NURSE – PATIENT COMMUNICATION AS PERCEIVED BY NURSES AND PATIENTS AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU OZALLA ENUGU

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ABSTRACT

This study was designed to obtain information on Nurse – Patient Communication as perceived by Nurses and Patients at University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla in Enugu State. Descriptive survey design was used for the study. The total population of 102 nurses and 122 patients at the medical and surgical wards of the hospital were studied. A researcher-developed questionnaire was the only tool used for data collection. Data collated were subjected to descriptive statistics and analyzed using Chi-square. Probability value less than 0.05 was considered statistically significant. Major findings revealed that majority of the respondents, 96 (94.1%) of nurses and 89 (72.9%) of the patients indicated verbal communication especially spoken words as the most commonly used method of nurse – patient communication at UNTH, Ituku Ozalla. Non verbal methods used are smiles and touch. Nurses 49(48.0%) communicate with patients most before procedures and as the need arises 71(69.6%), while patients 53(43.4%) claimed that nurses communicate with them mostly during a procedure, and about three times per shift 53(43.4%). Communication bordered more on reassurance, information about treatment regimen, health education and hospital routine/procedure. Language barrier (mean 2.55), stressful environment (mean 2.77), routine centered care (mean 2.59), patient’s unwillingness to discuss disease/feelings (mean 2.75) and patient preference to seek emotional support from family (mean 2.53) were major barriers according to nurses. Patients limited the barriers to hospital routine with language barrier and nurses’ workload as a common factor. Despite these barriers, majority of patients and nurses attested to being satisfied with nurse – patient communication. In conclusion, nurses could communicate with and care for patients better with less barriers. Therefore, Nurse Managers and all stakeholders should put all in place to provide supportive and facilitative environment for better nurse – patient communication as this would enhance patients’ care and satisfaction. 

TABLE OF CONTENT

Title page
Table of Contents
List of Tables
Abstract

CHAPTER ONE: INTRODUCTION
Background of Study
Statement of Problem
Purpose of the Study
Objectives of the Study
Research Questions
Significance of the Study
Scope of the Study
Operational Definition of Terms

CHAPTER TWO: LITERATURE REVIEW
Conceptual review:
Concept of Communication
The Communication Process
Concept of Nurse – Patient Communication
Methods of communication
Frequency of Nurse – Patient Communication
Content of Nurse – Patient Communication
Concept of Patient Satisfaction
Barriers to Nurse – Patient Communication
Theory Underpinning the Study
Application of Interpersonal Relationship Theory to the Study
Empirical Review
Summary of Literature Reviewed

CHAPTER THREE: RESEARCH METHODS
Research Design
Area of Study
Population of the Study
Subject of the Study
Instrument for Data Collection
Validity of Instrument
Reliability of the Instrument
Ethical Consideration
Procedure for Data Collection
Method of Data Analysis

CHAPTER FOUR: PRESENTATION OF RESULTS
Demographic data
Research Question 1
Research Question 2
Research Question 3
Research Question 4
Research Question 5

CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Findings
Implication of the Study for Nursing
Limitation of the Study
Suggestions for Further Studies
Summary
Conclusion
Recommendations
References
Appendix

 CHAPTER ONE
INTRODUCTION
Background to the Study
Effective communication with patients is increasingly understood as a key to effective, patient – centered care in all health care settings (Smith & Pressman, 2010) while poor communication is the number one cause of serious medical errors (Orlovsky, 2007). Effective communication occurs when the expertise, skills and unique perspectives of nurses and physicians are integrated,  resulting in an improvement in the quality of patient care (Lindeke & Sieckert, 2005). To communicate effectively, Orlovsky advocates that nurses should be assertive, respectful, master the art of small talk, overcome conflict and know the end result.
Nurses spend most of their working time and have most contact with patients doing connecting work that complement doctor’s consultation. They provide the ‘glue’ escorting a patients into the consulting room; identifying with challenges in adhering to lifestyle changes by reporting their own experience, allowing patients to disclose concerns not shared with doctors; being chatty; sharing a joke; and providing explanations where doctors’ communications have failed (Collins, 2009).  These qualities require understanding of the essential ingredients of communication. Making meaningful use of communication skills demands appreciation of the contexts in which skills are used in practice, to be able to translate them. Collins explained further that considering the acuity of patients in the hospital, as well as the rapidity with which their conditions might change, limitations in the communication effectiveness of nursing staff may pose a substantial threat to patient safety.
According to Smith & Pressman, Nursing is a communicative intervention and the foundation of nursing lies in the communicative attitude which is manifested in the striving for mutual understanding, coordination and coactions. A critical component of nursing practice is the ability of the nurse to communicate effectively with the patient. Berman, Synder, Kozier and Erbs (2008), stated that communication is aimed at having a positive influence on the patient for healthy living and recovery from sickness, illness and stress factor. Therefore a two-way effect is essential in the concept of nurse - patient communication in a clinical setting.    

Nurse – patient communication is a process of social interpersonal relationship which brings a positive change in the behavior and responses of the patient (Hein, 2006). According to Anderson (2013), the first step towards effective communication in nursing is honesty, and other important factors are availability and responsiveness. Communication reassures relatives that their loved ones are receiving the necessary treatment which is indicative of best practice in nursing field (Wright, 2012). Communication is essential to the process of care and it assists in targeting patients’ healthcare needs, therefore, the type of communication between nurse practitioner and patient can influence patient outcome (Suarez-Almazor, 2004). The hospital environment affects the emotional disposition of the client / patient and the nurse needs to develop good interpersonal relationship with both the patients and their families to facilitate cooperation and adherence to prescription.     The patient understands his health needs, the rationale for the nurses’ actions, and thus cooperates and participates with the treatment regimen and nursing care (Jones, 2009). Nurses as well need patients’ information communicated to them during history taking and other interactions with the patient. The field of nursing communication highlights the need for comprehensible pronunciation, active listening skills, non-verbal communication, ability to bridge professional and lay language, written communication, cultural awareness in achieving effective communication in the health care environment (Wright, 2012).  It is essential that we know the key components of the communication process, how to improve our skills, and the potential problems that exist with errors in communication (Anderson, 2013). Verbal communication is a primary way of transmitting vital information concerning patient issues in hospital settings (Raica, 2009). Listening to a patient is important to understanding a patient, but the patient also communicates nonverbally. Oftentimes a nurse will learn more from observing a patient’s nonverbal cues than from listening to a patient’s verbal communication. Breeze (2013) listed the modes of nonverbal communication as: physical appearance, physical distance between caregiver and patient, tone of voice, facial expression and body language.  Patient - directed gaze appears to be a useful technique both for decoding people’s mental problems and for showing interest in the patient’s story..... 

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