Definition and Characteristics of "HELPING RELATIONSHIPS"

Therapeutic Communication as the Nurse's Moral Responsibility

Nurses must have a high responsibility based on caring and compassion, and a feeling of wanting to help others to grow and develop. Abdalati (1983), Bucauli (1978) and Amsari (1995) add that as a religious person, nurses cannot be indifferent. An individual who does not care about others is a selfish sinner.

Furthermore Pasquali & Arnold (1989) and Watson (1979) state that "human care" consists of efforts that protect, enhance and preserve / perpetuate a sense of humanity by helping others in finding meaning in their pain, suffering and existence: helping others to improve knowledge and self control. Surely everyone is taught by God to help others who need help. The behavior of helping others needs to be trained and familiarized, so that eventually it becomes part of the personality.

Definition and Characteristics of "HELPING RELATIONSHIPS"

A professional nurse always strives to behave in a therapeutic manner, which means that every interaction made has a therapeutic effect that allows the client to grow and develop. The goals of the therapeutic relationship are directed at client growth which, according to Stuart and Sundeen (1995) and Limberg, Huter & Kruszweski (1983) include:

• self-realization, self-acceptance and self respect;
• clear identity and a high sense of integrity;
• the ability to foster intimate and interdependent and interdependent and loving relationships;
• improvement in function and ability to satisfy needs and achieve realistic personal goals.

The goal of the therapeutic relationship will be achieved if the nurse in "helping relationship" has the following characteristics.

• Self-awareness of their beliefs. Nurses are able to explain about themselves, beliefs, what they think is important in their lives, then he will be able to help others answer these questions.
• The ability to analyze one's own feelings. Nurses gradually learn to recognize and overcome various feelings including feelings of anger, grief and frustration.
• Ability to be a role model. Nurses need to have a healthy lifestyle and patterns, including maintaining health so that others can emulate.
• Altruistic. Nurses feel the satisfaction of being able to help others in a humane way.
• A sense of ethical and moral responsibility. Every decision made always considers the principles that uphold human health / well-being.

Communication Type

Interpersonal communication is an interaction that has occurred between at least two or more people in a small group, especially in the form of face-to-face and most often used in nursing services. Healthy interpersonal communication enables problem solving, sharing ideas, decision making and personal growth. According to Potter and Perry (1993), Swansburg (1990), Szilagyi (1984), and Tappen (1995) there are three types of communication namely verbal, written and non verbal.

Verbal communication

The most common type of communication used in nursing services at a hospital is verbal exchange of information, especially conversations with tools or symbols used to express ideas or feelings, evoke emotional responses, or describe objects, observations and memories. Often also to convey hidden meanings , and test one's interests. The advantage of face-to-face verbal communication is that it allows each individual to respond directly.

Effective verbal communication must:

- Clear and concise.
Effective communication must be simple, short and direct. Fewer words are used the less likely there is confusion. Clarity can be achieved by speaking slowly and speaking clearly. The use of examples can make explanations easier to understand. Repeat the important parts of message delivered. Recipients need to know what, why, how, when, who and where. In short, using words that express ideas simply, "Tell me where your pain is" is better than "I want you to describe to me the part that you feel is bad".

- Vocabulary.
Communication will not succeed, if the sender of the message is not able to translate words and speech. Many technical terms are used in nursing and medicine, and if used by nurses, clients become confused and unable to follow instructions or learn important information. Speak messages with terms understood by the client. Instead of saying "sit, while I will consult your lungs" it would be better to say "sit while I listen to your lungs".

- Denotative and connotative meaning.
Denotative meaning provides the same understanding of the word used, while the connotative meaning is the thoughts, feelings or ideas contained in a word. The word "serious" is understood by clients as a near-death condition, but nurses will use the word "critical" to describe near-death circumstances. When communicating with clients, nurses must carefully choose words so that they are not easily misinterpreted. Especially it is very important when explaining the therapeutic goals, therapy and client's condition.

- Pause and speed of speech.
The right speed and tempo of speech also determines the success of verbal communication. Prolonged interruptions and a quick diversion to other points may give the impression that the nurse is hiding something from the client. Nurses should not speak quickly so that the words are unclear. Interference needs to be used to emphasize certain things, give the listener time to listen and understand the meaning of the word. The right interruption can be done by thinking about what will be said before saying it, listening to non-verbal cues from the listener that might indicate understanding. The nurse can also ask the listener if he is talking too slowly or too fast and needs to be repeated.

- Time and relevance.
The right time is very important to capture messages. If the client is crying in pain, it's not time to explain the risk of surgery. Even if the message is pronounced clearly and concisely, an incorrect time can prevent accurate reception of the message. Therefore, nurses must be sensitive to the timeliness to communicate. Likewise verbal communication will be more meaningful if the message delivered is related to the interests and needs of the client.

- Humor.
Dugan (1998) states that laughter helps reduce tension and pain caused by stress, increasing the success of nurses in providing emotional support to clients. Sullivan and Deane (1988) report that humor stimulates the production of catecholamines, reduces anxiety, facilitates respiratory relaxation and increases metabolism. But nurses need to be careful not to use humor to cover fear and discomfort or cover up their inability to communicate with clients.

Non Verbal Communication

Non-verbal communication is the transfer of messages without using words. Is the most appropriate and convincing way to convey messages to others. Nurses need to be aware of verbal and non-verbal messages delivered by clients from the time of assessment to evaluation of nursing care, because non-verbal cues add meaning to verbal messages. Nurses who perceive nonverbal messages will be better able to understand clients, detect conditions and determine nursing care needs.

Non-verbal communication is observed in:

- Metacommunication.
Communication depends not only on the message but also on the relationship between the speaker and the speaker. Metacommunication is a commentary on the content of the conversation and the nature of the relationship between the speaker, the message behind the words that convey the attitude and feelings of the sender to the listener example: smile when you're angry.

- Personal appearance
One's appearance is one of the first things to be noticed during interpersonal communication. The first impression arises in the 20 seconds to the first 4 minutes. Eighty-four percent of an impression of a person is based on his appearance (Lalli-ascosi, 1990 in Potter and Perry, 1993). Physical form, how to dress and decorate shows personality, social status, work, religion, culture and self-concept. Nurses who pay attention to their appearance can lead to positive self and professional image. Nurse's physical appearance influences the client's perception of the service / nursing care received, because each client has an image of how a nurse's appearance should be. Although the appearance does not fully reflect the ability of the nurse, it may be more difficult for nurses to build trust in the client if the nurse does not meet the client's image.

- Intonation (tone of voice).
The tone of the speech has a great impact on the meaning of a message sent, because a person's emotions can directly affect the tone of his voice. Nurses must be aware of their emotions when interacting with clients, because the intention to convey genuine interest in the client can be hindered by the nurse's tone of voice. .

- Facial expressions.
The results of a study showed six main emotional states that are visible through facial expressions: surprise, fear, anger, disgust, happiness and sadness. Facial expressions are often used as an important basis in determining interpersonal opinions. Eye contact is very important in interpersonal communication. People who maintain eye contact during the conversation are perceived as trustworthy, and are likely to be good observers. Nurses should not look down when talking to clients, so when talking should be seated so that nurses do not appear dominant if eye contact with clients is done in a parallel state.

- Body attitude and facial expressions.
Body attitudes and expressions describe attitudes, emotions, self-concepts, and physical states. The nurse can deduce useful information by observing the client's posture and steps. The step can be influenced by physical factors such as pain, medication or fracture.

- Touch.
Affection, emotional support, and attention are conveyed through touch. Touch is an important part of the nurse-client relationship, but must pay attention to social norms. When providing nursing care, parish touches the client, such as when bathing, doing a physical examination, or helping to put on clothes. It is important to realize that illness makes clients dependent on nurses to make interpersonal contact so it is difficult to avoid touch. Bradley & Edinburg (1982) and Wilson & Kneisl (1992) states that it is important to consider whether the use of touch is understandable and acceptable to clients, so it must be done with sensitivity and caution.

Phases of "HELPING RELATIONSHIPS"

Stuart and Sundeen (1995) introduce four phases of "helping relationships" that develop sequentially and each phase has a different task. The phase of the relationship is as follows.

Pre-interaction phase.

In the preterteration phase, the task of nursing is
(1) exploring one's own feelings, fantasies, and fears;
(2) analyzing one's own strengths and professional limitations;
(3) collect data about the client if possible;
(4) planning the first meeting with the client.

The orientation and introduction phase.

The nursing task in this phase is
(1) establishes reasons for clients to seek help;
(2) fostering mutual trust, acceptance and open communication;
(3) explore the client's thoughts, feelings and actions;
(4) identifying client problems;
(5) defining goals with clients;
(6) formulating a contract together including the name, role, responsibilities, expectations, objectives, meeting place, meeting time, conditions for termination, and confidentiality.

Work phase.
According to Stuart and Sundeen (1995) in the work phase, nursing is on duty;
(1) explore related stressors;
(2) increasing the development of client's appreciation and the use of constructive coping mechanisms; and
(3) discuss and overcome resistant behavior.

Termination.
In this last phase, nursing is on duty;
(1) fostering the reality of separation;
(2) reviewing therapy progress and achieving goals; and
(3) explore together feelings of rejection, loss, sadness and anger and other related behaviors.


BIBLIOGRAPHY

Cook, j.S., and Fontaine, K.L. (1987). Essentials of Mental Health Nursing. California: addition-Wesley Publishing Company.
Kozier, B., and Erb., G. (1992) Fundamentals of Nursing: Concepts and Procedure. (2nd ed). California: Wesley Publishing Company Addition
Lindberg., J.B. Hunter, M.L., and Kruszewki, A.Z. (1983). Introduction to Person-Centered Nursing. Philadelphia: J.B. Lippincott Company.
Potter, P.A., and Perry, A.G., (1989). Fundamentals of Nursing Concepts, Process and Practice. (2nd ed). St. Louis: The Mosby Company.

Tag : Nursing Education