Relationship between Nurses' Therapeutic Communication to Patient Family Anxiety in Emergency Conditions

Introduction: One of the nursing actions to overcome anxiety problems is to carry out therapeutic communication. With the existence of therapeutic communication, nurses can help clients and families understand better through verbal and non-verbal communication. However, there is often a gap between good communication theory and communication practice, leading to gaps in the field. The study wanted to determine the relationship between the nurse's therapeutic communication and the anxiety level of the patient's family experiencing emergency conditions. Methods: This study employed a cross-sectional and descriptive correlational research design with a sample size of 50 respondents using purposive sampling. Results: The results showed a relationship between nurses' therapeutic communication and the anxiety level of patients' families experiencing emergency conditions, with a p-value of 0.003. This study indicated that most of the nurses' therapeutic communication was good (96%), and the patient's family anxiety level was mild (88%). Conclusion: Good therapeutic communication by nurses can reduce family anxiety.


INTRODUCTION
Emergencies are unpredictable and can occur anywhere and anytime.Disease, traffic accidents, or natural disasters can cause trouble.A crisis is a condition that can threaten life, and an emergency is a condition where immediate action is needed to deal with the threat to the patient's life.Troubles must get immediate help, such as first aid, to further help in the hospital [1].
Emergencies occur yearly, affecting around 270 million people and causing more than 130,000 deaths per year [2].Meanwhile, in Japan, based on observation data, there are about 2.6 million cases annually in Osaka [2].
Based on observations made by the Quality Watch Research Program in the UK, 41 million emergency cases occurred from 2010 to 2013 [3].The application of therapeutic communication is essential for health services.The application can be applied directly to patients and their families, which can increase visitor comfort.Meanwhile, Indonesia's national emergency case incidence rate has not been fully summarized.This is because it is difficult to collect data due to the vast area of Indonesia and the number of health centers spread across various regions.
Emergencies can cause psychological problems, one of which is anxiety.Anxiety is one of the responses often experienced by the patient's family when facing emergency problems because individuals will use more emotional energy than they realize when facing emergency problems.Research shows that family anxiety will increase when an emergency occurs, especially in the emergency room [4].This state has no specific object but is experienced subjectively and communicated interpersonally [5].
Psychological changes such as anxiety are usually expressed through attitudes and feelings of worry, restlessness, dissatisfaction, or fear and threat [1].
The impact of anxiety is divided into two, namely, the physical and implications for psychosocial functioning [5].This research supports that more female respondents experienced anxiety.They stated that anxiety often experienced by Women due to incompetence is more active and explorative [12].In contrast, men are more relaxed than women when dealing with specific situations.Women are considered more sensitive and use their feelings, while men are deemed to be mentally strong in dealing with dangerous responses [12].
Meanwhile, men usually work, so they can rarely attend or stay for patients in the hospital [13].Socioeconomic status is associated with patterns of psychiatric disorders.It is known that low socioeconomic class people have a higher prevalence of psychiatric disorders [14].Insufficient or inadequate economic conditions can increase anxiety in the patient's family.This is also in line with research conducted by Vellyana in 2017 that which states that income used to indicate economic status influences anxiety levels [6].The results showed that the prevalence rate of pay below the minimum wage experienced more anxiety than respondents with income above the minimum wage [6].and patients' families [14], [15].
The high school level of education is included in the secondary education level, which is considered sufficient to understand and respond to a problem.The easier it is to learn new things, the more educated a person is, the more knowledge he has [17].
Education is critical in influencing a person's mind.When encountering a problem, an educated person will try to think as well as possible in solving the problem [18].
Respondents' expertise in communicating with nurses can also be based on their level of education.
Education affects the learning process; the higher a person's education, the easier it is to receive information.Compared to people with a college education, the level of high school education is undoubtedly lower regarding knowledge insight; therefore, respondents with a high school education still need to be more optimal in communicating with nurses.The results of this study align with other theories, which state that the higher a person's education, the more they can reason and hold their emotions well to reduce their anxiety [18].
A person's anxious response depends on personal maturity, understanding in the face of self-esteem challenges and coping mechanisms, and self-defense mechanisms used to overcome their anxiety, including suppressing conflicts, impulses that cannot be accepted consciously, and not wanting to think about things that are less pleasant to themselves [18].
Anxiety occurs because anxiety is used as a stressor, which is a person's feeling of fear of an unpleasant situation that is subjectively experienced and communicated interpersonally [10].Manifestations of anxiety that can appear include difficulty sleeping, chest palpitations, sweating even though it is not the hot, hot, or cold body, headache, tense or stiff muscles, stomach pain, panting, or shortness of breath [10].
This study aligns with WHO's (2023) Communication During Patient handover research [19].The results of this study state that effective and efficient communication is needed not only communication between health workers in providing nursing care but also an excellent ability to communicate with patients, as well as patients' families, so that both patients and patient's families are well informed, and ultimately can accelerate the patient's recovery time [20].

CONFLICT OF INTEREST
In this study, the researcher has no conflict of interest in preparing proposals, collecting data, processing data, or publishing research results.
Therapeutic communication carried out by nurses must be systematic, and the stages of therapeutic touch must include preinteraction, introduction, orientation, work, and termination steps [15].Therapeutic communication is professionally designed and conducted for medicinal purposes.A nurse can help the patient's family and the patient overcome their problems through communication nursing field is the basis and key for a nurse.Communication creates a relationship between nurses, clients, and other health workers [16].Still, communication is necessary for someone to feel strange.The need for nurses to foster a relationship of trust with clients through therapeutic communication is helpful as a support in the implementation of nursing care and to know what is being felt and needed by clients.A nurse must possess communication skills because communication is a process used to collect assessment data, provide education or health information, influence patients to apply it in life, show concern, provide comfort, foster confidence, and respect the patient's values.After all, effective communication is essential in creating relationships between nurses and patients Therapeutic communication includes interpersonal communication.The basis of this communication is the mutual need between nurses and clients, which can be categorized as a personal communication between nurses and clients: nurses help, and clients receive help.Nurses use therapeutic communication using a consciously planned, purposeful, and client-centered approach [20].The decrease in anxiety from the pretest to posttest in the treatment group proves that communication and therapeutic relationships between nurses and clients can reduce client anxiety.Communication and therapeutic relationships fostered between nurses and clients can help reduce client anxiety [10].Clients can explore their feelings, share their fears and worries about facing the situation, and get the necessary solutions and knowledge.Therapeutic communication is a primary modality of the central intervention consisting of verbal and non-verbal techniques to improve patient welfare [20].LIMITATIONS This study had limitations because it was conducted in the pediatric emergency room, including the PICU and pediatric room.The number of respondents was less than 100.If researchers want to add spaces such as the emergency room or ICU or add hospitals, it will conflict with the purpose of the study.patients or families through critical times and providing peace for visitors.Health services must apply therapeutic communication to all patient families and patients receiving nursing care to increase the comfort of patients and patient families.The practical application of therapeutic communication in the ICU, HCU, and Emergency unit can effectively reduce patient and family anxiety.and patient families.Therapeutic communication by nurses who aim to approach, provide complete information, and focus on the patient's recovery can reduce anxiety in the patient's family.So, better therapeutic communication by nurses can reduce anxiety in the patient's family.

Table 1
Frequency Distribution of Respondents (n=50) and a STAI (State-Trait Anxiety Inventory) questionnaire.The STAI questionnaire has two parts: State Anxiety and Trait Anxiety [7].State Anxiety consists of 20 questions that indicate how a person feels "right now," and Trait Anxiety contains 20 questions that indicate how a person feels "usually or generally."The anxiety levels on this questionnaire are mild anxiety, moderate anxiety, and severe anxiety.The data obtained from the summation of the scores of the results of filling out the questionnaire for the anxiety scale, put into the division of categories, namely if the number of scores 20-The statistical analyses used in this study were descriptive analysis and Spearman Rank correlation.Descriptive analysis was used to identify the respondent characteristics.Spearman Rank correlation aimed to measure the relationship between two variables in the study.In this context, Spearman Rank correlation was used to analyze the relationship between the variables observed in the research and measure the extent to which the relationship is solid and significant.