Use of Therapeutic Communication Techniques among Staff Nurses to Newly

Widows/Widowers in Selected Tertiary Hospitals in Nueva Ecija

______________________________

A Research Papers Presented to

Prof. Norvin Miguel RN

College of Nursing

WESLEYAN UNIVERSITY-PHILIPPINES

Cabanatuan City

______________________________

In Partial Fulfillment of the Requirements

for the subject Nursing Research

_________________________

Jennifer V. Rodriguez

BSN 3 Block 1

Chapter 1

THE PROBLEM AND ITS SETTING

Introduction

“Till death do us part “...Little did we know that these words would ring true

so early in our lives.

The death of someone close to us is one of life’s most stressful events. We

fear loss of companionship and the changes it will bring to our lives. It takes time to

heal and each of us responds differently. Many individuals lose a spouse through

death. It is very important for us, as a society, to have a better understanding of the

grief and loss process. Understanding the process is challenging due to the diversity

of ethnic and cultural backgrounds, spiritual beliefs, and the ways in which men and

women process their emotions differently (or are expected to process them

differently) because of social or cultural stigma.

Grieving or mourning is not a weakness; it is necessity. Even though the

present is felt to be intolerably painful, especially to those who lost their spouse

early, it is healthy and normal for a bereaved person to experience intense emotions

and swift mood changes. These are natural reaction to loss. Differing bereavements

along the life cycle may have different manifestations and problems which are age-

related, mostly because of cognitive and emotional skills along the way. Man will

exhibit mourning to the loss of a spouse. Reactions in one type of bereavement may

be perfectly normal, but in another the same reaction could be problematic most of

the time, it was the very reason why individuals didn’t recover from the death of

someone close to them.

Widows/widowers experiencing one or more of the stages should not force the

process. The grief process is highly personal and should not be rushed on the basis

of an individual's self-imposed time frame. One should merely be aware that most of

the stages will be worked through and that, hopefully, the ultimate stage of

"acceptance" will be reached. Some psychologists believe that the harder a person

fights the fact that a spouse has died, the more likely that person will remain in the

denial stage. Those that experience problems working through one of Kubler-Ross’s

stages should consider professional grief counseling or support groups. Today, one

of the most critical components of the health care delivery process is the interaction

between the care provider and the bereaved individuals, nurses especially in

hospital settings try to lessen the pain that a newly widow experienced by using

therapeutic communication techniques, it requires a great deal of sensitivity as

well as expertise in using interviewing skills. Therapeutic communication is

healing and bringing about positive change through open communication in a

patient who is suffering from problems. To slowly guide a patient through the

messed up situation he/she is in and help him/her overcome it. They are dedicated

to providing bereaved and widowed members assistance with their specific needs.

“Sharing the memories, sharing the pain and sharing the hope that tomorrow is not

lost are what our members give to each other.

The above statements motivate me to conduct this survey to know how the

Staff Nurses in selected district hospitals in Nueva Ecija established therapeutic

relationship to the newly widows/widowers and how they identify clients concern

and needs especially their expression of emotion using therapeutic communication.

The purpose of this study is to determine how newly widows/widowers

overcome their loneliness of loosing their spouses earlier. And how the Staff Nurses

in selected tertiary hospitals in Nueva Ecija employed appropriate measures that

would help certain them to deal with loss using therapeutic communication

techniques.

Statement of the Problem

This study is about Use of Therapeutic Communication Techniques among

Staff Nurses to Newly Widows/Widowers in Selected Tertiary hospitals in Nueva

Ecija.

Specifically, it strives to answer the following questions:

1. How may Socio-Demographic Profile of Staff Nurses are described in terms

of:

1.1 Age

1.2 Gender

1.3 Religion

1.4 Duration of service

1.5 Educational attainment

2. How may Socio-Demographic Profile of the newly widows/widowers are

described in terms of:

2.1 Age

2.2 Gender

2.3 Religion

2.4 Number of Children

2.5 Occupation

3. What are the therapeutic communication techniques utilized by staff nurses in

dealing with newly widows/widowers?

4. How effective is the therapeutic communication technique as perceived by the

staff nurses in terms of:

4.1 Emotional

4.2 Psychological

4.3 Spiritual

4.4 Social

5. How effective is the therapeutic communication technique as perceived by the

newly widows/widowers in terms of:

5.1 Emotional

5.2 Psychological

5.3 Spiritual

5.4 Social

6. Is there any significant differences between the perception of Staff Nurses and

Newly widows/widowers in the effectiveness of therapeutic communication

techniques used?

Hypothesis of the study

There is significant differences between the perception of Staff Nurses and

Newly widows/widowers in the effectiveness of therapeutic communication

techniques used.

Significance of the study

It is hoped that whatever result this study may show they will be useful to

the following.

To the future researchers, who will conduct imminent studies related to

this piece.

To the bereaved individuals, to help people who are undergoing grief in

dealing with the loss of their love ones.

To Staff nurses, who are always dealing with death to enhance their abilities

in coping to this situation.

To Widows/Widowers, who overcome their loneliness of loosing their

spouse earlier.

To all individuals, to prepare each of them in dealing with death.

Scope and Delimitations

This study focused on the effectiveness of therapeutic communication

techniques used by the Staff nurses to Newly widows/widowers in Selected District

Hospitals in Nueva Ecija.

Questionnaire was used to determine the information needed. An interview

was done to gather further subjective details.

This study was conducted between the periods of January -February 2011

with a total number of more than 15 widows/widowers and 15 staff nurses

randomly selected respondents from preferred district hospitals in Nueva Ecija who

have experienced death before this study was undertaken.

Conceptual Framework

Therapeutic communication is a process by which a caregiver leads her

patient to restorative change through a purposefully structured exchange of ideas.

Practitioners articulate in a way that conveys understanding of the client's

experience, fostering an environment of honest contemplation. This style of

communicating approaches the patient as a whole, recognizing how his feelings and

perceptions contribute to the success of therapy.

Open Questioning encourage the patient to elaborate on his perspective. A

closed question is one that can be answered with yes, no or a simple one-word

response. This approach severely limits the quality information that can be gathered

from the encounter. Open questions usually start with who, what, where, how,

when, or auxiliary verbs such as could, would or can. For example, asking a question

such as "Could you tell me a little bit more about the situation?" can provide the

caregiver with valuable details that may prove instrumental to the success of

therapy.

Expressing Implicit Thoughts. Language is a means of communicating one's

thoughts to another; however people rarely express themselves fully with words.

When someone is speaking, a larger set of ideas are concealed behind their

statements. Bringing forth a patient's inner feelings and thoughts demonstrates a

great level of understanding and empathy. If a patient is complaining about having

to repeat things, the nurse could say "Sounds as though you feel like no one is

listening to you." Although the client didn't say so directly, the accuracy of her

response was implied.

At times, silence can speak volumes. By simply resisting the human urge to

fill empty air with words, a nurse can non-verbally encourage his patient to re-

evaluate her perspective. Additionally, repeating the last phrase stated by the client

in an upward inflection, followed by silence, causes the patient to measure the truth

in what she believes. This is a subtle way of inspiring the client to widen her view,

without inciting defensive reaction.

THERAPEUTIC COMMUNICATION involves the use of techniques such as

using silence, offering self, restating, reflecting, and seeking clarification to name a

few. Therapeutic communication involves displaying a genuine interest in the

person communicating that is demonstrated through the use of a relaxed and

comfortable body posture. Therapeutic communication requires the components of

empathy, positive regard, and a positive sense of self (Craven & Hirnle, 2000).

Barriers to Effective Communication. An effective communication barrier is

one of the problems faced by many organizations. Many social psychologists opine

that there is 50% to 70% loss of meaning while conveying the messages from a

sender to a receiver. They estimate there are four basic places where

communication could be interpreted wrongly. A few barriers of effective

communication in an organization are given below.

Physical Barriers - One of the major barriers of communication in a

workplace is the physical barrier. Physical barriers in an organization includes large

working areas that are physically separated from others. Other distractions that

could cause a physical barrier in an organization are the environment, background

noise

Language - Inability to converse in a language that is known by both the

sender and receiver is the greatest barrier to effective communication. When a

person uses inappropriate words while conversing or writing, it could lead to

misunderstanding between the sender and a receiver.

Emotions - Your emotions could be a barrier to communication if you are

engrossed in your emotions for some reason. In such cases, you tend to have trouble

listening to others or understanding the message conveyed to you. A few of the

emotional interferences include hostility, anger, resentfulness and fear.

Lack of Subject Knowledge - If a person who sends a message lacks subject

knowledge then he may not be able to convey his message clearly. The receiver

could misunderstand his message, and this could lead to a barrier to effective

communication.

Stress - One of the major communication barriers faced by employees in

most of the organization is stress. When a person is under immense stress, he may

find it difficult to understand the message, leading to communication distortion. At

the time of stress, our psychological frame of mind depends on our beliefs,

experiences, goals and values. Thus, we fail to realize the essence of communication.

THERAPEUTIC COMMUNICATION TECHNIQUES

1. USING SILENCE...utilizing absence of verbal communication. Silence in

itself often encourages the patient to verbalize if it is an interested, expectant

silence.  This kind of silence indicated to the patient that the nurse expects him to

speak, to take the initiative, to communicate that which is most pressing.  It gives

the patient the opportunity to collect and organize his thoughts, to think through a

point, or to consider introducing a topic of greater concern to him than the one

being discussed.  A positive and accepting silence can be a valuable therapeutic tool. 

(1)  It encourages the patient to talk; (2) directs his thoughts to the task at hand--the

consideration of his problem; (3) reduces the pace of the interview when either the

nurse or the patient is pressing or pushing too hard; (4) gives the patient time to

consider alternative courses of action, delve deeply into his feelings, or weigh a

decision; (5) and allows the patient to discover that he can be accepted even though

he is silent, that even though he is shy and quiet, he has worth and is respected by

another person.

Much nonverbal communication occurs during these interludes.  The nurse

needs to be alert to what she is communicating as well as perceiving.  Even

momentary loss of interest can be interpreted as indifference.  Schwartz and

Schockley state that the utilization of silence is often difficult for nursing personnel,

since they think that nothing is happening and that they are wasting their time.  In

long periods of silence, they may become bored and their attention wanders from

the patient.  If the nurse could observe the patient and herself carefully, she might

discover that a great deal happens between then at these times.

INPUT PROCESS OUTPUT

Figure 1 – Conceptual Paradigm of the Study

Specific Problems of the study: What are the therapeutic

communication techniques utilized by staff nurses in dealing with newly widows/widowers?

How effective is the therapeutic communication technique as perceived by the staff nurses in terms of:

4.1 Emotional4.2 Psychological 4.3 Spiritual4.4 Social

How effective is the therapeutic communication technique as perceived by the newly widows/widowers in terms of:

5.1 Emotional5.2 Psychological 5.3 Spiritual5.4 Social

Is there significant differences between the perception of Staff Nurses and Newly widows/widowers in the effectiveness of therapeutic communication techniques used?

Statement of the Problem.

1. Socio-Demographic Profile of Staff Nurses are described in terms of:

1.1 Age1.2 Gender1.3 Religion1.4 Duration of service1.5 Educational attainment

Socio-Demographic Profile of the newly widows/widowers are described in terms of:

2.1 Age2.2 Gender2.3 Religion2.4 Number of Children2.5 Occupation

Tools for gathering data collection through survey questionnaire and ocular interview

3.Statistical Treatment of Data

Analysis, presentation and interpretation of findings.

1. Improved economic status in their lives through the help of Department of Health.2. Final assessment on the improved clinical performances of staff nurses on the delivery of quality nursing care and education to all patients with better health and better body and mind and very satisfactory nursing service through their best performance, effort and time to assists the patients in the delivery of quality health care service and community health nursing program implementation.2. The patients have overcome their behavioral, psychological and financial problems considering they healed from the therapeutic communications through discovered medical treatment and solutions.- Summary of findings and conclusion/ recommendations

Definition of terms

To give the readers a clear view of what this study was all about, the

following terms were defined.

Grief is a total response to the emotional experience related to loss. It is manifested

in thoughts, feelings, behavior associated with overwhelming distress or sorrow.

Bereavement is the subjective response experienced by the surviving love ones

after the death of a person with whom they have shared significant relationship.

Mourning is a behavioral process through which grief is eventually resolved or

altered; it is often influenced by culture, spiritual beliefs and customs.

Loved one someone with whom you have profound affection and deep devotion.

Denial s a defense mechanism postulated by Sigmund Freud, in which a person is

faced with a fact that is too uncomfortable to accept and rejects it instead, insisting

that it is not true despite what may be overwhelming evidence.

Hospital in the modern sense, is an institution for health care providing patient

treatment by specialized staff and equipment, and often, but not always providing

for longer-term patient stays.

Tertiary Hospital provides the first level of outpatient or inpatient care for patients

who have been referred by their primary care providers. It forms the apex of the

pyramid of primary care. They play a critical role in providing individuals and

families with timely medical care, including surgery for the conditions that typically

account for a large share of a population’s disease burden.

Nurse is a healthcare professional who, in collaboration with other members of a

health care team, is responsible for: treatment, safety, and recovery of acutely or

chronically ill individuals; health promotion and maintenance within families,

communities and populations; and, treatment of life-threatening emergencies in a

wide range of health care setting

Therapeutic Communication is an interpersonal interaction between nurse and

client which the nurse focuses on clients need to promote an effective exchange of

information or verbalize feelings.

Chapter 2

REVIEW OF RELATED LITERATURE and STUDIES

This chapter presents the reviewed related literature and studies that were

published and conducted in the Philippines and abroad which gave the present

study information and background.

Foreign Literature

Communication techniques are very important in which ever profession you

are, especially care giving professions. As such, communication techniques in

nursing are very significant. The way in which a care giving professional

communicates with the patient can bring about a sea change in how the patient

feels. Hence, scroll down to know about therapeutic communication techniques for

nursing.

The emphasis in this subject is on looking at the beginning knowledge and

skills which will enable any interaction to be effective and then to extend the

knowledge and skills to enable effective interactions with patients. Students who

have traversed life well enough to enter a university course have skills in

communication. However, these lay developed skills need to be brought into focus

to become a feature of a professional who is to care for people. The knowledge and

skills that you begin to develop in this subject will need to be further explored and

extended in other subjects as you proceed through the Bachelor of Nursing Course.

Indeed many of the concepts introduced in this subject, such as self awareness and

listening skills, will be developed on a career /life long basis.

Therapeutic and communication are two complex words that are at the heart

of all nursing practice.

Therapeutic – refers to the science and art of healing (Miller and Keane,

1972); of or pertaining to a treatment or beneficial act (Potter and Perry, 1989).

This can be further extended to include what Rogers (1961) calls the helping

relationship, which is one that promotes growth and development and improved

coping with life for the other person.

Communication – has a number of definitions that tend to either emphasize

the message or the meaning. Mohan, McGregor and Strano (2002) provide the

following: the ordered transfer of meaning: social interaction through messages:

reciprocal creation of meaning: sharing of information, ideas or attitudes between

or among people.

DeVito (2001, p. 5) suggests that communication is an act by one or more

persons of sending and receiving messages that are disturbed by ‘noise’, occur

within a context, have some effect and provide some opportunity.

Navarra, Lipkowitz and Navarra (2004) maintain that therapeutic

communication was devised because we so frequently traumatize each other in the

way we interact. In organizations there is much talk that is small talk, gossip,

sarcasm or a non-response. In families we frequently feel free to make fun of each

other, loose our tempers and criticize. We carry out these forms of interaction

automatically – without thinking. However therapeutic communication is aimed at

establishing relationships and within these relationships interactions which

encourage rather than discourage patients Navarra et al (2003) state

…If you think communication is just a matter of

common sense think again…most of our instinctive

responses – things we often say throughout the day to

each other – are often non-therapeutic. …Until you’re

aware of how you sound and the implications of what

you’re saying, you really don’t "just know" how to be

therapeutic.

Navarra et al (2003) provide the following examples of how what we often

say can be non-therapeutic. Asking a patient "Why…?" is usually threatening and

telling a depressed patient that "we all suffer sometimes" discounts their feeling

even if you are trying to be warm and sincere and helpful.

No nursing interaction with a patient is just a dressing or an injection. The

patient is always the whole person with a complete personality and sensitivities.

The nursing role with patients is a therapeutic role. The nurse listens, guides and

responds to the patient in such a way as to assist the patient in expressing their

feelings (Bradley and Edinberg, 2005). You rely heavily on getting along with and

talking to your patients. Learning how to listen, to understand, to respond and so

forth are all essential for caring for the whole person.

According to Alexandra Kennedy, (2007) many of us left with regrets after a

love one dies: unspoken goodbyes, unexpressed love, unhealed hurts and

unresolved issues. These regrets can manifest as ongoing symptoms such as apathy,

addiction, chronic physical problems, depression, compulsive behavior and social

isolation. But once we realize that we can still have an inner relationship with a

deceased love one, we can begin to heal our unresolved grief. Using our

imaginations we can access this special relationship and resolve old hurts and

regrets express our love and received guidance.

The death of a loved one is extremely painful, but the loss of a spouse is

perhaps one of the most difficult issues to deal with. The bonds that are created

during a marriage, and especially for one that has lasted over a period of time, are

known to persist even beyond the death of that partner (Stroebe, 2001).

Welcome to Widowstooyoung.com and let me say that if you are visiting this

site then I offer my deepest sympathy for the loss of your spouse. I hope you may

find some comfort in knowing there are many of us across the nation who has

shared your same loss. As our family and friends offer condolences we all know that

they cannot even imagine what we are going through. This website is intended to

connect people who can and do understand.

It is the one year anniversary of this site and it has been 18 months since the

passing of my wife of almost 11 years, Terri. As I read my original letter I wrote a

year ago it is interesting to see how this website has evolved and, though slightly

different from my original intent, it has helped many people across the US and even

internationally. I originally started this website so that support groups could be

formed, in particular one for those of us living in Minnesota. However, our loss could

be considered quite rare. I have had hundreds visit this site and there exists 54

members as of this writing. I guess we can be thankful for how uncommon our loss

is but we also know that everyday someone is losing a spouse much too early in life.

We are all experiencing a battle to find our future, to find a way to live the

rest of our lives without the one we loved so deeply. On this website you can read

many stories about others who have lost and also the things they have done or are

doing to help themselves regain value is this world. For me there were 3 specific

things I did to deal with my grief. I'd like to share these just to give you one example

of what you might find on this site.

Terri passed away on June 2, 2003 of a brain aneurysm. It was very sudden

and without warning. She was my soul mate, my best friend, my lover and a

cherished mother and grandmother. In 29 hours my life was changed forever. After

about 2 months I decided to get some counseling. I attended a grief support group.

This was helpful for the first meeting or two in that I learned I was not alone. Others

had experienced similar losses and many were long battles with cancer or other

diseases. By the third meeting I realized the group seemed to be fueling the grief

rather than helping people deal with it. So continuing with this was not for me.

Interestingly enough, others from the website often comment how most of these

support groups have much older members which has made these groups less

effective for younger widows/widowers.

The second step I took was to find God and Jesus. I was never very religious

but thankfully Terri was. I know she is in heaven waiting patiently for me to join her

in God's time. I was very fortunate to have worked for a very compassionate

company who offered up a spiritual advisor to work with me. We had 5 sessions

together to discuss many important aspects of the bible and specifically Jesus'

purpose as our savior. I found a lot of comfort in this and often pray for strength and

courage to get through the toughest days and challenges life throws at us.

The final action was a fateful meeting of a very special friend on the internet.

I searched the web for some help, support groups, etc. and came across a web site

for grief. I left a message but did not return to see if anyone had responded. A

person from New York had also visited that website and responded to my note.

When she did not see me respond she sent me an e-mail directly and we began

sharing our stories. Anne lost her very beloved fiancé only a few weeks after Terri

died. Dick's death was also very sudden and without warning. Anne and I became

very close friends. We shared our deepest feelings in e-mails and over the phone. I

don't think either one of us would have survived through this without this

friendship. Today we remain the very best of friends and you will be surprised to

know that we still, to this day, have not met in person. We both look forward to that

day when we will meet; (we've agreed worst case we will be at each other's

wedding). You can see we've helped each other to except the fact we are young

enough to find love again and we support each other in our pursuit of happiness.

Anne is my inspiration for this website and I hope that many persons who

visit this website will also find similar contacts and friends who can help each other

through the worst grief one can experience; the loss of a spouse, fiancé or the love of

their life. May God bless you through the pain of grief and the return to a happy,

healthy life.

Therapeutic communication helps nurses form working relationships with

patient or family and fulfills the purposes of nursing process. Therapeutic

communication helps the nurse assist the grieving and dying person in coping with

loss. (Potter and Perry’s Foundation in Nursing Theory and Practice.)Even when the

nurse has experience with therapeutic communication, there can still be the

problem of a breakdown in that communication. The nurse can have empathy,

respect for the person, and use active listening skills, but the problem could still

come about. The reason it happens is that the nurse also needs to do critical

thinking. That kind of thinking means that that she is always assessing the patient

and the situation (McNabb, 2006). Another point is that sometimes it can be very

difficult to see things from the perspective of the patient. (Bournes and Mitchell

2002, p. 59) state, "health is the way people go on and live what is important to

them, moment to moment and day to day".

Foreign Studies

The 'Therapeutic Communication' is well chosen. It directly identifies what

therapeutic communication techniques mean. It is caring and healing through

communication. To slowly guide a patient through the messed up situation he/she is

in and help him/her overcome it. The job of psychiatric nursing and psychotherapy

is increasingly vital as people are increasingly falling prey to depression and

hollowness inside even though they live a life of material abundance and have

opportunities like never before. The job of a therapist is to help a patient get to the

root cause of his problems through a process of introspection, guided by the

therapist. That is why, a therapist needs to be non-judgmental and create an

atmosphere where, the patient lets down his guards and communicates openly due

to the trust he develops in the therapist.

Therapeutic communication techniques are one of the most important parts

of psychotherapy. Therapists need to have a range of therapeutic communication

techniques which help them in dealing with patients with myriad personalities and

problem patterns. One of the most important things is that a therapist needs to be

sincere and take genuine interest in the person he is trying to help. He needs to walk

a thin line of empathy for the patient while still not letting that affect his objective

thinking and analysis of the patient's problems.

Studying transcripts or therapeutic communication techniques examples can

help in gaining insight into how the art of reaching through the defenses of a patient

is practiced. Case study of similar cases is very important as it can give extra clues

for a solution. Therapeutic communication techniques in health care and nursing

are also very important. A patient recovering from a debilitating illness needs

encouragement and a lot of care from the nursing staff. Positive body language like a

smile and demeanor which makes the patient feel cared can bolster the healing

process of a patient. Therapeutic communication techniques in nursing are aimed at

healing the mind while medicines can only cure the body. In the next section let us

see some of the types of therapeutic communication techniques that are used by

therapists.

Types of therapeutic communication techniques. Here are the major types of

therapeutic communication techniques that make it easier for the patient to open up

and the therapist to gain insight into what is the source of a patient's problems.

Undivided attention and listening. Giving your undivided attention to

a patient when he talks is very important. Listening intently to what

he says and being sympathetic and encouraging through eye contact

and body language helps a lot. He should feel that you want to listen to

him and are genuinely trying to understand his problems. These non

verbal cues are crucial in the initial phase of therapy in creating an

encouraging atmosphere.

Reflecting thoughts. One way of therapeutic communication and one

of the subtlest techniques is reflecting. A patient's statement is

redirected towards him through similar wording which makes him

think about it again from another perspective.

Sharing and encouraging interaction. One way of helping and

connecting with a patient is to share your own personal experiences

with him. This will encourage him to share his own experiences and

problems more easily.

Direct questioning and problem solving. This is the straightforward

process where based on the facts and information, gained through

questions about problems of patient, the therapist makes concrete

suggestions about possible suggestions. This approach can work in

case of only certain specific kinds of problems.

Identifying inconsistencies and contradictions. Through the way of

conversation the therapist must identify the inconsistencies and

contradictions in the thinking of the patient. He must also subtly point

out behavioral patterns and habits that are wrong and causing harm.

One needs to quietly go on emphasizing the importance of a

behavioral change and bring the patient to the point where he

acknowledges that he needs to change to get better.

James Leigh Wickert B.A., University of Georgia, (2008) states that grief is

real because loss is real. Each person has their own unique and distinctive way in

which they grieve. There is no time factor for how long it may take someone to

process their grief and loss, for some it may take a few months, for others, years. We

plan weeks ahead for our birthday, months ahead to take a vacation, and usually a

year ahead for our weddings. We plan decades ahead for our retirements. However,

when death arrives we are usually much unprepared and it takes most of us by

surprise.

“What is left ungrieved remains stored in our body, heart, and soul. It can

come out each time we experience loss anew” (Kubler-Ross & Kessler, 2005, p. 73).

Why the issue of how widows and widowers may process their grief and losses

differently, if it all, is of tremendous value to social workers and therapists as it can

help assist them in creating better solutions in working with these populations.

Learning to acknowledge and address how different genders cope with loss during

widowhood may be the gateway to developing newer and more innovative group

and individual sessions.

Local Literature

Therapeutic communication is healing and bringing about positive change

through open communication in a patient who is suffering from problems. In this

study, the overview different types of communication techniques that are used by

psychotherapists and psychiatric nurses to help their patients.

The problems and the maladies of the body are sometimes easily curable, but

the problems of a mind are not that easily solved. To put together the pieces of a

fragmented and shattered mind and help it heal itself requires therapeutic

communication techniques. A person can only get better and gain his confidence

back when he strives to do so, on his own. The role of the therapist and therapeutic

communication is to guide them back and help them open up and face their fears

and challenges with confidence. Some of the therapeutic communication techniques

in psychiatric nursing and psychotherapy that are known to be effective.

According to Roland Tolentino,(2007) grieving is the state of the mind that

prohibits the people left behind to bury the memories of the deceased, making it the

very reason why most people never learned to accept the fact that their love one

was already gone. Tolentino states that death is not mainly concerned about the

deceased but to the people who are bereaving over the loss. Saying “I’m grieving for

my loved ones that just passed away” is like saying “I’m grieving for myself.

Death means the life has just ended that the families and loved ones were left

behind must go on living without the departed one. Once the death has occurred in

your family, your life won’t be the same again. Too often try to go on living as if

nothing happened. The sooner one realizes they lose and accept the fact of life will

be different, the smoother the process the healing will be.(Indrasona

Wijinayake,”Hope for Widows” Health & Home Vol.35, No.6) (Manila,Philippines

Publishing House,1994),p.9

Local Studies

The way you communicate with others in personal and public arenas reflects

a lot about your personality. If you are communicating positively then you would

obviously get a same kind of response and vibes (unless you encounter a jerk!).

Pertaining to all this, since the past few years, communication skills and techniques

have gained a lot of importance in almost all the professions. It is more so with

professions where you meet numerous people like hospitality, public relations,

human resources, health care, and media and so on. But the field where

communication has an impact which can really make the other person's life better is

nursing within health care. The way a nurse deal with the patients is extremely

important for the well being of the patient, mentally and physically. The question

which crops up here is, are there communication techniques in nursing? Well, yes

there are. Find out what they are in the text below.

Techniques of communication in nursing. General communication techniques

Speaking or Verbal Communication: If most of us would not have been

able to speak, I wonder what we all would have done. I mean, just try

and gauge the amount of time we spend speaking and talking in a day!

But coming back to nursing, nurses or any other type of care givers

need to speak clearly first of all. Maintaining slow, even tone helps the

patient to understand what they want to say. Once they put across the

point, wait for the patient to respond. Nursing requires you to be slow

and gentle, so not rushing thorough is one of the techniques for

communicating effectively.

Non-Verbal Communication: When dealing with patients who cannot

hear well, nurses ideally need to use hands along with speech to tell

what they want to say. Further, they also need to look out for non

verbal cues they are reflecting - the body language, voice and so on.

Please say the things which you are convinced about. Use other

methods like writing or drawing out pictures and the likes so that the

patient gets to know what you want to say if he or she is unable to

understand you. Even silence can work wonders when it is about non

verbal communication. These are very important nursing

communication strategies.

These and the few other techniques like helpful behavior and positive

mentality are important components of communication skills for

nursing practice. Now, let’s take a look at therapeutic communication

techniques for nursing.

Nursing therapeutic communication techniques Attention: To attract

and hold the patient's attention and to add a personal touch, use the

name of the patient. Similarly, just as you would call the patient by his

or her name, it is always nice to introduce yourself too. It adds a

comfort level to the interaction and lays the foundation for a good

rapport. Other things which can ensure a nurse the optimum attention

from a patient are: checking out on their basic needs, avoiding

distractions, having an eye contact and few other seemingly

insignificant things, which are, however, very crucial.

Behavior: While dealing with patients, a nurse should empathize and

acknowledge the mentality of the patient. A nurse's behavior should

reflect that and if that is not the case, it does communicate many

things to the patient. Encouragement is another essential factor in

case of communication techniques in nursing and patient care.

Already the patient is sort of demoralized and if the nurse discourages

the patient on top of it, the patient would have it. So, as therapeutic

technique, encouragement works wonders. Generally being helpful,

concerned, bright and friendly is the best therapeutic behavioral

technique.

Help in Dealing with Disorientation: Hospitalization is a very

traumatic experience for the elderly and thus they might tend to get

disoriented. So, if they say something which is not true, just calmly tell

them the truth in a normal tone, without challenging what they have

said. If patients are dealing with memory loss, give them gentle and

polite reminders all the time. Show them or tell them how to do a

particular thing.

Be Interactive: Wherever and whenever possible, a patient should be

included in decision making. After all, it is about the patient. Let the

patient be communicated as if he or she is in control. Avoid talking

about patients to others as if they do not exist. Being interactive does

not mean that you nag or pester the patient to open up. Let the patient

open up and express his or her feelings only when they want to. Do

not rush into that.

Communication techniques in nursing are umpteen if you delve even

deeper into the scheme of things. The above was just a glimpse of

what are the fundamentals in it. There are many more therapeutic

communication techniques for nursing like being patient, being clear,

listening to the patient and so on. As one gains experience, he or she

imbibes these qualities.

To cut a long story short, the penultimate aim is to make the patient

feel better and foster a feeling that he or she is going to be just fine. If

you do that, there is nothing as satisfying as that for all the Florence

Nightingales out there!

Justification of the Study

All the literature and studies included in this research study were related to

the present study. There were published in the local and foreign publication and

downloaded through the internet website and came from our university library and

mainly concerned on the “Use of Therapeutic Communication Techniques among

Staff Nurses to Newly Widows/Widowers in Selected district hospitals in Nueva

Ecija”. This is because all data used in it were gathered from selected staff nurse

and widow/widower patient in selected tertiary hospitals in Nueva Ecija

respondents.

Chapter 3

METHODS, PROCEDURES AND SOURCES OF DATA

This chapter presents the research mechanics employed by the researcher in

completing this work. It discusses the method utilized by the researcher, the

research instrument, and sources of data, data gathering procedures and statistical

treatment of data.

Research Method

The researcher employed the descriptive method in this study. According to

Barrientos Tan1 (2005) a descriptive research is a study that describes the nature of

the phenomenon under investigation after a survey of a trends, practices and

conditions that related to the phenomenon. The researchers employed the

descriptive method is this study. This type of research method will answers

questions and satisfies the curiosity about a certain phenomenon it will also

describes and elaborates the natures and causes of an existing phenomenon at the

time of study. The descriptive method is concerned with existing conditions. Its

meaning and significance and then making adequate interpretations of data. The

present study is concerned with the use of therapeutic communication techniques

among staff nurses to newly widows/widowers in selected district hospitals in

Nueva Ecija.

Research Locale

This study was conducted in selected Tertiary hospital in Nueva Ecija namely, E.L.

Joson Memorial Hospital, Dr. Paulino J. Garcia Memorial Research And Medical

Center, Wesleyan University General Hospital and Cardiovascular Center. These

Hospitals were chosen based on their status as tertiary hospitals that qualify them

to the needs of the study.

Figure 1. Eduardo L. Joson Memorial Hospital

The Eduardo L. Joson Memorial Hospital formerly known as the Nueva Ecija

General Hospital situated along the Maharlika Highway, Daan Sarile, Cabanatuan

City, and Province of Nueva Ecija, Philippines. A Department of Health (DOH)

licensed 100-bed capacity level 2 government hospital.

It started as a medical and dental dispensary in 1968; a community project of

the provincial government realized the needs for expansion, catering more on

maternity services, so that it was then called the Nueva Ecija Maternity and

Community Hospital. Subsequent health needs of the provincial constituents have

expanded the institution and became a General Hospital. From then on, it catered to

all of the basic medical specialties like pediatrics, internal medicine, surgery,

obstetrics and gynecology, and anesthesia.

Today, under the budgetary funding and support of the Provincial Government

of Nueva Ecija and in support and full coordination with the Provincial Health Office,

the institution has lived up to its category as a service-oriented hospital.

Figure 2. , Dr. Paulino J. Garcia Memorial Research and Medical Center

  The Dr. Paulino J. Garcia Memorial Research and Medical Center (Dr. PJGMRMC)

was first known as the Nueva Ecija Provincial Hospital located at Mabini Street,

Cabanatuan City. It was established under the Commonwealth Act 3114, as

amended by Act 3168 and other acts. It was opened to the public on December 15,

1930 with a capacity of 30 beds. As of now, it has a 400 bed capacity and has been

the major referral center of the different health care facilities within the province of

Nueva Ecija and other nearby provinces. It was currently recognized as one of the

Tertiary Level Hospitals here in Nueva Ecija.

SAMPLING PROCEDURE

The researcher used purposive or judgmental sampling. In this study

subjects are handpicked to be included in sampling frame based on certain qualities

for purposes of the study. Subjects are viewed as typical cases or experts that

provide enough data answer research questions.

The criteria employed by me as the researcher in this study is that the

respondents are the one who involved in this study and familiar to the use of

therapeutic communication techniques among staff nurses to newly

widows/widowers. More than 15 widows/widowers and 15 staff nurses are chosen

as the respondents of this study selected through purposive random sampling.

Respondents of the Study

The respondents of the study are selected newly widows/widowers and staff

nurses in selected Tertiary Hospitals in Nueva Ecija.

Sources of Data

The researcher is able to utilized more than 15 newly widows/widowers and

staff nurses as the respondents. These respondents will serve as the source of the

information needed in this research about the use of therapeutic communication

techniques among staff nurses to newly widows/widowers in selected District

Hospitals in Nueva Ecija.

Research Instruments

Questionnaire is use as the research instrument in collecting data needed in

this study. It is a paper pencil approach where participants were asked to answer a

set of printed data questions. Data and information are based on demographic

profile and perceptual assessments of the respondents regarding the variables of

the study.

Data Gathering Procedure

The researcher must able to formulate questionnaire based on the problems

cited in the statement of the problem. After questions I finalized and organized it

will pass to my adviser for some corrections, after corrections done by the adviser

the questionnaire will pass to their adviser together with the approval letter for the

acceptance and permission in conducting this research. The researcher will

distribute the questionnaires to the newly widows/widowers and staff nurses

during their free time retrieve it after the respondent have fully accomplished all the

questions. The data to be gathered will be tabulated for interpretation and

presentation.

Statistical Treatment of Data

The data gathered from all questionnaires will be treated statistically,

tabulated and computed with the used of frequency counts, percentage and ranking.

Frequency and Percentage Distribution

This is method to describe the data on profile , it is listing of all scores and

numerical values from a set of data and the number of times each score or values

appears; score may be listed from higher to lowest and lowest to highest.

Percentage

The percentage age is computed to determine the proportion of a part to a

whole such as given number of respondents in relation to entire population.

To get the percentage, the formula used was of Dr.Tan

P (%) =f/N x 100

Where;

P-stands for percentage

F-stands for frequency of responses

N-stands for total number of respondents

All data gathered from the respondents regarding about the use of

therapeutic communication techniques among staff nurses to newly

widows/widowers in selected District Hospitals in Nueva Ecija were statistically

treated. I used tabulated and computed it with the use of frequency counts,

percentage and ranking.

Frequency Distribution

Percentage Distribution

This is used to get the proportion of part, the formula used:

F (100)

_____________

N

Statistical Treatment of Data

For Percentage:

% = F/N x 100

Where:

% = percent

F = Frequency

N = No. of respondents

For the Weighted Mean:

WM = TWF/N

Where:

WM = Weighted Mean

TWF = Total Weighted Mean

N = Number of Respondents

Since the research study involved selected staff nurses to newly

widows/widowers respondents regarding about the use of therapeutic

communication techniques and since the data were nominal, simple statistical tools

like the frequency counts, percentage, weighted mean and the ranking system were

used in the presentation, analysis and interpretation of data (Tan-Barrientos, 2007).

Verbal Description

The researcher also made tables and tallied these according to rank. In

ranking the following were calculated: The table of equivalent used to retract the

weighted mean is as follows:

The following range of responses, verbal descriptions and rankings were

used to categorize the classifications of responses that will be applied according to

the table or part given below: They also made tables and tallied these according to

rank. In ranking the following were calculated:

DEGREE OF RESPONSES RANK VALUES

SA - Strongly Agree 4

A - Agree 3

DA - Strongly Disagree 2

SD - Disagree 1

EQUIVALENTS VERBAL EQUIVALENTS

4.50 – ABOVE Strongly Agree

3.50 – 4.49 Agree

2.50 – 3.49 Moderate Agree

1.50 – 2.49 Strongly Disagree

0.50 – 1.40 Disagree

Ranking

Based on the weighted mean, ranking will be used to indicate the positional

advantage or relative placement of the different items to describe an order of value

from highest to lowest. The greater the weighted mean, the higher the rank.

(Calderon, 2006) pointed out that data should be treated statistically because

it now plays a vital role in research study. A statistical method helps the researcher

in determining the validity and reliability of their research instrument.

Statistical manipulation organized raw data systematically to make the latter

appropriate for the study. It is used to test hypothesis, statistical treatments give

meaning and indispensably determines the levels of significance of vital statistical

measure.

When two or more items have identical means, their ranks will be computed

by getting the sum of their actual ranks and dividing the result by the number of

items with identical means (Tan-Barrientos, 2007).

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