THE EFFECT OF DOCTOR-NURSE RELATIONSHIP ON PATIENT CARE (CASE STUDY OF FEDERAL MEDICAL CENTRE OWERRI, IMO STATE)
This study sought to make the effects of doctor-nurse relationship explicit, using the Uniben Teachng hospital as the setting. The population of the study was all nurses and patients of Uniben Teachng hospital. A random probability sampling technique was used to sample 83 composing of 68 patients and 15 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 patients 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 crosstab revealed that female patients co-operate more and listens to the instructions of nurses than male patients. The study revealed three kinds of doctor-nurse relationships. The kinds of doctor-nurse relationship revealed were positive relationship, negative relationship and over-involved relationship. Negative doctor-nurse 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 doctor-nurse 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
BACKGROUND OF THE STUDY
Effective doctor-nurse relationship is imperative in nursing care since this makes the patient feels at home and ease in and out of the hospital setting. It symbolizes agreement between the nurse and the patient to work together for the good of the patient. For a nurse patient relationship to be therapeutic there must be good communication between nurses and patients. Good communication skills make the difference between average and excellent nursing care.
Patients are described to have less power in the nurse patient relationship which can add to their vulnerability if they are not treated with respect by nurses. Emotional, physical and mental problem of patients can make them difficult to handle by nurses in the relationship. In view of this nurses need to strengthen their interpersonal relationship and their professional standard by exhibiting to the maximum level the principles of therapeutic relationship.
The underlying principles of the therapeutic relationship are the same regardless of the length of contact: respect, genuineness, empathy, active listening, trust and confidentiality. The purpose of the therapeutic relationship is to support the patient, to promote healing and to support or enhance functioning. A therapeutic relationship differs from social relationship in that it is health focused and patient centered with defined boundaries. Peplau (1991) described the nurse focus interest in the patient as “professional closeness”
Irrespective of the qualification, facilitation of a therapeutic doctor-nurse relationship has always been the cornerstone of nursing and includes self-knowledge and knowledge about the
essential components of therapeutic communication. These components include unconditional acceptance of the patient, the ability to listen and to hear, constructive non- verbal skills and verbal communication techniques. The use of rapport and alliance enables this process to happen by providing support, consistency and reliability in patient care (Gilbert 2009).
However, the bureaucratic environment in hospitals is driven by technology and a mainly medical model of care, making a therapeutic relationship between nurses and their patients difficult. The focus of communication in the doctor-nurse relationship is to satisfy patients‟ needs that are patient-centered care.
STATEMENT OF THE PROBLEM
According to literature of nursing care, nurses are obliged to treat patients with maximum respect and empathy. Attending behaviour is a patient-centered process and the basic conditions required on the part of the nurse for attending to occur are genuineness, warmth and empathy (Burnard, 1990; Stein-Parbury, 1993). It is the responsibility of the nurse to be aware of the power imbalance, to recognize the potential for clients to feel intimidated and to create a therapeutic relationship. This awareness therefore helps to establish and maintain appropriate boundaries.
However, articles, news, and experiences of some patients reveal that patients are not treated well in the doctor-nurse relationship. Patients are often without defenses and might depend on nurses to meet basic needs. Patients might not have a network of supportive family and friends and may want to depend on the nurse beyond the practice setting. Some patients, such as those with mental health problems or those in need of ongoing care, could be particularly vulnerable.
It was because of this discrepancy that the study was conducted at Uniben Teachng hospital to find out the kind of relationship between nurses and patients. This will help to improve upon the doctor-nurse relationship in the hospital.
OBJECTIVES OF THE STUDY
This study addressed the following objectives:
- To determine whether the socio-demographic characteristics of the nurse and the patients influence the type of relationship between the
- To examine the effects of doctor-nurse relationship on the health of the
- To find out the various types of doctor-nurse
Prior to the statement of problem discussed above, the study sought to answer the following research questions:
- How do the socio-demographic characteristics of the nurse and the patient influence the type of relationship between the two?
- What are the effects of doctor-nurse relationship on the health of the patient?
- What are the various types of doctor-nurse relationship?
SIGNIFICANCE OF THE STUDY
The study was aimed at providing relevant reasons why patients should be treated with maximum respect, confidentiality, empathy and warm in the hospital settings. Complete health does not mean only absence of disease or infirmity but also mental and social wellbeing. The stud addressed the importance of incorporating bio-psychosocial model into healthcare. The
findings of the study will improve the understanding of doctor-nurse relationship by both nurses and patients.
Findings of the study will reveal the importance of using patient centered approach rather than task centered approach in the nursing care by nurses. The research will also add to the existing body of knowledge in the subject field.
Patients hope to be treated with respect, warm and genuineness. However, nurses, overlook the implications of their relationship with patients. The study was important because it will make it explicit the effects of doctor-nurse relationship on the health of patient. When nurses become aware that their negative attitudes and behaviour negatively affect the relationship with patients and ultimately deteriorate their adjustment to illness, there is a possibility that they will improve their interpersonal relationship with patient.
SCOPE OF THE STUDY
The study was conducted at Uniben Teachng hospital. People of Uniben and its environs receive treatment from this hospital. The study intended to cover effects of doctor-nurse relationship on the health of patients.
DEFINITIONS OF CONCEPTS
Effect: Effect in this study refers to the end result of the doctor-nurse relationship on the health of the patient in and out of the hospital setting. Effect can mean negative or positive depending on the kind of doctor-nurse relationship.
Doctor-nurse relationship: Doctor-nurse relationship refers to how nurses communicate and interact with patients during provision of healthcare services.
Research methodology is a collective term for the structured process of conducting research. Methodology is generally a guideline system for solving a problem, with specific components such as phases, tasks, methods, techniques and tools (Irny and Rose 2005).
Methodology includes the research design, population, sampling procedures, and instruments for data collection, data sources and quantitative method of data analysis.
Research design refers to a framework for the collection and analysis of data. It is the arrangement of conditions for the collection and analysis of data in a manner that aims to combine relevance to the research‟s purpose with economy in procedure. It is therefore the conceptual structure within which research is conducted. A case study examines a phenomenon in its natural setting, employing multiple methods of data collection to gather information from one or a few entities.
Case study research design was used by the researcher in conducting the study. Case study entails the detailed and intensive analysis of a single case. Sake (1995) indicates that a case study research is concerned with complexity and particular nature of the case in question.
Having Uniben Teachng hospital as the setting of study allowed the researcher to have a better understanding of the effects of doctor-nurse relationship. The researcher interacted with nurses, and patients of the hospital to have in-depth knowledge of doctor-nurse relationship. The case study helped the researcher access the records of the hospital.
Sources of Data
Data source refers to any material consulted or used in the due course of the study. Both primary and secondary data were used in the study.
Refers to any material most likely to shed true light on the information the researcher seeks. Primary sources come straight from people or workers you are researching and therefore are the most direct kind of information you can collect (Audrey et al, 1989). Examples of these data sources include dairies, unpublished works, eyewitness report, official report and speeches. The researcher used primary data source on the basis that it provided first-hand information in order to minimize errors. Primary data can be collected through questionnaires, direct observation, interviews, among others, but was however gathered by the researcher by means of questionnaires and observation.
Secondary data is the data that have been already collected by and readily available from other sources. It is often an examination of a study someone else has made on a subject or an evaluation of commentary, or summary of primary data materials, journal articles, critical reviews, and text books on the subject matter. The secondary sources of data for this study included journal articles, text books and internet publications.
According to Burns and Grove (1993:779), a population is defined as all elements (individuals, objects and events) that meet the sample criteria for inclusion in a study. Population
is therefore any set of people or events from which the sample is selected and to which the study results will generalize. The targeted population for this study was all nurses and patients of Uniben Teachng hospital. The population constituted nurses of different levels in terms of education, experience, ethnic group and religious denomination.
The staff of the Uniben Teachng hospital is estimated to be 300 including nurses, doctors, laboratory technicians and supervisors.
Sample size refers to number of items to be selected from the universe to constitute the sample. An optimum sample size is the one which fulfills the requirements of efficiency, representativeness, reliability and flexibility.
A sample of 83 comprising of 15 nurses and 68 patients of the population was selected by the researcher to conduct the study. The sample size was optimum because they fulfilled the requirements of efficiency, representativeness, reliability and flexibility.
There are quite a number of sampling techniques but the simple random sampling technique was adopted by the researcher to select the respondents for the research. A simple random sample is a subset of individuals (a sample) chosen from a larger set (a population). Each individual was chosen randomly and entirely by chance, such that each individual had the same probability of being chosen at any stage during the sampling process, and each subset of individuals had the same probability of being chosen for the sample as any other subset of individuals (Yates, Daniel S.; David S. Moore, Daren S. Starnes, 2008).
Cut-papers bearing “yes” or “no” were used by the researcher to get the sample. The cut papers were folded and mixed thoroughly and slipped them in a container. Patients and nurses were asked to pick a cut paper after rotating the container. Those who picked “yes” were automatically included in the sample.
Data Collection Method
In trying to collect data, instruments such as questionnaires, direct observation among others are used. For the purpose of this study however, the instruments which were used are observation and questionnaires. The questionnaires were made up of both open and close-ended questions.
An open-ended question is designed to encourage a full, meaningful answer using the subject‟s own knowledge and/or feelings. They tend to be more objective and less leading.
A close-ended question is a question format that limits respondents with a list of answer choices from which they must choose to answer the question (Dillman D., Smyth J., &Christioan LM, 2009). Primary data will be obtained through responses from questionnaires that will be administered whereas secondary data will be obtained through internet sources, books and journals.
The researcher chose questionnaires because of the following reasons below:
It reduces biasing error as a result of the absence of the interviewer. The respondent‟s responses to the questions will therefore not be affected by the characteristics and the techniques of the researcher.
It is quick and cheaper to administer.
Apart from the strengths that have been listed above, questionnaires have their weaknesses; for example, there is the question of validity and accuracy (Burns & Grove 1993:368). The subjects might not reflect their true opinions but might answer what they think will please the researcher, and valuable information may be lost as answers are usually brief.
Data processing and analysis involves the transformation of data gathered from the field into systematic categories and the transformation of these categories into codes to enable quantitative analysis and tabulation (Nachimias D. and Nachimias C., 1976).
The researcher used Statistical Package for Service Solution (SPSS) to analyse the data into presentable form. The researcher will use descriptive statistics to make the analyses more meaningful. This involved preparing data collected into some useful, clear and understandable information. Data collected will be presented using simple tables and cross tabulations.
Conﬁdentiality, anonymity, and informed consent were ensured by the researcher.
When subjects are promised confidentiality it means that the information they provide will not be publicly reported in a way which identifies them (Polit&Hungler 1995:139). In this study, confidentiality will be maintained by keeping the collected data confidential and not revealing the subjects‟ identities when reporting or publishing the study (Burns & Grove 1993:99).
Burns and Grove (1993:762) define anonymity as when subjects cannot be linked, even by the researcher, with his or her individual responses. In this study anonymity will be ensured by not disclosing the patient’s and nurses‟ name on the questionnaire and research reports and detaching the written consent from the questionnaire.
The researcher will seek consent of nurses and patients before questionnaires are completed by them. Burns and Grove (1993:776) define informed consent as the prospective subject’s agreement to participate voluntarily in a study, which is reached after assimilation of essential information about the study. Nurses and patients will be informed of their rights to voluntarily consent or decline to participate, and to withdraw participation at any time without penalty.
LIMITATION OF THE STUDY
The researcher foresaw that this study will involve some limitations. These limitations included finance, language barrier, time constraints and co-operations from nurses and patients that were asked to fill questionnaires. Some respondents requested for money before filling questionnaires. Some respondent, moreover, were not be able to read and probably fill the form. This therefore called for translation of the English to respondent‟s language. These limitations hindered the smooth running of this research. Despite all these constraints and problems, the researcher believes that the study covered enough respondent for generalization.
ORGANISATION OF THE STUDY
The research was divided into four chapters. Chapter one began with the background of the study constituting the introduction to the topic. It included statement of the problem, research objectives, research questions, and hypothesis, methodology used in undertaking the research, significance of the study, the study‟s limitations, the scope of coverage and then the study‟s organization. Chapter two dealt with the review of relevant literature to the subject discussed as well as related texts. It looks at the theories, concept and various views by authors relating to the area of study. Chapter three involved the presentation and analysis of collected data. Chapter four contained the summary, conclusion and recommendations as well as the appendices.