RESEARCH PROPOSAL

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Effective nurse-patient relationship is imperative in nursing care since this makes the
patient feels at home and ease in and out of the hospital setting. It symbolizes agreement between
the nurse and the patient to work together for the good of the patient. For a nurse patient
relationship to be therapeutic there must be good communication between nurses and patients.
Good communication skills make the difference between average and excellent nursing care.

Patients are described to have less power in the nurse patient relationship which can add
to their vulnerability if they are not treated with respect by nurses. Emotional, physical and
mental problem of patients can make them difficult to handle by nurses in the relationship. In
view of this nurses need to strengthen their interpersonal relationship and their professional
standard by exhibiting to the maximum level the principles of therapeutic relationship.

The underlying principles of the therapeutic relationship are the same regardless of the
length of contact: respect, genuineness, empathy, active listening, trust and confidentiality. The
purpose of the therapeutic relationship is to support the patient, to promote healing and to
support or enhance functioning. A therapeutic relationship differs from social relationship in that
it is health focused and patient centered with defined boundaries. Peplau (1991) described the
nurse focus interest in the patient as “professional closeness”

Irrespective of the qualification, facilitation of a therapeutic nurse-patient relationship

has always been the cornerstone of nursing and includes self-knowledge and knowledge about
the essential components of therapeutic communication. These components include
unconditional acceptance of the patient, the ability to listen and to hear, constructive non- verbal
skills and verbal communication techniques. The use of rapport and alliance enables this process
to happen by providing support, consistency and reliability in patient care (Gilbert 2009).

However, the bureaucratic environment in hospitals is driven by technology and a mainly

medical model of care, making a therapeutic relationship between nurses and their patients
difficult. The focus of communication in the nurse-patient relationship is to satisfy patients‟
needs that are patient-centered care.

1.2 STATEMENT OF THE PROBLEM

According to literature of nursing care, nurses are obliged to treat patients with maximum
respect and empathy. Attending behaviour is a patient-centered process and the basic conditions
required on the part of the nurse for attending to occur are genuineness, warmth and empathy
(Burnard, 1990; Stein-Parbury, 1993). It is the responsibility of the nurse to be aware of the
power imbalance, to recognize the potential for clients to feel intimidated and to create a
therapeutic relationship. This awareness therefore helps to establish and maintain appropriate
boundaries.

However, articles, news, and experiences of some patients reveal that patients are not
treated well in the nurse-patient relationship. Patients are often without defenses and might
depend on nurses to meet basic needs. Patients might not have a network of supportive family
and friends and may want to depend on the nurse beyond the practice setting. Some patients,
such as those with mental health problems or those in need of ongoing care, could be particularly
vulnerable.
It was because of this discrepancy that the study was conducted at Ho Teaching Hospital
to find out the kind of relationship between nurses and patients. This will help to improve upon
the nurse-patient relationship in the hospital.

1.3 OBJECTIVES OF THE STUDY

1.3.1 GENERAL OBJECTIVE

The general objective of this study is to identify the effects of nurse-patient relationship on the
health of the patient and to support, promote and enhance healing or functioning.
1.3.2 SPECIFIC OBJECTIVES

This study addressed the following objectives:

1. To determine whether the socio-demographic characteristics of the nurse and the patients
influence the type of relationship between the two.

2. To examine the effects of nurse-patients relationship on the health of the patients.

3. To find out the various types of nurse-patients relationship.

1.4 RESEARCH QUESTIONS

Prior to the statement of problem discussed above, the study sought to answer the following
research questions:

1. How do the socio-demographic characteristics of the nurse and the patient influence the
type of relationship between the two?

2. What are the effects of nurse-patient relationship on the health of the patient?

3. What are the various types of nurse-patients relationship?

1.5 SIGNIFICANCE OF THE STUDY

The study was aimed at providing relevant reasons why patients should be treated
with maximum respect, confidentiality, empathy and warm in the hospital settings.
Complete health does not mean only absence of disease or infirmity but also mental and
social wellbeing. The stud addressed the importance of incorporating bio-psychosocial
model into healthcare. The findings of the study will improve the understanding of nurse-
patient relationship by both nurses and patients.
 Findings of the study will reveal the importance of using patient centered approach
rather than task centered approach in the nursing care by nurses. The research will also add
to the existing body of knowledge in the subject field.
Patients hope to be treated with respect, warm and genuineness. However, nurses,
overlook the implications of their relationship with patients. The study was important
because it will make it explicit the effects of nurse-patient relationship on the health of
patient. When nurses become aware that their negative attitudes and behaviour negatively
affect the relationship with patients and ultimately deteriorate their adjustment to illness,
there is a possibility that they will improve their interpersonal relationship with patient.

SCOPE OF THE STUDY

The study was conducted at Ho Teaching Hospital. People of Ho and its environs receive
treatment from this hospital. The study intended to cover effects of nurse-patient relationship on
the health of patients.
1.7 DEFINITIONS OF CONCEPTS

Effect: Effect in this study refers to the end result of the nurse-patient relationship on the health
of the patient in and out of the hospital setting. Effect can mean negative or positive depending
on the kind of nurse-patient relationship.

Nurse-patient relationship: Nurse-patient relationship refers to how nurses communicate and

interact with patients during provision of healthcare services.

1.8 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.
1.8.1 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 Ho Teaching Hospital as the setting of study allowed the researchers to have a
better understanding of the effects of nurse-patient relationship. The researcher interacted with
nurses, and patients of the hospital to have in-depth knowledge of nurse-patient relationship. The
case study helped the researcher access the records of the hospital.

1.8.2 Sources of Data

Data source refers to any material consulted or used in the due course of the study. Both
primary and secondary data were used in the study.

1.8.3 Primary Data

Refers to any material most likely to shed true light on the information the researcher
seeks. Primary sources come straight from people or workers you are researching and therefore
are the most direct kind of information you can collect (Audrey et al, 1989). Examples of these
data sources include dairies, unpublished works, eyewitness report, official report and speeches.
The researcher used primary data source on the basis that it provided first-hand information in
order to minimize errors. Primary data can be collected through questionnaires, direct
observation, interviews, among others, but was however gathered by the researcher by means of
questionnaires and observation.
1.8.4 Secondary Data

Secondary data is the data that have been already collected by and readily available from
other sources. It is often an examination of a study someone else has made on a subject or an
evaluation of commentary, or summary of primary data materials, journal articles, critical
reviews, and text books on the subject matter. The secondary sources of data for this study
included journal articles, text books and internet publications.

1.8.5 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 Ho Teaching Hospital. The
population constituted nurses of different levels in terms of education, experience, ethnic group
and religious denomination. The staff of the Ho Teaching Hospital is estimated to be 500
including nurses, doctors, laboratory technicians and supervisors

1.8.6 Sample Size

Sample size refers to number of items to be selected from the universe to constitute the
sample. An optimum sample size is the one which fulfills the requirements of efficiency,
representativeness, reliability and flexibility.

A sample of 83 comprising of 15 nurses and 68 patients of the population was selected by

the researcher to conduct the study. The sample size was optimum because they fulfilled the
requirements of efficiency, representativeness, reliability and flexibility.

1.8.7 Sampling Procedure

There are quite a number of sampling techniques but the simple random sampling
technique was adopted by the researcher to select the respondents for the research. A simple
random sample is a subset of individuals (a sample) chosen from a larger set (a population). Each
individual was chosen randomly and entirely by chance, such that each individual had the same
probability of being chosen at any stage during the sampling process, and each subset of
individuals had the same probability of being chosen for the sample as any other subset of
individuals (Yates, Daniel S.; David S. Moore, Daren S. Starnes, 2008).
Cut-papers bearing “yes” or “no” were used by the researcher to get the sample. The cut
papers were folded and mixed thoroughly and slipped them in a container. Patients and nurses
were asked to pick a cut paper after rotating the container. Those who picked “yes” were
automatically included in the sample.

1.8.8 Data Collection Method

In trying to collect data, instruments such as questionnaires, direct observation among

others are used. For the purpose of this study however, the instruments which were used are
observation and questionnaires. The questionnaires were made up of both open and close-ended
questions.

An open-ended question is designed to encourage a full, meaningful answer using the

subject’s own knowledge and/or feelings. They tend to be more objective and less leading.

A close-ended question is a question format that limits respondents with a list of answer choices
from which they must choose to answer the question (Dillman D., Smyth J., &Christian LM,
2009). Primary data will be obtained through responses from questionnaires that will be
administered whereas secondary data will be obtained through internet sources, books and
journals.

The researcher chose questionnaires because of the following reasons below:

It reduces biasing error as a result of the absence of the interviewer. The respondent’s responses
to the questions will therefore not be affected by the characteristics and the techniques of the
researcher. It is quick and cheaper to administer.

Apart from the strengths that have been listed above, questionnaires have their
weaknesses; for example, there is the question of validity and accuracy (Burns & Grove,
1993,p.368). The subjects might not reflect their true opinions but might answer what they think
will please the researcher, and valuable information may be lost as answers are usually brief.

1.8.9 Data Analysis

Data processing and analysis involves the transformation of data gathered from the field
into systematic categories and the transformation of these categories into codes to enable
quantitative analysis and tabulation (Nachimias D & Nachimias C, 1976).

The researcher used Statistical Package for Service Solution (SPSS) to analyze the data
into presentable form. The researcher will use descriptive statistics to make the analyses more
meaningful. This involved preparing data collected into some useful, clear and understandable
information. Data collected will be presented using simple tables and cross tabulations.