COMPARATIVE ANALYSIS OF PATIENTS’ AND NURSES’ PERCEPTIONS OF NURSE CARING BEHAVIOURS IN TWO TERTIARY HOSPITALS IN JOS

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TABLE OF CONTENTS

Title Page        .           .           .           .           .           .           .           .           .           i

Approval         .           .           .           .           .           .           .           .           .           ii

Certification    .           .           .           .           .           .           .           .           .          iii

Dedication      .           .           .           .           .           .           .           .           .           iv

Acknowledgement      .           .           .           .           .           .           .           .          v

Table of Contents       .           .           .           .           .           .           .          .            vi

List of Figures .          .           .           .           .           .         .            viii

List of Tables  .           .           .           .           .           .           .           .           .           ix

Abstract          .           .           .           .           .           .           .           .           .          xi

CHAPTER ONE: INTRODUCTION

Background of the Study       .           .           .           .           .           .           .           1

Statement of Problem .           .           .           .           .           .           .           .           3

Purpose of the Study  .           .           .           .           .           .           .           .           5

Research Questions                 .           .           .           .           .           .           .           6

Research Hypothesis   .           .           .           .           .           –           .           .           6

Significance of the Study       .           .           .           .           .           .           .           6

Scope of the Study     .           .           .           .           .           .           .           .           7

Operational Definitions          .           .           .           .           .           .           .           8

CHAPTER TWO: LITERATURE REVIEW     

Conceptual Review     .            .           .           .           .           .           10

Review of Theories Underlying the Study           .           .           .           31

Empirical Review          .           .           .           .           .           .           44

Summary of Reviewed Literature      .    .           .           .           .           61

CHAPTER THREE: RESEARCH METHOD    

Research Design         .           .           .           .           .           .           .           62

Area of Study .           .           .           .           .           .           .           .           62

Population of the Study          .           .           .           .           .           .           65

Sample                        .           .           .           .           .           .           .           .           65

Sampling Procedure    .           .           .           .           .           .           .           67

Instrument for Data Collection           .           .           .           .           .           72

Validity of Instrument                .           .           .           .           .           75

Reliability of Instrument         .           .           .           .           .           .           76

Ethical Consideration .           .           .           .           .           .           .           77

Procedure for Data Collection            .           .           .           .           .           78

Method of Data Analysis       .           .           .           .           .           .           81       

CHAPTER FOUR: PRESENTATION OF RESULTS

CHAPTER FIVE:senter o     Each Questionnaire surgical wardsusesople with halDISCUSSION OF FINDINGS

Implications of Findings         .           .           .           .           .           .           129

Peculiarity and Limitations of the Study              .           .           129

Summary         .           .           .           .           .           .           .           .           129

Conclusion      .           .           .           .           .           .           .           .           131

Suggestion for Further Research        .           .           .           .           .           132

Recommendation        .           .           .           .           .           .           .           132

References      .           .           .           .           .           .           .           .           134

Appendices     .           .           .           .           .           .           .           .           140

LIST OF FIGURES

Figure                                                   Title                            Page

1:         The interrelationship of five perspectives of caring   .           14

2:         Conceptual model for the study based on Watson’s 10

carative factors and the five perspectives of care       .           .           .           60

LIST OF TABLES

Table                                                  Title                                Page

1:         Demographic characteristics of respondents .       .           83

2:         Adjusted mean scores and standard deviations of patients’

perceptions of nurse caring behaviours           .           .           .           .           85

3:         Patients’ mean scores, standard deviations and one sample item t-test

values for the 37 items of the CBAQ            .           .         153

4:         The 10 highest scored nurse caring behaviour statements by patients

with their ranking        .           .           .           .           .           .           .           87

5:         The 10 lowest scored nurse caring behaviour statements by patients

with their ranking        .           .           .           .           .           .           .           88

6:         Adjusted mean scores and standard deviations for nurses’ perceptions of nurse caring behaviour           .           .           90

7:         Nurses Mean Scores, Standard Deviations and t-values for the 37

Items of the CBAQ    .           .           .           .           .           .           .        156

8:         The 10 highest scored nurse caring behaviour statements by nurses

with their ranking        .           .           .           .           .           .           .           92

9:         The 10 lowest scored nurse caring behaviour statements by nurses

with their ranking        .           .           .           .           .           .           .           93

10:       Mean values and standard Deviation of patients and Nurses on

CBAQ subscales in rank order and their comparison .           .           .           95

11:       Patients’ ranking of the I0 most important Nurse caring behaviour

and their comparison to Nurses (n=167)         .           .           .           .           97

12:       Nurses Rankings of the 10 most important caring behaviours

and their comparisons to patients (n = 165)    .           .           .           .           98

13:       Patients rankings of the 10 least important caring behaviors and their comparison to nurses (n-167)  .     .           .           .           99

14:       Nurses rankings of the 10 least important caring behaviour and their
comparison to patients (n = 165)                .           .         100

15:       Mean scores and standard deviation of patients and nurses on the

CBAQ caring behaviour items              .           .                  102

16:       Summary of one-way analysis of variance on patients and nurses

perceptions of CBAQ caring behavior as indicators of care              .     102

ABSTRACT

The purpose of this study was to comparatively assess patients’ and nurses’ perceptions of nurse caring behaviours in Jos University Teaching hospital (JUTH) and Plateau State Specialist Hospital (PSSH) Jos. A cross-sectional descriptive survey design was employed to study 332 patients and nurses.  No sampling was done as all the subjects who met the inclusion criteria were included in the study. Data were collected using a modified Caring Behavior Assessment questionnaire (CBA-Q) (37 items), a 5-point likert-type scale and arranged in 7-subscales. Data were analyzed using descriptive and inferential statistics. The result indicated that all the caring behaviours statements except item 17  (“Visiting patient if patient moves to another hospital units” with item mean of 2.63; SD = 1.33 and t-value of 1.24 which is below the mean criterion value of 2.50) were accepted as indicators of care by patients. The findings that “using soft gentle voice with patients”, “being kind and considerate to patients”, “answering patients’ questions clearly”, and “giving patients’ treatments and medications on time” were the four highest (most important) scored items by patients. The findings that “visiting patient if patient moves to another hospital unit” “preparing patient for death when it is inevitable”, “Praying with and or for patient” and “checks his or her perception of the patient with the patient before initiating any action” were the four lowest (least important) scored items by patients. The result is indicative that all the caring behaviour statements except item 17 (“visiting patient if patient moves to another hospital unit”, with item mean of 2.62, SD = 0.90, and t-observed value of 1.69 which is below the mean criterion of 2.50) were accepted as indicators of care by nurses.  The findings that “giving patients treatments and medications on time”, “treating patients information confidentially”, “using soft gentle voice with patient” and “showing patient love”, were the four highest (most important) scored items by nurses. The findings that “visiting patient if patient moves to another hospital unit, “is calm” and  “preparing patient for death when it is  inevitable” were the three lowest (least important) scored items by nurses.  Comparison of mean scores and standard deviation of patients and nurses on CBAQ subscale showed that patients and nurses perceived humanism/faith hope sensitivity”, “helping/trusting” and “human needs assistant as the most important and  “existential phenomenological/spiritual forces” as the least important subscale. The mean scores showed that nurses gave higher mean values than did patients to all the seven subscales. A comparison of the top 10 CBAQ items between patients’ and nurses’ perception revealed similarities as well as differences. Patients and nurses agreed on 6 out of the 10 most important items and do not agree on the remaining 4 top 10 caring behaviour statements. The result also indicated that nurses more than patients value the subscale “humanism faith hope sensitivity” while patients valued the subscale; “human needs assistant” more than nurses. In total, nurses scored higher in 31(83.7%) items than patients who scored higher than nurses in only 5 (13.5%) items. A comparison of the 10 least important CBAQ items showed  that patients and nurses agree on 5 out of 10 of the 10 least important items. Items 17 and 23 on the CBAQ (visiting patients when patient moves to another hospital unit”, and “check his or her perception of the patient with the patient before initiating any action” were ranked same by both patients and nurses. There is a significant difference in the perceptions of CBAQ statements as indicators of care between patients and nurses (F=7.456, P < 0.05) P = 007. It was recommended that the result of the study be communicated to nursing staff of the two hospitals. In order to help nurses meet caring expectations of clients and enhance patients’ positive health outcomes. The result from this study therefore provide improvement implications for the care of patients, like concrete information on what behaviours the patient would like to experience.

CHAPTER ONE

 INTRODUCTION

Background of the Study

Caring is when a loving and kind gesture is demonstrated by a person as he or she functions to promote wellness, well being, maintain health, alleviate sufferings, rehabilitate the disabled individuals, family, group, community, or population. “Nurse caring” is the process by which the nurse becomes responsive to another person as a unique individual, perceives the other’s feelings, and sets that person apart from the ordinary” (Watson 1998 in Batsdusdottir and Jonsdettir, 2002). Nurse caring behaviour on the other hand, refers to “those things that a nurse says or does that communicate caring to the patients (Batsdusdottir and Jorsdottir, 2002). Caring is the service the nurse renders while caring behaviours are those attitude, competencies and skills the nurse exhibits while rendering the services (Ehiemere, 2011).

Caring which has been identified as the essence of nursing, the dominant, distinctive and underlying feature of nursing practice (Leininger, 1979in Erb and Kozier, 2008), has traditionally been at the core of nursing (Larrabee, Putman and Wu, 2006). Nursing as a profession places the greatest demands specific to the development and refinement of the caring component of nursing (Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010). Thus, the study of human caring as an essential characteristic of nursing practice has gradually expanded from early definitional, philosophical and cultural writings on the meaning of caring to evidence-based care (Boykin and Schoenhofer, 2000). To be meaningful, Azimzadeh, Rahmani, Valinzaadeh and Zamanzadeh (2010), maintained that nurse caring must be based upon mutual agreement between nurses and patients as to what constitutes nurse caring behaviours. Nurses cannot be certain that their behaviour is consistent with patients’ perception and expectations of their care.  Nurses cannot therefore assume that patients perceive their caring efforts as they are intended. To avoid this problem, it is imperative that nurses validate with the patients that their care needs are being met (Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010).

There is currently considerable emphasis on the provision of patient-centred care in all aspects of health care (Greenhalgh, 1998 in Azimzadeh, Rahmani, Valizadeh and Zamazadeh, 2010). What is most important here is to make clear or ascertain factors that influence patients’ satisfaction to enable nurses improve quality of nursing care.  Kimble (2003) observed that the degree of congruence between patients’ expectations of nurse caring behaviour and their perception of the care they really get forms their satisfaction with nursing care. Hence, Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, (2010) concluded that there could be a relationship between nurses’ caring behaviours and patients’ satisfaction.

Previous studies on caring (David, Ozawa, Puangrat and Takeo, 2002; Watson, 2002) focused on nurses’ perceptions of what constitutes caring for the patient, patients’ perception of what is important in making them feel cared for, and comparisms of patients’ and nurses’ perceptions of what constitutes important nurse caring behaviours (Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010). Many of these studies have generally demonstrated significant discrepancies (differences) in patients’ and nurses’ perceptions of nurse caring behaviours, (Chang, 2005). This discrepancies may result in patients’ needs being unmet and patients’ dissatisfaction with the care received.

Kimble (2003) opined that the perception of an uncaring nurses’ behaviours can lead to increased anxiety and diminished coping abilities for patients and litigation for nurses and health institutions. Although human caring has been perceived as a universal phenomenon, the expressions, processes and patterns vary among cultures (Leininger, 1998 in Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010). This means that culture and values affect our understanding of the concept of caring (Evans, Mizuno, Okada, Ozawa and Taked, 2005). Since nurse caring behaivour is central and crucial in hospital for achieving, effective, efficient, minimal risk to patients, satisfaction of patients, and overall physical, psychological and sociological patients’ positive health outcomes, there is therefore a need to ascertain nurses’ and patients’ perceptions of nurse caring behaviours in different settings. This is a practical approach to the caring concept and the basis for this study in a Nigerian setting where there is a dearth of literature on comparative analysis of patients’ and nurses’ perceptions to nurse caring behaviour.

Statement of Problem

COMPARATIVE ANALYSIS OF PATIENTS’ AND NURSES’ PERCEPTIONS OF NURSE CARING BEHAVIOURS IN TWO TERTIARY HOSPITALS IN JOS