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 lifes 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 agerelated, 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 didnt 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-Rosss 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

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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 Specific Problems of canstudy: Statement of is that he the be accepted even though he the silent, that1. Improved economic status in even though he their lives through the help of Problem. What are the therapeutic is shy and quiet, he has worth and is respected by another person.Health. Department of 1. Socio-Demographic communication 2. Final assessment on the Profile of Staff Nurses techniques utilized by improved clinical performances are described in during these interludes. staff nurses in dealing communication occurs terms Much nonverbal of staff nurses on the delivery of: with newly The nurse needs to be alert to what she is communicating as well as care and of quality nursing 1.1 Age widows/widowers? education to all patients with 1.2 Gender of interest can be interpreted as perceiving. Even the How effective is momentary loss better health and better body 1.3 Religion therapeutic indifference. technique Schwartz 1.4 Duration of service and Schockley state that the mind and very satisfactory and utilization of communication nursing service through their as perceived by the staff silence is often difficult 1.5 Educational personnel, since they think that for nursing attainment best performance, effort and Socio-Demographic nurses in terms of: nothing is happening and that they of the newly their time. In longpatients in are wasting time to assists the Profile 4.1 Emotional the delivery of quality health widows/widowers are 4.2 Psychological periods of silence, they may become bored and their attention care service and community described in terms of: 4.3 Spiritual nursing wanders from the patient. Age nurse could observehealth patient and program the 2.1 If the 4.4 Social implementation. 2.2 Gender herself effective is the How carefully, she might discover that a great deal happens 2. The patients have overcome 2.3 Religion therapeutic their behavioral, psychological between thentechnique times. at these 2.4 Number of Children communication and financial problems 2.5 Occupation as perceived by the newly considering they healed from widows/widowers in the therapeutic communications Tools for gathering data terms of: through discovered medical collection through 5.1 Emotional treatment and solutions. INPUT PROCESS survey questionnaire 5.2 Psychological - Summary of findings and and ocular interview 5.3 Spiritual OUTPUT conclusion/ recommendations 5.4 Social 3.Statistical Treatment of Data Is there significant differences between the Analysis, presentation perception of Staff Nurses and interpretation of and Newly findings. widows/widowers in the effectiveness of therapeutic communication techniques used?

Figure 1 Conceptual Paradigm of the Study

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 populations 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 and communication these is aimed at establishing which relationships within relationships interactions

encourage rather than discourage patients Navarra et al (2003) state If you think communication is just a matter of common sense think againmost of our instinctive responses things we often say throughout the day to each other are often

non-therapeutic. Until youre aware of how you sound and the implications of what youre saying, you really dont "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 fianc 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, fianc 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 Perrys 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 the to be non-judgmental lets down and his create an and atmosphere where, patient guards

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 Im grieving for my loved ones that just passed away is like saying Im 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 wont 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, lets 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. study. These Hospitals were chosen based on their status as tertiary hospitals that qualify them to the needs of the

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 Nueva Ecija. Sources of Data The researcher and is able to utilized as more than 15 newly These widows/widowers staff nurses the respondents. respondents of the study are selected newly widows/widowers and staff nurses in selected Tertiary Hospitals in

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 N (100)

_____________

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 VALUES SA - Strongly Agree A - Agree DA - Strongly Disagree SD - Disagree EQUIVALENTS EQUIVALENTS 4.50 ABOVE Agree 3.50 4.49 2.50 3.49 Agree 1.50 2.49 Disagree 0.50 1.40 Ranking Disagree Strongly Agree Moderate Strongly 2 1 VERBAL 4 3 RANK

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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Books International, 2002), p. 74. Guralnik, David, The Websters New World Desk Dictionary, (New York: Prentice-Hall Press, 2001), p. 89. Kahayon, A.H., and G.V. Aquino. General Psychology. : National Bookstore Inc., 3rd edition. Lupdag, A., Educational Psychology. Manila: Rex Bookstore Inc., 2005 p. 128 Nocon, Ferdinand P., et al, General Statistics, (Mandaluyong City, National Bookstore, 2000). The American Heritage Medical Dictionary Copyright, 2007, 2004 by Houghton Company. Tan-Barrientos, Cresita, PhEd, Research Guide in Nursing Education, (Manila; Science and Health Center, 2001). Whitney, F.L. Cliffs, N.J., Prentice Hall, Inc., 2000, p.425. The Elements of research. 3rd edition Englewood Mifflin Company. Published by Houghton Mifflin Metro Manila

B. Magazines and Newspapers/Journals Hart, C. Anthony, and Nigel A. Cunliffe. "therapeutic Communications" (2007) p. 408. Moss, Peter J., and Michael W. McKendrick. "Use of Therapeutic Communication Techniques" 2007) p. 402. C. Internet websites Chapman, Robert, The New Websters International Dictionary On-Line,

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