SKENARIO

SKILLS LAB COMMUNICATION SKILLS: COUNSELING

KASUS Osteoporosis dengan fraktur spontan

Identitas Diri

Nama : Ny. I
Usia : 60 Th
Jenis Kelamin : Perempuan
Alamat : JL. Santai Sehat no. 7 Rt. 04 Rw 04 Kelurahan Babalongan Kota
mBandung
Pekerjaan : Pensiunan
Agama : Islam
Pendidikan terakhir : S1
Status Pernikahan : Menikah dengan 3 Anak,2 cucu

Keluhan Utama: Nyeri tulang belakang

 Pasien sudah lama mengalami nyeri di tulang belakang sejak 2 tahun yang lalu.
Rasa sakit tersebut terutama saat bergerak ke posisi berdiri. Aktivitas fisik
terbatas saat membungkuk. Awal mulanya rasa sakit tersebut dirasakan tiba-
tiba. Pasien sudah menopause sejak 3 tahun yang lalu.
 Pasien awalnya berobat biasa menggunakan obat warung atau obat beli dari
apotek. Pasien juga sering minum jamu-jamuan racikan untuk mengatasi rasa
nyeri-nyeri sebelum sakit yang sekarang, juga masih mengonsumsinya untuk
mengatasi keluhan yang sekarang. Keluhan lain di sangkal pasien.
 Pasien sehari-hari buruk dalam asupan makanan dan jarang beraktivitas
sebelumnya.
 Pasien mengaku khawatir dengan sakit tulang belakangnya bertambah parah
dan terbatas gerakannya. Sakit tulang belakang menganggu kegiatan sehari-
hari. Sakit berkurang kalau tidak banyak gerakan ke arah berdiri dan jika
meminum jamu racikan dan obat warung. Sebelum datang ke dokter, pasien
membeli obat Pereda nyeri dan beristirahat.
Alternatif yang di tawarkan oleh Konselor:
1. Pemeriksaaan X Ray
2. Mangatur makanan berisikan Calcium dan Vitamin D
3. Memberhentikan jamu racikan dan menghentikan obat golongan
kortikosteroid
Jelaskan positif dan negatif dari tiap-tiap solusi sehingga pasien dapat memutuskan
dengan baik.

Pemerikasaan Fisik: (diketahui dari RM Klien/ Pasien)

Keadaan Umum : Sakit ringan

Kesadaran : Kompos mentis
TTV
 TD : 135/70 mmg
 Nadi : 78 x/menit
 Respirasi : 24 x/menit
 Suhu : 36,80 C
Antropometri
 BB : 57 KG
 TB : 160 cm

Status Generalis:
Kepala : Simetris, Konjungtiva anemis tidak ada, sklera ikterik tidak
ada, deformitas hidung (-), secret (-), mukosa mulut dan lidah
basah, tonsil T1-T1 faring tenang
Leher : Simetris, KGB tidak teraba
Thoraks : Bentuk dan gerak simetris
Pulmo: Sonor, VBS ki=ka, wheezing (-/-), ronkhi (-/-)
Cor: Bunyi Jantung S1/S2 murni regular, murmur (-)
Abdomen : Cembung lembut
Bising usus (+) normal, NT (-)
Pekak samping (-), pekak pindah (-), Hepar dan lien tidak teraba
membesar
Ekstremitas : Tidak tampak deformitas
Tidak tampak edema
Akral Hangat
CRT < 2 dtk
 Pola Makan:

Waktu Makanan Ukuran Rumah Tangga

04.00 Bakwan 1 potong

Sambal 1 porsi
Nasi 1 porsi
18.00 Nasi 1 porsi
Baso 1 porsi
Gorengan 2 potong
19.00 Cuanki 1 porsi

21.00 Seblak 1 porsi

Cek List Konseling

No. Procedures
Step of Counseling
1. Within the counseling, please keep these 3 notions:
I. Verbal Communication
 Low Intonation
 Soft not loud
 Clear including when emphasizing
2. II. Non-verbal communication
 Eye contact
 Active listening
 Body language

3. III. Empathy: accept that every person is similar as a human, without

looking at skin color, economic status, ethnic, and religion
differences. Thus, understand client’s problem as if it was all human
problems is substantial. Empathy can be seen in verbal
communication by NOT directly judging patient/client’s perception,
but instead, indirectly, by explaining the knowledge with avoiding
medical jargons, then let the client decides whether he/she
understands or not, then realizes that he/she is lack of the
knowledge; and most importantly, non-verbal communication by
performing proper eye contact and body language to the patient.
No. Procedures
Step of Counseling
Now, start the counseling:
A. Building rapport
4. 1. Greeting and ask the client’s name
5. 2. Introduce yourself and explain the goal of counseling that is, to make
clients decide the solution(s)
6. 3. Ask for client’s agreement
B. Exploration and understanding
7. 4. Assessing what is the background situation (Background)
8. 5. Ask about common areas generating strong feelings and elicits the
client’s emotional response (Affect)
9. 6. Ask how much the client’s problems bother him or her life (Troubling)
10. 7. Assess the client’s coping with his/her problems without directly
prejudice whether it is wrong because he/she might already have prior
mis-or-half-true perceptions that can be originated from lacking
knowledge (Handling)
8. Making the client understand of his or her problem by defining his/her
prior knowledge, perception, behavior and environment problems;
explain the evidenced-knowledge, good perception, and family and or
friend/peer/community supports [either one] can help changing his/her
behavior; and this can relate to the occurrence of his/her disease.
9. Checking client’s understanding with his/her problem

10. Management goal setting and implementation by discussing several

alternatives of solutions including each solution’s advantageous
(benefit) and disadvantageous (barriers). Do not give suggestion or
unrealistic hope because it will make the patient/client dependent on us
11. Ask clients to decide (choose) at least one of the solutions, and ask to
participate in
12. Ask the clients for next counseling appointment and terminate/end this
counseling session
Referensi

1. Wick JY. Spontaneous fracture: multiple causes. The Consultant pharmacist : the journal of the
American Society of Consultant Pharmacists. 2009;24(2):100-2, 5-8, 10-2.
2. Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, et al. Quality of life issues in
women with vertebral fractures due to osteoporosis. Arthritis and rheumatism. 1993;36(6):750-
6.
3. Alami S, Hervouet L, Poiraudeau S, Briot K, Roux C. Barriers to Effective Postmenopausal
Osteoporosis Treatment: A Qualitative Study of Patients' and Practitioners' Views. PloS one.
2016;11(6):e0158365.