It is a patient named Ms vivian who having ovaries cancer. She was reflected about what she had been go through along this treatment.at first, she was sitting at wheelchair waiting for medical check – up after a moment, she was called for it. In the x- ray room the doctor is very rude. His communication with Ms. vivian is not good. He make her just like a toy. After that, she going to the CT (sean computerised tomography scan). Besides ,the nurse also some thing that is bad cummonication with her. She also forget where she put there wheelchair before she started the CT scan. She was less communicate with her. Then the nurse send it to meet the doctor Jason for doing anather check- up with her. The doctor was so damn. He had great the patient is ms. vivian, then started doing the interview to known the problem with the her. He did this to Ms vivian. Importance of communication in nursing is a interactive process that ivolves an of exchange of meaning between people. Communication important to nursing because communication is a two – way process involving the sending and receiving of messages .besides, process of communication like face to face communication involves a sender, a message, a receiver and a response or feedback. The communication also is on going, the receiver of the message then becomes the sender`s response and the original sender then becomes the receiver. They are type of communication is lateral refers to communication between individuals who are at the some level. Vertical it takes place between upper level lower level. One way communication is flow of information is in one direction. The last type of communication is sender and receiver participate equally.

Communication in the nurses need to recognize barriers or nontherapeutic responses to effective communication, improperly decoding the patient`s intended message, and placing the nurse`s needs are major barriers to communication. The communication barriers is stereotyping are offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid. These responses categorize patient and negate their uniqueness as individuals. Besides, agreeing and diagreeing, akin to judgmental responses agreeing and diagreeing imply that the is either right or wrong and that the nurse is in a position to judge this. These responses deter patient from thinking through their position and may cause to become defensive. However, critical thinking skills in analysis of communication barriers also must be have in nurse gaining an idea of what it means to think critically, solve, problems, and make decisions, nurse to become aware of their own thinking style and abilities. The must be make decisions in both their personal and professions lives. The steps of the decisions- making process include identitying the criteria, seeking alternatives, axamining alternatives, projecting, implementing, and evaluating the action. Everyone has at least some levels of critical-thinking skill, and that skill can be developed with practice. Some guidelines to enchance critical- thinking skills and attittudes include performing at self assesment, tolerating dissonance and ambiguity, seeking situations where good thinking is productive, and creating enviroments that support crital tinking. Example. Dr.Jason give treatment in a patient so agresive reach patient feel so had is Ms. Vivian feel had because step the doctor interwiew the patient non have are eye contact, verbal communication and also privacy the not to support because the doctor not screen the patient before him make the treatment eith patient. The doctor also calling the nurse during want to make the treatment him go out in thre room and him never to closes back the door teach the feel so not safity live in the room because non respect with patient the patient not effective wtih another, have are cooperation with patient is very importants for nurses.

American Assocition of Critical – Care Nurses (AACN). (2005). AACN standards for establising and sustaining healthy work enviroment: A journey to excellence. Aliso Viejo, CA: Author.
NANDA International. (2007). NANDA nursing diagnosis: Definitions & classification 2007-2008. Philadelphia: Author.
Norris,S.P. & Ennis, R.H (1989). Evaluating critical thinking. Pacific Crove, CA: Midwest Publications, Critical Thinking Press.
http:// www. Criticalthinking.net/ critical_thinking. Htm (17/6/10:1610 hrs).

Critical thinking skills in analysis of communication barriers also must be attentive listening, paraphrasing, clarifying, and other effective communication techniques. Communication skills listed above and ability to overcome resistive behaviors if they occur. Example, doctor Jason must have are personal statements can be helpful in solidifying the rapport between the nurse and the patient. The awareness in overcoming such barriers is like doctor must have are introduce self before make the treatment. Besides, connect with the patient make contact and be at eye level when speaking to patient. Appreciate the patient situtions firstly listen and focus an what the patient is saying, her point of view and express concern. Awareness in overcaming such barriers is respond to patient needs clarity what is being asked in simple words. Empower the patient find out what patient knowns about her condition. Encouraged her to ask qestion and work as patners to develop her care plan acknowledge her opinions and allow her to make approriate choices. The doctor like DR. Jason must active listening about the problem that patient spoken words, observe non verbal messages interprete thier meaning and gives the patient feedback.

Reflection is the consideration of action, feelings and knowledge. It make we think over we past experience and analyze test it in new sitution. Development to guide we for future actions and improvement.Patient management to violation of nurse relationship boundaries, the guidelines must be respect. Besides, standard statements which nurse`s accountability in nurse to patient relationship.Therapeutic communication in nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship.

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