CHAPTER I
INTRODUCTION
1.1 Background
Chronic illness is the irreversible presence, accumulation or latency of disease states or impairments that involve the total human environment for supportive care, maintenance of function and prevention of further disability. Chronic conditions are having one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision and care. Patient-professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct "disease worlds" among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions.
The prevalence of chronic diseases has risen in the United States, which means that more patients find themselves managing chronic health conditions on a daily basis, and their quality of life is dependent on their ability to do so. Patients who are in volved in their own care and motivated to manage chronic health conditions have better disease outcomes and greater satisfaction with symptom control. Literature on shared decision making and chronic disease management suggests that patient activation and self-efficacy are critically important for effective patient participation in care . Many chronic disease self-management interventions are rooted in Bandura’s Social Cognitive Theory that posits that self-efficacy, or sense of self confidence about performing a task, strongly influences self-carebehaviors. Studies suggest that higher self-efficacy contributes to better health status, including improved well being ,improved self rated health, and reduced depression and mortality
1.2 Formulation of The Problem
1. How to concept of effective communication
2. How to communicate effectively in patients with chronic disease
1.3 Purpose
The purpose of this paper is :
1. To know about the concept of effective communication
2. To know about communicate effectively patients with chronic disease
Communicating Effectively with Client Experiencing Chronic Condition
2.1. Definition of communication
Communication is the act of conveying intended meaning to another entity through the use of mutually understood signs and semiotic rules. The basic steps of communication are the forming of communicative intent, message composition, message encoding, transmission of signal, reception of signal, message decoding and finally interpretation of the message by the recipient.
Communication is about more than just exchanging information. It's about understanding the emotion and intentions behind the information. Effective communication is also a two-way street. It’s not only how you convey a message so that it is received and understood by someone in exactly the way you intended, it’s also how you listen to gain the full meaning of what’s being said and to make the other person feel heard and understood.
More than just the words you use, effective communication combines a set of skills including nonverbal communication, engaged listening, managing stress in the moment, the ability to communicate assertively, and the capacity to recognize and understand your own emotions and those of the person you’re communicating with.
Effective communication is the glue that helps you deepen your connections to others and improve teamwork, decision making, and problem solving. It enables you to communicate even negative or difficult messages without creating conflict or destroying trust. While effective communication is a learned skill, it is more effective when it’s spontaneous rather than formulaic. A speech that is read, for example, rarely has the same impact as a speech that’s delivered (or appears to be delivered) spontaneously. Of course, it takes time and effort to develop these skills and become an effective communicator. The more effort and practice you put in, the more instinctive and spontaneous your communication skills will become.
2.2 Definition of chronic condition
A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or adisease that comes with time. The termchronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include arthritis, asthma,cancer, COPD, diabetes and viral diseases such as hepatitis C and HIV/AIDS.In medicine, the opposite of chronic is acute. A chronic course is further distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between.The non-communicable diseases are also usually lasting medical conditions but are separated by their non-infectious causes. In contrast, some chronic diseases, such as HIV/AIDS, are caused by transmissible infections. Chronic diseases constitute a major cause of mortality, with the World Health Organization (WHO) attributing 38 million deaths a year deaths to non-communicable diseases.
2.3 The important things to communicate effectively in patients
communication, also known as speaking, is an important form of communication in a healthcare facility. During the course of a work day most healthcare workers spend time talking with coworkers, supervisors, managers, or patients.
To be a professional nurses, we are responsible to care for persons who are ill. Patients need our voice to speak or advovate them self. As a nurse, we are perfectly positioned to utilize effective interpersonal communication, and in doing so, support our own emotional, psychological, and spiritual development. An effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life.
Pat Croce who is motivational speakers and entrepreneur, recommends five rules to incorporate while conveying a message, known as the 5 C of Communication:
1. Clear
Speak to clearly state your message. You must provide a chance to the recipient of your communication to give you a question for ensure that you are understood.
2. Concise
Do not ramble and get to the point, because your important message can be lost in the nonessential information you include.
3. Consistent
Make the message consistent at all times and Report your findings in a accurate manner, do not change your story to make it more dramatic. Do not tell one person what you saw and later change your observations as you retell the story to another person.
4. Credible
Make sure your message is real because many people can tell if your words are insincere. Do not heap praise on someone just because you want to win their favor.
5. Courteous
Being courteous when you communicate sets the right tone and attitude. Words and phrases such as “hello,” “thank you,” “please,” “excuse me,” and “I’m sorry” are easy, effective ways to demonstrate respect. Even if you are interacting with someone you dislike. Keep your personal feelings out of your work interactions.
The most successful communicators in the healthcare profession is when we having a bad day is no excuse for using an irritated tone when speaking with a patient or coworker. Personal problems should not be brought into the workplace. Speak clearly and use a tone when addressing your patient, beacause it can be easily heard. Shouting or mumbling will not help get your point across. Careless slang expressions, especially vulgarities, are also unacceptable when dealing with patients.
not all patient came from same country as you, so they may speak in other language. That’s why Some patients will not be able to communicate with you because they speak another language. Most hospitals have a policy in place to deal with this situation. Additionally, many facilities have a list of employees who speak other languages in addition to English. Be particularly careful to avoid slang expressions as these can be especially confusing to non-English speakers. Most importantly, make sure that the patient can understand the information being communicated. You should also make sure you understand any questions that the patient wants to communicate.
In Disstressed Patients, Patients can become nervous, confused, scared, sick, and angry when they enter the unfamiliar environment of a healthcare facility. Becoming angry or frustrated with an unsettled patient will only make the situation worse. Remain calm and speak in a steady, confident voice. Put yourself in the patient’s place and respond with compassion. Hopefully, the distressed patient has brought someone to help him or her understand what you are trying to communicate. If not, proceed slowly and carefully as you work with distressed, unaccompanied patients .
Tactful communication skills are important. Being able to communicate in a concise, supportive, non-threatening manner takes skill and practice. Researchers say that up to 90% of communication is non-verbal. Body language, facial expressions, posture, timing, tone and location can have considerable impact on communication.
Effective listening skills also are part of effective communication. Nine percent of the day is spent writing, 16% reading, 30% speaking and more than 45% listening. To become better listeners, and thus better communicators, one must: look at the speaker, don't interrupt, focus on understanding, check one's own emotions, suspend judgment, determine the immediate need, sum up the conversation, clarify any misunderstandings and make listening a priority. Listening increases knowledge, generates ideas, builds relationships, exhibits respect for others and promotes teamwork.
Active listening activities needed for making communication to be effective. However, listening is a key element in all communication. listening skills may not immediately come to mind, that’s why If you do not receive the message that is being sent, communication has not taken place. If you understand how to be a good listener, you will be a far better healthcare worker, spouse, friend, and communicator. Active listening activities requires physical and mental attention, energy, concentration, and discipline. As part of your career in healthcare, you will be attending meetings, following directions from your supervisor, working with patients, and giving and receiving feedback.
Strategies for Active Listening Applying the following active listening strategies can help you build effective relationships in school, in the healthcare environment, and in life
1) Desire to be a good listener
You must want to be a better listener. Is your intention to learn about and understand the other person? Or do you feel restless until the speaker stops talking because you want to prove your intelligence and have a chance to shine?
2) Be open and willing to learn
When listening to someone giving you instruction, are you resistant to learning new information? Be open to different points of view, different styles of lecturing, and new ideas.
3) Show interest
When speaking one-on-one with a patient, it is important to show interest in the other person. Good eye contact, a gentle touch if appropriate, and other body language shows that you are interested in what the patient has to say. If you tune out the message due to disinterest, communication will not take place. Pay attention to the speaker.
4) Resist judgment
If the speaker is wearing strange clothing, has a reputation for being troublesome, speaks in an annoying voice, or displays other distracting features, focus on the message the person is conveying. Try not to be distracted by these less important aspects of the person.
5) Do not interrupt
Have you ever been continually interrupted when trying to get a point across to a friend? Recall how frustrating you found the interruptions. Allow the speaker to give you his entire message without interrupting him. If you need to ask a question, wait until the speaker fi nishes his general message.
6) Show empathy and respect
Focus on understanding the message and viewpoint of the speaker. Look for common views and ways in which you are alike. Listen with the intent to understand.
7) Look as if you are listening
Active listening requires high energy— sit up and uncross your legs. Maintain eye contact with the speaker and lean slightly forward.
8) Give feedback
Repeat what you think the speaker meant. For example: “If I understand you correctly…,” “Please correct me if my understanding is wrong…,” “What I believe you are saying is…”
In the communication it is possible to experience Speech Anxiety. Speech anxiety is the single most common social anxiety. The anxiety can range from simple nervousness to a degree that makes the speaker physically ill. However, for most people pre-speech anxiety consists of tightness in their chest, dry mouth, and clammy palms. Whatever the source of your speech anxiety, there are many steps that you can take to reduce nervousness and gain control of your presentation. The steps fall into three categories:
a. Preparation
· Know the audience.
· Preview the venue, if possible.
· Do the research and know the facts.
· Consider the emotional issues of the message.
· Anticipate the questions that may be asked and prepare answers.
b. Practice
· Present the speech aloud until it is completely familiar.
· Read the speech in front of a mirror and ensure that body language aids the message.
· Seize all opportunities to speak aloud to become more comfortable in front of groups (e.g., ask questions in meetings, join Toastmasters or another public-speaking group, speak to small friendly groups, present slides to family or friends, or teach a course).
c. Acceptance
· Accept that you may misspeak during the presentation and plan to correct yourself immediately and smoothly.
· Use relaxation techniques, such as:
Ø Stretching
Ø Muscle tensing and relaxing
Ø Deep breathin
Ø Body alignment
Ø Consciously choosing to let go of tension
Ø Visualizing an effective presentation
2.4 Communication methode generaly in health care
Communication involves the imparting or interchanging thoughts, opinions, or information among people by speech, writing, or signs. People communicate in different ways.
2.4.1 Types of Communication
Numerous new instruments have emerged over the years to help people communicate effectively:
a) Verbal
Verbal communication entails the use of words in delivering the intended message. The two major forms of verbal communication include written and oral communication.
b) Written communication
Includes traditional pen and paper letters and documents, typed electronic documents, e-mails, text chats, SMS and anything else conveyed through written symbols such as language. This type of communication is indispensable for formal business communications and issuing legal instructions.
Communication forms that predominantly use written communication include handbooks, brochures, contracts, memos, press releases, formal business proposals, and the like. The effectiveness of written communication depends on the writing style, grammar, vocabulary, and clarity.
c) Oral Communication
The other form of verbal communication is the spoken word, either face-to-face or through phone, voice chat, video conferencing or any other medium. Various forms of informal communications such as the grapevine or informal rumor mill, and formal communications such as lectures, conferences are forms of oral communication. Oral communication finds use in discussions and causal and informal conversations. The effectiveness of oral conversations depends on the clarity of speech, voice modulation, pitch, volume, speed, and even non-verbal communications such as body language and visual cues.\
Verbal communication makes the process of conveying thoughts easier and faster, and it remains the most successful form of communication. Yet, this makes up only seven percent of all human communication.
d) Nonverbal Communication
Nonverbal communication entails communicating by sending and receiving wordless messages. These messages usually reinforce verbal communication, but they can also convey thoughts and feelings on their own.
e) Physical nonverbal communication,
Physical nonverbal communicationor body language, includes facial expressions, eye contact, body posture, gestures such as a wave, pointed finger and the like, overall body movements, tone of voice, touch, and others.
Facial expressions are the most common among all nonverbal communication. For instance, a smile or a frown conveys distinct emotions hard to express through verbal communication. Research estimates that body language, including facial expressions, account for 55 percent of all communication.
f) Paralanguage
The way something is said, rather than what is actually said, is an important component of nonverbal communication. This includes voice quality, intonation, pitch, stress, emotion, tone, and style of speaking, and communicates approval, interest or the lack of it. Research estimates that tone of the voice accounts for 38 percent of all communications.
Other forms of nonverbal communication usually communicate one’s personality. These include:
- Aesthetic communication or creative expressions such as dancing, painting, and the like.
- Appearance or the style of dressing and grooming, which communicates one’s personality.
- Space language such as paintings and landscapes communicate social status and taste.
- Symbols such as religious, status, or ego-building symbols.
g) Visual Communication
A third type of communication is visual communication through visual aids such as signs, typography, drawing, graphic design, illustration, color and other electronic resources.
Visual communication with graphs and charts usually reinforces written communication, and can in many case replace written communication altogether. As the adage goes “a picture is worth a thousand words,” such visual communication is more powerful than verbal and nonverbal communication on many occasions. Technological developments have made expressing visual communications much easier than before.
A good understanding of the different types of communication and communication styles can help you know and deal with people better, clear up misunderstandings and misconceptions, and contribute to the success of the enterprise.
2.5 Communication methode for patient with chronic ilness
Communication is a human interaction more than just word to say. Intonation of our voice when we speak, make some essence for other person. The messages give an information, it can be from body language. And also writing is an important thing to send some information.
There are five important communication aspects:
Ø listening and attending (including patient/family complaints)
Ø non – verbal
Ø verbal
Ø questioning
Ø written.
It’s important to remember that your communication abilities will develop as you gain experience as a health care assistant. You’ll be communicating with patients/clients on a daily basis and developing your skills as you do. Communication is completely improve skill of health provider, as nurse communication must be well to get information from assessment at client/pantient. Terapeutik communication is one of many communication decided diagnose to intervention client.
Patients/client with chronic disease will get a sense of grieving and lost. As a nurse we should be able to understand it. Communication with chronic disease client isn’t easy, nurse must have knowledge about the disease and all about grieving and loss process. Nurse when in communication use concept of terapeutik communication.
Client reject some assessment question it’s normally happen, the nurse must use teraupetik communication. Building a trust and caring relationship with client and also their families, through the therapeutic communication skill forms the basis for paliatif care intervention.
The best communication with chronic disease is be honest communication, show empathy, listen carefully, keep an open mind, as well as verbal responses observed an nonverbal clients and families. Client may refuse to speak, avoid the topic or silent when doing communication. It was general response that may occur. Response grieving normal sadness, numbness, denial, anger, make communication difficult. If the client choose not to discuss the disease at this time, the nurse must be permite and say that the client can express it any time.
Clients fell free to choose and respect his decision to make the teraupetik relationship with the client to develop. Sometimes client need to solve their grieving before discussing it with others. When a client wants to talk about something, stacking contract time and the right place.
Techniques of therapeutic communication with chronic disease clients :
a) Know, recognize and accept their emotions of clients and families on the physical status and treatment needs.
The most important way is through communication when observing and working with clients and families, nurses need to learn about their feelings and reactions is a key communication intervention is heard.
Stages of therapeutic hearing :
Ø Stating that you hear, like a simple statement that you heard them, give the best opportunity to speak and express their thought.
Ø Giving the client a chance to clarify, and to continue or to dig deeper.
Ø Restating the emotions that have been disclosed by reflecting the emotions that have been expressed as to respond to the emotional.
Ø Digging more information by showing that you are interested.
b) Build relationships with clients and families to identify their understanding their disease and involvement, and their expectations for health workers. It is often assumed that a person with chronic illness and their families. Understand the disease process and treatment because they had long lived with the condition becomes unjustified assumption that the expected goals of nurses not in accordance with the client's goals and family. In planning should be made jointly and discussed in order to get an idea of understanding the client, the ability to accept the disease process, the impact of disease and the expected ability to function. If the client and family were in shock or denial is necessary to approach with a focus, among other things:
Ø Support over their emotions.
Ø Sharing and strengthening basic information about the illness.
c) Giving best support client expectations and their comfortable.
Stage to identify the client's expectations are:
Ø Sharing information about the disease process and an explanation about the handling of therapy, medication and changes that may occur
Ø Establish a routine nursing
Ø Encourage clients and families to ask questions and participate in making decisions
d) Coordination of care and treatment client needed with the ability and energy levels. Chronic illness can reduce energy client physically, mentally and emotionally. Financial worries can be a major stressor that can affect mental and emotional. If fatigue becomes chronic and impact on general health and ability to perform activities that are expected.
e) Give positive support and coping strategies and the use of multidisciplinary resources needed.
The aims of the nurse works with the client and family is helping them to overcome stress successfully with a strategy that focuses on:
Ø Prevention or decreased the stress
Ø Improving the capability to deal with stress
CHAPTER 3
Conclusion & Suggestion
3.1 Conclusion
Communication is about more than just exchanging information. It's about understanding the emotion and intentions behind the information. Effective communication is also a two-way street. It’s not only how you convey a message so that it is received and understood by someone in exactly the way you intended, it’s also how you listen to gain the full meaning of what’s being said and to make the other person feel heard and understood.
Chronic conditions are health conditions that continue over a long period of time, often for life. Although the terms "chronic condition" and "chronic illness" may be used interchangeably, a person with a chronic condition may or may not be unwell from day to day.
3.2 Suggestion
From this paper, we hope that the students can understand and know about Comunicating effectively with clients experiencing chronic condition in english.
REFERENCE
Anonim. 2009. Verbal and Written Communication. The Goodheart- Willcox Co., Inc.
Arli Aditya Parikesit. (2009), Peran Bahasa AsingdalamDuniaGlobalisasi [online].
FEMA’s Independent Study Program. 2005. Effective Communication. Emmitsburg: http://training.fema.gov
Flavell, H Roger, (1985), Developing English with Young Learners. London: MacMillan Publishers Limited.
Kozier,Barbara.(2004).Fundamentals Of Nursing: concepts, process, and practice (7 th ed.). New Jersey : Pearson
Lippincott Williams & Wilkins (2012) Helping patients with chronic conditions overcome barriers to self-care. The Nurse Practitioner Vol. 37, No. 3 2012
Nolte, Ellen & McKee, Martin. 2008. Caring for people with chronic conditions, A health system perspective. Health System and Policies Series. European Observatory: USA
Northouse, Peter Guy.(2010).Leadership : Theory and Practice.(5 th ed.). USA : SAGE
Potter & Perry. (2009).Fundamental keperawatan (7 th ed.).(vols 2.). drAdrina&marina, penerjemah). Jakarta :SalembaMedika.
Porges, Stephen W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self- regulation. New York: W. W. Norton & Company.
Sally Thorne, (2006) Patient Provider Communication in Chronic Illness A Health Promotion Window of Opportunity Supplement 1 to Vol. 29, No. 1S, pp. 4S–11S 2006
Vertino, K., (September 30, 2014) "Effective Interpersonal Communication: A Practical Guide to Improve Your Life" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 1.
Tidak ada komentar:
Posting Komentar