Abstract

A descriptive study of nurses in the Limbe and Buea regional hospitals on the “Knowledge and practices on communication and its use in stress management”. This study aims at assessing the knowledge and practices of these nurses and the challenges they face in communicating with patients and proposing possible solutions.

The study wishes to improve the nurse-client relationship through proper and effective communication and increase nurses’ knowledge on communication and thus better care of patients through alleviation of their stress.

This study was motivated by the lack of communication more precisely therapeutic communication seen in the field of practice which leaves patients unveiled in fear, worry, anxiety thus resulting in the delayed recovery of patients.

This study has as objectives to assess: nurses’ knowledge on communication and its use in stress management; their practices on communication; the challenges they face in communicating with patients. The study included 60 nurses working in all the units of the Regional Hospital Limbe and Regional Hospital Annex Buea that meet the inclusion criteria and are willing to participate.

A total of 60 questionnaires which was the instrument for data collection was used. The questionnaire was made up of 20 questions and divided into 4 sections based on the research objectives plus demographic data.

Data was analyzed and presented using Microsoft word excel, tables, bar charts, pie charts, and histograms. Assessment of the nurses’ knowledge on communication and its use in stress management revealed that only 58.33% of the nurses could correctly define communication. 50% of all the nurses could not identify all the symptoms of stress.

As concerns their practices on communication, 75% of the nurses said they give their patients time to share their ideas and ask questions while 56.67% said they inform their patients of their condition often and very often. However, nurses face various challenges in communicating with patients.

This study has revealed that nurses need to improve on their knowledge of communication and stress because they lack adequate knowledge and be able to use this communication to identify and manage the stress of their patients.

Nurses are therefore recommended through this study to improve on their knowledge on communication and improve on interpersonal relationships with patients through therapeutic communication thereby quick recovery of patients.

CHAPTER ONE

INTRODUCTION

Communication is the basic element of human interaction that allows people to establish, maintain and improve contacts with others. Nursing is a communicative intervention and is founded on effective communication.

The word communication originates from ‘communis’, a Greek word, meaning ‘to make common’. It is the transmission and receiving of information, feelings, and or attitudes with the overall purpose of having understood producing a response [1]. It is always important to communicate effectively and efficiently with patients and members of the healthcare team, thus providing education and emotional support for patients and their families to reduce their anxieties and to build a trusting and empathic nurse-patient relationship. Clear and appropriate communication and professional behaviour is therefore necessary and expected[2].

When illness is serious enough to warrant an individual’s confinement to a hospital, the process of hospitalization may produce stress (for all concerned) independent of that precipitated by the illness itself. Illness may be a stress-provoking situation not only for the individual but also for the members of his immediate family [3].

Anyone that has to be thrust into a hospital or emergency room environment has a level of anxiety. To begin to establish this nurse-client relationship, the nurse must assess the overall message that the client is communicating to the nurse, such as fear, pain, sadness, anxiety, or apathy. This level can go up considerably when the client feels that they have been abandoned or that there is no one there that really cares about how they feel [4].

Communication is therapeutic. Building relationships is the cornerstone of nursing work, particularly with patients with learning disabilities; communication is a prerequisite to that process. It can also be life-saving[5].

Therapeutic communication, as defined by the medical dictionary is“a process in which the nurse consciously influences a client or helps the client to a better understanding through verbal or nonverbal communication”.

Therapeutic communication involves the use of specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect.

Just as stress has been proven to adversely affect the health of individuals, the therapeutic approach to communication can actually help. In any given situation everyone uses communication.

Everyone has seen an 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[4]

When a client is the recipient of therapeutic communication from a caring individual, a level of trust is achieved, and more than that, the client’s entire countenance can change for the better. Their blood pressure, respiration, and levels of stress can simultaneously decrease.

When this takes place, the management of pain, if any is involved, can be resolved more quickly. The goal for a nurse is to become proficient in the medical field[4].

1.0 Introduction

This chapter will be talking about the background of the study, the problem statement, the research hypothesis, research objectives including general and specific objectives, research questions, the significance of the study, the scope of the study, and operational definition of some terms.

1.1 Background Of Study

The importance of communication in health care hit the headlines recently at the British Medical Association’s annual consultants’ conference earlier this month.

Jargon, said the doctors, could harm patients’ care.Through communication, a patient can: be reassured; be put at ease; be taken seriously; understand their illness more fully; voice their fears and concerns; feel empowered; be motivated to follow a medication regimen; express a desire to have treatment (or not); be given time and treated with respect.

Effective communication is, therefore, more than delivering quality, patient-centered care. It is also the vehicle through which patients’ involvement is optimized[5].

The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication has not been systematically studied or measured[6]

Ineffective nursing communication occurred at one hospital as illustrated in the following example: A patient complained that no one had been in all night to check on her. The Patient Relations Representative went to find out if that was true.

She found out that the patient’s nurse had in fact been into the room four times, doing things for or to the patient each time. Four times! The nurse had been there physically and felt caring, yet the person who was the patient didn’t feel she received any quality contact or caring from the nurse [7]

Nurses’ communication skills have been criticized for many years, as has the training in communication skills that nurses receive[8].

Although effective communication with patients is increasingly understood as a key to effective, patient-centered care in all health care settings, the quantity, and quality of training that nurses get in ways to promote and enhance effective nurse: patient communication is sadly lacking.

This is true in the context of the pre-service training of nurses, and it is even more true with regard to the in-service training and continuing education of nurses. There are, fortunately, some rare exceptions.

This annotated bibliography is intended to provide information about, and connections with, the relatively few publications that contain practical information and ideas about how to do a better job of helping nurses learn to jointly establish meaning (i.e., truly communicate) with patients with the wide variety of communication vulnerabilities and communication challenges that patients bring with them, or develop in the course of their treatment.

Today, as the Joint Commission in the United States moves rapidly forward with “new and revised requirements to improve patient: nurse communication applicable to the hospital accreditation program” (emphasis theirs), it is especially important for those responsible for hospital care, and those responsible for training nurses for positions in hospitals, to take a fresh look at the quality and extent of the training they provide to nurses in this crucial area.

The evidence keeps mounting that communication barriers, breakdowns, and problems are the root cause of more “sentinel events,” medical errors, unnecessary costs, and inadequate treatments than any other single cause[9].

Patients and families count on nurses to keep them informed, to connect them to their physicians and other caregivers, to listen to them, to ease their anxiety, and to protect and watch over them during their healthcare experience.

Because of these high expectations of nurses, it’s no wonder that nursing performance, and more specifically, the nurse-patient relationship, is so central to patient satisfaction and a quality patient experience [7].

1.2 Problem Statement

However, this is not what is seen or observed in the hospitals with the increasing number of patients who develop high blood pressures when in the hospital which is evident of the stress that arises, and nothing is done about it. And also patients spend longer times in the hospital while some are discharged and within a short period of time, they return back to the hospital.

Crotty [10], Reid [11] and Hodges et al[12] highlighted that nurses do not communicate well with patients and approach patients only to deal with administrative or functional activities.

Throughout my years of study and practice at the hospitals, I have noticed the lack of attention nurses pay to their patients and caregivers. I realized in the field that nurses attend to patients just when they have treatments to be served to them or to give them their laboratory results/or request form or to give their written prescriptions or to tell them something the doctor said or to carry out some bedside procedure.

Whereas nursing being the caring profession that it is goes beyond the administrative and functional aspects. They spend the rest of their free time sitting at the nurses’ station idling or conversing.

Rarely would you see nurses conversing with patients during their free times? Communication with patients has been left but for some special cases and with some special persons seen in cases where the Nurse in Charge dialogues or educates a patient and or significant order in her office.

This is very saddening because this lack of good and proper communication between nurses and clients has led to increase inpatient stress and thus delay recovery of the patients. Nurses ought to be there for patients at all points in time in the care and management of their condition not only physically but also psychologically.

All this has therefore put this researcher to work to assess nurses’ knowledge and practices on communication and its implementation in preventing and relieving the stress of patients and their caregivers as well while also identifying the cause of the stress.

Thus, if it was shown that nurses of the Regional hospitals of Buea and Limbe acquire and apply effective communication skills then patients would have lower chances of developing stress during illness and/or treatment period.

On the other hand, if patients’ reactions to treatment were significantly different, there would be a need to modify communication strategies or treatment plans.

Hence the impact of communication on care outcomes will need to be studied as well as the causes of stress as this would help in planning care and thus improve care outcomes.

1.3 Research Hypothesis

Many patients develop a certain degree of stress when sick that may be due to the illness or hospitalization or both and could be identified and eliminated with proper and adequate communication between the nurse and the patient but this is not the case as nurses lack adequate knowledge in communication and the ability to identify the causes of stress and an individual in stress while using this communication to prevent and manage patients’ stress.

1.4 Research Objectives

General Objective

To investigate nurses’ knowledge and practices on communication and its use in stress management of patients and the challenges they face in communicating with patients.

Specific Objectives

1. To assess nurses’ knowledge of communication and its use in stress use in stress management.
2. To assess their practices on communication.
3. To assess the challenges they face in communicating with patients and the possible solution.