREPARATION

1. Tools and Materials (Material)

1. Illustration of cases or real conditions of families in society

 2. Proposal for activities
3. SP communication format
4. SP communication scenario
5. Observation instrument
6. Groups / families in the community
7. Setting: family house / RT / RW
8. Leaflet/ flipchart / poster / LCD.

2. Environmental Preparation

Design environment /setting a place for interaction (appropriate setting location in the case
(e.g., treatment room, clinic, consultation room, or home).

3. Role Division

a. Form groups.
b. Defining roles: the patient / family model, and the role of the nurse, as well
observer.

4. Development of Conversation Scenarios (according to format)

a. Orientation phase
b. Work phase
c. Termination phase.

Example of SP Communication Scenarios

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Family Situation

Mr. Bani's family, 55 years old, consists of 5 people, consisting of his wife and 3 children.
Currently the family is experiencing health problems. His wife and child suffer from
pulmonary tuberculosis. The patient said that he did not know how to prevent other
families from becoming infected. You plan to take preventive measures and health
promotion to prevent the spread of the problem to other family members.

Nursing Diagnosis:

 Lack of family knowledge.

Nursing Plan:

1. Take a family approach.

 2. Do health promotion in the form of health education for families with tuberculosis
problems.

Purpose:

Increased family knowledge and cooperation in preventing problems.

SP Communications

Orientation Phase

Greetings: "Good morning, ladies and gentlemen, and everyone. I am Mrs. Tri” (looking at
the family's response).

Evaluation and validation: “How are you today? I saw that my mother looked weak and
often coughed ”.

Contract: “Today I will provide counselling about tuberculosis and how to prevent it. The
time is 30-45 minutes, are you ready? The place is in this living room, right?”

Work Phase: (Write down the words according to the goals and plans to be achieved /
carried out)

Nurse: "Before I explain how to prevent TB disease, first let me explain what TB disease is".

Family: (Response)
Nurse: “TB disease is. . . "Until all the material is delivered.
Patient: (listening)
Nurse: (Communicating in the context of family health promotion to completion according
to the material made in the activity proposal).

Termination Phase:

Subjective / objective evaluation: “How do you all feel, father, mother and siblings? Try to
explain how to prevent TB disease transmission? "

Follow-up plan: "After everyone understands, I hope to immediately make efforts to clean
the environment and arrange adequate ventilation and lighting".

Upcoming contract: “Tomorrow I will come again to see the changes in your house,
especially the ventilation and lighting.

B. IMPLEMENTATION
1. Take turns playing roles by using SP communication to families with TB problems
according to the SP Communication example above.

2. During the process of playing the role of a nurse, observer make observations using the
therapeutic communication observation format, give an objective assessment and convey
the results after completing the exercise role play.

C. EVALUATION (POST-IMPLEMENTATION)

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask for team members to improve your skills in interaction and communication.
4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate your communication practices, use the assessment format provided. Count the
check marks (frequency), are you satisfied with the results achieved? Repeat if your
assessment is still lacking.

Ability Communication Skills = Frequency / Number of items X 100%

Exercise 2: Group Communication Practice

Case Illustration:

At the “Bunga Mawar” Posyandu Elderly, you can find many elderly people with high blood
pressure. One way to maintain blood pressure within normal limits is exercise. You get the
task of doing health promotion by providing training to the elderly group on elderly
gymnastics. This is done so that the elderly has positive health activities, are relaxed, and
their blood pressure is controlled.

Duty:

1. Form small groups (3-4 people).

2. Discuss the SP communication conversation scenario according to the stages /
phases of communication as an example (Use the SP communication format as an
example).
3. Practice the SP communication that has been made by playing roles according to
their respective roles in the elderly group at the posyandu.
4. Do it role play alternately, and each member must have served as a nurse.
 5. Determine the role of each as: the elderly patient group (model patient), and the
role of the nurse.
6. Practice is carried out according to the practical stages.

A. PREPARATION

1. Tools and Materials (Materials)

1. Case
2. SP communication format
3. SP communication scenario
4. Observation instrument
5. Model patient.
2. Environmental Preparation

Design environment /setting a place for interaction (appropriate setting location in

cases (e.g., a treatment room, clinic, consultation room, or home).

3. Division of roles

1. Form groups.
2. Defining roles: elderly patient group models, and the role of the nurse.
3. Observer.

4. Conversation Scenario Development-SP Communication (according to Format for

Discussion in Groups)

1. Orientation phase
2. Work phase
3. Termination phase

B. IMPLEMENTATION

1. Take turns playing roles using SP communication that the group has developed
based on the illustration of the elderly case in exercise 2 above.
2. During the process of playing the role of a nurse, observer make observations using
the therapeutic communication observation format, give an objective assessment
and convey the results after completing the exercise role play.

C. POST-IMPLEMENTATION EVALUATION

1. Express your feelings after doing the exercises / practices.

2. Identify your strengths and weaknesses during the interaction / communication
process.
3. Ask for team members to improve your skills in interaction and communication.
 4. Make note of the shortcomings for future improvement and use your strengths to
increase your motivation.

Exercise Evaluation Guide

To evaluate the communication practices that you have done, use the assessment format
(observation) provided. Calculate the score you got, are you satisfied with the results
achieved? Repeat if your assessment is still lacking.

Ability Communication Skills = Frequency / Number of items X 100%

SUMMARY

1) Communicating in a family / group is not easy, communicators must have strategic

ways as an effort to achieve communication goals.

2) The factors that influence group communication are group size, goals,
cohesiveness, networking, and leadership.

3) Health promotion is a science and art to help people make their lifestyle optimally
healthy, namely a balance of physical, emotional, social, spiritual and intellectual
health. The form of health promotion can be done through health education, disease
prevention, and health protection. To do this, the nurse's understanding of
communication and communication strategies in the group needs to be mastered in
order to achieve maximum results.