A Study to Assess the Use of Therapeutic Communication by Nurses and Its Relationship
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“A STUDY TO ASSESS THE USE OF THERAPEUTIC COMMUNICATION BY NURSES AND ITS RELATIONSHIP WITH NURSING CARE SATISFACTION AMONG THE PATIENT’S OF SELECTED HOSPITALS OF TUMKUR.”
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
ARYA P.V MEDICAL SURGICAL NURSING
AKSHAYA COLLEGE OF NURSING TUMKUR, KARNATAKA. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the candidate :Ms. ARYA P.V.
And address M.sc Nursing 1st year
Akshaya college of nursing,
Tumkur, Karnataka.
2.Name of the institution : Akshaya college of nursing,
Tumkur, Karnataka.
3.Course of study and subject : M.sc nursing 1st year, Medical surgical nursing.
4.Date of admission to course :
5.Title of the Topic : “A Study to assess the use of therapeutic communication by Nurses and its relationship with nursing care satisfaction among the patients of selected hospitals of tumkur.”
6. BRIEF RESUME OF THE INTENDED WORK
Introduction A large part of a nursing career involves both verbal and non-verbal transmission of information to the patient and to the medical team and vice versa. When considering this idea of nursing and communication there is what is called therapeutic communication in nursing. This involves the human element of appropriate emotions in the nursing arena. 1
Therapeutic communication in nursing reinforces the nurse client relationship. It makes the nurse appear more humane to a patient. Therapeutic communication in nursing can help cut through barriers of cultures and gender, establish a connection and help deal in a situation where empathy is needed with the patient.1
Even when the nurse has experience with therapeutic communication, there can still be the problem of a back ground in that communication. The nurse can have empathy, respect for the person, and use active listening skills, but the problem could still come about. The reason is that the nurse also needs to do critical thinking. That kind of thinking means that she is always assessing the patient and the situation another point is that sometimes it can be very difficult to see things from the perspective of patients. 2
Therapeutic communication in nursing allows for the patient and family to feel like someone actually cares for him or her in their time of need. This can be fundamental in the recovery or death process of a patient. Modern health care systems are seeking to adopt more client-oriented approach to the delivery of health care. With this program me shifts, patient satisfaction and quality of life are becoming increasingly as important as a more traditional clinic outcomes in the monitoring and evaluation of health care delivery.3
Although the quality of therapeutic alliance is thought to predict patient’s general satisfaction, the strength of this relationship has not been examined qualitatively using valid and reliable instrument.3 Patient’s satisfaction is a multi dimensional construct that includes – humaneness of staff, availability of care, convenience financial accessibility, quality of care and condition of facilities. Patient satisfaction is an important component of the health care industry in this competitive modern era. It leads to drift in both new and old patients, which hinders the sustainability of any hospital in long run. Nursing care services includes both holistic and comprehensives care for the patients. This planned care has not been achieved by the patients because of various pit falls. The dissatisfaction of in-patient can be due to type of illness , hospital facilities, dietary services and nursing care , communication etc. any dissatisfaction demands careful analysis of the root cause of the problem.4
6.1 NEED OF STUDY
The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuining care, opportunities for socialization occur primarily during interaction or communication with staff and these interactions have been found to be limited. One way to improve nursing staff communication is through communication enhancement interaction.5
Even when the nurse has experience with therapeutic communication, there can still be the problem of a breakdown in that communication. The nurse can have empathy, respect for the person, and use active listening skills, but the problem could still come about. The reason it happens is that the nurse also needs to do critical thinking. That kind of thinking means that that she is always assessing the patient and the situation (McNabb, 2006). Another point is that sometimes it can be very difficult to see things from the perspective of the patient. Bournes and Mitchell (2002, p. 59) state, "health is the way people go on and live what is important to them, moment to moment and day to day".5
There are no published scales of the perceived therapeutic communication skills of general practitioner. It should be noted that a patient may regard his or her general practitioner as providing a satisfactory service despite a lack of certain skills. In a survey conducted by department of public health, Ireland on the level of satisfaction among the patients, 94% doctors and nurses were perceived it friendly by 61% and 72% and rude by 1% and 1% of patient’s respectively. In a study conducted at Magdeburg, Germany only 3.6% of patients were dissatisfied. In a case such as this the nurse should stay and further explore how the person actually feels. There are many factors associated with the healing and comforting aspects of therapeutic communication. Circumstances, surroundings, and timing all play a role in the effect of therapeutic communication. If a client is being rushed down for an emergency surgery there might not be time for a bedside conversation, but the holding of a hand could convey much more than words to the client at such a moment.6 Hence, it was felt that is a need to know the satisfaction level of patients and also get the feedback about the use of therapeutic communication by nurses. There are very few studies in India that measure patient satisfaction with the therapeutic communication used by nurses in health care organizations Everyone has seen the individual that looks like they are either angry, stressed, feeling ill or maybe sad. These emotions are communicated to others not always by words, but by gestures and facial expressions. A nurse must always be aware of these expressions in clients, for these expressions may be the only way that the nurse can tell if there is something else going on that needs their attention. The term given to this type of non-verbal communication is called, meta-communication. In meta-communication, the client may look at their amputated stump and say that it doesn’t really look that bad, while at the same time tearsare rolling down from their eyes.6
Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3-5h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults' quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling. 6 6.2 REVIEW OF LITERATURE
Irma P.M et.al conducted a study in 2007 on evaluation of communication training programmes in nursing care. According, to them an important aspect of nursing care is communication with patients. Nurse’s major communication tasks are not only to inform the patients the patients about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patient’s concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables not only is the training program taken into account as a variable which may be responsible for nurses’ behavioral change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program’s degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses’ skills, on nurses’ behavioral changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design.6
Junaid Masood, Halen Forristal, Robert Cornes et.al conducted a Questionnaire study in 2007 on audit of patient satisfaction with uro-oncology nurse specialists. Acc. to the study specialist nurses have an established role in the management of urological cancer in helping patients to understand their disease and treatment options and in offering counseling and emotional support. There is evidence to suggest that patients who see the nurse specialists express more satisfaction and have less anxiety than those who see junior doctors. The Questions were concerned with the provision of information to patients and with the satisfaction of the nurse specialist service. The results showed that patients found contact with the uro-oncology nurse specialist supportive, informative and beneficial to their treatment.7
Sharma. B conducted a study in year 2007 to assess the level of satisfaction of patients regarding nursing care provided to patients. A descriptive study with cross – sectional survey was used to collect data from 40 patients, selected by convenient sampling technique from vinayaka mission’s hospital, Salem. Data were collected using semi structured interview schedule. Demographic characteristics revealed that 32.5% of patients were above 55 years of age, 67% were males, 35% of them had high school education, 84% were Hindus, and 52% were from the joint family and 57% from rural areas. Further 25% of patients were labourers and 45% belonged to the income group of below Rs.2000 per month. Patients from medical ward were 32.5%, surgical ward 17.5%, or the ward 7.5% semi private ward 20% and private ward 22.5%, 60% of them were not previously exposed to this hospital and admitted in the hospital for 3-5 days. Level of satisfaction among patients showed that highest percentage (57.5%) of patients were moderately satisfied 20% of patients were fully satisfied . however 17.5% of patients were minimally satisfied and only 5% of patients were not satisfied with nursing care provided to them in hospital.8
Pontes, Alexandra carvalho et.al conducted a study in 2006 to analyze the process of therapeutic communication as developed by nurses who work in hospital units according to peplau’s theory. It is a descriptive- exploratory research accomplished in municipal district of Fortaleza, CE, Brazil. The participants of the study were 14 patients and 12 nurses, through a semi-structured interview. Data were organized in thematic. Results demonstrated that since admission to hospital discharge, there is communication and interaction with a interpersonal relationship. Several times, however, that communication does not occur as it was supposed to, because nurse in her work does not priorize the visit to patients in her daily activities. Patients have difficulties to distinguish nurses from other health care professionals, which difficult the approach and development of therapeutic communication.9
Bolus R, Pitts J. conducted a study in 2005 on patient satisfaction and quality of life in regular users of the public health chronic disease clinics in south Trinidad .This cross-sectional study comprised patients who attended the diabetic and renal public clinics of the south west regional health authority. A random sample of 40% of patients attending the three public chronic disease clinics in the south regional health authority district were interviewed. Participants were then asked to complete the Questionnaire which consisted of socio demographic, quality of life, health services items. Overall, the Questionnaire had 35 items and was completed in 15 min. Patient satisfaction was assessed from questions designed to measure satisfaction with services provided, facilities and staff. Participants were asked to rate quality of healthcare services, condition of the facility and performance of staff using the likert scale – excellent, very good, good, fair, and poor. Results shows that approximately two –third of participants rated treatment and courtesies of staff as good to excellent. Approx 54% of participants rated their communication with staff concerning their illness and treatments as good to excellent 60% of the participants gave a rating of good to excellent for the adequacy of explanations on the use of medications given by staff at clinic visits. Overall, two-third of participants gave a rating of good to excellent on the overall performance of staff.10
Ibrahim S Al-Eisa et.al conducted a study in 2003 to evaluate patient’s satisfaction with primary health care centers (PHCCs) services at capital health region, Kuwait. A cross-sectional survey using Arabic language questionnaires was done. The questionnaires included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of services in the PHCC at capital health region rated from 1-5 points ranged from very dissatisfied through to very satisfied, the higher the score the higher the satisfaction . A convenient sample of 1250 patients attending the PHCC aged 18 years and above was included in the study. The response rate of completed questionnaires was 82.8%. The mean score of overall satisfaction was 4.59 out of a maximum of 5 points. Subjects aged above 50 years showed the highest overall and differential satisfaction. Male subjects and those who completed primary school showed the highest overall satisfaction (4.63 mean points and 4.68 mean points’ resp.). Other socio- demographic characteristics were not significantly related to overall satisfaction scores.11
Perla, Lisa conducted a study in 2003 on evaluation of communication enhancement intervention on staff and patient in a complex continuing care facility. 21- Nursing staff and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effect of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the interventions. Nurse outcome variables included nurse’s job satisfaction and their relationships with patients, patient outcomes variables included two measures of patient satisfaction with care. Results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. 12 Sasi. V conducted a study in 2000 to assess the patient satisfaction on nursing care services among in- patients of selected Mahatma Gandhi Medical College and Hospital, Puduchery. Descriptive design using survey approach was used. Convenient sampling technique was used. The sample size was 100 in-patients. The data was collected using structured interview schedule on patients. Satisfaction oppionnaire on nursing care services. Tool has two parts, 1st deals with demographic variables and 2nd with patient satisfaction oppionnaire on nursing care services. It includes 20 statements focusing on nursing-care services. 5 point scoring was used. According to results, 17% of the patients were not satisfied about discharge plan and only 19% of them were well satisfied with the dietary services. Regarding overall patient satisfaction, about 58% of them were well satisfied with the nursing care services and 42% of them were moderately satisfied. None of them fell under the category of not satisfied.13
Suzanne McNamee conducted a patient satisfaction survey on the cardiothoracic surgical ward (cw16) between June and October 1993. The survey was designed to assess the level of satisfaction patients had with their hospitalization on cw- 16 both pre-operatively and post- operatively and also with their visit to preadmission clinic. Questionnaires were used for data collection. These Questionnaires were distributed to patients either the day before their anticipated discharge from cw-16 or the morning of the day of discharge. Patients were informed that their responses would remain anonymous. Significantly, 43 patients (66%) out of 100 said they found the preadmission clinic helpful . some very encouraging results for the nursing staff were obtained from the survey 75% of the patients said that they were very – satisfied with the nursing staff’s attention to their pain relief and additionally 18% were ‘satisfied’, or ‘very satisfied’ with the nursing staff’s attention to patient concerns and problems during their stay . only one patient was dissatisfied with the information/education given by ward nursing staff about discharge medication, care at home following discharge and follow –up appointments.14
Ahlam A. Mansour and Muneera H.Al-osimy conducted a study in 1993 on satisfaction level among primary health care patients in Saudi Arabia. The aim of this study was to assess the satisfaction of patients with different expects of primary health care services in Riyadh. The sample consisted of 300 patients chosen systematically from three primary health care centers in Riyadh. The data were collected by personal interviews the tool consisted of demographic data, a 4- point rating scale of 40 statements measuring satisfaction with different expects of primary health care services and an open question eliciting the patient’s suggestions for improvements. The anaylis of variance (ANOVA) was used to determine the difference in level of patients satisfaction between the three centers the results show that the patients were moderately satisfy with services .They were most satisfy with the effectiveness and human aspects of care , and least satisfy with the thoroughness and continuity aspects of care .15
6.3 PROBLEM STATEMENT
“A study to assess the use of therapeutic communication by nurse and its relationship with nursing care satisfaction among patients in selected hospitals of tumkur.”
6.4 OBJECTIVES
1. To assess the use of therapeutic communication by nurses with the patients admitted in the selected hospitals of tumkur.
2. To determine the level of patient satisfaction.
3. To determine the relationship between therapeutic communication and level of patient
satisfaction.
6.5 OPERATIONAL DEFINITIONS
1. ASSESS:- It is the organized systemic and continuous process of collecting data from the patients admitted in selected hospital of Tumkur. 2. STUDY:- To apply the mind to read and examine for the purpose of learning and understanding.
3. THERAPEUTIC COMMUNICATION NURSING:- A process by which the nurse consciously influences a client or helps the client to better understanding through
verbal and non –verbal communication.
4. RELATIONSHIP :-The way in which two or more concepts ,objects ,people are connected or the state of being connected.
5. NURSING:- It is a dynamic ,therapeutic and educative process in meeting the health needs of the individual,family and society.
6. CARE:- It is a provision of welfare and protection to children , The elderly in need , the sick and other vulnerable people.
7. SATISFACTION :- the good feeling that you have achieved something or when something that you wanted to happen does happen.
6.6 ASSUMPTIONS
1. Use of therapeutic communication by nurses will help to improve the nursing care satisfaction of patients.
2. Use of therapeutic communication by nurses will help in early recovery of patients admitted in hospitals.
6.7 HYPOTHESIS
H1- Use of therapeutic communication will increase the level of Patient satisfaction. H0- Therapeutic communication used by nurses will have no effect on the level of patient satisfaction.
6.8 RESEARCH METHODOLOGY
Research approach:-
Quantitative research approach.
Research Study design:-
Non-experimental descriptive design.
Research Variables :- Independent Variable - Therapeutic communication.
Dependent Variable - Patient satisfaction.
Research setting:- Selected hospitals of Tumkur.
Setting of the study:- I.C.U, private wards and general wards of Private hospital of Tumkur.
Inclusion criteria:-
Patients admitted in I.C.U, private wards and general wards.
Patients with ability to speak , read and understand English language .
Patients with normal mental status.
Patients who are willing to participate. Exclusion criteria:-
Chronically ill patients.
Patients with any psychiatric illness.
Patients with hearing, visual, or speech defect.
Population :-
All patients admitted in selected hospital of Tumkur.
Sample :-
50 patients admitted in I.C.U., private ward and general wards of Private hospital, of Tumkur.
Sampling technique:- Convenient sampling.
7. METHODS OF DATA COLLECTION
Data collection tools:-
Likert scale to assess use of therapeutic communication and patient satisfaction.
Selection of tool:-
Tool was developed by the researchers under the guidance of guide and experts after deep study and review of various journals, articles, books, and internet search. Questions were formulated to assess the use of therapeutic communication and patient satisfaction. Description of tool:-
Questionnaire consists of two sections:-
Section A: it includes demographic characteristics of sample such as age, gender, education, religion etc.
Section B: it consists of questions regarding therapeutic communication and patient satisfaction.
1st 17 questions were formulated in the form of likert scale to assess therapeutic communication, whereby responses range from excellent to poor. Last three questions were formulated to assess patient satisfaction of nursing care.
Scoring: - Questionnaire was formed on likert scale in which responses varied from excellent to poor. All the items were formulated in positive way so that excellent response scored highest, i.e -5 and poor lowest, i.e -1
Excellent- 5
Very good- 4
Good- 3
Fair- 2
Poor- 1
Validity of tool:-
The content validity of the tool is established in consultation with guide and experts from the field of medical surgical nursing and biostatics.
Data collection procedure:-
A formal permission was taken from the director of Private Hospital, Tumkur. Total 50 subjects were selected for the study as per the criteria of selection. Explanation was given regarding the study to the patients. Informed consent was taken. Then, close- endedquestionnaire was distributed and collected after 10-15 minutes. Data collection was done from 10th Feb. 11 to 10th March. 11.
Ethical issues:-
Informed consent from all subjects was taken.
Confidentiality of the information of subjects was maintained.
Try out:-
The data collection procedure was tried out on 50 patients and data collection procedure was found to be feasible.
Plan for data analysis:-
Descriptive and inferential statistics was used for analysis of data.
Descriptive analysis presented as percentage , frequency and mean.
Inferential analysis presented as correlation coefficient. Alpha value was set at 0.05 levels. 8. REFERENCES
1. Communication skills , 2007 ;available from : http://www your communication skills.com/ therapeutic communication in nursing.html.
2. A case study presentation discussing the importance of therapeutic communication in nursing. American journal nursing,2007;available from: http://www.academon.com/ nursing-therapeutic communication.
3. Patient satisfaction. west Indian medical journal ,March 2007,volume-56(issue 2); available from : http://caribben.scielo.org/scielo.php 2 script.sci – attend & PID = 30043-31440007000200002 & lag.ENS nrm.
4. Qureshi Waseem, khan. A nazir.et al, case study on patient satisfaction in SMHS Hospital , Srinagar, J&K, Nightingale Nursing Times. 2005; Volume -12 (Issue 3):Pp154-155.
5. Junaid Massod , Helen Forristal, Robert cornes et.al. a Questionnaire study on audit of patient satisfaction with uro-oncology nurse specialists. International journals of urological nursing,2007 ;volume 1 (Issue 2) :Pp 81-86, Available from : http://www3.interscience.wiley.com/journal/117982860/abstract? CRETRY = 1 & SRETRY=0.
6. Irma Pm, Krwjver , ado Kerkstra et.al . a study on evaluation of communication training programmes in nursing care. Journal of advanced nursing . 2007; Volume – 34 (Issue 6) :Pp 772-779, Available from :http://igitur – archieve . Library .uu.nl/fss/2007-0705 – 203454/bensing – 01 – communication skills of nurses .pdf. Robyn Knapp,therapeutic communication in nursing profession et.al www.street directory.com. , Nightingale Nursing Times. 2005; Volume -12 (Issue 3):Pp154-155. lag.ENS nrm
7. Suzanne Mc Namee . A patient satisfaction survey on the cardiothoracic surgical ward (cw- 16) between june and October . 1993; available from// www.ciap.health.nsw.gov.au/hospolic/stvincents/1995/a 03.html. 8. Pearl , lisa. A study on evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility .journal of advanced nursing . 2003 ; volume – 54 (Issue 1): Pp 35-44, available from: http://www.ncbi.nlm.nih.gov/pubmed/16533689.
9. 9. Ahlam A. Mansour , Muneera H.Al – osimy. A study on satisfaction level among primary health care patients in Saudi Arabia. Journal of community health . 1993; volume-18( Issue 3): Pp 163-173, Available from : http://www.springerlink.com/content/k518330p21 h 30pu55/.
10. Sharma . B. A study to assess the level of satisfaction of patients regarding nursing care provided to patients. Nightingale nursing times .2007 ; volume 4 (Issue 1):Pp 28-32.
11. Bolus R, Pitts J. A study on patient satisfaction and quality of life in regular users of the public health cronic disease clinics in south Trinidad . West Indian medical journal. 2007; volume – 56(Issue -2):Pp108, available from : http://caribbean.scielo.org/pdf/Wwimj/v56n2/a02v56n2.pdf.
12. Ibrahim S Al-Eisa et.al . a study to evaluate patient satisfaction with primary health care centers(PHCCs) services at capital health region, Kuwait. Middle east Journal of family Medicine . 2005; volume 3 (Issue 3), available from :http:// www.mejfm.com/journal/july05/patient’s-satisfaction.htm.
13. Pontes,Alexandra carvalho et.al. a study to analyze the process of therapeutic communication as developed by nurses who work in hospital units according to peplau’s theory. U.S National Institues of health .2008 ; volume 61(Issue 3):Pp312-318, Available from: http://www.ncbi.nlm.nih.gov/pubmed/18604425.
14. Sasi.V.A study to assess the patient satisfaction on nursing care services among in- patients of selected Mahatma Gandhi Medical College and Hospital,Punducherry. Nightingale Nursing Times.2005; Volume 12 (Issue 3):Pp160-165.
15. Ewa Wallin , per – olov Lundgren et.al. a study to assess the patient satisfaction with regards to demographic variables.2000; volume-8 (Issue 2):Pp 79-88. 9 ETHICAL CLEARANCE CERTIFICATE (Under Ethical Clearance Committee) We are hereby granting the permission to Ms. Arya P.V. 1st year M.Sc.(N) Akshaya College of Nursing, Tumkur “to conducted the study on various patients admitted in general wards, ICU & private wards of selected hospitals in Tumkur”.
She has selected the topic:- “A study to assess the use of therapeutic communication by nurses and its relationship with nursing care satisfaction among the patients of selected hospitals of tumkur.” Further she is informed about the following:- 1. She should not disturb the daily routine of the hospital. 2. She should not harm the study subjects during the course of data collection or intervention. 3. Informed consent should be obtained from the study subjects. 4. She should maintain the confidentiality and anonymity of the subjects and information gathered. MEMBERS OF THE COMMITTEE
NAME DESIGNATION SIGNATURE
1. Mrs. Umarani R.M.Sc.(N) Principal …….………… Akshaya College of Nursing. 2. Mrs. Jalajakshi B.Sc.L.L.B. Legal Advisor ……………….. Akshaya Education Society. 3. Dr. Shobha S. MBBS DGO Secretary ………………..
4. Mrs. Sheethammal M.Sc.(N) Asst. Professor ……………….. Akshaya College of Nursing. 10. Signature of Candidate :
11. Remarks of the Guide :
12. Name & Designation of :
12.1 Guide :
12.2 Signature :
12.3 Co-Guide (if any) :
12.4 Signature :
12.5 Head of Department :
12.6 Signature :
13. 13.1 Remarks of the Principal:
13.2 Signature :