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NURSE – PATIENT COMMUNICATION AS PERCEIVED BY NURSES AND PATIENTS

10,000 3,000

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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.

Barriers to nurse – patient communication could be nurse or patient oriented. Such barriers to effective nurse – patient communication include heavy nursing workload, hard nursing tasks, lack of welfare facilities for nurses, unfamiliarity of nurses with patients’ dialect, contagious diseases, sex differences, age differences and social class differences (Anoosheh, Zarkhah, Faqhihzadeh & Vaismoradi, 2009). Barriers like language / ethnic barriers, staffing shortages, assumption, distractions, use of medical jargons and misdirection exist, and can be overcome with little thought and planning (Magee, 2013). Discussions with colleagues help to alleviate jargon, and allow barriers to communication to be viewed and addressed.

Despite these barriers, an efficient nurse should be knowledgeable and tactful to overcome them and ensure a successful effective nurse – patient communication in nursing practice (William & Bower, 2008). Patient oriented barriers could be lack of proper education, patient’s health/disease condition, socio-cultural background, languages, and religious belief (Hein, 2006). Communication is central to nurse – patient interaction, and without it nurses cannot make patients needs and care regimen known to them. Experiencing effective communication with patients and their families is one of the basic goals of nursing. Recent evidence has shown that ineffective communication can have adverse effects on patient compliance, and leave patient feeling anxious, uncertain and generally dissatisfied with their care (Uitterhoeve, Bensing,Grol, DeMulder & Achterberg, 2010). When nurses provide information adapted to patients’ needs, they are motivated to actively participate in their care (Larsson, Sahlsten, Segesten & Plos, 2011).

 

Statement of Problem

Communication in nursing profession can be a complicated process and the possibility of sending or receiving incorrect messages frequently exists (Anderson, 2013). Generally, nurse – patient communication is expected to have a positive influence on the patient, but on the other hand nurses are unable to interact effectively to influence the patients (Hein, 2006). Hagaghary (2008) identified that lack of communication between nurses and patients is one of the major factors militating against rendering effective care to patients. A study of nurses and care workers’ perceptions of their nurse-patient therapeutic relationship in private general hospitals, Gauteng, South Africa as contained in Hagaghary (2008), revealed a general insensitivity and lack of awareness and reflection on the part of nurses and care workers with regard to the patients’ emotional needs.

To provide ethical, high quality care, the nurse must be aware of and respond appropriately to the patient’s cultural beliefs, values, language and literacy level. Having a framework and establishing expectations can help the nurse and the organization improve the quality of patient-centered communication. Taking a patient-centered approach can lead to high quality patient care, improved community relations, enhanced morale and cost savings for health care organizations (Badzek, 2006).

A study by Fakhr-Movahedi, Salsali, Negharandeh and Rahnavard (2011) showed that in spite of the nurses’ and patients’ belief in the importance of communication, in practice each party’s role in communication leaves much to be desired because of some structural and socio-cultural factors that hinder effective communication. Nurses in University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, like every nurse come in contact with and take care of a large number of patients each day. What do they communicate and how do they communicate with their patients? What challenges do they encounter in trying to communicate with them?  Do they achieve patient satisfaction through their communication method(s)? This study attempts to answer the above questions.

 

Purpose of the Study

The purpose of the study is to empirically investigate the pattern of nurse – patient communication as perceived by nurses and patients at UNTH, Enugu.

Objectives of the Study

The objectives of the study are to:

  1. Identify the communication methods used during nurse- patient communication at UNTH, Ituku Ozalla.
  2. Determine the frequency of nurse-patient communication during and after procedure at UNTH.
  3. Identify the contents of nurse-patient communication at UNTH.
  4. Identify the difficulties / barriers to nurse – patient communication as perceived by nurses and patients at UNTH.
  5. Determine patients’ satisfaction with nurse – patient communication at UNTH.

 

Research Questions

  1. What are the communication methods used during nurse – patient communication at UNTH?
  2. What is the frequency of nurse-patient communication during and after procedure at UNTH?
  3. What are the contents of nurse patient communication at UNTH?
  4. What are the difficulties encountered / barriers to nurse – patient communication as perceived by nurses and patients at UNTH?
  5. To what extent are patients satisfied with nurse – patient communication at UNTH?

 

Significance of Study

The result of the study will reveal the method, frequency and content of nurse – patient communication at UNTH. The published work will be beneficial to nurses, patients, the health institutions and other researchers.

Findings from this study will challenge nurses to widen their knowledge, skills and practice of therapeutic communication with patients especially in clinical settings. This will increase nurses’ understanding of the effect of nurse – patient communication on outcome of illness/disease, thus enabling nurses to appreciate the importance of effective nurse – patient communication in health care.

Findings will help the patients to understand the importance of prompt communication of their problems to the nurses and the role it plays in the general management / prognosis of illnesses.

The hospital management / policy makers, with the knowledge of the findings will begin to appreciate the constraints in effective nurse – patient communication, and develop policies to improve it.

Generally, findings will improve nurse – patient communication, responsiveness of hospital staff and overall patient experience. This study will be useful as a source of reference in this area of study for future researchers.

Scope of the Study

This study will be delimited to the perception of nurses and patients about nurse – patient communication at University of Nigeria Teaching Hospital in Ituku Ozalla, Enugu State. The variables for the study include methods, frequency, content of and barriers to communication between nurses and patients, as well as patients’ satisfaction with nurses’ communication during hospitalization.

 

Operational Definition of Terms

  • Nurse – patient communication: Refers to any form of interaction that involves transfer of information between the nurse and the patient in a clinical environment like drug administration and other nursing procedures.
  • Pattern of nurse – patient communication: Refers to the method and frequency of nurse – patient communication used by nurses at UNTH.

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