Communication aspects between the nurse and the immobile patient
Communication between nurse and patient is an important part of the therapy process. Identifying the skills that health care providers need to acquire during vocational training. Performing the main interventions identified in the nursing process.
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| Язык | английский |
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St. Elizabeth University of Health and Social Sciences
Communication aspects between the nurse and the immobile patient
Popovicova M.
Bratislava, Slovakia
Introduction
Communication is related to the life of each person, significantly influences him, enriches him with new knowledge and attitudes, regulates our actions and behavior, helps us to integrate into society and make social contacts [1]. High-quality nursing care is unimaginable without communicating between a healthcare professional and a patient, but also among healthcare professionals. The profession requires specific skills that healthcare professionals must acquire during professional training [2]. Communicating with a person who is in a difficult life situation, has pain, suffers, is nervous or annoyed, it is not easy. It is also difficult to converse, get and give not only information but also encouragement and hope [3]. Many people assume that when they learn talking automatically, they communicate effectively. However, it is true that good communication is an endless continuous process that needs to be continually improved and developed [4]. Communication itself is influenced by the age, the culture of the individual, the socioeconomic status, the amount of used words the intonation, the volume, the height and the color of the voice, the tempo and the rhythm of a sentence [5]. A nurse who expresses real interest in the conversation, actively listens, evaluates the patient sufficiently and controls the role of the communicator, greatly enhances the quality of relationships with the patient [6]. Wrong communication and approach without an empathetic basis lead patients to reject cooperation, feelings of anxiety, fear, distrust, and also aggression. Thus there are various complications in providing of nursing care and the fulfillment of interventions identified in the nursing process. Nurse-patient communication is an important part of the therapeutic process. In order for communication to become effective, it must also carry a certain amount of ethics [7]. Without observing the ethical aspects of nurse-patient communication, these attributes of efficiency would not be fulfilled, and would include only signs of some coolness, superficiality, and indifference.
Methodology of research
Communication is important for the work of a nurse. It is as important as her level of professional knowledge and practical skills. When the patient is admitted to the department, the nurse becomes the patient closest person to help him / her. A person who is often in full health suddenly finds himself in a state of illness that brings with him feelings of fear, uncertainty, pain, and fears of the unknown needs a close person to find support and help. For the patient, at the time, the nurse's human approach is important as well as her medical knowledge. It is at that time that their mutual communication relationship comes to the forefront. The healing process requires good communication based on ethical principles. The research objective was to analyze the current state of communication of nurses in health care from the point of view of patients and also to establish the level of ethical aspects of communicating with nurses in interaction with the patient.
Methods of data analysis
The sample in our research consists of patients with a deliberate choice. This was a group of patients hospitalized in internal, surgical, neurological, and long-term care wards. We used the tools of descriptive statistics in the descriptive part of the research. We processed the obtained answers by using the Microsoft Office 2013 and statistical software Statistica 13. The processed data are presented in the work by frequency tables with absolute and relative frequency. Hypotheses have been verified by inductive statistics tools. Most of the variables have been chosen as numerical variables with values on a 5- degree scale. To verify the hypotheses we used a single-factor scatter analysis (ANOVA test) - it is nonparametric version, the Kruskall-Wallis test. We make a decision on the significance of the differences based on the calculated p-value and the importance level of 0.05.
Table 1. Place of hospitalization
|
Place of hospitalization |
Number % |
|
|
Internal ward of the Hospital |
25 22 |
|
|
Neurological ward of the Hospital |
24 21 |
|
|
Surgery ward of the Hospital |
23 20 |
|
|
Long-care ward of the Hospital |
21 19 |
|
|
Nursing Home |
20 18 |
|
|
Together |
113 100 |
As shown in Table 1, from each ward or facility returned approximately the same number of completed questionnaires. In absolute terms, it is between 20 and 25 respondents, in a relative 18% to 22% of the selection.
Research results
Based on the theoretical knowledge, the main and also the partial objectives, we deduced the following hypotheses:
Hypothesis: adheringthe ethical aspects of communicating nurses with patients is significantly related to the location of the ward / facility where the nurse is working.
Table 2. Courtesy of nurses by ward
|
Courtesy of nurses |
Average |
Median |
|
|
Long-care ward |
4,14 |
4 |
|
|
Internal ward |
4,08 |
4 |
|
|
Neurological ward |
4,00 |
4 |
|
|
Surgery ward |
3,96 |
4 |
|
|
Nursing Home |
3,90 |
4 |
|
|
Together |
4,02 |
4 |
|
|
Testing statistics |
1,105 |
||
|
p-Value |
0,8935 |
Table 2 shows the rating of nursery courtesies in individual wards. The best rating (4.41) of this approach was assigned to nurses by patients from the long-term care ward. A little lower courtesy ratings (4.08) was assigned to nurses from the internal ward. Further departments received even lower ratings - 4.00 neurological ward, 3.96 surgery ward and 3.90 nursing home. However, these calculated averages are not very different. Even medians are the same for all groups - value 4. Even the p-value of 0.8935 indicates the median match. Zero hypothesis cannot be rejected and we have to accept it. We state that the subhypothesis H1.1 has not been confirmed. Observance of courtesy in communication by the nurses is unrelated to the type of device or department.
Table 3. Greetings of nurses by ward
|
Greetings of nurses |
Average |
Median |
|
|
Neurological ward |
4,46 |
5 |
|
|
Nursing Home |
4,10 |
5 |
|
|
Surgery ward |
4,09 |
5 |
|
|
Internal ward |
4,08 |
4 |
|
|
Long-care ward |
3,95 |
4 |
|
|
Together |
4,14 |
5 |
|
|
Testing statistics |
2,336 |
||
|
p-Value |
0,674 |
Within the wards, we compared the behavior of the nurses at the entrance of the room whether they would greet the patient at the entrance (Table 3). The best rating (4.46) of this aspect was found at the neurological ward. A lower and almost identical average assessment is found in the nursing home (4,10), the surgical department (4,09) and the internal department (4,08). The lowest rating of 3.95 was reached in the department for long-term care. But again it is not much lower rating than the previous ones. The medians reach values of 4 and 5 in each group. However, these differences are evaluated as statistically insignificant, since the p-value of the test is 0.674, which is well above the importance level. Even here Zero hypothesis cannot be rejected and we have to accept it. Similarly, we state that the subhypothesis H1.2 has not been confirmed.
Table 4. Introducing by wards
|
Introducing themselves |
Average |
Median |
|
|
Neurological ward |
3,13 |
3 |
|
|
Nursing Home |
3,00 |
3 |
|
|
Surgery ward |
2,83 |
3 |
|
|
Internal ward |
2,68 |
3 |
|
|
Together |
2,88 |
3 |
|
|
Long-care ward |
2,81 |
2 |
|
|
Testing statistics |
2,946 |
||
|
p-Value |
0,5669 |
Introducing the nurses in the first contact with the patient should be an act of obvious behavior. Nevertheless, we have found that this is not so in many cases. Table 4 shows compliance with this aspect by a ward. As can be seen from the table, the assessment of this behavior is not much different between the wards. Average values vary slightly between wards and range from 2.81 to 3.13. Medians have value of 3 in all groups except for one. Such small differences are not sufficient to reject median compliance. Also, based on the p- value of 0.5669, we come to the conclusion that a zero hypothesis cannot be rejected and must be accepted. We state that the subhypothesis H1.3 has not been confirmed.
Table 5. Starting conversation by wards
|
Starting conversation |
Average |
Median |
|
|
Surgery ward |
3,7 |
4 |
|
|
Internal ward |
3,64 |
4 |
|
|
Neurological ward |
3,71 |
4 |
|
|
Long-care ward |
3,33 |
3 |
|
|
Nursing Home |
3,25 |
3 |
|
|
Together |
3,54 |
3 |
|
|
Testing statistics |
5,310 |
||
|
p-Value |
0,2569 |
Neither the starting conversation with the patient by the nurse is not significantly different between the different wards. An average rating of this aspect is from 3.25 to 3.70. Rating medians acquire value 3 or 4. Differences, however, are not significant, as p-value of 0.2569 is above the importance level. Therefore, in the context of the starting conversation i, there is no significant difference between nurses from different wards. therapy health training nursing
In the personal communication of the nurses, we have identified differences between wards in the personal communication of the nurses only in one aspect (Table 6). The best assessment of this behavior was achieved by nurses in the Neurological ward with a median of 3.58 and median 4. Other wards reached median 3 and averages ranged from 2.71 to 3.30. The P-value of the 0.043 test is less than the importance level. Therefore, we reject the Zero hypothesis and state that the subhypothesis H1.5 has been confirmed.
Table 6. Personal communication by wards
|
Personal communication |
Average |
Median |
|
|
Neurological ward |
3,58 |
4 |
|
|
Nursing Home |
3,33 |
3 |
|
|
Internal ward |
3,12 |
3 |
|
|
Surgery ward |
2,96 |
3 |
|
|
Long-care ward |
2,71 |
3 |
|
|
Together |
3,14 |
3 |
|
|
Testing statistics |
9,836 |
||
|
p-Value |
0,043 |
Table 7. Physical contact from the nurses by wards Average Median
|
Neurological ward |
2,67 |
3 |
|
|
Nursing Home |
2,55 |
3 |
|
|
Long-care ward |
2,52 |
3 |
|
|
Surgery ward |
2,39 |
2 |
|
|
Internal ward |
2,28 |
2 |
|
|
Together |
2,48 |
2 |
|
|
Testing statistics |
1,761 |
||
|
p-Value |
0,7796 |
The last aspect of the behavior of the nurses that we have compared according to wards is the physical contact of the nurses. As can be seen from Table 7, the diameters on the individual wards are relatively close - from 2.28 to 2.67. The median values are 2 and 3. Again, as with other aspects, the p-value is high, so zero hypothesis cannot be rejected. This hypothesis H1.6 has not been confirmed.
Conclusion Hypothesis Adherence to ethical aspects in communicating nurses to patients is unrelated to the place where the nurse is working. The exception is one subhypothesis. It confirmed the statistically significant correlation between the personal communication of the nurses and the place of their workplace. In other aspects, we have not found a significant link.
Discussion
For a nurse who is confronted with a person as a beneficiary of her work, is very important area of social skills. In nursing practice, high emphasis is put on the ability of the nurse to interact with patients and co-workers. The ability to communicate should be the basic professional tool for each nurse and should serve to establish and develop cooperation with a patient [3,4]. Communication makes it possible to establish contact with the patient, to perceive him better, to observe him, but above all to understand him [8]. It is necessary that nurse is able to initiate, effectively support and maintain proper communication. The successful treatment often depends on effective communication and, of course, the satisfaction of both sides. The target of the research was to analyze the current state of communication of nurses in health care from the point of view of patients and to find out whether nurses adhere to the ethical aspects of communicating with them. Survey was conducted through a questionnaire survey and involved 113 patients hospitalized in internal, neurological, surgical, long-term wards and a nursing home. Ethical aspects of nurse-patient communication was assessed through aspects. We included the importance of greetings at the entrance to the room, the opportunity to express our own will, sharing of joy and worries, the willingness to listen, having enough/lack of time for communication, the space for expressing the difficulties, the explanation of the procedures for the examinations and the clarity of the statement. Regarding the observance of the ethical aspects in order to find out whether it is related to the place of hospitalization of the patient, we found the difference only in one aspect, in the context of starting personal communication that would not only have a medical basis but rather a focus on the feelings and interests of the patient. In this area, the best assessment was made by the nurses in the neurological unit. There are several studies about ethical aspects of communicating nurses with patients. The research carried out by Kopacikova and co. (2010 [9]) has taken place in the ward of long-term ill patients and was attended by 36 nurses and 60 patients. Its aim was to map the effectiveness of nurse communication with the patient. In their results, they report that up to 53.33% of patients answered that the nurse communicated with them only during carrying out nursing activities. In the neighboring Poland, Bozena Tarczynska [10] conducted communication research in her graduation thesis (2008). As a sample, 50 patients were chosen and hospitalized at the cardiac, surgical, traumatological and neurological units in town of Jelenia Gora. In the questionnaire, the author was interested in the clarity of the nurse's statements. 80% were satisfied and stated the manner of expression as simple, clear and understandable. Only 20% of the patients expressed dissatisfaction and marked the nurses' speech as difficult, very professional and hard to understand.
Conclusions
Usually, when sick people are admitted to a hospital, they expect from medical staff kind behavior. They are handicapped by their illness and altered health status [11]. That is why it is in the hands of the staff to overcome the barriers towards the sick person. It should be about an enriching exchange of views, communication. It is important to use empathy, trueness - that is, openness, specificity, concreteness. It is also necessary to prove to the patient his interest in him as a human being. Show heart, kindness and never unconcern. Respect him as a unique, unrepeatable being. Only then is it possible to develop a relationship based on the trust of the sick to us [12,13].
- Therefore, it is necessary in the first contact with the patient not to forget to introduce remember.
- Remember to knock before entering the room and greet the patient.
- Organize your work so that you can find enough space and time for polite communication.
- Not forget about nonverbal expressions such as touch, caress and smile.
- Incorporate as much of the assessment as possible in communications and avoid the use of devaluation.
- Lead with patients more personal talks that would - Using empathy to understand the patient's current
be more focused on personal interests and so on. feelings and not to disregard them.
References
1. Barkasi, D. 2016. Rozvijanie a vyuzivanie komunikacnych zrucnosti socialneho pracovnika. In Komunikacia v prostredi socialnej prace. Zbornik prispevkov z medzinarodnej vedeckej konferencie. Kosice : Vysoka skola zdravotnictva a socialnej prace sv. Alzbety Bratislava, Detasovane pracovisko bl. Z. G. Mallu, 2016.
2. Zacharova, E. - Simickova-Cizkova, J. 2011. Zaklady psychologie pro zdravotnicke odbory. 1. vyd. Praha : Grada Publishing a.s., 2011. pp. 288.
3. Venglarova, M. - Mahrova, G. 2006. Komunikace pro zdravotni sestry. Praha : Grada Publishing a.s., 2006. pp. 144.
4. Gabura, J. 2010. Komunikacia pre pomahajuce profesie. 1. vyd. Bratislava : Univerzita Komenskeho, 2010. 196 s.
5. Zacharova, E. 2010. Specifika komunikace sestry a pacienta v klinicke praxi. In Sestra. 2010, roc. XX., c. 7-8, pp. 28.
6. Vozarova, J. 2011. Komunikacia sestry s geriatrickym pacientom. In Sestra. 2011, roc. X., c. 7-8, pp. 40.
7. Vansac, P. 2016. Antropologicky pohl'ad na socialnu komunikaciu In Komunikacia v prostredi socialnej prace, Zbornik prispevkov z medzinarodnej vedeckej konferencie, Vysoka skola zdravotnictva a socialnej prace sv. Alzbety, n.o. v Bratislave, Detasovane pracovisko bl. Z G. Mallu Kosice, Kosice 2016, s. 192 - 200
8. Gulasova, I., Babecka J., 2019. Communication with the patient by another culture of seniors. In: Zbornik z XLI. Scientific conference of pedagogical staff with international participation "Education in nursing focused on health promotion and protection - multidisciplinary cooperation with social workers and workers working in public health III., Varia. Partizanske - Bojnice, December 10, 2019.
9. Kopacikova, M. - Stanciak, J. - Novotny, J. 2010. Efektivnosf komunikacie pri osetrovani seniora. In Nove trendy vo vzdelavani a praxi osetrovatel'stva a porodnej asistencie. Zbornik z konferencie konanej dna: 25-26 marca 2010. Ruzomberok : Verbum vydavatelstvo Katolickej univerzity, 2010. pp. 96.
10. Tarczynska, B. 2008. Komunikacja interpersonalna w relacji piel^gniarka-pacjent : praca dyplomowa. In Wielowymiarowosc roli i zadan piel^gniarki w roznych dziedzinach zycia spolecznego. Legnica : Wyzsza Szkola Medyczna, 2008, c. 6. [citovane 2016-02-06]. s. 30,33.
11. Belovicova, M. 2019. Vybrane kapitoly z geriatrie. Ucebnica pre studentov zdravotnickych odborov.VSZaSP sv. Alzbety, Tlaciaren Svidnicka, 2019. 78s.
12. Krivohlavy, J. - Pecenkova, J. 2004. Dusevni hygiena zdravotni sestry. Praha : Grada Publishing a.s., 2004. pp. 80.
13. Kicinkova, A. 2016. Eticke aspekty komunikacie sestry s pacientom : diplomova praca. Bratislava : VSZaSP sv. Alzbety, 2016. pp 92.
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