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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 one‟s 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 there‟s a chance of

recovery or nothing to expect at all. Moreover, the role of the nurse is to lessen 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 client‟s 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 student‟s 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 student‟s 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.

Nurse‟s 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 patient‟s 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 Nightingale‟s 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 information-

presenting 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 other‟s 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

patient‟s 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 patient‟s 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 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 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 Nightingale‟s 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 information-

presenting 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 other‟s

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 self-

awareness, 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 one‟s 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 patient‟s “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 nurse-

patient 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 they don‟t see behind

the scenes.



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Statement of the Problem

The study will determine the patient‟s 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. What is the demographic profile of the respondent in terms of:

1.1 Patient/Client

1.1.1 Gender

1.1.2 Age

1.1.3 Civil Status

2. What is the patient‟s 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 patient‟s perception on the

effectiveness and Interpersonal relations among BSN Level IV?



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Significance of the Study

This study discusses the patient‟s 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 patient‟s 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 one‟s 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 nurse-

patient 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 city‟s 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 respondent‟s 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-a-

framework-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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PATIENT‟S PERCEPTION ON THE EFFECTIVENESS OF INTERPERSONALRELATIONS 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 confinedin 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 “Patient‟s 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

Documents

REVISED THESIS.docx