Assessment of Challenges of Media Public Health Communication in Select Rural Communities in Edo State
Chapter One
Research Purpose
The purpose of the study is to explore the challenges of effective media public health communication in rural communities, as well as to explore the possible improvement strategies for effective communication.
Research objectives
- 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 improved
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 Edo 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 Edo 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 media public health communication, 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 media public health communication, 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.
Research approach and design
A descriptive design, with a qualitative approach, utilizing in-depth interviews, was applied to explore the challenges of, and improvement strategies for, effective communication in rural communities, in Edo state. The purpose of a research design is to provide a plan for answering the research question (Wood & Kerr, 2011). De Vos, Strydom, Fouche and Delport (2011) describe a design as, all those decisions contained in the plan, or blueprint of the intended study. A descriptive design is used to determine current problems in practice and to identify what others, in similar situations, are doing (Burns & Grove, 2009). Additionally, the descriptive design is used, when more information is required (Brink et al., 2012). The descriptive design was considered to be the most appropriate for the purpose of this current study, as advised by Boswell and Cannon (2015), as it provides in-depth information about the characteristics of the participants in the field of study, in this current case, communication in rural communities. Brink et al. (2012) states that qualitative designs explore the meaning and describe, as well as promote the understanding of human experiences, such as pain, grief, hope or caring. Accordingly, a qualitative approach was employed, as it allowed participation with the nurses and patients through in-depth interviews, to obtain information on communication in rural communities. Qualitative researchers study issues in their natural setting, by trying to make sense of the phenomenon, in terms of the meanings people attach to them. In this current study, the researcher interviewed the participants at rural communities in Edo state.
Exploratory research is conducted to acquire an understanding of a situation, phenomenon, and persons, for example, media public health communication in rural communities, in Edo state (De Vos et al., 2011). It is also applied to “satisfy the researcher’s curiosity and desire for a better understanding” of media public health communication in rural communities (Bless, Higson-Smith & Sithole, 2013). An advantage of exploratory research is that it allows the participants to respond in their own words. The responses from participants are rich and explanatory in nature (Creswell, 2014). An exploratory design was relevant to this current study, since the researcher was focused on exploring the challenges of effective media public health communication, during the delivery of healthcare in rural communities, as well as possible improvement strategies for effective communication.
Study population
Krueger and Casey (2009) defines a study population as all the individuals, who meet the sample criteria for inclusion in a study, sometimes also referred to as the target population. Jooste (2010a) states that the study population is the whole group of individuals, who are of interest to the researcher. De Vos et al. (2011) further define it as setting boundaries regarding the participants.
Professional nurses
The study population included all 25 nurses (n=25) working in the urban emergency centre and overnight ward in Edo state. To ensure 24 hours coverage of the emergency centre and overnight ward, 7 days a week, nurses at the emergency centre are divided into 2 day teams and 2 night teams working opposite each other.
Patients
The population included all patients, who would have been discharged from the urban emergency centre and overnight ward on any given day. Currently, approximately 30 patients (n=30), including children under the age of 18 years, were discharged from the emergency centre and overnight ward on any given day.
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 media public health communication, 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:
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.
Limitations of the study
This research study was only conducted at rural communities (EC) and overnight ward. The population comprised of all patients that had been admitted to, and discharged from the EC and overnight ward, and all the professional nurses employed at the EC. Ten (10) patients and eight (8) professional nurses were purposefully selected, according to the inclusion and exclusion criteria. The study, therefore, was limited to a small study sample of patients discharged from the EC and the overnight ward, as well as the professional nurses employed at the EC and the overnight ward, in Edo state. The researcher, however, ensured that data saturation was reached. The findings, therefore, cannot be generalised and is limited and applicable to the context of this current study. Additional limitations relate to the researcher, who also conducted the interviews, being employed as a nurse manager at the institution under study. This may have an influenced the professional nurse’s responses, as they might have revealed what they thought the researcher wanted to hear. Therefore, despite the researcher’s attempt at bracketing, it must be acknowledged that, however minimal, the researcher’s presence might have influenced this current study.
The study was not conducted as originally planned due to difficulties in interviewing the patients and professional nurses. Some patients, who were asked to participate, did not show much interest in sharing their personal experiences, and others did not want to wait to be interviewed, after being discharged. Despite the researcher’s assurances that all research ethics had been adhered to, the participants might still have been reluctant to share more explicitly, for fear of being identified and exposed by the institution, which might also have influenced this current study.
It was also very challenging to interview the professional nurses on the four shifts, due to a complex and very busy emergency center, being short staffed, with inexperienced agency staff, which needed assistance and support.
Recommendations
The implications of the findings of this current study for nursing practice, policy development, nursing education, and nursing research for the improvement of communication are presented next.
Recommendations for nursing practice
- The research reveals that there is an overwhelming need to further research environmental challenges, resource limitations, staff capacity and skills that influence the staff’s current and future needs, patient care experience and improvement of communication;
- Strengthening of the work place model PCCM, to promote a friendly, accepting and warm environment that would contribute to the positive health outcomes of the organisation;
- A mechanism to address the lack of information and communication for changes in critical patient movement should be
Recommendations for education
- Appropriate programmes should be provided to the patients, family members, community and staff in their work environment for example educational television programmes, education packets, new employee orientation, rounding, online resources,
- Effective communication skills should be taught to all healthcare workers at emergency care
- Orientation of newly appointed healthcare professionals should be provided, to communicate effectively, the procedures in the emergency
- Ensure that the physical environment provides confidentially and
- Recommendations for policy development
- Existing health communication models should include addressing the patients’ communicated problems (such as waiting times) and concerns, in a satisfactory
- The availability of a resource in the first language requires creativity and flexibility in the emergency areas, to assist the health workers in their communication with their patients.
Conclusion
Based on the findings, the researcher concluded that patients and nurses perceived the challenges to influence how professional nurses communicated with them in the emergency centre and overnight ward. These challenges, such as increased patient numbers and skills shortage, under which the professional nurses have to perform their patient care duties, had a negative effect on communication. Ultimately, the researcher trusts that the recommendations made will be acted on appropriately, as this could possibly help to resolve the challenges experienced by the patients and professional nurses.
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