The Effect Of Doctor-Nurse Relationship On Patient Care (A Case Study Of Federal Medical Centre Owerri, Imo State)

Medical and Health Science Project and Seminar Material

The Effect Of Doctor-Nurse Relationship On Patient Care (A Case Study Of Federal Medical Centre Owerri, Imo State)


Abstract


This study seeks to examine the effect of doctor-nurse relationship on patient care in Federal Medical Centre Owerri, Imo State. The null hypotheses were formulated to guide the study. They are: Medical teamwork; hospital administrative structure; and doctor-nurse value orientation. In order to generate data for testing these hypotheses, a 42 item questionnaire was developed by the researcher and validated by the supervisor. Survey research design was adopted while data collected from 200 randomly selected respondents (male & female).

Purposive, stratified and simple random sampling procedures were variously applied at appropriate stages of the study. The generated data was statistically tested using chi-square analysis procedure. The analysis revealed that: there is a significant relationship between medical team work and patient care, hospital administrative structure, doctor-nurse value orientation and patient care. It was however recommended that collaborative work relationship between doctors and nurses should be encouraged for effective health care delivery system.


Chapter One


Introduction

1.1 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.


1.2 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 Federal Medical centre owerri to find out the kind of relationship between nurses and patients. This will help to improve upon the doctor-nurse relationship in the hospital.


1.3 Objectives Of The Study

This study addressed the following objectives:

  1. To determine whether the socio-demographic characteristics of the nurse and the patients influence the type of relationship between the two.
  2. To examine the effects of doctor-nurse relationship on the health of the patients.
  3. To find out the various types of doctor-nurse relationship.

1.4 Research Questions

Prior to the statement of problem discussed above, the study sought to answer the following research questions:

  1. How do the socio-demographic characteristics of the nurse and the patient influence the type of relationship between the two?
  2. What are the effects of doctor-nurse relationship on the health of the patient?
  3. What are the various types of doctor-nurse relationship?

1.5 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 studaddressedtheimportanceofincorporatingbio-psychosocialmodelintohealthcare.Thefindings 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.


1.6 Scope Of The Study

The study was conducted at Federal Medical centre owerri. People of Owerri and its environs receive treatment from this hospital. The study intended to cover effects of doctor-nurse relationship on the health of patients.


1.7 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.


1.8 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.


1.9 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 the research methodology
  • Chapter four involved the presentation and analysis of collected data.
  • Chapter five contained the summary, conclusion and recommendations as well as the appendices.

Chapter Five


Summary Of Findings, Conclusion And Recommendations

5.1 Introduction

The chapter presented the summary of major findings of the study. The study examined the effect of doctor-nurse relationship on the health of patients at the Federal Medical centre owerri. Key findings relevant to the objectives of the study, conclusion and recommendations are hereby presented in this chapter.


5.2 Summary Of Key Findings

The demographic characteristics of nurses sampled at the Federal Medical centre owerri for the purpose of the study revealed that the nursing profession is female dominated field. In relation to the findings of the study, the female nurse population stood at 93.3%, with males‟ nurses being 6.7% of the total respondents. Additionally, the study revealed that most of the nurses are singled (66%). The study showed that the nursing population was dominated by youth, with 53.3% of respondents being between the ages of 25 and 34 years. Furthermore the study revealed that the nursing field was dominated by nurses of with diploma qualifications.

The demographic characteristics of patients sampled at the Federal Medical centre owerri also revealed that equal number of males and females got sick and therefore entered into relationship with nurses. The study showed that patients who attend hospital and had relationship with nurses are mostly single (51.5%). The study further revealed that majority of patients who entered into relationship with nurse was between the age ranges 25-44 years representing 29.4%. It also showed that majority of patients (39.7%) who visited the hospital had attained SHS and it equivalent certificates.

The first objective of the study was to find out if the socio-demographic characteristics of nurses and patients influence the kind of relationship between them. The researcher delved into the socio-demographic characteristics of the nurse and the patient to see whether they influence the type of relationship between the two. Considering the socio-demographic characteristics of the nurse, the study revealed no significant influence. Crosstab used to compare the sex of nurses and their management of insult from patients for instance revealed that both sexes took the insult normal and never affects their relationship with patients. The age of nurses revealed no significant influence on the relationship that exists between nurses and patients. The working experience of nurses revealed no significant influence too on the relationship between them and patients.. The study revealed that female patients co-operate more than the male patients in their relationship with nurses. The education level of patients did not affect their relationship with nurses. The crosstab used to find the relationship between the marital status of patient and patients feel to instruct nurses revealed that patients who are single calmly received orders of nurses and did not teach them of what to do.

The second objective of the study sought to find out the effects of doctor-nurse relationship on the health of patients. Respondents were asked to rate some effects of negative and positive relationship on the health of patients under agree, uncertain and disagree. The study revealed that negative doctor-nurse relationship can kill patients slowly; can deteriorate the physical, psychological and emotional state (depression, anxiety and stress) of patients and worsens patients‟ adjustment to illness. The positive doctor-nurse relationship were also seen to ensure greater adherence of patients to treatment, improves the level of patients satisfaction, ensures patients‟ sense of safety and protection and ultimately increases patients‟ recovery rate.

The final objective was to find out the various types of doctor-nurse relationship. As the way of seeking answers to this objective, the respondents were asked to indicate the kind of relationship that is possible in the doctor-nurse relationship. Nurses were further asked to list the type of doctor-nurse relationship. The study therefore discovered that there are three types of nurse- patient relationship. The types of relationship that are possible were 1) Positive or Therapeutic relationship, 2) Negative or Non-therapeutic relationship and 3) Over-involved relationship as indicated by the nurses.


5.3 Conclusion

Health, as defined by the World Health Organisations (WHO), is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The mental and social wellbeing as a function of the relationship between nurses and patients need to improve to ensure complete health. There has been increasing need of hospitals to ensure the mental and social well-being in addition to the physical need ensured of which the Federal Medical centre owerri is of no exception. The study therefore sought to examine the effects of doctor-nurse relationship on the health of patients at Federal Medical centre owerri. The study revealed that three types of relationship are possible in the doctor-nurse relationship. Positive doctor-nurse relationship, negative doctor-nurse relationship and Over-involved doctor-nurse relationship were seen as the prevalent relationships. They study went further to revealed the influence of socio-demographic characteristics of both patients and nurses in the relationship between the two. The socio-demographic of nurse revealed no significant influences in the kind of relationship they offer while the socio-demographics of patients revealed that females co-operate in the relationship than males and patients who single also do not instruct nurses what they should do but rather adhere to treatment options. In the effects of the doctor-nurse relationship on the health of patients, the study revealed that patients‟ slow death, deterioration of patients‟ physical, psychological and emotional state and their lack of adjustment to their illness are the effects of negative doctor-nurse relationship. The positive doctor-nurse relationship were also seen to ensure greater adherence of patients to treatment, improves the level of patients satisfaction, ensures patients‟ sense of safety and protection and ultimately increases patients‟ recovery rate.


5.4 Recommendations

Based on the findings of the study, the following recommendation were out to improve the doctor-nurse relationship. Recommendations are given under nurses, patients and management of the hospital and the government.

The first recommendation is that nurses must be trained in human relationship. The relevance of the bio-psychosocial model should be incorporated into their academic curriculum to enhance their relationship with patients.

Another is that the 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.

The management of the hospital should grant nurses more days off duty in order to restore lost energy. This will help nurses deal with negative effects of stress that could be transferred into their relationship with patients.


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