The Effect of Doctor-Nurse Relationship on Patient Care: A Case Study of Federal Medical Centre Owerri, Imo State
Chapter One
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 the doctor-nurse relationship on the health of the
- To find out the various types of doctor-nurse
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
The chapter reviewed important related literature under doctor-nurse relationship. Some of the relevant literatures this chapter reviewed were the concept of doctor-nurse relationship, component of therapeutic doctor-nurse relationship, types of relationship, and effects of nurse- patient relationship and patients‟ perception of doctor-nurse relationship. Beside these, the chapter also looks at the theoretical perspective of doctor-nurse relationship.
CONCEPT OF DOCTOR-NURSE RELATIONSHIP
The relationship that exists between nurses and patients is very important because it can either put a strain and stress on patient or ease their pain. In a Journal of College of Registered Nurses of British Columbia (2006), doctor-nurse relationship was seen to exist to satisfy the patient need and not that of the nurse. It further asserted that nurses are always responsible to establish and maintain boundaries with patients, irrespective of how the patient behaves.
Journal of College of nurses of Ontario (2006) supported the above statement with a comment that therapeutic nursing services contribute to the patient‟s health and well-being. The journal further comments that nurse are obliged to establish and maintain effective relationship by using their nursing knowledge and skills while they apply caring attitudes and behaviours.
The therapeutic doctor-nurse relationship is the primary, thus the core of all nursing treatment methods regardless of the major aim. (Varcarolis, 2006) The very first process between nurse and client is to establish an understanding in the patient that the nurse is entering into a relationship with the patient that essentially is safe, confidential, reliable, and consistent with appropriate and clear boundaries (LaRowe, 2004). It is true that disorders that have strong biochemical and genetic components such as schizophrenia and major affective disorders cannot be healed through therapeutic means. However, many of the accompanying emotional problems such as poor self-image and low self-esteem can be significantly improved through a therapeutic nurse-client alliance or relationship (LaRowe,2004).
In doctor-nurse relationship, communication is very important to achieve a consensus about healthcare treatment. The World Health Organization (WHO) (2000), European Union (EU) (2004), Department of Health (DH) (2004) and the National Health Service (NHS) Modernisation Agency (2003) have all emphasised the importance of patient-focused communication between health professionals and patients. According to these organizations patient focused communication is important because it ensure patient‟s satisfaction, inclusive decision making in caregiving and an efficient health service. Charlton et al. (2008) found that, by using a person-centered approach in the interaction between nurses and patients, care outcomes were improved in (1) patient satisfaction; (2) adherence to treatment options; and (3) patient health.
CHAPTHER THREE
STUDY METHODOLOGY
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
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 Federal Medical centre owerri 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.
Study Population
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 Federal Medical centre owerri. The population constituted nurses of different levels in terms of education, experience, ethnic group and religious denomination.
The staff of the Federal Medical centre owerri is estimated to be 300 including nurses, doctors, laboratory technicians and supervisors.
CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION
INTRODUCTION
This chapter dealt with the presentation and discussion of the final conclusion of the study. It consisted of a background examination of characteristics of the respondents, examination of relevant data which had direct bearing on the research questions and an insight into providing appropriate answers to the question. The respondents of the study were patients and nurses of Federal Medical centre owerri.
Examination of the results acquired from the questionnaires administered is as follows. Questionnaires totaling eighty three (83) made up of sixty eight (68) patients and fifteen(15) nurses were given out to patients and nurses respectively at Federal Medical centre owerri. All the eighty three (83) questionnaires were returned and none was rejected by the researcher.
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
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.
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.
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.
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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