Nurses perception to the implementation of therapeutic communication in intensive care unit

Therapeutic communication in intensive rooms was a therapeutic communication initiated by nurses to patients with intensive conditions whichrequired critical thinking, fast and precise measures in coping with each patient's needs. To figure out the nurses’ perceptions of the application of therapeutic communication in Intensive room.The study was qualitative phenomenological study, involving eight intensive care nurses participants from IGD, HCU, ICU and NICU. The inclusion criteria were nurses who had worked at least 1 year in the intensive unit, with a minimum education level of bachelor in nursing, through in-depth interviews. The data were analyzed using the Colaizzi method. There were 4 themes identified in the nurses’ perception of the application of therapeutic communication: communication to help the healing process, adaptation and information, stages, technical and benefits of communication. The communication which had not been widely explored wasthe one to help the patients' adaptation process to illness and the communication in emergency situations . The therapeutic communication model is adjusted to the goals and characteristics of patients. Especially for the patients in emergency condition, the nurses are required to have sensitivity and communication skills which have not been sufficiently explored. The communication tends to be directional, not interactive, while the non-verbal communication has not been carried out optimally.


INTRODUCTION
The Therapeutic communication is an aspect that affects the quality of health services, where everyone has the same right to access health services (Health Law No. 36 of 2009, Article 5). It is one of the service standards in hospital accreditation, which is the goal of the safety of the patient(National Hospital Accreditation Standards -SNARS, 2018). Therapeutic communication is communication carried out by nurses or other medical personnel with patients or nurses with other medical personnel, and with the patient's family based on mutual trust as the art of healing [1].
Communication in the health service team has an important role in achieving good nursing and health service outcomes for patients [2]. This is supported by the inclusion of therapeutic communication as an independent intervention that can carried out by each nurse in supporting other interventions in resolving nursing problems in the part of patients. It has beenunderlined that communication is contained in the Indonesian Nursing Intervention Standards (SIKI) (Indonesian National Nurses Association (PPNI, 2018) and Nursing Interventions Classification (NIC) which are 2 basic guidelines in the preparation of nursing interventions used today [3].
The purposes of communication related to the quality of nursing care are the patient's safety and the patient's satisfaction. Tthe relationship between communication factors and patient safety incidents shows that ISBN: 978 602-6697-63-9 Proceeding homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/1 121 good and effective communication can prevent patient safety incidents from occurring. Effective communication will reduce incidents that risk the patient's safety and increasing the patient's satisfaction (Audrey M. Burgener, 2017), decreasing the patient family's anxiety and reducing errors in medical decision making made by the patient's family [4]. The type of communication in the intensive room consists of two aspects, i.e. the communication between the practitioner and the patient/family and the importance of the communication process with the family for the patient's recovery [5].
Several studies related to the implementation of therapeutic communication in the intensive room show poor results, including therapeutic communication in the ER at the stage of doubt which means that it has not reached the level of patient satisfaction [6], job satisfaction, work motivation, and work climate, support from friends and support from the head of the room [7] the character of the executor includes gender, age, the patient's emergency condition [8], physical and mental fatigue, language, leadership support and hospital management, support facilities and job awards [9] In fact, it is mentioned that communication is a factor that affects LOS (Length of Stay) in the ER [10]. Communication in Emergency is very complex and prone to miss communication. The most dominant specific problem is the result of a lack of knowledge on transitional conditions, inconsistency of medical records, large numbers of patients, long working hours, and decreased focus of officers [11].
In the current development of technology and information, where health services focus on patients, the demands of implementing therapeutic communication are increasingly needed in relation to the patient's need for good quality health services. The poor implementation of therapeutic communication can result in a decrease in the quality of nursing care, LOS, and an increased risk of patient safety incidents, patient/family anxiety. Because of the important role of therapeutic communication in the success and quality of health services, therapeutic communication is a national and international issue which is still being discussed and researched. This study aims to explore nurses' perceptions about the application of therapeutic communication in the intensive room of Banyumas Regional Hospital. Intensive room nurses regarding the application of therapeutic communication is very subjective. Hence, the researchers choose a qualitative method with a phenomenological approach. It is hoped that this research will find novelty in the application of therapeutic communication in the intensive room.

RESEARCH METHOD
This qualitative research using phenomenology approach took place in 4 intensive rooms of Banyumas Regional Hospital, namely IGD, HCU, ICU, and NICU. The study involved 8 participants who were nurses in the intensive room, with an average length of work in the room of more than 1 year, aged between 40 -45 years, with an educational background of S1 nursing. Data collection was obtained using in-depth interviews using voice recorder. Data analysis used the colaizzi approach, which includes 7 stages, namely; transcribing and translating the results of interviews, digging important statements, formulating the meaning of important statements, organizing the meanings formulated in aggregate into theme groups, writing complete descriptions of existing phenomena, identifying fundamental statements, and validating fundamental statements of each participant [10].

RESULTS AND DISCUSSIONS
All the results of the interviews with participants were then analyzed by Colaizzi method; transcribing and translating the results of the interviews by writing the interviews in complete verbatim form, and extracting important statements.At this stage the researcher made the interview result matrix, formulated the meaning of the significant statements, the researcher identified the keywords of each answer participants, giving the formal meaning of important statements into thematic groups, the researcher classifies several keywords into a theme, from the existing themes the researcher fully describes a phenomenon, then the researcher identifies the core concepts related to the emerging themes, validates a complete description of a phenomenon with each participant [12].
From the themes proposed by the researcher, as material for interviews with the participants, four themes were obtained from the answers of the participants. Those were : 3.1. Communication as a Process to help patient's healing; Adaptation and Information "In my opinion, therapeutic communication is communication made by nurses to help the patient's healing process, where nurses need skills to carry out this therapeutic communication, in general." (P1). "… Helping patients in dealing with stress and illness means that we hope that the patients treated here are more adaptable and enthusiastic in undergoing their treatment…"(P5). "... The nurse's ability to convey information to the patient, with the aim of improving the patient's health ..." (P7).

Benefits of Therapeutic communication in the intensive room of Banyumas Regional Hospital
"... Even though in a state of decreased consciousness, sometimes something is still remembered, this makes the patient feel cared for and calm" (P2) "… For example, neonatals who used to cry and we hold and we hug them, many become calm…Or nenonatal who are lethargic, we give motivation and touch to survive, many then show improvement, for example saturation rises, HR increases, like that. (P7)