thesis on psychodynmic traits in adherence to therapeutic communication skills
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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
pro cess 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.
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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.
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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 mid1960s 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, socialinteraction, 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.
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The conceptual framework of the interpersonal system had the greatest
influence on the development of this theory. King state d, 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 thenurse has heard and followed the clients train of thought. It does not indicate agreement but is not
judgmental.
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BROAD OPENINGSIt makes explicit that the client has the lead for interaction. For the client who is hesitant abouttalking, broad openings may stimulate him or her to take the initiative.
ENCOURAGING DESCRIPTION
OF PERCEPTIONSTo understand the client, the nurse must seethings from his perspective. Encouraging theclient to describe ideas fully may relieve thetension the client is feeling.
EXPLORINGIt helps client examine issues more carefullywhen topics are given superficially. Any problemor concern is better understood if explored indepth.
GENERAL LEADSUsing neutral expressions to encourage patientsto continue talking. It indicates that the nurse islistening and following what the client is sayingwithout taking the initiative for interaction.
GIVING INFORMATIONProviding information that will help patients makebetter choices. Informing the client of factsincreases his knowledge about a topic or lets theclient know what to expect.
OFFERING SELFMaking self-available and showing interest andconcern. The nurse can offer his presence,interest and desire to understand.
SEEKING INFORMATION Asking patient to restate, elaborate, or giveexamples of ideas or feelings to seek clarificationof what is unclear. The nurse should seekclarification throughout the interactions with theclient.
SUGGESTING
COLLABORATION
The nurse seeks to offer a relationship in whichthe client can identify problems in living withothers, grow emotionally, and improve the abilityto form satisfactory relationships.
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SUMMARIZINGReviewing the main points of discussions andmaking appropriate conclusions. It allows bothclient and nurse to depart with the same ideasand 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 da y 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 communicati on 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
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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-in-
Your-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:
http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002 -
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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
Parents or guardian of the pediatric
patients
Level of perception to the
therapeutic communication
Enhancement of the therapeutic
communication skills of the nursingstudents
Republic Act No. 9173
An act providing for a moreresponsive nursing profession,
repealing for the purpose of theRepublic Act No. 7164 other known
as the Philippine nursing act of
1991 and for other purposes
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. General leads;
j. 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
S p = 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 clientto a better understanding through verbal or nonverbal communication.