Rationale Are you okay?

Little did we know that these words means so much to the patients we are interacting with every day. 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 or mend on the emotions that the patient is dealing with, it requires a great deal of sensitivity and a good knowledge in regarding with the techniques or traits we are about to use., Communication is a process by which information is given from one person to another either directly in face-to-face meetings or indirectly. It involves intrapersonal and interpersonal exchanges. (King, 1981). Communication can be defined as the process of transmitting messages and interpreting meaning. (Wilson and others, 1995) with therapeutic communication, the sender, or nurse seeks to illicit a response from the receiver, the patient that is beneficial to the patients mental and physical health. In addition, nurses interaction with various people in the course of their profession. Hence, high aptitude in communication helps the nurse maintain balance and effective relationships within the entire sphere of professional practice and help meet legal, ethical and clinical standards of care. Failure to effectively communicate causes serious difficulty especially to these pediatric patients where the value of trust is still undeveloped, for nurses these may lead to increase liability and threatens professional credibility. Moreover, it is necessary to build therapeutic communication for this journey. Nurses give therapeutic communication to people under stress: clients, families and
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colleagues. They function as client advocates and as members of interdisciplinary teams who may have different ideas about priorities for care (Potter and Perry, 2005). Therapeutic communication can be very effective in dealing with troubled children. Establishing a therapeutic relationship is one of the most important

responsibilities of the nurse when working with clients. Communication is the means by which a therapeutic relationship is initiated, maintained, and terminated. However, it should be noted that gaining expertise in communication as in any aspect of nursing, requires both understanding of the communication process and reflection about ones communication expertise as a nurse (Guipando, 1983). On the other hand, therapeutic communication is n important asset of a nurse, most especially to the Filipino nurses. According to some experts, Filipino nurses are much sought out inn communicating with and caring for patients. Thus there is indeed a need for nursing students to develop their therapeutic communication skills. Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the clients specific needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the clients experience. All nurses need skills in therapeutic communication to effectively apply the nursing process and to meet the standard of care of their clients. Therapeutic communication must be enhanced and practiced constantly as it is an integral part of the health care delivery especially in the ward with pediatric patients where patients cannot comprehend facts about health immediately nor can they read. However, only nurses who are well trained with therapeutic communication can most of the time gain their trust and reach the minds of the patients.

Although along with therapeutic communication, we also have the non- therapeutic communication which nurses should recognize so that they would know what not to do during their exposure on the ward, the researchers considers the therapeutic communication in relation to this study. A common misconception by students learning the art of therapeutic communication is that they always must be ready with questions the instant the client has finished speaking. Hence, they are constantly thinking ahead regarding the next question rather than actively listening to what the patient is saying. The result can be that the nurse does not understand the clients concerns, and the conversation is vague, superficial, frustrating and irritating most especially to pediatric patients who have lesser patience in dealing with this kind of conversation. Through this study this kind of misconception can be changed and corrected. As a whole, this study deal with the therapeutic communication skills of third year nursing students as they communicate with their pediatric patients. It aims to show the various therapeutic communication skills utilized by junior student nurses as well as the perception of the parents of the patients on the level of competence of the student nurses in applying their skills in the ward. The researchers also intend to use the result of this investigation as an eye opener for everyone in the college of nursing in the importance of developing strategies that will help the students to further improve their quality of care and therapeutic relationship despite the toil in dealing with pediatric patients by way of therapeutic communication.

Theoretical Background This study is anchored on the Goal Attainment Theory of Imogene King which states that, a personal relationship is the vehicle for the delivery of nursing care, which she defines as a dynamic interpersonal process in which the nurse and client are affected by each others behaviour, as well as by the health care system. The nurses goal is to use communication to assist the client in re-establishing or maintaining a positive adaptation to the environment (Williams, 2004). This conceptual model was developed by Imogene King for nursing in the mid 1960s with the idea that human beings are open systems interacting with the environment. Kings work is considered a conceptual model because it comprises both a conceptual framework and a theory. The central focus of Kings framework is man as a dynamic human being whose perceptions of objects, persons, and events influence his behaviour, social interaction, and health. Kings conceptual framework includes three interacting systems with each system having its own distinct group of concepts and characteristics. These systems include personal systems, interpersonal systems, and social systems. Kings basic assumption maintained that nursing is a process that involves caring for human beings with health being the ultimate goal. The three systems that constitute Kings conceptual framework provided the basis for the development of her theory of Goal Attainment. The personal system that King speaks of refers to the individual. The concepts within the personal system and fundamental in understanding human beings are perception, self, body image, growth and development, time, and space. King viewed perception as the most important variable because perception
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influences behaviour. King summarized the connections among the concepts in the following statement: An individuals grow and develop through the life span, experiences with changes in structure and function of their bodies over time influence their perceptions of self. Interpersonal systems involve individuals interacting with one another. King refers to two individuals interacting as dyads, three individuals as triads, and four or more individuals as small or large groups. The concepts associated with interpersonal systems are interaction, transaction, communication, role and stress. The interactions and transactions that occur between the nurse and the client, or the dyad, represent an example of an interpersonal system. Communication between the nurse and the client can be classified as verbal or nonverbal. Verbal exchanges include both spoken and written communication, while nonverbal communication includes such things as appearance, distance facial expression, posture and touch. The third and final interacting system in kings model is the social system.

Social systems are groups of people within the community or the society that share common goals, interest, and values. Social systems provide a framework for social interaction and relationships, and establish rules of behavior and courses of action. Examples of social system include the family, the school and the church. It is within these organizations that the individuals beliefs, attitudes, values and customs are formed. The concepts that king identified as relating to social systems are

organization, authority, power, status and decision making. The relationship between these three systems led to kings theory of goal attainment.

The conceptual framework of the interpersonal system had the greatest influence on the development of this theory. King stated, Although personal systems and social systems influence quality of care, the major elements in theory goal attainment are discovered in the interpersonal systems in which two people, who are usually strangers, come together in a health care organization to help and to be helped to maintain a state of health that permits functioning in roles. King believes that interactions between the nurse and the client lead to transactions that result in goal attainment. Furthermore, king proposes that through mutual goal setting and goal attainment, transactions result in enhanced growth and development for the client. King used ten major concepts from the personal and interpersonal system to support the theory of Goal attainment. Those concepts include human interactions, perception, communication, role, stress, time, space, growth and development, and transactions. To capture the essence of these interrelated concepts, king states that nurse and client interactions are characterized by verbal and nonverbal communication, in which information is exchanged and interpreted; by transactions, in which values, needs, and wants of each member of the dyad are shared; by perceptions of nurse and client and the situation; by self in role of client and self in role of nurse; and by stressors influencing each person and the situation in time and space. Kings Theory is supported by Videbecks concept of communication which states that communication is far more complex than a message sent in a straight line between a sender and receiver. It is a process that involves give and take between the participants. Verbal and nonverbal messages are transmitted back and forth between sender and receiver. For example a patient can be silent while a nurse is explaining the effect of the medication given, however, the patient may be
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communicating a response to the nurses message by body stance, facial expression, and eye contact (or lack of it). The receiver perceives and interprets the message and then provides feedback on the message was received. The sender then has information on what the receiver has heard and how he or she responded to the message and, on this basis, can decide whether to continue the communication and, if so, how to proceed. The nurse should use words that are clear as possible when speaking to the client so that the client can understand the message. The nurse should be aware that anxious people lose cognitive processing skills the higher the anxiety, the less the ability to process concepts so the nurse uses concrete messages are important for accurate information exchange. In a concrete message, the words are explicit and need no interpretation (www.rno.org). The nurse can use many therapeutic techniques to interact with clients. The choice of technique depends on the intent of the interaction and the clients ability to communicate verbally. Overall, it is the nurse who selects the technique that will facilitate the interaction (Weitzel, et.al., 1983). Here below, are some effective techniques to promote therapeutic communication (Videbeck, 2004):

THERAPEUTIC COMMUNICATION

INTERPRETATION

ACCEPTING

Indicates reception; indicates that the nurse the nurse has heard and followed the clients train of thought. It does not indicate agreement but is not judgmental.
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BROAD OPENINGS

It makes explicit that the client has the lead for interaction. For the client who is hesitant about talking, broad openings may stimulate him or her to take the initiative. To understand the client, the nurse must see things from his perspective. Encouraging the client to describe ideas fully may relieve the tension the client is feeling. It helps client examine issues more carefully when topics are given superficially. Any problem or concern is better understood if explored in depth. Using neutral expressions to encourage patients to continue talking. It indicates that the nurse is listening and following what the client is saying without taking the initiative for interaction.

ENCOURAGING DESCRIPTION OF PERCEPTIONS

EXPLORING

GENERAL LEADS

GIVING INFORMATION

Providing information that will help patients make better choices. Informing the client of facts increases his knowledge about a topic or lets the client know what to expect.

OFFERING SELF

Making self-available and showing interest and concern. The nurse can offer his presence, interest and desire to understand.

SEEKING INFORMATION

Asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear. The nurse should seek clarification throughout the interactions with the client.

SUGGESTING COLLABORATION

The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships.

SUMMARIZING

Reviewing the main points of discussions and making appropriate conclusions. It allows both client and nurse to depart with the same ideas and provides a sense of closure at the end of discussion.

In contrast, there are many nontherapeutic techniques that the nurse should avoid. These responses cut off the communication and make it more difficult for the interaction to continue. Responses such as Everything will work out or Maybe tomorrow will be a better day may be intended to comfort the client2, but instead may impede the communication process. Asking Why questions (in an effort to gain information) may be perceived as criticism by the client, conveying a negative judgment from the nurse. Many of these responses are common in social interaction. Therefore, it takes practice for the nurse to avoid making these types of comments (Videbeck, 2011). Gaining expertise in communications in any aspect of Nursing requires both an understanding of the communication process and reflection about ones communication experiences as a nurse. Nurses who have developed good critical thinking skills make the best communicators. They are able to draw upon theoretical knowledge with what has been learned through personal experience. They can interpret messages received from others, analyse their content, make inference about their meaning, evaluate their effect, explain rationale for communication techniques used, and self-examine personal communication skills (Guipando, 1983). Based on a theory known as the Five Factor Model, there are essentially five overriding personality traits. This list of personality traits are the dominant factors that shape all our personalities and encompass the more subtle individual traits. This

article gives a personality traits list and examines each of the big five and how they may affect how your child relates to the rest of the world. The Big Five Personality Traits of a child (1.) Conscientiousness. The conscientious child is organized and disciplined. You can recognize this in how kids keep their toys, color, and complete school work. The conscientious child to shows self-discipline and prefers planned activities over spontaneous behaviour. This trait is associated with a strong performance and a high level of commitment. Of all the personality characteristics, this one is associated with great students and professionals later in life. (2). Agreeableness. The agreeable child is friendly and pleasant to be around. His relationships will be mostly strong. He has tendency toward compassion and cooperation. He will rarely be suspicious or antagonistic with others. This child is a social creature, and gets energy from being around other kids and adults. This is the kid who gets along with everyone. You just have to watch out that he isnt taken advantage of. (3.) Neuroticism. The neurotic child is a worrier. Shes often anxious and her emotions can fluctuate quite a bit. She is vulnerable to experience unpleasant emotions such as anger and anxiety easily. This is sometimes referred to as emotional instability. Watch for signs of depression and sadness during the teen years. Although this trait is inborn, parents can help alleviate stress by providing and communicating a safe and stable environment. This personality trait often leads to physical ailments. (4.) Openness. The open child is your daredevil. She loves adventures and trying new things and is very insightful and imaginative. This is the child who entertains you with wise-beyond-her-years one liners and stunning creativity. She appreciates art and unusual ideas. She is not afraid to take risks and therefore may not take your parental advice either. (5.) Extraversion. The extraverted child is assertive, talkative, and loves to be the center of attention. Hes got a lot of

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energy and optimism. He has a tendency to seek stimulation and the company of others. While he may prefer not to be alone, he can become overwhelmed if this trait is allowed to go unchecked. Extraverts actually need time alone

(http://leladavidson.hubpages.com/hub/Recognizing-the-Big-5-Personality-Traits-inYour-Child). In addition, related to Kings theory. Republic Act No. 9173. Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. Members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established; (b) establish linkages with community resources and coordination with
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the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice; Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, that the program and activity for the continuing professional education shall be submitted to and approved by the Board (www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002). Section 29. Qualification of Nursing Service Administrators. - A person occupying supervisory or managerial positions requiring knowledge of nursing must: (a)Be a good registered nurse in the Philippines. (b) Have at least two 2 years experience in general nursing service administration; (c) Possess a degree of Bachelors of Science in Nursing, with at least nine 9 units in management and administration courses at the graduate level; and (d) Be a member of good standing of the accredited professional organization of nurses; Provided, that a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, possess:
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(1) At least five years of experience in a supervisory or managerial position in nursing and (2) A master's degree major in nursing; Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief nurse shall be as specified in subsections (a), (b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health nursing shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority shall be given to those who have finished a master's degree in nursing and the completion of the General Staff Course (GSC): Provided, finally, That those occupying such positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify (www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002). According to Dr. Gail Porrier of the University of Louisiana at Lafayette, nurses are routinely called upon to use their therapeutic communication skills, written and verbal, for the following purposes: to promote consistent quality care; maintain continuity of care; to provide evidence of critical thinking that accompanies; the utilization of the nursing process; to establish accountability for care; to develop nurse-patient and nurse-other health care provider relationships. It should be pointed out that failing to communicate effectively with the patient from the first could actually destroy the delicate nurse-patient relationship together. The first few seconds of the nurse-patient interaction with either establish or destroy trust. And if the nurse loses trust of the patient, it is difficult to regain it (Oxtoby, 2005). Poor one-on-one communication can even be dangerous. It can lead to misdiagnosis or even medication errors. If the patient does not disclose to the nurse

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misinterprets what the patient is saying, it can be potentially life threatening (Oxtoby, 2005). Indeed, being able to communicate clearly with a patient is a challenge in the health care environment. Hence, the researchers conducted this study to ascertain the verbal and non-verbal communications skills of the junior student nurses in the hope of contributing recommendations as to how the student nurses enhance their skills.

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Goal attainment theory By: Imogene King

Republic Act No. 9173 An act providing for a more responsive nursing profession, repealing for the purpose of the Republic Act No. 7164 other known as the Philippine nursing act of 1991 and for other purposes

Parents or guardian of the pediatric patients

Level of perception to the therapeutic communication

Enhancement of the therapeutic communication skills of the nursing students

Figure 1 THEORITICAL CONCEPTUAL FRAMEWORK OF THE STUDY

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THE PROBLEM Statement of the Problem The purpose of this study is to determine if the nursing students are capable of implementing the necessary therapeutic communication towards pediatric patients. Specifically, this study seeks to answer the following questions: 1. What are the demographic profile of the respondents in terms of: a. Age; b. Gender; c. Civil status; d. Religion; e. Educational attainment; and f. Economic status? 2. What are the perception of the respondents in the therapeutic communication implemented by nursing students of Holy Name University: a. Accepting; b. Broad opening; c. Consensual validation; d. Encouraging comparison;

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e. Encouraging description of perceptions; f. Encouraging expression;

g. Exploring; h. Formulating a plan of action; i. j. General leads; Giving information;

3. Is there any significant correlation between the demographic profile of the respondents and their perception in the therapeutic communication

implemented by the nursing students of Holy Name University?

Statement of the Hypotheses 1. There is no relationship between the demographic profile of the respondents and their perception in the therapeutic communication implemented by the nursing students of Holy Name University. Significance of the Study This research would be beneficial to the following: Student nurses. The result of this research would increase their awareness in developing the quality of care they give and their therapeutic relationship with pediatric patients by way of communication. Clinical instructors. The study would furnish them knowledge of the communicative proficiency of their students who are sent to practice and help the
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students exploit authenticity, confidence and responsiveness while employing therapeutic communications to pediatric patients. School administrators. This study anticipates to motivate the clinical instructors to use new approach in helping the students progress their therapeutic communication skill activities such as hospital and community health exposure where their therapeutic communicating abilities to be tested and polished.

Scope and limitations This study focus on the therapeutic communication skills of the nursing students enrolled in Holy Name University and how these affect the patients perception of the student nurses communication competence. The number of respondents is limited to only thirty. The questionnaires given to them were self-made and these were given during the free time of the researchers and within one week of hospitalization of the respondents. The results of this study primarily presented the therapeutic communication skills commonly used by the student nurse in the pediatric ward.

RESEARCH METHODOLOGY Research Design This particular study employed the descriptive method of research. The collection of data was facilitated through the use of self-made questionnaires distributed to the patient respondents.
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Research Environment The research environment was the Governor Celestino Gallares Memorial Hospital located in Miguel Parras Steet, Tagbilaran City. It is only a ten minute- ride from the Josef Freinademetz Building, Dampas Campus,Janssen Heights. The building has various wards namely: OPD, under five clinics, Emergency Room, Obstetrics, Operating Room, Delivery Room, Medical 1, Medical 11, Surgical 1, Surgical 11, Pedia 1, Pedia 11 and Neonatal Intensive Care Unit. The latter eleven of these were the wards assignment of patients respondents. Research Respondents The research respondents were the parents/guardians of the paediatric patients at GCGMH particularly at the Pediatric Ward. Although the study maybe conducted on pediatric ward, the researchers opted to have parents or guardians as research participants of the study, so that biases will be avoided. There were approximately thirty respondents. The type of sampling used were T-test sampling and also the questionnaires given to them were self made and these were given during the free time of the researchers with the scope of one week of hospitalization of the respondents. Research instruments

The researchers made use of self-made questionnaire. The questionnaire which is used, aims to obtain data that provide significant information on ht following objectives: First part, the respondents demographic profile in terms of age, gender,
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religion, educational attainment, economic status. Second part, the perception of the respondents in the therapeutic communication implemented by the level 3 nursing students of HOLY NAME UNIVERSITY. Third part is there any significant correlation between the demographic profile of the respondents and their perception in the therapeutic communication implemented by level 3 nursing students. Research procedure Each researcher was held responsible for the distribution and collection of data. In response to the distribution of questionnaire, a formal letter was sent to GCGMHS chief of hospital, Dr. Nenita Moraga Po requesting access to patients to conduct the survey, but before the distribution of questionnaire was done researchers first made a research proposal and had it approved by the adviser. In order to maintain anonymity and to avoid bias, the researchers did not require the patients to give their names. Propriety was strictly observed during the gathering of data. Upon the completion of the answers were carefully tallied, interpreted and submitted to the statistician. Then data was further analysed.

Treatment of Data T- test was used to attain the statistical data in this study.

Where: X1 = mean of the first sample

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X2 = mean of the second sample n1 = sample size of the first sample n2 = sample size of the second sample Sp = pooled standard deviation

And; ( ) ( )

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DEFINITION OF TERMS

The study applied terms, which improved understanding in the light of the current study, are herein defined as follows.

Implementation. A method or a design of doing something.

Communication . the activity of conveying information.

Therapeutic communication. a process in which the nurse consciously influences a client or helps the client to a better understanding through verbal or nonverbal communication.

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