Abstract

Background: The relationship between nurse and patient is central to the practice of nursing. This therapeutic relationship has been deemed the “essence” (Forchuk, 2002); “crux” (Peplau, 1962); “core” (College of Nurses of Ontario, 2006); and the “heart” (Perraud et. al, 2006) of the discipline. It’s a professional and therapeutic interaction form of relationship which guarantees that the patients’ needs are placed on the priority, where the nurse takes the responsibility for the establishment and the maintenance of the boundaries with the patients, irrespective of how the patients behave (College of Nurses of Ontario 2006).  It is a helping relationship between a nurse and a patient based on mutual trust and respect, empowering of faith and hope with positive attitude and care in assisting the patient meet his/her gratification needs physically, emotional and spiritually. It is geared towards enhancing patient’s well-being. With the aim of investigating nurses knowledge on the therapeutic nurse patient relationship.

Method: The sampling technique being a convenient sampling, with a cross sectional descriptive study design, have a sample population of nurses working in the Regional Hospital Buea, with a sample size of 50 and data was collected using a well-structured questionnaire.

Results: With respect to the objectives; To determine nurse’s knowledge on therapeutic nurse patient relationship, 52% could identify the definition, 34%, the focus of nurse patient relationship. With regards nurses knowledge on role of the nurse, 64% could identify role of the nurse, and 36% could identify the components of the nurse patient relationship. And finally to determine nurses’ knowledge on the effect of nurse patient relationship, 78% said it empowered the patient and changes the patient perception of his/her wellbeing and 74% said it make the patient feel value and worthy.

Conclusion: At the end of this study, it was concluded that the nurses As per objective 1, 22(44%) of respondent had knowledge on the therapeutic nurse patient relationship. Based on objective 2, it could be concluded that 25(50%) of respondents had knowledge on the role of the nurse in the nurse patient relationship. Finally, on objective 3, only 38(76%) of respondents could identify the effects of the therapeutic nurse patient relationship.

CHAPTER ONE

INTRODUCTION

This chapter will be looking at the background of the study, problem statement, objectives, and research questions, significance of the study, scope of the study and operational definition of terms.

1.1 Background of the Study

The relationship between nurse and patient is central to the practice of nursing. This therapeutic relationship has been deemed the “essence” (Forchuk, 2002); “crux” (Peplau, 1962); “core” (College of Nurses of Ontario, 2006); and the “heart” (Perraud et. al, 2006) of the discipline. Peplau has been credited as the “mother” of modern nursing and bringing the nurse-patient relationship forward and central to practice (Forchuk, 1994; Tomey, 2006). The relationship between nurse and patient was developed in predictable stages and viewed as helping relationship wherein the exploration of the patient’s feelings and concerns leads to personal growth in both patient and nurse. The nurse remained aware of his/her own needs but there is a detachment of self-interest to become an agent of change for the patient (Peplau, 1988, 1992; Tomey, 2006). This belief is also reflected in the work of Orlando (1961) who stressed the reciprocity of the therapeutic relationship and believed the nurse and patient represented a dynamic whole each affecting the other. Travelbee extended and synthesized the interpersonal relationship theories of Peplau and Orlando (Tomey, 2006). Her work was an admonishment to the premise of remaining emotionally uninvolved with patients (Shattel et al., 2007). The therapeutic use of self is a fundamental characteristic of a nurse and that a therapeutic relationship is deliberately and consciously planned. Emotional involvement is necessary to establish a relationship; complete objectivity is neither possible nor desirable (Tomey, 2006). Beyond the phases and progress of the therapeutic relationship, what happens in the relationship has been explored in attempts to understand how it is helpful to the patient (Forchuk & Reynolds, 2001; Hagerty & Patusky, 2003; Walsh, 1999). The therapeutic relationship has come to be viewed with a collaborative nonhierarchical stance that involves a weaving of the nurse’s expertise with those of the patient (Wright, Watson & Bell, 1996). In alternate attempts to delineate components of the therapeutic relationship, other concepts studied have included empathy (Hardin & Haralis, 1983); connection (Miner-Williams, 2007; Wiebe, 2001); commitment and involvement (Morse, 1991); transference (Evans, 2007); nurturance (Raingruber, 2003); and boundaries of the relationship (Austin, Bergum, Nuttgens, & Peternelj-Taylor, 2006; Milton, 2008). With the arrival of missionaries in Africa, that is the 19th century, modern medicine came into play but before that health issues such as illness and deliveries were handled by herbalist and traditional birth attendant and they had great connection and interaction with their patients (Watt, 2004). According to watt therapeutic nurse-patient relationship existed before modern medicine, but this was only made clearer with the development of Peplau’s theory of interpersonal relations (Watt, 2004). As per the history of the therapeutic nurse-patient relationship in Cameroon, little is known but it could be traced back to the arrival of the colonial masters in the late 19th century (watt, 2004), this was similar to the experience of other countries for example china, where modern nursing according to Watt (2004) evolved due to the influence of western missionaries.

In a study conducted in several hospitals in Europe in 2005, in which patients’ perceptions on therapeutic nurse-patient relationship in relation to the stay in the hospital, it was proven that, over about 85% of patient stay in hospitals were shorter relative to the positive and great nurse-patient relationship (Evans, 2007). Also in another study conducted in USA in 2007, in some states, described that therapeutic nurse-patient relationships stands at about 96.8% (Milton, 2008). A study conducted from several hospitals in the Sub-Saharan region of Africa in 2013, described some sort of negligence some nurses portray in response to the patients’ functional inabilities. It was noted that most patients stay with their family members in the ward who take care of most of their physical/non-medical needs while the nurses only handle the medical or professional part of care. The family member manages all manner of care as the nurse including assisting their sick ones to take the medications, feeding, hygiene care, helping patient in ambulation and so on, as the nurse only gives instructions which sometimes may not be sufficient. This has been perceived to be irresponsibility on the nurses’ part. (A. K. Karani et al 2013). There is little information as concern therapeutic nursing patient relationship in Cameroon, but according to WHO (2014), in 2012 the population of Cameroon was 21,700,000, with gross national income per capita of 2,270 USD; life expectancy of 55/57 for men/women respectively; 0.8 physicians and 4.4 nurse’s/midwifery personnel per 10,000 populations respectively between 2006-2013. That with all of these proportion on the nursing personnel, patients/clients still experience a long stay in health facilities due to the lack of proper implementation of the therapeutic nurse-patient relationship as only about 28.7% of the nurse/midwifery personnel perform therapeutic nurse-patient relationship.

This study Investigating nurses’ knowledge on the therapeutic nurse patient relationship will be carry out from November 2019 to January 2020 in BUEA Regional hospital which is found in the South-west region, Fako division of Cameroon using nurses working in the Regional Hospital, data will be collect using self-administered questionnaire by the researcher herself with objectives to investigate the nurses’ knowledge on the therapeutic nurse patient relationship.

1.2 Statement of Problem

Comparing the study conduct in some region in sub Saharan Africa by Karani et al 2013, described some sort of negligence some nurses portray in response to the patients’ functional inabilities. It was noted that most patients stay with their family members in the ward who take care of most of their physical/non-medical needs while the nurses only handle the medical or professional part of care, and that of Milton, 2008, conducted in USA in 2007, in some states, described that therapeutic nurse-patient relationships stands at about 96.8%. Also, my experience as a student nurse in hospitals during my various placements did expose me to how nursing is practiced, which is contrary to what I was thought in school, which is void of the therapeutic nurse-patient relationship, where the nurses attend to patients only when it time for medication or wound dressing, which ought not to be so. So this motivated me to investigate nurses’ knowledge on the therapeutic nurse patient relationship in the Buea regional hospital.

1.3.1 General Objectives

Investigating nurses’ knowledge on the therapeutic nurse patient relationship

1.3.2 Specific Objectives

1. To investigate nurse knowledge on therapeutic nurse patent relationship
2. To investigate nurse knowledge on their role in the implementation of the therapeutic nurse patient relationship
3. To investigate the effect of therapeutic nurse patient relationship

1.4 Research Questions

1. What knowledge do nurses have on therapeutic nurse patient relationship?
2. What knowledge do nurse have as per their role in the implementation of the therapeutic nurse patient relationship?
3. What knowledge do nurses have on the effects of therapeutic nurse patient relationship?