EFFECT OF COMMUNICATION ON NURSE - PATIENT RELATIONSHIP IN NATIONAL

ORTHOPAEDIC HOSPITAL, IGBOBI, LAGOS

ARUNGWA Oluwatosin Taiwo, RN, RM, RON, PGD (SW), BNSc.
Department of Nursing Services, National Orthopaedic Hospital Igbobi, Lagos.

tosinarungwa@yahoo.com, Phone: +2348067613828

ABSTRACT INTRODUCTION

Introduction: Communication is fundamental in According to W ebster's New Collegiate

nursing practice. The development of an effective D ictionary1, "C om m unication stem s fro m the
nurse - patient relationship is essential for the
Latin w ord ' communicare', meaning to im part,
delivery of quality nursing care.
Purpose: This study was designed to find out the participate, convey and share inform ation

effect of communication on nurse - patient about'. I t is the act o f reciprocal process o f

relationship in National Orthopaedic Hospital Igbobi,
Lagos. The objective was to determine the effect of
nurses' interaction / communication on patients'
recovery and to ascertain the attitude of nurses
towards patients.
Methods: Eighty nurses and eighty patients were
used and subjects were selected using stratified
random techniques. Data collected were organised,
analysed, and interpreted using tables and figures.
im parting or interchanging thoughts, attitudes,
em otions, opinions or inform ation by speech,
w ritin g or signs. C om m unication, being an
integral part o f behavioural transactions is
fundam ental to all nursing and interpersonal
relationships. Research indicates th a t health
care providers w ho believe in the im portance

Findings: The study revealed that majority of the o f the psychosocial aspects o f p atie n t care are
nurses do not have detailed knowledge about nurse m ore effective in com m unicating w ith parents
- patient communication due to constraints/ barriers
and attending to th e ir psychosocial needs.2
(inadequate nursing staff, poor remuneration of
nurses, increased workload, poor infrastructure and Despite e ffo rts to im m ediately access

equipment) but nurses participate most in nursing inform ation, com m unicate instantaneously,
care at the planning and implementation phase. and strive fo r more efficiency throu g h
Implication for practice: The present practice of
fundam ental and technological advances,
nursing requires adequate continuous education on
current related nursing courses especially therapeutic there are grow ing concerns th a t inform ation is

nurse-patient communication, graduate, and post being shared b ut less is com m unicated.
graduate degrees. Government/ Agencies should
ensure adequate provision and remuneration of
S ta te m e n t o f Problem
nursing staffs, supply, and maintenance of standard
A good nurse - patient relationship requires
equipment and infrastructure and subsidizing medical
bill with prompt medical services. effective com m unication between the patient
and the nurse. Nurses exhibit lapses in the
KEYWORDS: Communication, Nurse, Patient, course o f com m unicating w ith th e ir patients,
Relationship, Effect
such as:

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

1. Exhibiting poor nurse-patient relationship, awareness among many professional

dissatisfaction of patients towards nurses' colleagues on the value of effective

care. communication on nurse - patient relationship

and help to understand impact of
2. Poor application of communication skill by
communication as an integral part of nursing
nurses and patients.
process. This study will also assist nurses to
3. Few application of the knowledge of
develop good communication skills which will
nurse-patient relationship to clinical
help produce quality care and effective
practice by nurses.
nursing management.

Thus, the need to find out the effect communication
has on nurse-patient relationship.
Objectives of the Study
1) To evaluate the knowledge of nurses on
R E VIEW OF LITERATURE
According to Peplau3, Communication is an
interpersonal process involving the selection
of symbols or concepts that go someway
towards developing a common understanding.

nurse-patient communication. Communication has been defined as the

transmission of information, thoughts and
2) To determine the effect of nurses' interaction
feelings so that they are satisfactorily received
/ communication on patients' recovery.
or understood.4 According to Newman and
3) To ascertain the attitude of nurses towards
Summer5, Communication is an exchange of
patients using self-administered structured
facts, ideas, opinions or emotions by two or
questionnaire.
more persons.

Significance of Study
Elem ent o f C om m unication
The practice of nursing is a critical factor influencing The S e n d e r/E n c o d e r/S p e a k e r is the
the quality of patients' care in health facilities and person who initiates the communication
communities. In nurse - patient relationship, process by clearly stating the message with a

communication involves more than transmission of certain intention in m ind.6, 7- 8' 9 The

information, it is also transmission of feeling, is the person

who receives the message by understanding
recognizing these feelings and letting patients know
or translating it into meaning.1, 4'6,7,9 The
that their feelings have been recognised.
m essage is an encoded transmission of ideas.
The m edium is decided prior to the
Investigating the effect of communication on
composition of the message.6, 8' and 9
nurse - patient relationship is relevant
Feedback being the most im portant element
because the findings will help to create
of communication is effective only if the

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

the receiver gives feedback to the sender after the
message has been communicated. 6,8,and9
Medium of communication could be verbal, written, or
n on-verbal. It
Interpersonal, intrapersonal or group), written (e.g.
Letters, faxes, email, reports, memo etc) and non­
verbal (e.g. smile, touch, wave, etc) with each
following its set of rules and regulation . 6,8,9,10
could be ve rb a l/o ra l (e.g.

The C
v yom
i i Hm unkA
H i , 0 i PfiM
v v wt rr rf n
w rvav nv

The Communication Process

nw

SOURCE RECEIVER

S tag es o f Communication
These are: Sender, Message, Encoding, Channel, Receiver, Decoding, and Feedback9,11.

Nurse - Patient Communication relationship. Hence, the nurse identifies

According to V irginia Henderson, A nurse is a patient's problem and experiences.

person trained to assist th e individual, sick or
III. Exploitation: The patient gains a sense of
w ell in th e perform ance o f those activities
co ntribu tin g to health or its recovery (o r to a independence and navigates the health care

peaceful death) th a t he w ould perform system as an active participant in his/her

unaided if he had th e necessary stre ng th , w ill,
care, Hence exploiting the nurse-patient
o r know ledge8,9.
relationship to identify treatment goals,
A p atie n t is a health care recipient w ho is ill or
hospitalised12. galvanize health care resources and attain an
Peplau's th e o ry delineated fo u r phases o f
optimal level of functioning.
nurse - p atie n t re la tion sh ip 13. These include:
IV. Resolution: With effective communication,
I. Orientation: Patient exhibits willingness to
the patient moves towards full independence
seek treatment and trust the nurse by
and resolution of health care problems or
communicating his/her needs as the nurse
needs.
conveys empathy, care and attempts to

understand patient's experience.

The practice o f nursing is a critical fa cto r
II. Identification: This provides the basis for
influencing th e q u a lity o f p atie n ts' care in
acceptance, understanding, and a helping health facilities and com m unities. According to

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

International Council o f Nurses (ICN), the expression can render communication

goal o f nursing care is to assist individual in ineffective . 11 According to Kaul Asha, Cultural
achieving optimal health, well being and differences in communication transcend
quality of life as determined by those spoken language . 18 Other barriers include
receiving care or consistent with the values language differences, cultural differences,
and known wishes of the individual.4,8' and 14 gender, health status, and developmental

In nurse - patient relationship, communication level, use of health care jargons, distance,

involves more than transmission of information, it is tim e, and space o f interaction .9

also transmission of feeling, recognizing these

Oermann et al, suggest good communication
feelings and letting patients know that their feelings
is essential fo r quality nursing care hence, it is
have been recognized.9,11
imperative th a t nursing research elicits patient
experiences o f nurse-patient communication
Real communication means talking, listening, and identifies w hat they value most in their
thinking, interacting, planning, and responding interaction w ith nurses.19, 20 Chant et al,

simultaneously. The nurse-patient interaction suggest that nurses do not communicate well

requires all the nurse's senses, attention, interest, because of the organisational culture . 21

and competencies to analyze behavioural and

Nurses have the necessary skills to
emotional responses into the context of a given
communicate well with patients but choose
interaction. Modes of communication are influenced
not to because of lack o f organizational
by nurse's adeptness at establishing rapport, trust, support and encouragement such as
empathy and active listening as a means of increased workload, poor remuneration, stress,

facilitating healthy nurse- patient relationship. 11,15 muddled message, wrong channel, faulty

Nurses do not communicate well with patient and
approach patients only to deal with administrative
or functional activities. 16,17
transmission etc.22,23, and 24 Hence, criticism of
nurses' communication may be unrealistic as
no benchmark for effective nurse - patient
communication currently exists . 2 3 ,25

A non-Patient-Centred Communication can

Therapeutic Communication
adversely affect the development o f a positive
Good nurse-patient relationship involves
nurse - patient relationship that is essential
recognizing and responding to the patient as
for the provision o f quality patient care . 11
a whole person, an approach frequently
Linguistic barrier such as discrepancies in
termed 'patient-centered' care, thereby
sophistication of vocabulary and individual
revealing positive impact on satisfaction,
differences in the use o f certain words and
clinical outcomes, greater efficiency in

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

practice, better patient retention and their ongoing assessment of communication

reduction in complaints of malpractices.4,5,9,13, to themselves, their patients and fellow health
26 Influence of patients' interaction towards professional, thereby enabling nurses to
nurses includes environmental factors, identify and successfully employ appropriate
invasion into their privacy and patients' communication technique thereby yielding a
previous experiences with nurse, among deeper understanding of patient's experience
others. The RESPECT (Rapport, Empathy, and needs thus facilitating nursing care . 1 1 ,14
Support, Partnership, Explanations, Cultural
Competencies and Trust) model crystallizes The acronym ADPIE: (Assessment, Diagnosis,
the patient-centred approach to Planning, Implementation and Evaluation) is
communication . 1 1 ,14 the best approach to holistic care because
each problem identified is evaluated per shift
According to Baker, Nurses need to be aware thereby simplifying charting and eliminating
of their personal communication 'style' in traditional separate care plan.9, 27

patient's interactions and willingness to Documentation of our nursing care is essential

modify that style as necessary to respond
appropriately to patient as a person as well as
someone in need of clinical skills. 22 These
could be demonstrated by nurses; focusing
their attention on patient's clues, identifying
patient's problems, planning appropriate
measures to meet patient's needs, meeting
patient's need, monitoring and utilizing body
language, practising listening skills (active,
reflective and emphatic), asking questions
that yield information, offer support by giving
answers that will be understood, partner with
for professional responsibility, legal protection,
regulatory standards, reimbursement, and
evidence of quality nursing care delivery9.
Hence, the study of communication effect on
nurse - patient relationship.
METHODS
Study Design: A cross-sectional survey using self
administered structured questionnaires to nurses
and patients was adopted to assess the effect of
communication on nurse - patient relationship in

patient, develop cultural competency, provide National Orthopaedic Hospital Igbobi, Lagos.
motivational counselling, demonstrate Structured questions were adopted to collect
empathy and compassion and evaluate the information from respondents on the variables
effectiveness of personal interaction.7,8' 16,19, of interest. Data were collected from nurses
23
and in-patients using self administered
Communication, Critical Thinking, structured questionnaires which consist of two
Nursing Process, and Documentation sections: demographic data of the
Effective communication and critical thinking respondents and communication data of the
refers to the vigilance that nurses must use in respondents (in three subsections: data for

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos
nurses only, data for patients only and data
for both nurses and patients).
Ethical permission to undertake the study was
obtained from the Nursing Department of
NOHIL, and same granted. The subjects'
consent was sought verbally, they were
treated with utmost confidentiality, and they
cooperated with the researcher.
A total of 160 questionnaires
administered (80 questionnaires for nurses
and 80 questionnaires for in-patients). 160
Questionnaires were analysed using Statistical
Package for Social Science Software (SPSS)
9th Edition.
Study Setting: National Orthopaedic Hospital
Igbobi is located within Yaba Local
Nurses serve their patients in the most
important capacities. We know that they serve
as our first lines of communication when
something goes wrong or when we are
concerned about health.
42
Government Area of Lagos State, Nigeria. It is
a World Health Organization Collaboration
Centre. It is a specialty training and research
centre. It serves all the inhabitants of the
twenty Local Governments and thirty-seven
Local Council Development Areas of Lagos
State and other states of the country. It
consists of sixteen wards and 250 nurses'
staff strength. The care facility is a 450
were bedded setting for the in-patient and out­
patient department where discharged patients
and those in need of outpatient care are
cared for.
Sampling Technique: Stratified random
technique was used to select the respondents
with questionnaires distributed into most of
the in-patient wards (excluded Intensive Care
and Burns Unit).
Lois Capps
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 E f f e c t o f C o m m u n ic a t io n o n N u r s e - P a t i e n t R e la t io n s h ip in N a t i o n a l O r t h o p a e d i c H o s p it a l, Ig b o b i, L a g o s

FINDINGS:

TABLE 1 : S o cio - D e m o g ra p h ic C h a ra c te ris tic s o f th e R e s p o n d e n ts

Characteristics Nurses P atients Total Percentage C um ulative
(8 0 ) (8 0 ) Frequency (1 0 0 % ) Frequency
(1 6 0 )
Age group
16 - 30 years 12 17 29 18.1 18.1
3 1 - 4 5 years 45 25 70 43.75 61.85
46 - 60 years 23 27 50 31.25 93.1
61 - 75 years - 11 11 6.9 100
Educational Status
BSc & Above (postgraduate) 7 8 15 9.4 9.4
BSc (graduate) 26 22 48 30 39.4
Undergraduate 47 26 73 45.6 85.0
Primary & Secondary School - 24 24 15 100
Barriers o f Nurse - P atient
Com m unication
Language 25 28 53 33.1 33.1
Religion 19 17 36 22.5 55.6
Culture 29 24 53 33.1 88.7
Gender 7 11 18 11.3 100
Factors influencing nurses'
in teraction w ith patien ts
Culture 20 - 40 25 25
Perception 16 - 32 20 45
Space and Distance 19 - 38 23.8 68.8
Timing 25 - 50 31.2 100
Factors influencing patien t's
in teraction w ith nurses
Past experience - 16 32 20 20
Nurses' attitude - 29 58 36.2 56.2
Invasion o f privacy - 12 24 15 71.2
Environmental factors - 23 46 28.8 100
Factors th a t can enhance
good nurse - p a tie n t
com m unication
Provision o f adeguate nursing 21 15 36 22.5 22.5
staff
Subsidizing medical bill and 10 30 40 25 47.5
prompt medical services
Supply and maintenance o f 15 18 33 20.6 68.1
standard eguipment and
infrastructure.
Respect fo r patients' cultural 6 14 20 12.5 80.6
belief
Adeguate remuneration for 28 3 31 19.4 100
nurses
Phase nurses p articipate
m ost in th e nursing care o f
th e ir patients
Assessment phase 14 -
28 17.5 17.5
Diagnostic phase 12 - 24 15 32.5
Planning phase 16 - 32 20 52.5
Implementation phase 28 - 56 35 87.5
Evaluation phase 10 - 20 12.5 100

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

Table 1 reveals the socio-demographic Forty (25%) respondents believed subsidizing

characteristics of both nurses and patients. The medical bill and prompt medical services
enhance good nurse-patient relationship, 36
distribution of age showed that the respondents
(22.5%) believed provision of adequate
were aged between 15 and 75 years and only
nursing staff will while 33 (20.6%) believed
6.9% were 61 - 75 years. Seventy-three
supply and maintenance of standard
(45.6%) respondents were undergraduates and equipment and infrastructure will.

24 (15%) were in primary and secondary

This shows that nurses' interaction with
schools. This shows that majority of the
patients is influenced by distance, time and
respondents were educated. Fifty-three (33.1%)
space while patients' interaction with nurses is
respondents had language barrier and 53 influenced by nurses' attitude and

(33.1%) cultural barrier. This shows that environmental factor such as expensive and
delayed medical services, inadequate nursing
language and culture are barriers of nurse -
staff, inadequate equipment, etc.
patient relationship. 31.2% of the nurses

claimed time influences their interaction with Thirty-five percent of the nurses declared they
patients and 23.8% of the nurses indicted space participate most in the implementation phase

and distance while 36.2% of the patients claimed
nurses' attitude influences their interaction with
nurses and 28.8% of the patients claimed
environmental factor.
when nursing their patients and 20% of
nurses alluded to the planning phase. This
shows that nurses participate most in the care
of their patients during the planning and
implementation phases.

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TABLE 2 : Socio - Demographic Characteristics o f the Respondents (patients only)

Characteristics Patients Total Percentage Cumulative

(80) Frequency (100% ) Frequency
(160)
Qualities nurses exhibit most
Empathy 20 40 25 25
Trust 19 38 23.7 48.7
Active listening 15 30 18.8 67.5
Non-Challant attitude 26 52 32.5 100
Nurses always initiate conversation
with patients
Agree 38 76 47.5 47.5
Strongly Agree 12 24 15 62.5
Disagree 19 38 23.7 86.2
Strongly Disagree 11 22 13.8 100
Nurses always listen attentively to
their patients
Agree 23 46 28.7 28.7
Strongly Agree 20 40 25 53.7
Disagree 20 40 25 78.7
Strongly Disagree 17 34 21.3 100
Nurses see situation from patient's
view
Agree 14 28 17.5 17.5
Strongly Agree 17 34 21.3 38.8
Disagree 18 36 22.5 61.3
Strongly Disagree 31 62 38.7 100
Nurses have good interpersonal
relationship with patients
Agree 22 44 27.5 27.5
Strongly Agree 11 22 13.8 41.3
Disagree 21 42 26.2 67.5
Strongly Disagree 26 52 32.5 100
Nurses' touch on patient promotes
healing
Agree 27 54 33.8 33.8
Strongly Agree 30 60 37.5 71.3
Disagree 16 32 20 91.3
Strongly Disagree 7 14 8.7 100
Nurses give their patients feedback
Agree 20 40 25 25
Strongly Agree 7 14 8.8 33.8
Disagree 35 70 43.7 77.5
Strongly Disagree 18 36 22.5 100

Table 2 shows the socio-demographic
characteristics of the patients. Twenty-six of
the patients claimed the quality nurses exhibit
most is non-challant attitude and 25% claimed
empathy. Thirty-eight of the patients agreed
that nurses always initiate conversation with
patients while 23.7% of the patients disagreed.
28.7% of the patients agreed that nurses
always listen attentively to their patients while
21.3% of the patients strongly disagreed.
Thirty-one of the patients strongly disagreed
that nurses see situation from patients' view

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 E f f e c t o f C o m m u n ic a t io n o n N u r s e - P a t i e n t R e la tio n s h ip in N a t i o n a l O r t h o p a e d ic H o s p it a l, Ig b o b i, L a g o s

and 22.5% disagreed. Twenty-six of the The socio-demographic data show that time
patients strongly disagreed that nurses have and culture influence nurses' interaction with
good interpersonal relationship with patients patients, nurses' attitude and environmental

and 26.2% disagreed. Twenty-seven of the factors influence patients' interaction with

patients agreed that nurses' touch on the nurses and nurses participate most in nursing

patients promote healing and 37.5% strongly care at the planning and implementation

agreed. Thirty-five o f the patients disagreed phases. This is in line with Hodges e t.a l who
stated that nurses do not communicate well
that nurses give them feedback on
with patients and approach patients only to
conversation being made and 22.5% strongly
deal with administrative and functional
disagreed.
activities. The study revealed that factors that
can enhance good nurse-patient
This shows that nurses always initiate
communication are subsidizing medical bill with
conversation with their patients, listen
prompt medical services and provision of
attentively to their patients but do not see
adequate nursing staff. This finding concurs
situation from patient's view and do not give
with Chant ef.a/who stated that nurses do not
feedback to their patients. Hence, patients
communicate well with patients because of
believe that nurses' touch on them promotes
organizational cultures.
healing but nurses display non-challant attitude
and do not have good interpersonal On attitude of nurses towards patients, the
relationship with patients. study showed that nurses' exhibit non-challant
attitude resulting into no cordial interpersonal
relationship between nurses and their patients.
D I SCUSSION
This finding concurs with Crotty who stated
The socio-demographic data showed that
that communication that is not patient-centred
majority o f the nurses are either diploma
can adversely affect the development of a
holders or undergraduates and most of their
positive nurse-patient relationship that is
patients are learned; this reveals that nurses
essential for the provision of quality care. The
must have been taught and trained on Peplau's
finding also shows that nurses initiate
theory. The outcome o f this study reveals that
conversation with patients, do not always listen
language and culture are barriers o f nurse-
attentively to their patients, and do not see
patient communication. This is in line with
situation from patients' view.
Kneisl who stated that use o f certain words and This is contrary but essential to what Baker S.K.
expression can render communication stated that nurses need to be aware of their
ineffective and Kaul, cultural differences in personal communication style in patient's
communication transcend spoken language. interaction and willingness to modify that style

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 Effect o f Communication on Nurse - Patient Relationship in National Orthopaedic Hospital, Igbobi, Lagos

as necessary to respond appropriately to with continuous maintenance to all government

patient's needs. The study showed that nurses hospitals, and subsidize hospital bills.
do not give feedback to their patients; this
impairs their nursing process revealing each IMPLICATION FOR FURTHER RESEARCH
patient's problem is not evaluated per shift These are:
thereby complicating charting and altering • Eff ect of adequate standard
essential documentation.
infrastructure and modern equipment

w ith continuous maintenance on

IMPLICATION OF STUDY TO NURSING patients' recovery.
Nurses should always treat patients individually
• Effect of proficient modern technologies
with patience by effectively utilizing the nursing
by nurses on therapeutic relationship.
care plan always. Nurses have basic
educational background required for their • Knowledge, attitude, and practice of

profession, but the present practice of nursing registered nurses towards proficient

requires adequate continuous education on utilization of modern technologies to

current related nursing courses especially benefit patients' care.

therapeutic nurse-patient communication, References

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