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CHAPTER 1 THE PROBLEM AND REVIEW OF RELATED LITERATURE AND STUDIES

Introduction

Patient-centered communication is a basic component of nursing which facilitates the development of a positive nurse-patient relationship and along with other organizational factors, results in the delivery of quality nursing care. In most instances, a nurse plays an essential role in the life of a patient. The concerns and cares they give to their patients is a big factor that uplifts each ones spirit, therefore the goal of the nurses of Olivarez College BSN IV is to create a harmonious relationship between their patients through a well organize and meaningful interactions.

The study of the relationship between patient and nurse is important to see how efficient a patient recovers, to understand his illness fully; whether theres a chance of recovery or nothing to expect at all. Moreover, the role of the nurse is to lessen the

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emotional and physical pain of every patient. In dealing with these, a need for better communication strategies and methods should be applied. There may be some existing practices exercised by hospitals for their nurses and patients, but a thorough study to improve it better is an advantage. (Cruz, JA 2010)

One good way of communicating with a patient is by merely listening to them. Letting them express their thoughts and anxieties may help them feel better. Furthermore, an understanding smile, a good sense of humor, a compassionate outlook and friendly gestures can alleviate their pain and anxiety.

The focus of this research is the patients perception of an effective nurse -patient relationship. The most common method of interaction is communication.

Communication is the sending of ones information to another and may be done verbally or non-verbally.

BACKGROUND OF THE STUDY

Nurses play an important role in health communication. They are the ones who are always in close contact with the patients. Having effective communication skills and being able to employ them in communicating to the patients is very essential for every nurse. A nurse must be able to communicate effectively to the patient, its family and their co-workers, as well. It is important for health care personnel to understand the

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doubts, fears and the anxieties of the patients who come to them for treatment. It is equally important to talk in an understanding tone to those who have not voiced their fears but are obviously scared.

Patience is also essential in dealing with hard headed and unbeliever patients especially when the patient is suffering and in pain during medication and they tend to refuse taking medicines anymore. Nurses feel a sense of accomplishment when they give a positive influence on their clients health status. Learning experiences with simulation offer the nursing student an opportunity to further develop knowledge, skills and critical thinking abilities prior to practicing in the clinical setting.

Role play, as well as manikin use, can enhance the nursing students ability to respond to a variety of patient care scenarios before actually encountering them in the clinical setting (Billings & Halstead, 2005). Active learning with immediate feedback reinforces the nursing students performance and confidence in relating to patients and other professionals in the healthcare setting (Billings & Halstead, 2005). A student nurse can easily relate to the situation of their patients in terms of their know-how and further sturdy of their illnesses. This study aims to know how patients can perceive and cooperate for the fulfilment of their rehabilitation.

Cutcliffe and McKenna (2005) reported that during treatment, hospital and community patients interact more with nurses than with any other health professional in

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the multidisciplinary team. These authors also highlighted that nurses are continuing to expand their role into medical and even surgical practice.

Nurses expanding practical role and its consequent negative impact on the interpersonal dimension of the patient care has also been well documented I recent years (Northouse and Northouse, 2004). These authors said that nurses are only too willing to accept changes to their role from outside the profession which, it can be argued, undermines the sense of ownership they have in relation to their own unique interpersonal patient contact.

According to McMahon (2002), Florence Nightingale once complained that her concept of nursing has been turned into nothing more than the administration of medicines. McMahon expressed concern that the nurses themselves perceive nursing as some form of comfort-giving or providing assistance towards the patients self -care, claiming that nurses themselves find it difficult to define what the nature of nursing is.

Nursing proves as difficult to define as care, which means that the role of the nurse and how it is differentiated from other health professions is often misunderstood. Perhaps nurses provide care and doctors provide treatment, but McMahon (2002) argues that neither addresses the skills and knowledge needed in modern nursing to provide good-quality care, nor explains why students take three years to train before they become qualified nurses.

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Since Florence Nightingales time, nursing could be seen as having moved from a task-oriented practice towards a therapeutic process that encompasses a wide range of nursing roles, focused on the individual patient and his or her health and well-being. McMahon (2007:7) attempts to define therapeutic nursing abilities as being characterized by six skills: developing the nurse-patient relationship; caring and comforting; using evidence-based physical interventions; teaching; manipulating the environment; adopting complementary health practices.

These are all the skills developed by nurses during their pre-registration education; all of them demand good communication skills for effectiveness. It appears that this argument supports the notion that nursing, in addition to the applied knowledge and attitude, is underpinned essentially by communication skills.

The therapeutic effect of good communication delivered through good care is supported by evidence. Social support appears to have a role in providing reassurance and can even lower blood pressure (Kamarck et al., 1998). Health professionals who can communicate at an emotional level are seen as warm, caring and emphatic, and engender trust in their patients, which encourages disclosure of worries and concerns that the patients might otherwise not reveal (Bensing, 1991; Letvak, 1995). Additionally, informative and useful communication between the practitioner and the patient is shown to encourage patients to take more interest in their condition, ask questions, and develop greater understanding and self-care (Crow et al., 1999). This is particularly so when the patient is given time and encouragement to ask questions and be involved in

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treatment decisions. It is also shown that patients can experience measurable health benefits when nurses provide a good environment, use therapeutic communication, give accurate information and encourage positive motivation in patients (Kwekkeboom, 1997).

So, good communication in the nurse-patient encounter is itself a beneficial and therapeutic intervention as well as the vehicle for good care, and can be regarded as important as other care or treatment. In brief, evidence suggests that the health communication helps patients to: express their physical and emotional needs; ask questions and be more involved in their care; gain a sense of control over their condition and treatment; develop trust and confidence in the process and so comply with treatment; gain physical health benefits such as reduced pain and lowered blood pressure.

As we can see in the models and examples, effective communication relies a great deal on the skills of the message sender and the ability of the receiver to interpret what is being communicated. These aspects of communication epitomize the interpersonal skills of a good communicator. The skilled communicator has informationpresenting abilities and good listening skills. In addition, a skilled communicator is aware of and make allowances for barriers to communication such as cultural differences, emotional and cognitive states of others, and external distractions. Michael Argyle (1983) suggests that skilful interpersonal behavior includes the following. Perception of others reactions: The communicator is attuned to the others behaviorand

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signs of understanding or misunderstanding. Attention to feedback and corrective action: the communicator has learnt what kind of response is needed according to the feedback from the other.

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Review of Related Literature and Studies

The relationship between the nurse and the patient is often seen as a therapeutic relationship in itself that is based on partnership, intimacy, and reciprocity (McMahon, 2002). Its purpose is different from a social relationship in that it has a focus on the patients well-being as a priority, and the nurse and the patient do not need to have anything in common or even like each other (Arnold and Boggs, 2006). This relationship can last only five minutes in an accident and emergency department or primary care practice, or can continue and develop for months or years during chronic illness management. It can be intensely personal when breaking bad news, or quite superficial such as when directing a patient to the appropriate clinic room. However, all of these scenarios are nurse-patient encounters that impart to the patient something of the support and meaningfulness of their engagement with health care. They tell the patient whether they are viewed as important and valued, and whether they will be listed to or discriminated against.

According to McMahon (2002), Florence Nightingale once complained that her concept of nursing had been turned into nothing more than the administration of medicines. McMahon expressed concern that nurses themselves perceives nursing as some form of comfort-giving, or providing assistance towards the patients self -care, claiming that nurses themselves find it difficult to define what the nature of nursing is.

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Nursing proves as difficult to define as care, which means that the rol e of the nurse and how it is differentiated from other health professions is often misunderstood. Perhaps nurses provide care and doctors provide treatment, but McMahon (2002) argues that this neither addresses the skills and knowledge needed in modern nursing to provide good-quality care, nor explains why students take three years to train before they become qualified nurses.

Since Florence Nightingales time, nursing could be seen as having moved from a task-oriented practice towards a therapeutic process that encompasses a wide range of nursing roles, focused on the individual patient and his or her health and well-being. McManhon (2002:7) attempts to define therapeutic nursing abilities as being characterized by six skills: developing the nurse-patient relationship; caring and comforting; using evidence-based physical interventions; teaching; manipulating the environment; adopting complementary health practices.

These skills are developed by nurses during their pre-registration education; all of them demand good communication skills for effectiveness. It appears that this argument supports the notion that nursing, in addition to the applied knowledge and attitude, is underpinned essentially by communication skills.

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The therapeutic effect of good communication delivered through good care is supported by evidence. Social support appears to have a role in providing reassurance and can even lower blood pressure (Kamarck et al., 1998). Health professionals who can communicate at an emotional level are seen as warm, caring, and empathic, and engender trust in their parents, which encourages disclosure of worries and concerns that patients might otherwise not reveal (Bensing, 1991; Letvak, 1995). Additionally, informative and useful communication between the practitioner and the patient is shown to encourage patients to take more interest in their condition, ask questions, and develop greater understanding and self-care (Crow et al., 1999). This is particularly so when the patient is given time and encouragement to ask questions and be involved in treatment decisions. It is also shown that patients can experience measurable health benefits when nurses provide a good environment, use therapeutic communication, give accurate information, and encourage positive motivation in patients (Kwekkeboom, 1997).

So good communication in the nurse-patient encounter is itself a beneficial and therapeutic intervention as well as the vehicle for good care, and can be regarded as important as other care or treatment. In brief, evidence suggests that health communication helps patients to: express their physical and emotional needs; ask questions and be more involved in their care, gain a sense of control over their condition and treatment; develop trust and confidence in the process and so comply with treatment; gain physical health benefits such as reduced pain and lowered blood pressure.

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As we can see in the models and example, effective communication relies a great deal on the skills of the message sender and the ability of the receiver to interpret what is being communicated. These aspects of communication epitomize the interpersonal skills of a good communicator. The skilled communicator has informationpresenting abilities and good listening skills. In addition, a skilled communicator is aware of and makes allowances for barriers to communication such as cultural differences, the emotional and cognitive states of others, and external distractions. Michael Argyle (1983) suggest that skilful interpersonal behaviour includes the following. Perception of others reactions: the communicator is attuned to the others behaviour and signs of understanding or misunderstanding. Attention to feedback and corrective action: the communicators has learnt what kind of response is needed according to the feedback from the other.

For instance, reticence from the others may prompt encouraging remarks of prompt questioning timing of social responses: This requires the communicator to know when to speak, when to listen, when to interrupt or prompt, or when to take the lead or be led. Self-presentation: A good communicator has self-awareness and is able to use this self-knowledge to present themselves to the other. This gives the other feedback about who the communicator is and therefore how to interpret and respond to them. For instance, sitting in a forward-leaning position assures the other that they are being listened to. Rewardingness: This is the ability to engage the other in the communication and know how to reward communication behaviour. For instance, using nods, smiles, and eye contact encourages someone to talk about themselves.

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Taking the role of the other: Here, the communicator can put themselves in the shoes of the other in order to understand how they are seen. For instance, if they realize that being dressed formally is off putting to a young teenager, they can respond by removing a tie or rolling up their sleeves. Argyle breaks communication skills down into behavioural skills rather than skills of insight, understanding, and cognition. Another definition of good communication comes from Becker et al. (1987: 9), who suggest that skilful communicator must be able to identify the emotions or intent expressed by the other person and make sophisticated judgements about the form and timing of the appropriate response . In this definition, the skilled communicator uses accurate perception and good judgement to understand the interactions and know how to make appropriate judgements. It may be that all of these factors are part of the skills of a good communicator--that skills are made up of a good sense of reality, awareness of self and others, accurate reading of situations, good timing, and ability to use the self to facilitate meaningful and positive communication. Many of these skills can be learnt and developed through the practice and through personal development by improving selfawareness, and awareness and understanding of other people and heir cognitive and emotional states.

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Synthesis

Hamilton, S.J., Martin, D.J. (2007) A framework for effective communication skills. Extended version of Nursing Times; 103: 48, 30-31 outlines a framework for nurses to further improve and develop their communication skills during interaction with patients. It also shows how to implement this framework in nursing practice, and nurses role in communication skills is further outlined through the use of an acronym.

The nurse-patient therapeutic relationship is the psychosocial bond that fosters and nurtures the healing of a patient. The therapeutic relationship between a patient and his psychiatric nurse is a special bond between human beings that possesses several unique attributes, from the development of trust, providing a safe retreat from the world where the patient will not be judged or directed, but encouraged to learn and participate in his/her own healing (Charnofsky; 2001).

According to researchers, patient-centered communication is a basic component of nursing which facilitates the development of a positive nurse-patient relationship and along with other organizational factors, results in the delivery of quality nursing care. In most instances, a nurse plays an essential role in the life of a patient. The concerns and cares they give to their patients is a big factor that uplifts each ones spirit, therefore the goal of nurses of Olivarez College BSN IV is to create a harmonious relationship between their patients through a well-organized and meaningful interactions.

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Conceptual Framework

Nursing is a significant, therapeutic interpersonal process; it functions cooperatively with other human processes that make health possible for individuals in communities. In specific situations in which a professional health team offers health services, nurses participate in the organization of conditions that facilitate natural on going tendencies in human organisms.

Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living.

It is likely that the nursing process is educative and therapeutic when nurse and patient can come to know and to respect others, as persons who are alike, and yet, different, as persons who share in the solution of problems. In general, personal relationships with patient have been tabooed in nursing. Perhaps one reason for this injunction has been misunderstanding of what is a personal relationship. For the purposes of nursing practice, a personal relationship is one in which two persons come to know one another well enough to face the problem at hand in a cooperative way.

According to Peplau, there are two general categories of interacting conditions that is essential for experiencing health, that is, (1) Physiological demands that is the required material conditions and (2) Interpersonal conditions, that are individual and

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social, and that meet personality need and allow the expression and use of capacities in a productive way. As these conditions are fully known and are provided and used by individuals and communities, more and more individuals will be enabled to experience greater health.

Peplau identifies four phases in the nurse-patient relationship. In the first phase, orientation, nurse and patient are strangers; they meet because of the patients felt need, and work together to recognize, clarify and define facts connected to the need. During the second phase, identification, the patient participates in the setting of the goals and has a feeling belonging, selectively responding to those who can meet his or her needs. The third phase, exploitation, sees the patient actively seeking and drawing knowledge and expertise of those who can help him or her. The final phase, resolution, which occurs after the successful completion of the other phases, leads to the termination of the nurse-patient relationship.

According to Intervention in Psychiatric Nursing by Joyce Travelbee, the nursepatient relationship has a number of goals. The nurse helps the patient cope with his or her problems and also help him or her to understand them. The nurse helps the patient understand his or her active participation in the experience, while also helping in the realistic identification of emerging problems. The nurse helps the patient find a new alternative for the problem and try out new patients of behavior. The nurse also helps the patient with communication and in finding meaning in his or her illness.

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On the basis of these goals, the therapeutic relationship can be divided into several types. In the immediate relationship, the nurse and patient do not know each other and the nurse has to interact or intervene to help the patient with an immediate severe difficulty. In the short-term relationship the nurse may know the patient but is not responsible for him or her. In the long term relationship the nurse interacts with the patient and tries to provide a corrective emotional experience, while supporting him or her and giving care.

The nurse patient relationship, according to research by Press Ganey Associates Inc., sets the tone of the care experience and has a powerful impact on patient satisfaction. Nurses spend the most time with patients. Patients see nurses interactions with others on the care team and draw conclusions about the hospital based on their observations. Also, nurses attitudes toward their work, their co -workers and the organization affect patient and family judgement of all the things th ey dont see behind the scenes.

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Statement of the Problem

The study will determine the patients perception on the effectiveness of interpersonal relations among BSN Level IV of Olivarez College S.Y. 2011-2012 to enhance the interpersonal nursing skills of the students in a clinical setting.

Specifically, it seeks to answer the following questions; 1. 1.1 What is the demographic profile of the respondent in terms of: Patient/Client

1.1.1 Gender 1.1.2 Age 1.1.3 Civil Status 2. What is the patients perception on the effectiveness of interpersonal relationship

among BSN Level IV? 3. Is there a significant relationship between Profile and Interpersonal relations

among BSN Level IV? 4. Is there a significant relationship between patients perception on the

effectiveness and Interpersonal relations among BSN Level IV?

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Significance of the Study

This study discusses the patients perception on the effectiveness of interpersonal relations among BSN Level IV of Olivarez College S.Y. 2011-2012.

The result of the study will benefit the following:

Nursing Students: This study helps us on how to improve the interpersonal skills of the nursing students through nurse-patient interaction.

Clients: This helps us to understand why interpersonal relations are very important to enhance and helps on the patients process of healing.

Nursing Researchers: Studying and exploring the broad meaning and importance of interpersonal relations during nurse-patient interaction can give more learning objectives to enhance the interpersonal skills.

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Scope and Delimitation of the Study

This research will only focus on the patients of Medical Center Paranaque on their perception on the effectiveness of interpersonal relations among BSN Level IV of Olivarez College S.Y. 2011-2012.

To determine how is the interpersonal relations are essential components in delivering good quality nursing care. Helping the patient to gain trust and feel comfortable during their stay in the hospital.

Definition of Terms

This study helps define some terms:

Communication the sending of ones information to another that may be done verbally or no-verbally. It is identified as one of the essential skills that students must acquire in order to make progress through their education and training to become qualified nurses.

Interpersonal Relationship association between two or more people like nursepatient interaction.

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Nurse is a highly skilled health care professional who combines the art of caring with scientific knowledge and skills developed through their education and career.

Nursing - is a science and an art that focus on promoting quality of life throughout their life experiences from birth to care at the end of life. It is a profession on assisting individuals, families and communities to achieve and maintain optimal health and functioning.

Nurse-Patient Relationship series of experiences between the nurse and patient or on individual, or his family, in need of the presence of the nurse.

Patient any person who receives medical attention, care or treatment.

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Chapter II Methodology Research Design Research design is a systematic subjective approach used to describe life experiences and give them meaning also considered as a blueprint for research, dealing with the least four problems: which questions to study, which data are relevant, what data to collect, and how to analyse the results. Research design use in this study is qualitative research. Qualitative research is a method of inquiry employed in many different academic disciplines, traditionally in the social sciences, but also in market research and further contexts. Qualitative researchers aim to gather an in-depth understanding of human behavior and the reason that govern such behavior. The qualitative methods investigates the why and how of decision making, not just what, where, when. Hence, smaller but focused samples are more often needed than the large samples. The researchers focused on the objective reality seen as singular, the process of discovering reality was reductionist, and was believed that the knowledge of the whole can be gained through the knowledge of the parts. Subjects/Respondents The respondents were individually contracted by the researchers and the data were collected by means of personal interview.

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Research Locale Medical Center Paranaque is the largest tertiary hospital in the City of Paranaque. It is known to be one of the citys reputable hospitals, situated in a 7,800 square meter prime lot along Dr. A. Santos Ave., Sucat, Paranaque City. The hospital has a 95-bed capacity which provides a wide range of medical and health services, such as Surgery, Pediatrics, Obstetrics & Gynecology, Internal Medicine and other related medical services. MCP is a private Corporation with 450 Stockholders mostly well-known physicians in their various specializations. History of Medical Center Paranaque MCP was founded by a group of enterprising physicians and businessmen in 1977. The inauguration of the hospital took place on November 12, 1978. It started with a capacity of 50 beds and offered services such as Operating and Delivery Room, Diagnostic X-ray, Laboratory Examination, Nursery, Dental Clinic, Pharmacy, ICU and ambulance services. On July 31, 1981, the Security and Exchange Commission approved the Incorporation of the hospital. As the years passed, the hospital steadily expanded with its present authorized bed capacity of 95. As more hospitals were established in the City to meet the growing number of patients. The MCP is continuously improving and upgrading their facilities to cope up with the modern demands of the hospital industry in upholding their commitment to provide a high quality health and medical services to the City of Paranaque. During their 21st year anniversary, they received achievement awards as one of the famous reputable hospital in the City.

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Materials The researchers will gather information through interviews and documentations. Intrumentation The tools used in this study for data collection were: Personal and demographic information from the patient and structure interview questions which will utilize the type of question. Data Gathering Procedure The researcher will make a face to face interview with the patient/respondents and talk with them about their insights, outlooks and perceptions on the interpersonal relations of the student nurses, using voice recorder with the respondents permission, questions will be asked spontaneously in a friendly conversation.

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References 1. Arnold, E. and Boggs, K. (2006) Interpersonal Relationships: Professional Communication Skills for Nurses, London: Elsevier 2. Becker, R. Heimberg, R., and Bellack, A. (1987) Social Skills Training for Treament of Depression. New York: Pergamon Press 3. Bensing, J (1991) Doctor-Patient Communication and the Quality of Care: An Observastio Study into Affective and Instrumental Behaviour in General Practice. Utrecht: Nivel/Utrecht University. (2000) Bringing the Gap: The Separate Worlds of Evidence-based Medicine and Patient-Centered Medicine, Patient Education and Counseling, 39: 17-25. 4. Cruz, JA (2010) The Effectiveness of Therapeutic Relationship Provided the Psychiatric Nurse in Contrast with the Psychiatrist As Perceived by Schizophrenic Patients, Our Lady of Fatima University, Antipolo City, Philippines. 5. Kamarck, T., Peterman, A., and Raynor, D. (1998) The Effects of Social Environment on Stress-related Cardiovascular Activation: Current Findings, Prospects and Implications, Annals of Behavioural Medicine, 20: 247 -56. 6. Kwekkeboom, K. (1997) The Placebo Effect in Symptom Management, Oncological Nursing Forum, 24(8): 1393-9. 7. NMC (2010) The Nursing and Midwifery Council 8. McMahon, R. (2002) Therapeutic Nursing: Theory Issues and Pactice, in R. McMahon and A. Pearson (eds) Nursing as Therapy. Cheltenham: Nelson Thornes. Internet 1. http:/www.nursingtimes.net/nursing-practise/leadership/clinical-development-aframework-for-effective=communication-skills/296359.article 2. The Therapeutic Relationship 01 December 2007. Web. 08 October, 2012. http://www.academon.com/term-paper/the-therapeutic-relationship-133749/

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PATIENTS PERCEPTION ON THE EFFECTIVENESS OF INTERPERSONAL RELATIONS AMONG BSN LEVEL IV OF OLIVAREZ COLLEGE SY. 2011-2012 Questionaire Name ___________________________________ Gender _________ Age _______ Civil Status ________________ Name of the Hosapital _______________________ Department/Ward _____________________________________________________ Date of Interview _____________________________ Orientation phase: 1. What are your common fears and expectations at the time you were confined in the hospital?

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Letter to the Hospital Director

Mr. Giovani Rebeta Director Medical Center Paranaque

Dear Sir, We are currently working on our thesis entitled Patients Perception on the Effectiveness of Interpersonal Relationship among BSN IV of Olivarez College S.Y. 2011-2012. It aims to help the student nurses gain more knowledge and enhance their skills to develop better rapport with their patient during RLE duty.

In line with this, we would like to ask your permission to conduct the pre-survey in the hospital especially the patients handled by the Level IV nursing students of Olivarez College, S.Y. 2011-2012.

Your approval to this endeavour will be highly appreciated.

Respectfully yours,

Jacquelyn A. Javier Group Leader

Noted by:

Approved by:

Joy Olendres

Mr. Rebeta