Challenges of Communicating Primary Health Care in Rural Communities in Niger State
CHAPTER ONE
- To explore the nurses’ and patients’ views on communication between them in the emergency centre, against the HRM PCCM.
- To determine the challenges of effective communication at the emergency centre, as experienced by nurses and patients.
- To establish the views of nurses and patients on how communication between them could be
CHAPTER TWO
LITERATURE REVIEW
Introduction
A literature review, according to Mouton (2013), is an assessment of a body of research that addresses the research question/s, and is a description of the literature relevant to a particular field or topic under study. It is not primary research, but rather reports on findings of studies conducted by researchers, globally. The intention of a literature review is to explore similar or related studies that could serve as the foundation for the intended study. Therefore, this chapter contains a review of literature that relates to communication in an emergency centre, in relation to what has already been published on the subject, as well as the current nursing practice.
Selecting and reviewing of the literature
A significant amount of literature was accessed over a period of 15 to 24 months. The review commenced before the proposal for the study was completed. On completion of the analysis of the data, it was clear that the findings of the study relate to aspects, such as professionalism, attitude and respect between nurses and patients. These concerns were not thoroughly addressed in the initial review. Therefore, after data analysis was completed, the review was strengthened and adapted to provide information that was aligned with the findings of the study.
Search engines, such as UWC Search (University of Niger state Library and Information Service) and EBSCO host (Elton B Stephens Company research database) were employed, as well as the on-going support and assistance of the supervisor. The majority of the materials selected for the review, from multiple electronic databases, were published within the last ten years. The databases of the University of Niger state library, and Pub med. Periodicals, journals and various monographs (pamphlets and books) were reviewed. The keywords included communication, emergency centre, healthcare, staff and patient satisfaction. Both South African and international publications were accessed.
Presentation of the literature
The findings from the literature are presented in the following order:
- Communication in healthcare
- Communication and patient satisfaction
- Communication and staff satisfaction
- Conceptual framework
- Patient-centeredness
- Model of communication
- Summary
- Communication in healthcare
The emergency centre is one of the most critical departments in healthcare settings. Effective communication is an important element that facilitates the smooth flow of operations and processes in the emergency centre (Jenkins, Calabria, Edelheim, Hodges, Markwell, Walo, Weeks & Witsel, 2011).
Therefore, communication among patients and healthcare professionals in the emergency centre is very important (Hakami & Hamdi, 2013). Nurses as professionals in the health care field, work to provide the best care for patients. Due to the team-based nature of their work, communication is an important and essential component of care for patients. It is vital to many professionals, especially health professionals; therefore, communication, as a basic competence, is the foundation to all nursing interaction, and central to all human interaction (Pun et al., 2015; Hakami & Hamdi, 2013). Communication is a multi- dimensional, multi-factorial phenomenon and a dynamic, complex process, closely related to the environment in which patients and healthcare professionals share their experiences (Hakami & Hamdi, 2013). The word ‘communicate’ stems from the Latin communicare and means to share, impart, participate, convey, or inform (Bach & Grant, 2009). The importance of communication and interaction for nursing has been highlighted by nurses and nursing scientists, since Florence Nightingale in the 19th century, and continues to this day (Fleischer, Berg, Zimmermann, Wüste & Behrens, 2009). Goethals, Gastmans & Dierckx de Casterle’ (2010) assert that nurses play a role of care ethics to promote moral care about the patient’s health and welfare. However, they are confronted with organizational and legal restrictions in their reasoning and decision-making, which may affect, prevent, and change the moral reasoning development of nurses, as well as effective communication.
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
In this chapter, the researcher provides an account of the research design and methodology used in this current study. The purpose of the study was to explore the challenges of effective communication between nurses and patients, during the delivery of healthcare in rural communities, as well as to explore possible improvement strategies for effective communication. Through a qualitative research methodology, the researcher explores the problem, or issue, pertaining to a particular group, or population, of which the variables cannot be easily measured (Creswell, 2014). It is envisaged that the data yielded by this current study would develop strategies to improve communication between nurses and patients, during the delivery of healthcare in rural communities. In order to meet the study purpose, the researcher applied a qualitative, exploratory and descriptive research design.
CHAPTER FOUR
RESULTS AND DISCUSSION
Introduction
In this chapter, the researcher presents the results of the data analysis conducted on the data gathered from the in-depth interviews with the patients and professional nurses, as well as an integrated discussion, using existing literature on the topic as a control. The results of the study fulfil the study’s aim, which was to explore the challenges of effective communication between nurses and patients, during the delivery of healthcare in rural communities, as well as possible improvement strategies for effective communication. The results relate to the study objectives, which were:
- To explore the nurses’ and patients’ views about communication between themselves in the emergency centre against the HRM PCCM.
- To determine the challenges to effective communication within the emergency centre as experienced by nurses and patients.
- To establish the views of nurses and patients on how communication between them can be improved
It is anticipated that the results of this current study will positively influence the six principles on which health policy is based, namely, safety, effectiveness, patient- centeredness, timorousness, efficiency, and equity. The presentation of the results is guided by the four principles of patient-centred care, which is the theoretical framework of this study, namely, respect; choice and empowerment; access and support; and information sharing. The categories and themes from the patients and professional nurses are illustrated in Table 4.1 and 4.2. Thereafter, the horizontal themes that cut across the vertical themes of the patients and professional nurses are illustrated
CHAPTER FIVE
SUMMARY, LIMITATIONS, RECOMMENDATIONS AND CONCLUSION
Introduction
This final chapter is divided into four main sections: summary, limitations, recommendations and conclusion. The summary provides a general idea of what the thesis was all about, and the findings obtained from the study. The limitations provide those characteristics of methodology that impacted the interpretation of the findings of the research. The recommendations provide suggestions that the researcher proposes to the various stakeholders, based on the findings of the study, and finally, the conclusion, containing the final remarks by the researcher, which are aligned with the purpose and objectives of the research study. It is also intended to assist the reader to understand why the research should matter to him/her after reading this thesis.
Summary
The purpose of the study was to explore the perceptions of patients and professional nurses on their communication during the delivery of healthcare, in an urban emergency centre. The Patient Centred Framework, combined with the Model for Effective Communication, has proven to be an effective framework to identify the challenges that were perceived by all the participants. A qualitative descriptive research design, to explore the perceptions of patients and professional nurses, was the method of choice. To ensure the validity and trustworthiness of the research findings, measures were taken to ensure credibility, dependability, confirmability, and transferability of the study and the results. For the study, all similar research was used as guiding principles. Data were collected through in-depth interviews, employing an interview guide with one open-ended question that was posed to the study participants. Probes were used to gain the necessary depth of discussion. A total of 8 professional nurses and ten patients were purposefully sampled. Data collection ended when data saturation was reached. The interview data were transcribed and analysed.
The analysis of the data was conducted, using the inductive process that followed the stages of developing themes, in line with the four principles of PCCM, which was the theoretical framework of this current study. These four principles include respect; choice and empowerment; access and support; and information sharing. From these principles, emerging from the data, horizontal themes were developed in an integrated manner, to represent both the findings of the interviews with patients and professional nurses. Subsequently, these findings were compared, contrasted and weighed against the existing body of literature.
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