COMMUNICATION

CHAPTER V THERAPEUTIC COMMUNICATION PRACTICES

AT EACH STAGE OF THE NURSING PROCESS, PHYSICAL,
MENTAL DISORDERS, AND SPECIAL NEEDS

PRELIMINARY

You are currently studying Chapter V on the practice of therapeutic communication at each
stage of the nursing process, physical, mental, and special needs disorders. Students are
encouraged to carry out communication strategies (SP), show therapeutic attitudes and
apply therapeutic communication techniques in certain situations according to the case
using the patient model that has been prepared beforehand. As in Chapter IV, in Chapter V,
a model patient is also prepared who will play the role of a sick person or a person who
needs services to visualize conditions that are similar to the real situation. Students are
encouraged to practice interaction and communication by using a communication
implementation strategy (SP) based on a scenario that has been made. Before practicing,

Communication in nursing activities is the most basic thing and becomes the main work tool
for nurses. The application of communication in nursing care is important for nurses
because every nurse's activity from assessment to evaluation of nursing care always uses
communication. Mastery of therapeutic communication in nursing practice, allows you to
carry out quality nursing practice.

After studying this chapter, it is hoped that you will be able to develop a communication
implementation strategy (SP) and practice it at every stage of the nursing process in nursing
care for patients with physical and mental problems and for patients with special needs
using attitudes and therapeutic communication techniques according to the phases of the
relationship. therapeutic nurses and patients.

The focus of the discussion in Chapter V is how students practice therapeutic

communication at each stage of the nursing process, physical, mental, and special needs
disorders, which are divided into four practices as follows.

 Practice 1: Practice Therapeutic Communication at Each Stage of the Nursing

Process

 Practice 2: Therapeutic Communication Practice in Patients with Physical Disorders

 Practice 3: Therapeutic Communication Practices in Mental Disorder Patients

 Practice 4: Therapeutic Communication Practices in Special Needs Patients

 This chapter is in the form of practical instructions that are important for you to use
when trying to practice or demonstrate communication and interaction with patients
as individuals when you carry out the stages of the nursing process, carry out nursing
care to patients in order to meet needs due to physical and mental problems, and
assist patients in their needs. special.

The chapter that contains practical instructions will present the steps in
communicating and interacting so that it will give you experiences 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 patient or model group who will play the role of a patient according to
cases and scenarios.
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 all the practical activities in this chapter well. HAPPY
LEARNING AND SUCCESS FOR YOU.

Practice: 1
Practice Therapeutic Communication at Each Stage of the Nursing
Process
Before following this practical, ensure that you understand the basic concepts of
communication and therapeutic communication in Chapter I and understand how they
apply to each stage of the nursing process in Chapter III.

After studying Practice 1 in Chapter V, it is hoped that you will be able to develop a
communication implementation strategy (SP) and practice it at each stage of the nursing
process including the assessment, diagnosis, planning, implementation, and evaluation
stages. Practice 1 will provide you with an experience of how to interact and communicate
at each stage of the nursing process using communication strategies and techniques.

After studying Practice 1, it is hoped that you will be able to:

1. developing a communication implementation strategy (SP) and putting it into

practice in the assessment phase of the nursing process using communication
strategies and techniques;
 2. develop a communication implementation strategy (SP) and practice it in the
diagnostic phase of the nursing process using communication strategies and
techniques;
3. developing a communication implementation strategy (SP) and putting it into
practice in the planning phase of the nursing process using communication strategies
and techniques;
4. developing a communication implementation strategy (SP) and putting it into
practice in the implementation phase of the nursing process using communication
strategies and techniques;
5. develop a communication implementation strategy (SP) and practice it in the
evaluation phase of the nursing process using communication strategies and
techniques.

Description (Theory)

The nursing process is a scientific and systematic method for solving client problems
through cooperation between nurse and client with the stages of assessment, nursing
diagnosis, planning, implementation, and evaluation.

In the assessment, nurses are required to be able to communicate well verbally and to
observe nonverbal behaviour and interpret the results of observations in the form of
problems. After the data is collected, then communicated in verbal language to clients or
other health teams and communicated in writing (documented) to be communicated to
other health teams and as a legal aspect of nursing care.

At this stage of nursing assessment (data collection), communication is carried out to clarify
data and conduct analysis before determining the client's nursing problem, then discussing
with the client. Nursing problems or diagnoses that have been defined are communicated /
conveyed to the client so that he is cooperative and tries to work together with the nurse to
solve the problem as well as to other nurses directly and in writing for documentation.

Communication that is important for nurses to do in the planning phase is to discuss the
plan that has been prepared by the nurse and with the client to determine the success
criteria to be achieved. In this phase, family involvement is also important so that they can
participate in client care.

At the implementation stage, communicating or discussing with other health professionals is

important in order to provide adequate treatment to clients. At this stage the nurse is very
effective in communicating with the patient because the nurse will use all abilities in
communication when explaining certain actions, providing health education, providing
counseling, strengthening support systems, helping to improve abilities coping, etc. Nurses
use verbal or nonverbal nursing actions to determine the patient's direct (spoken) or
unspoken response. All nursing activities / actions must be documented in writing to be
communicated to other health teams, identify follow-up plans, and legal aspects of nursing
care.
At the evaluation stage, the nurse assesses the success of the care and nursing actions that
have been carried out. All results are recorded in the client's care progress logbook, discuss
the results with the client, ask the client for responses to the success or failure of the
actions taken, and together with the client plan follow-up nursing care. If this has not been
successful, the nurse can discuss again with the client what is expected and how the role of
the client / family in achieving the goals and plans for the client's new nursing care.

Exercise 1: Therapeutic Communication Practice in the Assessment Phase

Case Illustration

A 50-year-old woman was admitted to the hospital complaining that she would not eat for
several days. The patient always feels nauseous and will vomit if forced to eat. The patient
appears thin, pale and weak. Clients complain of frequent dizziness and light-headedness.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss the SP Communication conversation scenario at the assessment stage of

the nursing process

 Practice SP communication that has been created by role playing.

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

A. PREPARATION

1. Tools and Materials (Material)

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

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

b. Division of roles
 1) Forming groups.

2) Determine the role: patient model, family model, and nurse role.

3)Observer.

c. Development of conversation scenarios (according to format)

1) Orientation phase

2) Work phase

3) The termination phases

Example of SP Communication Scenarios

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient's Condition

The 50-year-old MRS patient complained of not wanting to eat for several days. The patient
always feels nauseous and will vomit if forced to eat. The patient appears thin, pale and
weak.

Orientation Phase:

Therapeutic greetings:
Nurse: “Good morning, ma'am. I am nurse Tri who will be in charge of taking care of mother
today. Thank you, ma’am, for entrusting us to help solve your problems”.

Evaluation and Validation:

Nurse: “How are you feeling now? (wait for client's answer) I see that my mother is very
depressed and suffering from this problem.
Patient: (Pause).

Contract

Nurse: “I will collect data related to the pain that the mother is suffering from. I need
information about how the mother's problem started so that the mother cannot eat for
several days. The time I need is 15-20 minutes and mom still rest on this bed.

Patient: (Nods) Whatever.

Work Phase:
Nurse: "What are you feeling now?"

Patient: "Always nauseous and want to vomit".

Nurse: "Explain how the origin of the disease that you feel now!" (wait for client response).

Patient: “I don't know. A few weeks ago, my son was out of town for a long time, he is
working, and maybe it will take a long time for him to come home”.

Nurse: "Go on".

Patient: “My body is hot and I am shivering, my whole body feels weak. Since then, I have
been nauseous and want to throw up”.

Nurse: "What medications or actions have you done while the mother was at home?" (wait
for client response).

Patient: "I was given anti-nausea and vomiting drugs, but there was no result, what pain I
am not clear?"

Nurse: "Mothers should be more relaxed, nausea and vomiting can be caused due to
psychological tension".

Termination Phase:

Subjective / objective evaluation:

Nurse: "How are you feeling now?" (wait for patient response). "Based on the interview
data, we can identify together that mothers experience psychological tension because their
children leave them to work outside the city".

Patient: "Am I stressed?"

Follow up plan:
Nurse: “You have to keep trying to be calm, keep trying to eat and drink regularly. Try light
biscuits to start with and warm drinks.

Upcoming contracts:
Nurse: "Very well, ma'am. I will consult a doctor to overcome mother's anxiety, I will come
in 30 minutes to give medicine to you”.

B. IMPLEMENTATION

1. Take turns playing roles using SP communication in the assessment phase according
to 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: Therapeutic Communication Practice in the Determination phase of a Nursing

Diagnosis

Case Illustration

A 50-year-old woman was admitted to the hospital complaining that she would not eat for
several days. The patient always feels nauseous and will vomit if forced to eat. The patient
appears thin, pale and weak. Clients complain of frequent dizziness and light-headedness.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss SP Communication conversation scenarios at the diagnostic stage of the

nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.

4. Development of Conversation Scenarios - SP Communication (according to format)

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

Example of SP Communication Scenarios

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient Condition:

The patient aged 50 years was admitted to the hospital complaining that he did not want to
eat for several days. The patient always feels nauseous and will vomit if forced to eat. The
patient appears thin, pale and weak. Clients complain of frequent dizziness and light-
headedness.

Orientation Phase:

Therapeutic greetings:
Nurse: “Good morning, Mother. I am nurse Tri who will be in charge of taking care of
mother today. Thank you, ma’am, for entrusting us to help solve your problems”.
Evaluation and validation:

Nurse: "How are you feeling now?" (Client response waiting) "I see I was very depressed and
suffered over this problem".

Patient: (Silent)

Nurse Contract: “According to our agreement, today I will convey the problem (nursing
diagnosis) of the mother based on the assessment that I have done. The time I need is 15-20
minutes. Please sit back and relax on this bed if you feel weak”.

Patient:(Nods) "Yes".

Work Phase:

Nurse: “I have analysed the data from the interview with the mother yesterday, and
consulted with senior nurses and doctors who deal with maternal physical problems".

Patient: “Yes. What's the result? "

Nurse: “Based on the results of the analysis, the mother does not have any physical
problems to worry about" (wait for the client's response).

Patient: “Then what am I sick? I am very depressed by this complaint and my illness ”.

Nurse: “Yes, I understand your problem. Mothers must learn to be calm, think positively,
and try to solve problems well. We conclude that mothers experience chronic psychological
stress. Mother experiences anxiety.

Patient: “So, I don't have a serious illness, right? I just have chronic anxiety.”

Nurse: "Yes. The mother should be more relaxed, nausea and vomiting can be caused by
psychological stress.

Patient: "Then what should I do?"

Nurse: "We will discuss the nursing plan together so that we can overcome the problems
that the mother is facing."

Termination Phase:

Subjective / objective evaluation:

Nurse: "How are you feeling now?" (wait for patient response).

"What is the mother's nursing diagnosis?" Patient:

Patient: "I have anxiety".

Follow up plan:
Nurse: "You have to learn to deal with your problems."

Upcoming contracts:
Nurse: "Very well, ma'am. I'll come back in 15 minutes, and we'll have a discussion

with a nursing plan for dealing with maternal anxiety.

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 3: Therapeutic Communication Practice in the Planning Phase

Case Illustration

A 50-year-old woman was admitted to the hospital complaining that she would not eat for
several days. The patient always feels nauseous and will vomit if forced to eat. The patient
appears thin, pale and weak. Clients complain of frequent dizziness and light-headedness.

Duty:

 Form small groups (3-4 people).

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

phases of communication as an example (use the SP communication format as an
example).

 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.

 Determine their respective roles as elderly patients (model patients),

influential family (model) and the role of the nurse.

  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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.

4. Development of Conversation Scenarios - SP Communications (according to the format to

be discussed 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
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 4: Therapeutic Communication Practices in the Implementation Phase

Case Illustration

A 50-year-old woman was admitted to the hospital complaining that she would not eat for
several days. The patient always feels nauseous and will vomit if forced to eat. The patient
appears thin, pale and weak. Clients complain of frequent dizziness and light-headedness.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss SP Communication conversation scenarios at the implementation stage of

the nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Determine the role: patient model, mother model, and nurse role as well
observer.

4. Development of Conversation Scenarios - SP Communications (according to the format to

be discussed 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, the observer makes observations
using the therapeutic communication observation format, provides an objective
assessment and convey the results after completing the study. 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
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 5: Therapeutic Communication Practice in the Evaluation Phase

Case Illustration

A 50-year-old woman was admitted to the hospital complaining that she would not eat for
several days. The patient always feels nauseous and will vomit if forced to eat. The patient
appears thin, pale and weak. Clients complain of frequent dizziness and light-headedness.

Duty:

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

2. Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.
3. Use the SP communication format.
4. Discuss SP communication conversation scenarios at the evaluation stage of the
nursing process.
5. Practice SP communication that has been created by role playing.
6. 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
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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.

4. Development of Conversation Scenarios - SP Communications (according to the format to

be discussed 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 5 above.
2. During the process of playing the role of a nurse, the observer makes observations
using the therapeutic communication observation format, provides an objective
assessment and convey the results after completing the study. 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
provided. Calculate the score you got, are you satisfied with the results achieved? Repeat if
your assessment is still lacking.

SUMMARY

1) All nursing activities always use communication in nursing care by using the stages of the
communication process. The application of communication is carried out at every stage of
the nursing process starting from the assessment, Communication Skills Ability frequency =
x 100% Number of items nursing diagnosis, planning, implementation, and evaluation to
solve client / patient problems through cooperation between nurse and client / patient.

2) At each phase in the care process, the nurse must use therapeutic communication
techniques and use the communication implementation strategy including the phases of the
nurse-client therapeutic relationship starting with the preorientation phase followed by the
orientation, work, and termination phases.
Practice: 2
Therapeutic Communication Practices in Patients with Physical
Disorders
Before following this practice, ensure that you understand the basic concepts of
communication and therapeutic communication in Chapter I and understand how they
apply to each stage of the nursing process in Chapter III.

After studying Practice 2 in Chapter V, it is hoped that you will be able to develop a
communication implementation strategy (SP) and practice it with physically challenged
patients in order to meet basic human needs.

Practice 2 will provide you with an experience of how to interact and communicate with
physically impaired patients at each stage of the nursing process using communication
strategies and techniques.

After studying Practice 2, it is hoped that you will be able to:

1. developing a communication implementation strategy (SP) and practicing it with

physically impaired patients using the assessment stage communication strategies
and techniques;
2. developing communication implementation strategies (SP) and practicing them with
physically impaired patients using diagnostic stage communication strategies and
techniques;
3. developing communication implementation strategies (SPs) and practicing them with
physically impaired patients using the planning stage communication strategies and
techniques;
 4. developing a communication implementation strategy (SP) and practicing it with
physically impaired patients using the implementation stage communication
strategies and techniques;
5. developing a communication implementation strategy (SP) and practicing it with
physically impaired patients using the evaluation stage communication strategies
and techniques.

Description (Theory)

The nursing process is a scientific and systematic method for solving client problems, both
physical, psychological (mental), and with special needs through collaboration between
nurses and clients with the stages of assessment, nursing diagnosis, planning,
implementation and evaluation.

In the assessment, nurses are required to be able to communicate well verbally and to
observe nonverbal behaviour and interpret the results of observations in the form of
problems. After the data is collected, then communicated in verbal language to clients or
other health teams and communicated in writing (documented) to be communicated to
other health teams and as a legal aspect of nursing care.

Patients who have physical problems / disorders due to disturbed body systems will disrupt
basic human needs. As a holistic being, if the patient has physical problems, it will disrupt
their psychological and social needs. A nurse must be able to recognize various physical
problems that have an impact on not meeting basic human needs in order to provide
holistic nursing care with the nursing process approach as described and practiced in
Practice 1 Chapter V.

At this stage of the nursing assessment (data collection), communication is carried out to
clarify data and conduct analysis before determining the client's nursing problem. In the
planning phase, an important activity for the nurse to do is to discuss the plan that has been
prepared by the nurse and with the client to determine the success criteria to be achieved.
At the implementation stage, the important thing that nurses must do is to provide
adequate information to patients before carrying out the action, including in givinginformed
consent. At the evaluation stage, the nurse assesses the success of the care and nursing
actions that have been carried out. All results are recorded in the client's care progress
logbook, discuss the results with the client, ask the client for responses to the success or
failure of the actions taken, and together with the client plan follow-up nursing care.

Exercise 1: Therapeutic Communication Practices in Patients with Physical Disorders in the

Assessment phase

Case Illustration

The following are cases related to physical disturbances that have an impact on not meeting
oxygen needs (impaired oxygen demand).

A female client named Mrs. Neny, aged 40, was escorted by her family to the hospital
complaining of shortness of breath. Mrs. Neny complained that she had been coughing for
more than a week and today was added to the tightness that is getting worse accompanied
by discomfort in her chest. Client condition: looks pale, there is nostril breathing, respiration
rate more than 20x / minute.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss conversation scenarios for SP communication at the assessment stage of

the nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, family models, and the role of the nurse, as
well observer (according to the scenario to be developed).

4. Development of conversation scenarios (according to format)

1. The orientation phase

2. Work phase
3. The termination phases
Example of SP Communication Scenarios
IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient's Condition

Ms. Neny's patient, age 40 years old MRS with complaints of shortness of breath. Mrs. Neny
complained that she had been coughing for more than a week and today was added to the
tightness that is getting worse accompanied by discomfort in her chest. Client condition:
looks pale, there is nostril breathing, respiration rate more than 20x / minute.

Orientation Phase: (therapeutic greeting, evaluation / validation and contract)

Nurse: “Good morning, ma'am. Assalamualaikum".

Client: Answer client greetings

Nurse: “How are you feeling today? Mother looks fresh and prettier than usual ”.
Client: The client's response to his feelings and reward given by the nurse.
Nurse: “My goal for coming to you is to do a nursing examination / assessment to get data
related to respiratory problems that occur to you. The examination that I will do will take
approximately 15 minutes, I hope you can cooperate with me during the examination /
study I do”.

Client: Client response related to agreement in the contract performed.

Nurse: "Only in this bed and you can keep resting so you don't get cramped".
Client: Client response: nod or say "Yes".

Work Phase (related to the examination to be carried out)

Nurse: "Tell me about the time when you feel your shortness of breath getting worse" (wait
for client response). "Try to identify at what time the tightness you feel is getting heavier"
(wait for client response). "Was the mother's cough not accompanied by shortness of breath
before?" (wait for client response). "If you feel tight, what impact will you feel the hardest?"
(wait for client response).

Client: Responses related to nurse questions.

Nurse: “Now I will do a breath sound check using a stethoscope. Please you can cooperate
with me. Please Mother lie on your back. Come on, I will help to arrange a comfortable
position for you.

How is your current position comfortable for you? "

Client: Client response.

Nurse: "Excuse me, yes, ma'am, I will take off the top and examine the lungs. Take a deep
breath. Then, exhale and so on”.
Termination phase

Nurse: "Very well, Mother, thank you for being able to work with me in order to collect data
on maternal respiratory problems".

Client: Client response.

Nurse: "How will you feel after this examination?"

Client: Client response.

Nurse: “I will analyse your data to determine your nursing diagnosis and consult your doctor
about its treatment the best to Mother. Next, I will draw up a nursing care plan and will
come back to see the mother to discuss it”.

Client: Client response.

Nurse: "Very well, ma'am. Later, I'll be back in 10 minutes, thank you, yes. Good morning.
Assalamualaikum".

Nurse: Client answers.

IMPLEMENTATION

1. Perform role playing alternately using SP communication to the patient 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.

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: Therapeutic Communication Practice in Patients with Physical Disorders
Diagnosis Phase

Case Illustration

The following are cases related to physical disturbances that have an impact on not meeting
oxygen needs (impaired oxygen demand).

A female client named Mrs. Neny, aged 40 years, her family escorted to the hospital
complaining of shortness of breath. Mrs. Neny complained that she had been coughing for
more than a week and today was added to the tightness that is getting worse accompanied
by discomfort in her chest. Client condition: looks pale, there is nostril breathing, respiration
rate more than 20x / minute.

Duty:

 Form small groups (3-4 people).

 Determine their respective roles as patient models, family (models), and nurse
roles, as well observer.

 Use the SP communication format.

 Discuss SP communication conversation scenarios at the diagnostic stage of the

nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.

4. Development of Conversation Scenarios - SP Communications

(Format the nurse-patient conversation to be discussed as a group).

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

B. IMPLEMENTATION

1. Take turns playing the role using SP communication that the group has developed
based on the case illustration 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
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 3: Therapeutic Communication Practices in Patients with Physical Disorders

Planning Phase

Case Illustration
The following are cases related to physical disturbances that have an impact on not meeting
oxygen needs (impaired oxygen demand).

A female client named Mrs. Neny, aged 40, was escorted by her family to the hospital
complaining of shortness of breath. Mrs. Neny complained that she had been coughing for
more than a week and today was added to the tightness that is getting worse accompanied
by discomfort in her chest. Client condition: looks pale, there is nostril breathing, respiration
rate more than 20x / minute.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each as: patient model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss SP communication conversation scenarios at the planning stage of the

nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.
4. Development of Conversation Scenarios - SP Communications (Format the nurse-patient
conversation in a 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 3 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 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
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 4: Therapeutic Communication Practices in Patients with Physical Disorders

Implementation Phase

Case Illustration
The following are cases related to physical disturbances that have an impact on not meeting
oxygen needs (impaired oxygen demand).

A female client named Mrs. Neny, aged 40, was escorted by her family to the hospital
complaining of shortness of breath. Mrs. Neny complained that she had been coughing for
more than a week and today was added to the tightness that is getting worse accompanied
by discomfort in her chest. Client's condition: looks pale, there is nostril breathing,
respiration rate more than 20x / minute.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each patient as model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss SP Communication conversation scenarios at the implementation stage of

the nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well
observer.

4. Development of Conversation Scenarios - SP Communications (Format the nurse-patient

conversation to be discussed as a group).
 1. Orientation phase
2. Work phase
3. Termination phase

B. IMPLEMENTATION

1. Take turns playing the role using SP communication that the group has developed
based on the illustration of the elderly case in exercise 4 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 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
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 5: Therapeutic Communication Practices in Patients with Physical Disorders

Evaluation Phase

Case Illustration

The following are cases related to physical disturbances that have an impact on not meeting
oxygen needs (impaired oxygen demand).

A female client named Mrs. Neny, aged 40, was escorted by her family to the hospital
complaining of shortness of breath. Mrs. Neny complained that she had been coughing for
more than a week and today was added to the tightness that is getting worse accompanied
by discomfort in her chest. Client condition: looks pale, there is nostril breathing, respiration
rate more than 20x / minute.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each patient as model, family (model) and the role of the
nurse, as well observer.

 Use the SP communication format.

 Discuss SP communication conversation scenarios at the evaluation stage of the

nursing process.

 Practice SP communication that has been created by role playing.

 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
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. The division of roles

1. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, as well

observer.

4. Development of Conversation Scenarios - SP Communications (Format the nurse-patient

conversation in a 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 5 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 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
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. All maintenance activities always use communication. The application of

communication is carried out at every stage of the nursing process starting from
assessment, nursing diagnosis, planning, implementation, and evaluation to solve
client / patient problems with physical disorders in order to meet basic human needs
through cooperation between nurses and clients / patients.
2. At each phase in the care process, the nurse must use therapeutic communication
techniques and use communication implementation strategies including phases of
nurse-client therapeutic relationships starting with the preorientation phase
followed by the orientation, work, and termination phases.
Practice: 3
Therapeutic Communication Practices in Patients with Special Needs
Mental Disorders
Before joining this practical, make sure that you understand the basic concepts of
communication and therapeutic communication and understand how they apply in the
theory chapter.

After studying Practice 3 in Chapter V, it is hoped that you will be able to develop a
communication implementation strategy (SP) and practice it with patients with mental
disorders.

Practice 3 will provide you with experiences about how to interact and communicate with
patients with mental disorders at each stage of the nursing process using communication
strategies and techniques.

After learning Practice 3, it is hoped that you will be able to:

1. developing a communication implementation strategy (SP) and practicing it in

patients with mental disorders using the assessment stage communication strategies
and techniques;
2. developing communication implementation strategies (SP) and practicing them in
patients with mental disorders using diagnostic stage communication strategies and
techniques;
3. developing a communication strategy implementation (SP) and practicing it on
patients with mental disorders using the planning stage communication strategies
and techniques;
4. developing communication implementation strategies (SP) and practicing them in
patients with mental disorders using communication strategies and techniques at
the implementation stage;
5. develop a communication strategy implementation (SP) and practice it in patients
with mental disorders using the evaluation stage communication strategies and
techniques.

Description (Theory)
The nursing process is a scientific and systematic method for solving client problems, both
physical and psychological (mental) through cooperation between the nurse and client with
the stages of assessment, nursing diagnosis, planning, implementation, and evaluation.

In the assessment, nurses are required to be able to communicate well verbally and to
observe nonverbal behaviour and interpret the results of observations in the form of
problems. After the data is collected, then communicated in verbal language to clients or
other health teams and communicated in writing (documented) to be communicated to
other health teams and as a legal aspect of nursing care.

Patients with mental disorders need special strategies and communication skills. The
application of communication to patients with mental disorders and special needs is
important because communication is the main work tool in changing behaviour. The
application of communication in the two conditions above is difficult and requires patience,
acceptance, and special techniques. If we have difficulty achieving communication
effectiveness, then communication can be done unilaterally or if necessary, it can be done
with the consent of the family.

At this stage of the nursing assessment (data collection), communication is carried out to
clarify the data and conduct analysis before determining nursing problems with the patient
and family. In the planning phase, an important activity for the nurse to do is to discuss the
plan that has been prepared by the nurse and with the patient / family and determine the
success criteria to be achieved. At the implementation stage, the important thing that
nurses must do is to provide adequate information to patients before carrying out the
action, including in givinginformed consent. At the evaluation stage, the nurse assesses the
success of the care and nursing actions that have been carried out. All results are recorded
in the client's care progress logbook, discuss the results with the client, ask the client for
responses to the success or failure of the actions taken, and together with the client plan
follow-up nursing care.

Exercise 1: Therapeutic Communication Practices in Mental Disorders Assessment Phase

Case Illustration

The following are cases related to mental disorders.

A female patient named Neny, age 20, was escorted by her mother to the house

sick with complaints are often alone, do not want to hang out with other people, and
sometimes cry for no reason. This condition occurs after the patient broke up with his
girlfriend. During the assessment, the patient always avoids, cannot sit opposite, and stares
at the other person and sometimes locks himself in the room.

Duty:

 Form small groups (3-4 people).

 Determine the roles of each patient as model, family (model) and the role of the
nurse, as well observer.
  Use the SP communication format.

 Discuss conversation scenarios for SP communication at the assessment stage of

the nursing process.

 Practice SP communication that has been created by role playing.

 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
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. Form groups.
2. Defining roles: patient models, family models, and the role of the nurse, as
well observer (according to the scenario to be developed).
4. Conversation Scenario Development (according to Format)

a. Orientation phase.

1. Work phase.
2. Termination phase.

Examples of Communication Strategies for the Assessment Phase

IMPLEMENTATION STRATEGY (SP) COMMUNICATION

Patient's Condition

A female patient named Neny, aged 20 years, was escorted by her mother to the hospital
complaining that she was often alone, did not want to hang out with other people, and
sometimes cried for no reason. This condition occurs after the patient broke up with his
girlfriend. During the assessment, the patient always avoids, cannot sit opposite, and stares
at the other person and sometimes locks himself in the room.
Nursing Diagnosis / Problems:

 Withdraw.

Nursing Plan:

1. Build a trusting relationship.

2. Assess the cause of patient withdrawal.
3. Identify the patient's strengths and weaknesses.

Purpose:

 Patients can develop the ability to interact with other people.

SP Communications
Orientation Phase: (therapeutic greetings, evaluation / validation, and contracts)

Nurse: “Good morning, Ma'am. Assalamualaikum".

Patient: (Shut up and avoid).
Nurse: "How are you feeling today, Ma'am Neny?" "I can see that Ms. Neny looks less
enthusiastic today".
Patient: (Silence and avoiding / not staring at the other person).
Nurse: “My goal for coming to Mbak Neny is to do a nursing assessment to get data related
to Mbak Neny's problem. The examination that I will carry out will take approximately 15
minutes, I hope Mbak Neny can work together well”.

Patient: (Pause).
Nurse: Just put it in the garden so it's more relaxed.

Patient: (Pause).

Work Phase: (related to the examination to be carried out)

Nurse: "Tell me what happened so that you always stay away from other people?"

Patient: “I'm stupid. All stupid. Traitor".

Nurse: "I understand the problem that happened to Ms. Neny, but the problem will not be
resolved by just being quiet".

Patient: (Patient response is silent).

Nurse: "Tell me what caused Ms. Neny to shut herself up and not want to talk to other
people".

Patient: "I just want to die for what life if to be betrayed".

Nurse: “I really understand your feelings, Ma'am. For that, I will help Mbak Neny ”.

Patient: “My girlfriend left me. He's bad. He is now with my best friend”.

Termination Phase:

Nurse: “Very well, thank you, for being able to work with me in collecting data on the
problem of Ms. Neny. After I learned, the cause of Mbak Neny's problem was that her
boyfriend left her? "

Patient: (Pause).

Nurse: "Ms. Neny must be patient and improve good problem-solving skills, seek more
busyness, and improve communication".

Patient: "What should I do?"

Nurse: "You have to learn to accept reality and increase your activity".

Patient: (Pause).

Nurse: “How does he feel now? I concluded that the reason you were alone was feeling
angry because your boyfriend left you alone. Mbak has a problem of grieving (depression)
and must be addressed”.

Patient: (Pause).

Nurse: "We have to meet again, in 1 hour I will come again to help you plan actions to solve
this problem".
Patient: "Whatever".
Nurse: “Where's the good place? What time is it?"
Patient: "Yes".
Nurse: "After this meeting you should try to be open and start talking to other people
again".

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

Referring to the case illustration in Exercise 1, continue to develop communication SPs for
the following exercises such as the examples in the assessment phase and the
communication phase.

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

Exercise 2: Therapeutic Communication Practices in Mental Disorders Diagnostic Phase

Exercise 3: Therapeutic Communication Practices in Mental Disorders Planning Phase

Exercise 4: Therapeutic Communication Practices in Mental Disorders Implementation Phase

Exercise 5: Therapeutic Communication Practices in Mental Disorders Evaluation Phase

Next, do practice by doing role play role play according to the SP that has been developed
by following the following activity steps.

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. Form groups.
2. Defining roles: patient models, mother models, and nurse roles, or others
according to the scenario.
3. Observer.
4. Conversation Scenario Development - SP Communications

(Format the nurse-patient conversation to be discussed as a group).

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 5 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 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
provided. Calculate the score you got, are you satisfied with the results achieved? Repeat if
your assessment is still lacking.

SUMMARY
1. All maintenance activities always use communication. The application of
communication is carried out at every stage of the nursing process starting from
assessment, nursing diagnosis, planning, implementation, and evaluation to solve
the problems of clients / patients who have mental disorders.
2. At each phase in the care process, the nurse must use therapeutic communication
techniques and use communication implementation strategies including phases of
nurse-client therapeutic relationships starting with the preorientation phase
followed by the orientation, work, and termination phases.
Attachment

COMMUNICATION IMPLEMENTATION FORMATSTRATEGY (SP)

Patient's
Condition: ............................................... .................................................. ................................
.................. .............................. .................... .................................................. ...........................
.....................

Nursing
Diagnosis: ............................................... .................................................. ............ ...................
................... .................................................. ........ .......................................... .........

Nursing
Plan: ............................................... .................................................. ............ ............................
.......... .................................................. .................................................. .......... .........................
............... .................................................. .................................................. ........

Purpose: ................................................ .................................................. .................................

.............. ... .................................................. .................................................. ............................
.......

SP Communication:

Orientation
Phase: ............................................... .................................................. .......................... ...........
............. .................................................. .................................................. ........................

Therapeutic
Greetings: ............................................... .................................................. ..................... ..........
................... .................................................. .................................................. ...................

Evaluation and
validation: .............................................. .................................................. .................................
................. .

Contract:…………………………………………………………………………………………………………………… ...

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

Termination
Phase: ............................................... .................................................. .........................
Subjective / Objective
Evaluation: ............................................. .................................................. ......... .......................
.................. .................................................. .................................................. .......

Follow up
plan: .............................................. .................................................. .............. ...........................
......... .................................................. .................................................. ............

Upcoming
contract: ............................................. .................................................. .......... .........................
............... .................................................. .................................................. ...............................
................... .................................................. .................................................. ......

STANDARD OPERATIONAL PROCEDURES (SOP) /

COMMUNICATIONS IMPLEMENTATION STRATEGY (SP - COMMUNICATION)

PRECONFERENCE
Nursing major No. Document Page ..............
No. Revision ........

Defined
Fixed Procedure
Made by: Chairman
Nursing major:
Published date
February 2010
Is a strategy used by nurses in carrying out the process / care for mental
disorders clients through stages / phases of interaction starting from the
Definition
pre-interaction, orientation, work, and termination phases using
therapeutic communication techniques.
1. Direct nurse communication to stay focused on goals
Purpose 2. Provide nursing therapy through a communication model

1. Implementation of standards of care

2. Application of professional nursing practice
Policy
3. Application of communication models in mental nursing

Officer  Generalist nurse Mental nurse

Preparation: Pre-interaction / pre-orientation phase
1. Explore feelings of self, fear, and fantasy
2. Analyse self-professional strengths and limitations
1. Preparation of
3. Get initial data about clients
the nurse and
4. Make meeting plans / contracts with clients
patient
(activity, time and place)
2. Preparation of 1. Note book / client status (mental nursing assessment format)
 2. ballpoint (pen)
3. The client and the nurse sit opposite to take a therapeutic
tools and places distance (± 70 cm)
4. The room is comfortable and conducive

Orientation Phase:

1. Give therapeutic greetings, introduce yourself and ask / say the name
Procedure / Steps of the client (while shaking the client's hand)

2. Evaluation / Validation:
 Ask the client's current feelings

PRECONFERENCE
Nursing major Page ..............
No. Document No. Revision ........

Fixed Procedure Defined

Made By: T Chairman
Date of issue: Nursing major:
 Perform Validation (cognitive, affective and psychomotor) 3.
Contract:

 Explain the purpose of the meeting (according to the plan)

 Perform a time contract (15-20 minutes)

 Perform a place contract

Work Phase:

1. Ask client complaints and explore the client's reasons for

asking for help / assistance
2. Explore the client's thoughts, feelings and actions
3. Provide open communication, trust and acceptance of the
client for what it is
4. Identify the problem with the client and give the client the
opportunity to conclude the problem and provide
reinforcement
5. Give clients a chance to ask questions and give reinforcement

Termination Phase:

6. Objective / subjective evaluation:

 Ask the client's feelings after the interaction / meeting
  Evaluation of meeting results related to meeting objectives

7. Describe the follow-up plan after the meeting

8. Do it for an upcoming meeting (upcoming contract)
9. End interactions / communications with greetings and shaking
hands.

1. Implementation of communication in accordance with the

phases of interaction
Evaluation and 2. Record the results of interactions / actions on the client's
Documentation nursing status
3. Communicate results to clients / family