ENGLISH ARTICLE

EFFECTIVE NURSING COMMUNICATION

Arranged to fulfill the English Assigment V
Lecturer : Moh. Mahmud, SPd., MPd

Created By :
Group 8
Class 3A

1. Siti A’isyah
2. Tyania Awalia M.

NURSING DEPARTEMENT
MINISTRY OF HEALTH POLYTECHNIC SEMARANG
2020/2021
 Effective Nursing Communication

Abstract

Nurses are critical in the delivery of essential health services and are core in strengthen- ing the
health system. They bring people-centred care closer to the communities where they are needed
most, thereby helping improve health outcomes and the overall cost-efectiveness of services. Nurses
usually act as irst responders to complex humanitarian crises and disasters, protectors and advocates
for the community and communicators and co-ordinators within teams. Communication is a core
component of sound relation- ships, collaboration and co-operation, which in turn are essential
aspects of professional practice. The quality of communication in interactions between nurses and
patients has a major inluence on patient outcomes. Increases in nursing communication can lessen
medical errors and make a diference in positive patient outcomes. This chapter explores how efective
communication and interpersonal skills can enhance professional nursing practice and nursing
relationships with various stakeholders. It explains principles of communication, communication
process, purpose of communication, types of communi- cation, barriers to efective communication,
models of communication and strategies of improving communication and guidelines for successful
therapeutic interactions.

1. Introduction
Nurses are critical in the delivery of essential health services and are core in strengthening the
health system. They bring people-centred care closer to the communities where they are needed
most, thereby helping improve health outcomes and the overall cost-efectiveness of services.
Nurses usually act as irst responders to complex humanitarian crises and disasters; protectors
and advocates for the community and communicators and co-ordinators within teams.
Communication skills for nurses are essential but may be diicult to master.
Communication is the exchange of information between people by sending and receiving it
through speaking, writing or by using any other medium. Clear communication means that
information is conveyed efectively between people. To be a successful nurse, excellent com-
munication skills are required. Nurses speak to people of varying educational, cultural and social
backgrounds and must do so in an efective, caring and professional manner, espe- cially when
communicating with patients and their families. The quality of communication in interactions
 between nurses and patients has a major inluence on patient outcomes. This inluence can play a
very important role in areas such as patient health, education and adher- ence. Good
communication plays an important role in the organization’s efective function- ing. A nurse must
therefore, continuously try to improve his/her communication skills as poor communication can be
dangerous and lead to confusion.

2. Principles of communication
Principles of communication can be summarized as follows:
• Communication is a process;
• Communication is not linear, but circular;
• Communication is complex;
• Communication is irreversible; and
• Communication involves the total personality.
3. Communication process
Interaction between people is cyclic, which means that what one person says and does evokes a
reaction from the other person, and this reaction again stimulates another reaction from the irst
person. Three things are needed for successful communication. They are:
A sender;
A clear message; and
A receiver.
4. Purpose of communication
The purpose of communication is to inquire, inform, persuade, entertain, request and investigate. A
single message can have one or more of the following purposes:
• To convey information/opinion, for example, “I have headache” or “I am here to give you
medication”.
• To request information/opinion/behavior, for example, “Are you allergic to penicillin?” or
“Tell me more about the injury”.
• To give social acknowledgement, for example, “Hello” or “Good morning”.

These three primary types of messages can be combined in many ways so that they form an
interaction (conversation). The goals of the interaction can be comprehensive. Nurses strive to
make all their communication with patients therapeutic, that is, their communication is
purposefully and consciously planned to promote the patient’s health and wellbeing.
5. Types of communication
Verbal and non-verbal communications are the two main types of communication used by human
beings.
• Verbal communication
Verbal communication is associated with spoken words and is vitally important in the health-
care context. Members of the multi-disciplinary healthcare team communicate verbally with
one another and with patients as well as family members.
• Non Verbal communication
Non-verbal communication is not reliant on words. It is sent through the use of one’s body
rather than through speech or writing. This kind of communication, called body language, can
tell a great deal or can totally the wrong impression. It is worth noting that body language may
indicate a diferent meaning to what is spoken. As approximately 60% of communica- tion is
non-verbal, non-verbal skills are essential for efective communication. Often non- verbal
messages send stronger signals than verbal messages. Non-verbal communication is made up
of:

• Accent

• Bodily contact

• Direction of gaze

• Emotive tone in speech

• Facial and gestural movements

• Physical appearance

• Posture

• Proximity

• Speech errors

• Timing of speech
6. Communication process
The communication process may be explained by means of a linear model of communication,
interactive model of communication or transactional model of communication.
• Linear model of communication

Linear model of communication entails a sender, a message, a receiver and noise.

• Interactive model of communication

Interactive model of communication gives a slightly more complex explanation of the com-
munication process. Communication is seen as a process in which the listener gives feed-
back or responds to a message after a process of interpretation. A communicator creates and
interprets a message with a personal ield of expertise and/or a frame of reference.

• Transactional model of communication

Transactional model of communication acknowledges and gives emphasis to the dynamic nature of
interpersonal communication and the multiple roles of the communicators. Features such as time,
messages, noise, ields of experience, frames of reference, meanings, shared systems of com-
 municators and personal systems all pay a role in the process of communication. Communicators
often participate simultaneously (sending, receiving and interpreting). The unique interpretive and
perceptual processes of individuals thus play an essential role in the communication process.
7. Improving communication
Some ways of improving communication are as follows:

• Listen without interrupting the sender.

• Show empathy at all times and try to understand.

• Try to stay focused on the conversation. Do not however, force the patient to continue if he/
she becomes anxious or seems to wish to change the subject.

• Use the body language that indicates your interest and concern. Touch the patient if it seems
appropriate. Lean forward, listen intently and maintain eye contact if it culturally acceptable.

• Ofer factual information. This relieves anxiety. Do not ofer your personal opinion. Assure
the patient that you have professional discretion.

• Try to relect the feelings and thoughts the patient is expressing by rephrasing questions
and comments using their own words.

• Avoid unclear or misleading messages.

• Avoid giving long explanations.

• Give your co-workers your full atention when communicating with them.

• Ask questions to clarify unclear messages.

• Do not interrupt until the sender has completed the message.

• Provide a quiet environment without distractions.

• Be convincing wen communicating.

8. Communicating with patients
There are several points to be kept in mind when communicating with patients. The irst point
is that you are there to provide care and support to the patient.
• Be open, respectful and gracious in all your interactions with the patient and keep his/her
cultural preferences in mind.
• Answer nurses’ bells promptly.
 • Make sure you have the patients’ atention when communicating.
• Use words that are non-threatening – explain what you would like to do and do not give
orders to the patient.
• Use simple, understandable phrases, not medical terms as most patients do not understand these
terms.
• Speak clearly and courteously.
• Use a pleasant and normal tone of voice to the hard of hearing.
• Always stand so that the patient can see the nurse’s face when communicating, as lip read- ing
is part of all normal hearing.
• Use body language that is appropriate.
• Explain facts and procedures before donning a mask that covers the wearer’s mouth and
lower face.
• Be alert to the patient’s needs. Allow time for answers to your requests and to answer pa-
tient’s questions.
9. Communicating by phone
Nurses often communicate over the phone with patients, family members and colleagues and this
can lead to misunderstandings. The way in which the pone is answered and a message is interpreted
needs special skills because the body language of the person at the other end of the phone line
cannot be seen. When answering the phone or making a call:
• Always speak clearly into the mouthpiece of the phone.
• Ofer a greeting for example, good morning or good afternoon.
• Identify the unit or place of work.
• Identify yourself by indicating who you are and where you are phoning from.
• Identify the person to whom you are speaking.
• Politely listen to the message and make notes if you think you may not remember all the
information.
• If you are asked to call another person, note the date, time, caller’s name and telephone
number together with the message.
• Date and sign the message.
10. Assertive communication
The skill of assertiveness is important to nurses. Nurses are expected to be the patients’ advo- cates.
So, they need to have the assertive communication skills in order to be able to be patients’ advocates.
 Assertiveness enables a person to be honest with him/herself and in relationships with others.
Assertiveness helps to enhance relationships, avoid power games and is a vehicle for clear outcomes.
Hargis as cited by van Niekerk identiies four elements of assertive communication :

• Content – where the rights of the people involved are embedded gently in the statement. This
could be done by using an explanation, empathy for the listener, and praise for the listener, an
apology for the consequence for the listener or a compromise that is favorable to both people.

• Covert elements – where the speaker is able to recognize their rights and the rights of the lis-
tener in the communication process. These include respect, expressing feelings, having your
own priorities, being able to say ‘no’, being able to make mistakes and choosing to say nothing.

• Process – concerned with how people express themselves assertively. Is their body lan-
guage, intonation and choice of language relective of a conident assertive person? Are the
processes that make up communication congruent, in keeping with what is being said? The
process also involves managing the seting so that people are not embarrassed, or the noise
levels are kept to a minimum. Increasing the likelihood of assertive communication happen-
ing again involves feedback to the listener to show that their accomplishment is appreciated.

• Non-verbal cues – gesture, touch, proxemics and posture – also need to relect conidence,
regard and respect for self and others.
11. Therapeutic interactions
Therapeutic interactions are purposeful as opposed to social. Social interaction entertains the
participants, but in a professional situation, the nurse usually has a clinical objective that he/ she
wants to achieve with communication. The nurses therefore, decides on the purpose of the
interaction before or shortly after it begins. The following purposes are common in nursing :

• Assess a patient: The nurse wants to know more about a patient to identify his/her prob-
lems. This type of conversation can be a structured interview using an interview schedule.
The purpose of this conversation is always a beter understanding of the patient.

• Instruct a patient: Patient instruction may vary from an informal conversation during
which few facts are conveyed to an elaborate instruction session.

• Problem solving: If a patient discuss his/her problems with a nurse, the nurse helps the
patient to analyze the problem, consider possible alternative ways of handling it and how to
decide which way is the best. Problem solving is done with the patients and not for them.
 • Give emotional support: The presence of an empathetic nurse, that is, one who can enter
into the patient’s shoes and understand the patient’s experience, is immensely supportive of
the patient. Emotional support alleviates the loneliness of the patient’s experience of illness
and increases his/her dignity.
12. Guidelines for successful therapeutic interactions
After the purpose of the therapeutic interaction has been established, the following guidelines assist
in conducting a successful interaction:
• Maintaining a low-authority proile
The nurse must strive to maintain a low-authority proile at the beginning of the conversation.
As the conversation progresses, the nurse can use more directive techniques to ind out spe-
ciic information. There are usually diferences in age, sex, occupation, cultural background,
moral and religious convictions between the nurse and the patient. These diferences make it
impossible for the nurse to fully understand the patient’s behavior and reactions. It is there-
fore, important for the nurse to understand and accept diferences in patients’ cultures and
beliefs. When in doubt, check with the patient. If trust is established, patient will be willing to
teach the nurse.
• Use of understandable language
The nurse should determine the patient’s level of understanding and if necessary change the
use of language, comments and questions. Using the terminology which the patient does not
understand can also frighten the patient and make him/her think that he/she has a more
serious problem than he/she originally wanted help for. At the same time, the patient could
give incorrect information because due to confusion, he/she may give airmative answers to
questions about symptoms that he/she has not actually experienced. Nurses should share
their aims with patients before expecting them to participate in the interaction. They should
understand that there is a mutual understanding of each other’s point of departure. In an
assessment interview, the nurse can, for instance, say: “Mr Jones, I would like to give you
information on how to lose weight so as to bring down you high blood pressure, but I irst
need to ind out what you already know about the condition”. It is not only important that the
patients understand what nurses expect from the conversation; it is also essential that nurses
understand the patients and convey this understanding before they participate in the
conversation. When providing emotional support, this understanding is often all that is
necessary. For nurses to understand patients, they must encourage them to talk – not just
 about facts, but also about their feelings. The nurse must listen more than speak, both to
what the patient is saying verbally and what is being said non-verbally. Having listened
carefully, the nurse then concentrates and responds empathetically to the patients’ feelings.
Only when the nurse has a reasonably complete understanding of the patient’s situation and
has communicated this understanding, can she proceed to interventions, such as giving
information or solving a problem.
• Tailor the message to the totality of the person
Saying something does not necessary mean that the message has been received and under-
stood. It is the responsibility of the nurse to ensure that the person with whom he/she is
conversing understands the message. To ensure this, the message has to be adapted to the
language, culture and socio-economic status of the patient. The emotional or physical condi-
tion of patients may also make it diicult for them to receive long of complicated messages or
even any message. There may also be other disturbances in the immediate environment for
example, noise that can make the patient not to hear or understand the message. The message
must also be adapted to the age of the patient.
• Validate the interpretation with the patient
Validation means that you ask the patient whether your interpretation is correct or not. You
therefore, ask him/her to conirm your understanding of what he/she said. Many mis-
understandings arise because people interpret other people’s words without checking their
interpretation. The nurse should try to eliminate misunderstandings in the conversations by
checking meaning with the patient.
• Active listening
Active listening means concentrating all your senses and thoughts on the speaker. One can
usually deduce whether a person is listening actively by looking at the following non-verbal
indicators:
- Is the eye contact maintained with the person who is speaking?
- Are the body and face turned towards the speaker? It is, of course, also clear from the
verbal responses:
- Are there regular verbal responses, even if these consist only of encouraging sounds?
- Does the response indicate understanding, not only of the facts, but also of the feelings
and the implications of the facts?
It is much easier to speak than to listen. Nurses are, in general, very active people, who want
 help b acting quickly. To ‘just listen’ without expressing opinions or ofering advice is there-
fore, often not in their nature. Active listening is a valuable skill to acquire.
• Evaluate own communication
In the interest of nurse–patient relationship, it is essential that they ascertain whether their
communication has been successful. The following criteria can be used:
- Simplicity: Say what you want to say concisely and without using diicult or unfamiliar
terms.
- Clarity: Say precisely what you want to say without digressing, and support your verbal
message with non-verbal indicators.
- Relevance: Make sure that your message suits the situation, the time and the person
you are speaking to.
- Adaptability: Adapt your response to the clues the patient that the patient gives you.
- Respect: Always show respect for the individuality and dignity of the person you
are speaking to.
 Komunikasi Keperawatan yang Efektif

Abstrak

Perawat sangat penting dalam pemberian layanan kesehatan esensial dan merupakan inti dalam
memperkuat sistem kesehatan. Sedangkan, Komunikasi merupakan komponen inti dari hubungan
yang baik, kolaborasi dan kerjasama, yang pada gilirannya merupakan aspek penting dari praktik
profesional. Kualitas komunikasi dalam interaksi antara perawat dan pasien memiliki pengaruh besar
terhadap hasil pasien. Peningkatan dalam komunikasi keperawatan dapat mengurangi kesalahan
medis dan membuat perbedaan pada hasil positif pasien.

1. Pendahuluan
Perawat sangat penting dalam memberikan layanan kesehatan esensial dan merupakan inti dalam
memperkuat sistem kesehatan. Mereka bertindak sebagai penanggap pertama terhadap krisis dan
bencana kemanusiaan yang kompleks, pelindung dan pendukung komunitas dan komunikator serta
koordinator dalam tim. Keterampilan komunikasi untuk perawat sangat penting tetapi mungkin
sulit untuk dikuasai.
Komunikasi adalah pertukaran informasi antara orang-orang dengan mengirim dan menerimanya
melalui berbicara, menulis atau dengan menggunakan media lain. Kualitas komunikasi dalam
interaksi antara perawat dan pasien memiliki pengaruh besar terhadap hasil pasien. Perawat harus
terus berusaha meningkatkan keterampilan komunikasinya karena komunikasi yang buruk dapat
berbahaya dan menyebabkan kebingungan.

2. Prinsip komunikasi
• Komunikasi adalah suatu proses.
• Komunikasi tidak linier, tetapi melingkar.
• Komunikasi itu rumit.
• Komunikasi tidak bisa diubah.
• Komunikasi melibatkan kepribadian total.

3. Tujuan komunikasi
 Tujuan komunikasi adalah untuk menanyakan, menginformasikan, membujuk, menghibur,
meminta dan menyelidiki.

4. Jenis komunikasi Komunikasi

verbal dan non verbal merupakan dua jenis komunikasi utama yang digunakan oleh manusia :
• Komunikasi verbal
Anggota tim perawatan kesehatan multidisiplin berkomunikasi secara lisan dengan satu sama
lain dan dengan pasien serta anggota keluarga.
• Komunikasi Non Verbal
Jenis komunikasi ini, yang disebut bahasa tubuh, dapat menunjukkan banyak hal atau dapat
memberikan kesan yang salah. Komunikasi non verbal terdiri dari :

 Aksen.
 Kontak tubuh.
 Arah pandangan.
 Nada emosi dalam ucapan.
 Gerakan wajah dan gestur.
 Penampilan fisik.
 Postur.
 Kedekatan.
 Kesalahan bicara.
 Waktu bicara.

5. Proses komunikasi
Proses komunikasi dapat dijelaskan dengan menggunakan model komunikasi linier, interaktif
model komunikasi atau model komunikasi transaksional :

• Model Komunikasi Linier

Model Komunikasi linier memerlukan pengirim, pesan, penerima dan kebisingan.

  Interaktif Model Komunikasi
Interaktif Model Komunikasi memberikan penjelasan yang sedikit lebih kompleks tentang
proses komunikasi. Komunikasi dipandang sebagai proses di mana pendengar memberikan
umpan balik atau menanggapi pesan setelah melalui proses interpretasi.

• Model Komunikasi Transaksional

Model Komunikasi Transaksional mengakui dan memberi penekanan pada sifat dinamis
komunikasi interpersonal dan peran ganda komunikator.

6. Meningkatkan komunikasi

• Dengarkan tanpa mengganggu pengirim.

• Tunjukkan empati setiap saat dan cobalah untuk mengerti.

• Cobalah untuk tetap fokus pada percakapan.

• Gunakan bahasa tubuh yang menunjukkan minat dan perhatian Anda.

• Berikan informasi faktual. Ini mengurangi kecemasan.

• Cobalah untuk menghubungkan perasaan dan pikiran yang diungkapkan pasien dengan
menyusun ulang pertanyaan dan komentar menggunakan kata-kata mereka sendiri.

• Hindari pesan yang tidak jelas atau menyesatkan.

 • Hindari memberikan penjelasan yang panjang.

• Berikan perhatian penuh kepada rekan kerja Anda saat berkomunikasi dengan mereka.

• Ajukan pertanyaan untuk mengklarifikasi pesan yang tidak jelas.

• Jangan mengganggu sampai pengirim menyelesaikan pesannya.

• Berikan lingkungan yang tenang tanpa gangguan.

• Bersikaplah meyakinkan saat berkomunikasi.

7. Berkomunikasi dengan pasien

• Bersikaplah terbuka, hormat, dan ramah dalam semua interaksi.
• Pastikan Anda memperhatikan pasien saat berkomunikasi.
• Gunakan kata-kata yang tidak mengancam.
• Gunakan frasa yang sederhana dan mudah dimengerti.
• Bicaralah dengan jelas dan sopan.
• Gunakan nada suara yang menyenangkan dan normal untuk orang yang sulit mendengar.
• Selalu berdiri agar pasien dapat melihat wajah perawat saat berkomunikasi, karena membaca
bibir adalah bagian dari semua pendengaran normal.
• Gunakan bahasa tubuh yang sesuai.
• Jelaskan fakta dan prosedur sebelum mengenakan masker
• Waspadai kebutuhan pasien. Berikan waktu untuk menjawab permintaan Anda dan untuk
menjawab pertanyaan pasien.

8. Berkomunikasi melalui telepon

Saat menjawab telepon atau membuat panggilan:
• Selalu ucapkan dengan jelas ke corong telepon.
• Ofer sapaan misalnya selamat pagi atau selamat siang.
• Identifikasi unit atau tempat kerja.
• Identifikasi diri Anda dengan menunjukkan siapa Anda dan dari mana Anda menelepon.
• Identifikasi orang yang Anda ajak bicara.
• Dengarkan pesan dengan sopan dan buat catatan jika Anda merasa tidak dapat mengingat
semua informasi.
 • Jika Anda diminta untuk memanggil orang lain, catat tanggal, waktu, nama pemanggil dan
telepon nomor bersama dengan pesannya.
• Tanggal dan tanda tangani pesannya.

9. Komunikasi asertif
Perawat diharapkan menjadi advokat pasien. Jadi, mereka perlu memiliki keterampilan
komunikasi yang tegas agar bisa menjadi advokat pasien. Hargis sebagaimana dikutip van
Niekerk mengidentifikasikan empat elemen komunikasi tegas:

• Konten

Hak-hak orang yang terlibat tertanam dengan lembut dalam pernyataan tersebut. Hal ini
dapat dilakukan dengan menggunakan penjelasan, empati untuk pendengar, dan pujian
untuk pendengar, permintaan maaf atas konsekuensi pendengar atau kompromi yang
menguntungkan kedua orang.

• Unsur-unsur terselubung

Pembicara dapat mengenali hak-haknya dan hak-hak pendengarnya dalam proses

komunikasi. Ini termasuk rasa hormat, mengungkapkan perasaan, memiliki prioritas sendiri,
mampu mengatakan 'tidak', mampu membuat kesalahan dan memilih untuk tidak
mengatakan apa-apa.

• Proses

Apakah proses yang membentuk komunikasi kongruen, sesuai dengan apa yang dikatakan?
Prosesnya juga melibatkan pengelolaan seting sehingga orang tidak malu, atau tingkat
kebisingan dijaga seminimal mungkin.

• Isyarat non-verbal

Isyarat, sentuhan, proxemik dan postur - juga perlu berhubungan dengan kepercayaan diri,
penghargaan dan penghargaan untuk diri sendiri dan orang lain.

10. Interaksi terapeutik

Interaksi terapeutik memiliki tujuan dan bukan sosial. Tujuan berikut ini umum dalam
keperawatan:
 • Menilai pasien: Perawat ingin tahu lebih banyak tentang pasien untuk mengidentifikasi
masalahnya.

• Instruksikan pasien: Instruksi pasien mungkin berbeda dari percakapan informal selama
beberapa fakta disampaikan ke sesi instruksi yang rumit.

• Pemecahan masalah: Jika pasien mendiskusikan masalahnya dengan perawat, perawat

membantu pasien untuk menganalisis masalah, mempertimbangkan kemungkinan cara
alternatif untuk menanganinya dan bagaimana memutuskan cara mana yang terbaik.

• Berikan dukungan emosional: Kehadiran perawat yang berempati, yaitu yang bisa masuk
ke dalam posisi pasien dan memahami pengalaman pasien, sangat mendukung pasien.
Dukungan emosional mengurangi rasa kesepian dari pengalaman pasien sakit dan
meningkatkan martabatnya.

11. Panduan untuk interaksi terapeutik yang berhasil

Setelah tujuan interaksi terapeutik ditetapkan, pedoman berikut membantu dalam melakukan
interaksi yang berhasil:
• Mempertahankan proil otoritas rendah
Saat percakapan berlangsung, perawat dapat menggunakan teknik yang lebih direktif untuk
mengetahui informasi khusus.
• Penggunaan bahasa yang dapat dimengerti
Perawat harus menentukan tingkat pemahaman pasien dan jika perlu mengubah penggunaan
bahasa, komentar dan pertanyaan.
 Menyesuaikan pesan dengan totalitas orang tersebut.
Mengatakan sesuatu tidak berarti bahwa pesan tersebut telah diterima dan dipahami
Merupakan tanggung jawab perawat untuk memastikan bahwa orang yang dengannya dia
berada bercakap-cakap memahami pesannya.
 Validasi interpretasi dengan pasien
Validasi berarti Anda bertanya kepada pasien apakah interpretasi Anda benar atau tidak.
Oleh karena itu, Anda meminta dia untuk menegaskan pemahaman Anda tentang apa yang
dia katakan.
 Mendengarkan secara aktif
 Mendengarkan secara aktif berarti memusatkan semua indra dan pikiran Anda pada pembicara.
• Evaluasi komunikasi sendiri
Untuk kepentingan hubungan perawat-pasien, penting bagi mereka untuk memastikan
apakah Komunikasi berhasil. Kriteria berikut dapat digunakan:
- Kesederhanaan: Katakan apa yang ingin Anda katakan dengan singkat dan tanpa
menggunakan diicult atau unfamiliar istilah.
- Kejelasan: Katakan dengan tepat apa yang ingin Anda katakan tanpa menyimpang, dan
dukung pesan verbal Anda dengan indikator non-verbal.
- Relevansi: Pastikan pesan Anda sesuai dengan situasi, waktu, dan orang Anda sedang
berbicara dengan.
- Adaptabilitas: Sesuaikan respons Anda terhadap petunjuk pasien yang diberikan pasien
kepada Anda.
- Respect: Selalu tunjukkan rasa hormat terhadap individualitas dan martabat yang diajak
bicara.
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