ABSTRACT

This study sought to make Nurse’s knowledge on nurse-patients relationship explicit, using the Kumba District hospital Hospital as the setting. The population of the study was all nurses of District hospital Kumba. A random probability sampling technique was used to sample 60 nurses for the study. A case study sampling design was used to have in depth knowledge. Data was collected using questionnaire and observation as the tools of data collection. The findings revealed the influence of the socio-demographic characteristics of nurses and in the caring and curing relationship. No significant relationship was seen in the demographic characteristics of nurses and the kind of relationship they ensure. On the other hand, some demographics particularly the sex of patients revealed significant influence on their relationship with nurses. The study revealed three kinds of nurse-patient relationships. The kinds of nurse-patient relationship revealed were positive relationship, negative relationship and over-involved relationship. Negative nurse-patient relationship was seen to kill patients slowly; can deteriorate the physical, psychological and emotional state (depression, anxiety and stress) of patients and worsens patients‟ adjustment to illness while the positive nurse-patients relationship were also seen to ensure greater adherence of patients to treatment, increases patients‟ recovery rate, improves the level of patients satisfaction and ensures patients‟ sense of safety and protection. Per the findings of the study, it was recommended that the hospital environment should not be too formal where everything is officially carried out. The environment should therefore be informal to make the patients feel ease. This will release any undue pressure that might worsen their illness.

CHAPTER ONE

INTRODUCTION

1.0 Introduction

In our ever day life we interact with one another in one way or the other in whatever we are doing. Thus interaction involves communicating with one another, it begins with the first contact with one another. A nurse-patient relationship is defined as a helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient’s physical, emotional, and spiritual needs through the nusers knowledge and skill. This caring relationship develops in the first contact of the nurse and the patient, which results in harmony and healing.1 Effective verbal and nonverbal communication is an important part of the nurse-patient interaction, as well as providing care in a manner that enables the patient to be an equal partner in achieving wellness .Both the nurse and the patient can derive many benefits on this relationship. A good nurse-patient relationship involves good communication, a good and warm reception which makes the patient feel relief and confidence and helps the nurse get vital information that will help in treating the patient.

1.1 Background

The nurse–client relationship is an interaction between a nurse and “client” (patient) aimed at enhancing the well-being of the client, who may be an individual, a family, a group, or a community. In the context of the nurse–patient relationship, communication is used during PVS assessment “much like a stethoscope to actively listen and respond to an inner head-to-toe assessment” of the patient (Spade, 2008, p. 184). Norcross (2002) has concluded that essential elements of a therapeutic relationship—establishment and maintenance of the alliance between care provider and patient, empathy, goals consensus, and collaboration—lead to positive patient outcomes. Effective communication skills are a key factor in cultivating those essential elements while assessing and responding to the patient’s psychosocial variables of health.

Nurses spend the most time with patients during clinical care, which enables them to develop close relationships with patients. The nurse-patient relationship is core business for nurses (Fleischer et al., 2009). Halldorsdottir (2008) proposed that competence to connect with people is one of the prerequisites for developing the nurse–patient relationship. Unfortunately, evidence suggests individuals can experience ineffective communication with nurses in a range of settings, including in-hospital (Feder et al., 2018; Kolovos et al., 2016); residential aged care (Colón-Emeric et al., 2006); primary care (Ellington et al., 2012) and outpatient departments (de Leeuw et al., 2014).

There is evidence to suggest that particular conversations can be difficult for nurses including identifying goals of care (Feder et al., 2018; Jezewski et al., 2005); negotiating end of life (EOL) care (Holms et al., 2014; Huang et al., 2014), discussing sexuality (Moore et al., 2013); providing disease specific counselling (Karhila et al., 2003) and negotiating shared decisions (shared decision making) (Oliver et al., 2018). Bylund (2017) argued that all healthcare professionals (HCP) have existing skills that can be further developed with training to accentuate authentic communication with patients.

Research has identified the benefits of communication skills training (CST) for students enrolled in bachelorette health programs (Kaplonyi et al., 2017; Lau and Wang, 2013; Smith et al., 2018). However, there is evidence to suggest that communication skills and attitudes decline as students’ progress through their training (Rosenbaum, 2017), which may be related to clinical teachers’ lack of knowledge and skills to effectively teach about workplace communication (Rosenbaum, 2017). Synnot et al. (2018) explored priorities for consumers and other stakeholders in health communication and participation, defined as experiences or activities such as shared decision-making and person-centred care. They concluded that research needs to address structural and cultural barriers in health services (e.g., lack of patient-centred care) and build health professionals’ communication skills.

The therapeutic nature of the nurse-patient relationship is grounded in an ethic of caring. Florence Nightingale envisioned nursing as an art and a science…a blending of humanistic, caring presence with evidence-based knowledge and exquisite skill. In this article, the author explores the caring practice of nursing as a framework for understanding moral accountability and integrity in practice. Being morally accountable and responsible for one’s judgment and actions is central to the nurse’s role as a moral agent. Nurses who practice with moral integrity possess a strong sense of themselves and act in ways consistent with what they understand is the right thing to do. A review of the literature related to caring theory, the concepts of moral accountability and integrity, and the documents that speak of these values and concepts in professional practice.

Communication is the key ingredient of the nurse–patient relationship. Breaks in communication can lead to misunderstanding, confusion, and error, all of which can lead to a negative outcome. In the perioperative setting, it is imperative that patients have a full understanding of what they will be experiencing. There can be numerous barriers to achieving effective communication. These include, but are not limited to, language barriers, hearing deficit, developmental issues, literacy level, and cultural barriers. The perioperative nurse must assess each individual patient to determine which strategy would work best in each particular situation.

Nurses must learn to balance their rights and obligations within the nurse-patient relationship and accomplish the difficult work of moral inquiry. The individual nurse must decide how to rank her many competing values and beliefs to determine which best satisfies all of her core moral responsibilities. The hope is that the individual nurse would be able to resolve this moral quandary without being put in the position of having to decide whether to be an ethical nurse or an ethical person, there may well be certain consciences that are not suited for certain roles. For example, a nurse who is an adherent of the Jehovah’s Witness faith and feels herself unable

to participate, perhaps even touch blood for transfusion, may not be suited for employment in an emergency department or intensive care unit where that duty is frequently required.

1.2 Problem Statement

Comparing the study conduct in some region in sub Saharan Africa by A. K. Karani et al 2013, described some sort of negligence some nurses portray in response to the patients’ functional inabilities. It was noted that most patients stay with their family members in the ward who take care of most of their physical/non-medical needs while the nurses only handle the medical or professional part of care, and that of Milton, 2008, conducted in USA in 2007, in some states, described that therapeutic nurse-patient relationships stands at about 96.8%. Also, my experience as a student nurse in hospitals during my various placements did expose me to how nursing is practiced, which is contrary to what I was thought in school, which is void of the therapeutic nurse-patient relationship, where the nurses attend to patients only when it time for medication or wound dressing, which ought not to be so. So this motivated me to investigate nurses’ knowledge on the therapeutic nurse patient relationship in the Buea regional hospital.

1.3 Rationale

The rationale of this study is to find out what nurses of the district hospital kumba knows on nurse- patient relationship so as to draw up strategies on how the quality of nurse-patient relationship can be improved.

1.4 Research Question

1-What is the level of knowledge of the nurse/care provider in nurse- patient relationship?

2-What can be done to improve the nurses knowledge on the implementation of a good nurse-patient relationship

1.5 Hypotheses

There is little or no knowledge of nurse/care provider in nurse- patient relationship amongst nurses in DHK.

there is need to improve and create an awareness on nurses knowledge on the implementation of a good nurse-patient relationship.

1.6 Objectives of the study

1.6 . 1 GENERAL OBJECTIVES

The general objective of this study is to assess the knowledge of  the nurses/care provider on nurse patient relationship so as to draw up strategies to improve on it there by improving patient care.

1.6 2 SPECIFIC OBJECTIVES

The specific objectives of the study are;

To assess the nurses/care providers knowledge on nurse-patient relationship.

To draw up strategies on how to improve on the quality of nurse-patient relationship.