English for Nursing

Problems encountered by Indonesian

Nurses in Caring Foreign In-patients
 How to overcome
communication problem
Problems of local nurses:

 Local nurses speaks with limited abilities

 Local nurses know very little about the
culture of the patients.
 They share very limited information
 They cannot build patients’ trust
 Miscommunication frequently takes place.
 The Patient Perspectives
“On the unit in particular, I don‟t remember being called by my
name in the six days I was there. They asked me what name I
would like to be called and I told them but they didn‟t use it.”
***
“I felt like I was interrupting them when I asked for help.”
***
“There was one nurse who was really rude. I had an epidural and I
couldn’t feel my legs so I got scared, but this other nurse just
said, “Relax and enjoy that your pain is relieved.”
***
“I was treated badly by a nurse. I would have wanted to complain,
but there is no way to do that. You don’t want to jeopardize your
care. It would be nice if there was a way to get the message
across that this nurse needs some attention for her behavior.”
 The following guidelines developed by
Northern Westchester Hospital can
assist caregivers in setting the stage
for effective communication:
Prepare yourself for the optimal
exchange:
 I will give this patient my full attention.
 I will truly listen to what my patient is
saying before I respond.
 Continued
Create an environment that enhances a true exchange and
connection:
 I will acknowledge the patient by the name they prefer to be
called.
 I will introduce myself and will share some information about me.
 I will sit near my patient, rather than stand.
 I will make eye contact with my patient.
 I will be aware of my body language and its subconscious meaning.
 I will, whenever possible, reassure my patient through the power of
touch.
 I will repeat what my patient has asked me to ensure my
understanding of their question.
 I will engage family members present, recognizing their important
role in the care of the patient.
 Therapeutic Communication Techniques
Nursing practice is equipped with a strong basis of
communication skill.

“Therapeutic communication promotes

understanding that helps establish a constructive
relationship between the nurse and the client
(Berman et.al: 2008, p. 467)”.

Unlike the social relationship where there may not

be a specific purpose or direction, the therapeutic
helping relationship is client and goal directed.
 Nontherapeutic
Communication Techniques
 D-iscourages expression of feelings
 O-verwhelming the patient/client
 A-rguing with the client
 L-limiting the ideas, opinions, of the
client
 T-hreatening the client
 J-udgmental
 Nurse’s Profile
 Reinata Krisna Adinda
 Career: Carreworker at Yonezu
Rojinhoken Shisetsu
 Educational Background: Bachelor
Degree -- Stikes Hang Tuah Surabaya
 International Experience: A participant
of Student Exchangge Stikes Hang
Tuah Surabaya and Srimahasarakham
Nursing College
Academic Exchange
Indonesia – Thailand 2014
 Ernawati Sihombing

 Career: Careworker at National Hospital

Surabaya
 Educational Background: D3 Degree --
Stikes Hang Tuah Surabaya
• Sitting quietly (or walking with the client)
and waiting attentively until the client is able
Example
to put thoughts and feelings into words.
• Accepting pauses or silences that may extend
for several seconds or minutes without Descriptio
n
interjecting any verbal response.
Using Silence
 • "Can you tell me how it is for you?"
• "Perhaps you would like to talk about... " Example
• "Would it help to discuss your feelings? "
• "Where would you like to begin?"
• "And then what?“
• Using statements or questions that (a) encourage the
client to verbalize,(b) choose a topic of Descriptio
conversation, and (c) facilitate continued n
verbalization.
Providing General Leads
 • "Rate your pain on a scale of 0-10." (specific
statement)
• "Are you in pain?" (general statement) Example
• "You seem unconcerned about your diabetes."
(tentative statement)
• "You don't care about your diabetes and you never
will."
• (absolute statement)
• Making statements that are specific rather than
Descriptio
general, and tentative rather than absolute. n
Being Specific and Tentative
 • "I'd like to hear more about that."
• "Tell me about.... "
• "How have you been feeling lately?" Example
• "What brought you to the hospital?"
• "What is your opinion?"
• "You said you were frightened yesterday.
How do you feel now?“
• Asking broad questions that lead or invite the client to explore
(elaborate, clarify, describe, compare, or illustrate) thoughts or
feelings. Open-ended questions specify only the topic to be Descriptio
n
discussed and invite answers that are longer than one or two
words.
Questions
Using Open-Ended
 • Putting an arm over the client's Example
shoulder. Placing your hand over
the client's hand.
• Providing appropriate forms of touch to reinforce caring
feelings. Because tactile contacts vary considerably among Descriptio
individuals, families, and cultures, the nurse must be sensitive n
to the differences in attitudes and practices of clients and self.
Using Touch
 • Client: "I couldn't manage to eat any dinner last
night— not even the dessert."
• Nurse:"You had difficulty eating yesterday." Example
• Client:"Yes, I was very upset after my family left."
• Client:" I have trouble talking to strangers."
• Nurse:"You find it difficult talking to people you do
not know?“
• Actively listening for the client's basic message and then
repeating those thoughts and / or feelings in similar words.
This conveys that the nurse has listened and understood the Descriptio
n
client's basic message and also offers clients a clearer idea of
what they have said.
Restating or Paraphrasing
 • "I'm puzzled."
• "I'm not sure I understand that."
• "Would you please say that again?" Example
• "Would you tell me more?"
• "I meant this rather than that."
• "I'm sorry that wasn't very clear. Let me try to
explain another way.“
• To clarify the message, the nurse can restate the basic message
or confess confusion and ask the client to repeat or restate the Descriptio
message. Nurses can also clarify their own message with n
statements.
Seeking Clarification
 • Client: "My husband never gives me any presents."
• Nurse: "You mean he has never given you a present Example
for your birthday or Christmas?"
• Client:"Well—not never. He does get me something
for my birthday and Christmas, but he never thinks
of giving me anything at any other time.“
• A method similar to clarifying that verifies the meaning of Descriptio
specific words rather than the overall meaning of a message. n
consensual Validation
Perception checking or seeking
 • "I'll stay with you until your daughter
arrives."
• "We can sit here quietly for a while; we Example
don't need to talk unless you would like
to."
• "I'll help you to dress to go home, if you
like.“
• Suggesting one's presence, interest, or wish to understand the
client without making any demands or attaching conditions Descriptio
that the client must comply with to receive the nurse's n
attention.
Offering Self
 • "Your surgery is scheduled for 11AM
tomorrow."
• "You will feel a pulling sensation when Example
the tube is removed from your
abdomen."
• "I do not know the answer to that, but I
will find out from Mrs. King, the nurse
in charge.“
• Providing, in a simple and direct manner, specific factual
information the client may or may not request. When Descriptio
Information is not known, the nurse states this and indicates n
who has it or when the nurse will obtain it.
Giving Information
 • "You trimmed your beard and mustache
and washed your hair." Example
• "I notice you keep squinting your eyes.
Are you having difficulty seeing?"
• "You walked twice as far today with
your walker.“
• Giving recognition, in a non judgmental way, of a change in
behavior, an effort the client has made, or a contribution to a Descriptio
communication. Acknowledgment may be with or without n
understanding, verbal or non verbal.
Acknowledging
 • Client:"I vomited this morning."
• Nurse:"Was that after breakfast?" Example
• Client: "I feel that I have been a sleep
for weeks."
• Nurse:"You had your operation Monday,
and today is Tuesday.“
• Helping the client clarify an event, situation,
Descriptio
or happening in relationship to time. n
Clarifying Time or Sequence
 • "That telephone ring came from
the program on television."
Example
• " I see shadows from the window
coverings."
• "Your magazine is here in the
drawer. It has not been stolen.“
• Helping the client to differentiate the real
Descriptio
from the unreal. n
Presenting Reality
 • Client:"My wife says she will look after me,
but I don't think she can, what with the
children to take care of, and they're always Example
after her about something—clothes,
homework, what's for dinner that night."
• Nurse:"Sounds like you are worried about
how well she can manage.
• Helping the client expand on and develop a topic of importance. It is
important for the nurse to wait until the client finishes stating the main
concerns before attempting to focus. The focus may be an idea or a Descriptio
feeling; however, the nurse often emphasizes a feeling to help the n
client recognize an emotion disguised behind words.
Focusing
 • Client:"What can I do?"
• Nurse:"What do you think would be
helpful?" Example
• Client:"Do you think I should tell my
husband?"
• Nurse:"You seem unsure about telling
your husband.
• Directing ideas, feelings, questions, or content back
to clients to enable them to explore their own ideas Descriptio
n
and feelings about a situation.
Reflecting
 • "During the past half hour we have talked about... "
• "Tomorrow afternoon we may explore this further." Example
• "In a few days I'll review what you have learned
about the actions and effects of your insulin."
• "Tomorrow, I will look at your feeling journal."
• Stating the main points of a discussion to clarify the relevant
points discussed. This technique is useful at the end of an Descriptio
interview or to review a health teaching session. It often acts n
as an introduction to future care planning.
Summarizing and Planning
 Review on Therapeutic
Communication Techniques
1. Using Silence
2. Providing General Leads
3. Being Specific and Tentative
4. Using Open-Ended Questions
5. Using Touch
6. Restating or Paraphrasing
7. Seeking Clarification
8. Perception checking or seeking consensual Validation
9. Offering Self
10. Giving Information
11. Acknowledging
12. Clarifying Time or Sequence
13. Presenting Reality
14. Focusing
15. Reflecting
16. Summarizing and Planning
 Preparing for the Course
 Divide the class into 12 groups.
 Each group will have to learn about the topic assigned.
 Each meeting one group will be invited to present the
topic.
 Each presentation must consist of 4 parts, i.e.:
1. Discuss about the vocabulary you learn concerning the
topics
2. Illustration of the topic e.g., telling a case about a
patient’s problem.
3. Make a role play based on your topic.
4. Discuss the therapeutic communication techniques used
in your conversation.
 Check Your Understanding
 "What brought you to the hospital?“

 Client:" I have trouble talking to strangers."

Nurse:"You find it difficult talking to people you do not know?“

 Client: "My husband never gives me any presents."

Nurse: "You mean he has never given you a present for your
birthday or Christmas?"

 "You seem unconcerned about your diabetes.“

 Client:"I vomited this morning."

Nurse:"Was that after breakfast?"
 "You trimmed your beard and mustache and washed your hair.“
 "During the past half hour we have talked about... "
 "I'll help you to dress to go home, if you like.“
 "Would it help to discuss your feelings? “
 "I'm not sure I understand that.“
 "Your surgery is scheduled for 11AM tomorrow.“
 "Your magazine is here in the drawer. It has not been stolen.“

 Client:"What can I do?"

Nurse:"What do you think would be helpful?"