ASSESSMENT OF KNOWLEDGE OF COMMUNICATION IN RENDERING

NURSING CARE TO PATIENT IN GENERAL HOSPITAL KATSINA

BY

SALMANU AMINA

KASIMU KOFAR BAI SCHOOL OF NURSING KATSINA

IN PARTIAL FULFILMENT OF THE REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF “REGISTERED

NURSE CERTIFICATE”

NOVEMBER, 2020

DECLARATION

i
This is to declare that this research project titled “Assessment Of Knowledge Of

Communication In Rendering Nursing Care To Patient In General Hospital Katsina ”

was carried out by Salmanu Amina and is solely the result of my work except where

acknowledge as being derived from other person or resources.

Examination number:_________________________

(Salmanu Amina)

Kasimu kofar bai school of nursing Katsina

Signature:_________________________ Date:__________________

CERTIFICATION

ii
This is to certify that this research project by Salmanu Amina with examination

number……………………….. has been examined and approved for the award of

registered nurse certificate.

Signature:______________________ Date:_____________________

Mal. Binta Mustapha

(Project supervisor)

Signature: _____________________ Date:____________________

Mal. Muhammad Nuraddeen Umar

(School Director)

Signature: _______________________ Date: _____________________

Name:____________________________

(Chief examiner)

ABSTRACT

iii
The research study was conducted in General Hospital Katsina in order to come up with
findings that could be useful in improving effective communication on quality nursing care. The
research work examined thee skills for communication, determine the knowledge of effective
communication among nurses in rendering an effective nursing care in General hospital
Katsina, identity the barrier to effective communication between nurses and patient in
rendering an effective nursing care in General hospital Katsina and identify the possible ways
of improving communication skills between nurses and patient in general hospital Katsina. A
descriptive research design was adopted for the research work. A systematic random sampling
technique was used to select 50 respondents as a target population. A self structured
questionnaire was used to obtain information from the respondents and the data was analyzed
using frequency tables, bar chart and pie chart. The findings revealed that, majority of the
respondents agree that active listening skills, good conversational skills, are all skills for
effective communication. Likewise the study shows that, majority of the respondents agree that
socio-cultural differences, large number of patients and shortage of nurses, non-conducive
environment are among the factors that affect therapeutic communication. In conclusion, the
findings shows that provision of conducive environment, adequate manpower and training and
retraining of nurses on communication are among the measures to improve therapeutic
communication on nursing care. Employing more nurses, provision of conducive hospital
environment, organizing workshops and seminars for nurses on issues of communication
between nurses and patients were recommended.
Key word: Assessment, Communication, Knowledge, Nursing Care, Patients.

DEDICATION

iv
I dedicated my research project to my mother and also my nephew Tasneem and Ameenatu

thank you for supporting me

AKNOWLEDGEMENT

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All thank goes to Allah Almighty who has giving me the previllege, courage and confidence to

complete this noble task. But with passion of hard work, nothing remains difficult.

My heartfelt gratitude goes to the pillar behind my education who had endured sponsoring me

through situations of ease and adversity. My MOTHER, I have no words to adequately thank

you for all what you did to me, also my caring brother yaya Mustapha thank you for your

unlimited effort, word would not be enough for both of you may Allah bless you abundantly, I

also want to thank my brother and sister for all their support throughout my studies.

I want to appreciate and thank my supervisor in person of Malama Bintu Mustapha who

patiently guided and propelled me by allocating her valuable time for supervising this project

and also providing vital information and inputs whose impact were seen throughout this

research work.

I also want to appreciate my gratitude to the director, deputy director (admin and academic),

head of department, our class coordinator and the entire staff of Kasimu Kofar Bai school of

nursing Katsina.

A special thanks goes to my amour in person of Manseer Ma'aruf Dallaje for his immerse love

and support and encouragement throughout this journey May Allah bless his hustles.

it's inconclusive without mentioning my friends like Deeja, Ummyn Goggo, Deedee,Jamjam,

Siyerh,Hauwa leemart, and the entire members of group J6 without you people my stay to this

school will not be lively.

TABLE OF CONTENTS

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Contents Page
Title page - - - - - - - - - - i
Certification - - - - - - - - - - ii
Abstract - - - - - - - - - - iii
Dedication - - - - - - - - - - iv
Acknowledgement- - - - - - - - - v
Table of contents- - - - - - - - - vi-vii
List of tables - - - - - - - - - - viii
CHAPTER ONE
1.0 Introduction- - - - - - - - - 1
1.1 Background of the study- - - - - - - 1
1.2 Statement of the problem - - - - - - - 2
1.3 Objective of the study - - - - - - - - 2
1.4 Research questions - - - - - - - - 3
1.5 Significance of the study - - - - - - - 3
1.6 Scope of the study- -- - - - - - - 4
1.7 Operational terms definitions - - - - - - - 4
CHAPTER TWO
2.0 Literature review - - - - - - - - 5
2.1 Conceptual review - - - - - - - - 5
2.2 Theoretical Review - - - - - - - - 12
2.3 Empirical review - - - - - - - - 16

CHAPTER THREE
3.1 Research Design - - - - - - - - - 19
3.2 Research setting - - - - - - - - - 19
3.3 Target population - - - - - - - - 20
3.4 Sampling size - - - - - - - - - 20
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3.5 Sampling technique - - - - - - - 20
3.7 Validity of the instruments - - - - - - - 21
3.8 Reliability of the instrument - - - - - - - 21
3.9 Method of data collection - - - - - - - 22
3.10 Method of data analysis - - - - - - - 22
3.11 Ethical consideration - - - - - - - - 22
CHAPTER FOUR
4.0 Result - - - - - - - - - - 23
4.1 Data presentation - - - - - - - - 23
4.2 Answering research questions - - - - - - 33
CHAPTER FIVE
5.0 Discussion of findings - - - - - - - - 35
5.1 Key findings - - - - - - - - 35
5.2 Implication of the Findings with Literature Support - - - 36
5.3 Alignment of findings with previous findings of studies cited - - 37
5.4 Implications of Findings to Nursing- - - - - - 37
5.5 Limitation of the Study- - - - - - - 37
5.6 Summary of the Study - - -- - -- - - 38
5.7 Conclusion - - - - - - - - - -38
5.8 Recommendation - - - - - - - - -38
5.9 Suggestion for further studies - - - - - - - -39
References- - - - - - - - - - -40

LIST OF TABLE
viii
S/N TABLES DESCRIPTION PAGE
1 Table I Age range in years 23
2 Table II sex distribution of the respondents 24

3 Table III Distribution of highest educational qualification of the 24

respondents.

4 Table IV Distribution of occupational status of the respondents. 25

5 Table V Distribution of Respondents on large number of patient and 25
shortage of nurses as a barrier to effective communication.
6 Table VI Distribution of Respondents on language barrier as a factor 27
responsible for poor communication
7 Table Distribution of Respondents on Socio-cultural differences 27
VII as a factor that hinders effective communication
8 Table : Distribution of respondents on sincere intention to 28
VIII understand what concern the patient and show them kindness
9 Table IX Distribution of Respondents on good communication skills is 28
one among the knowledge of effective communication.
10 Table X Distribution of Respondents on is through having the 29
knowledge
11 Table XI Distribution on respondent on Providing time for the patient 30
to ask questions is among having knowledge of effective
communication.
12 Table Distribution of Respondents on provision of conducive 31
XII environment as a measure to improve effective
communication.
13 Table Distribution of Respondents on adequate Nursing staffing 32
XIII could complement the faster improvement in effective
communication.

LIST OF FIGURE
ix
S/N FIGURE DESCRIPTION PAGE
1 Figure I Distribution of Respondents on non-conducive 26
environment as a barrier to effective communication.
2 Figure II Distribution of respondents on further training of Nurses 32
on communication as a measure to improve effective
communication.

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 CHAPTER ONE

1.0Introduction.

1.1 Background of the Study.

Nursing as a health care science, focuses on serving the needs of human as a biopsychosocial

and spiritual being. Its practice requires not only scientific knowledge, but also interpersonal,

intellectual and technical abilities and skills. This means a composition of knowledge, clinical

work and interpersonal communication. Communication is a vital element in Nursing *in all

areas of activity and in all its interventions such as prevention, treatment, therapy, rehabilitation,

education and health promotion. The nursing process moreover as a scientific method of

exercise and implementation of Nursing, is achieved through dialogue, through interpersonal

environment and with specific skills of verbal communication. (Wikstrom,2011).

As communication we can define the exchange of information, thoughts and feelings among

people using speech or other means. Therapeutic practice involves the oral communication of

public health officials and nurses on the one hand and the patient or his relatives on the other. It

is a two way process. The patient conveys their fears and concerns to their nurse and helps them

make a correct nursing diagnosis. The nurse takes the information and in turn transmits other

information to the patient with discretion and delicacy as to the nature of the disease and advises

with treatment and a rehabilitation plan for health promotion.(Wikstrom,2011).

Effective communication requires an understanding of the patient and the experiences they

express. It requires skills and simultaneously the sincere intention of the nurse to understand

what concerns the patient. To understand the patient only is not sufficient but the nurse must

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also convey the message that he/she is understandable and acceptable. It is a reflection of the

knowledge of the participants, the way they think and feel and their capabilities.

(Papadontonaki,2012).

In order for the nurses to be successful in their work they have to study communication and

interpersonal relations in their education with special courses and internships. They need to

learn the various aspects and applications of communication in various fields of nursing .

(Wickstrom,2011).

1.2 Statement of Problem.

Effective communication skills and strategies are important for nurses. Clear communication is

conveyed effectively between nurses and patients, family members and colleagues. However it

is recognized that such skills are not always put into action in General hospital Katsina due to

large number of patients and shortage of nurses, non conducive environment that negatively

influence effective communication, language barriers and sociocultural differences hinder

communication.

In view of the above mentioned problems, the researcher want to assess the knowledge of

communication in rendering effective nursing care to patients in General Hospital Katsina.

1.3 Objectives of the Study.

1:To determine the knowledge of effective communication among nurses in rendering an

effective nursing care in General hospital Katsina.

2:To identity the barrier to effective communication between nurses and patient in rendering an

effective nursing care in General hospital Katsina.

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3:To identify the possible ways of improving communication skills between nurses and patient

in general hospital Katsina.

1.4 Research Questions

1) What are the barriers to effective communication between nurses and patients in general

hospital Katsina?

2) What are the knowledge of effective communication among nurses in rendering effective

nursing care in general hospital Katsina?

3) What are the possible ways of improving communication skills between nurses and patients

in general hospital Katsina ?

1.5 Significance Of The Study

At the end of this research study, the result obtained will help nurses in getting or obtaining data

from the patients and it will help the patient to open up and accept the services provided by the

nurses. It will also help the nurses in making proper diagnosis and meeting the patient's health

care needs, and also promotes the standard of nursing practices in general by patients accepting

health care services provided by the nurses.

The result obtained(*will go a long way to benefit the society through accessing information via

radio, television, mass media, or from their colleagues who visited the hospital for medical

checkup or health related matters which will inturn help in early diagnosis and prompt

management and prevention of any ailment that may affect the society. It will also play a role to

the society through easy access to health* care services thereby improving the health status of

the society.

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1.6 Scope Of The Study

The study focused on the assessment of the knowledge of communication in rendering effective

nursing care to patients in general hospital Katsina. It also highlighted on the importance of

effective communication between nurses and patients in general hospital Katsina and possible

ways of improving communication skills.

1.7 Operational Definition

Assessment: is the organized, systematic and a continuous process of collecting data from a

subject.

knowledge: is a familiarity, awareness or understanding of something or someone such as

fact(propositional knowledge), skills(procedural knowledge), or object (acquaintance

knowledge).

Communication: is the process of transmitting messages and interpreting their meanings.

Rendering: the act of delivering service to someone.

Nursing: the profession or process of caring for patients or clients.

Care: attention or concern given to a needy.

Patient: A person who receives treatment from a doctor or other medically educated person.

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 CHAPTER TWO

LITERATURE REVIEW

2.1.Conceptual Review

2.1.1 Definition:

Communication is an exchange of facts, ideas, opinions or emotions by two or more persons.

Communication is the process of passing information and understanding from one person to

another(Taylor, et Al 2013).

Communication is the process by which information is transmitted between individuals or

organizations so that understanding response results(Little, 2013).

2.1.2 Components Of Communication

SENDER: This is also known as the encoder, source, transmitter or communicator. It is the first

component or element and initiator of communication. The person receives stimulus from self

and responds to it, initiates the message, get the message ready internally ny* selecting the code

or symbols which the receiver will understand and then put in the language which is shared by

both of them (sender and receiver).To acts as a guide, the encoder must have set objectives to be

accomplished in the message.(unugo,2012)

MESSAGE: This is the second component of communication. It is a piece of information

spoken, written(or action) passed from one person to another. In nursing, the message is health

information, instruction or activity from the health personnel to an individual or target group in

order to achieve the identified stated objectives to meet the need of individual or a community.

(Unugo,2012)).

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CHANNEL: This is the third component of communication. It is the route through which the

message is passed to the receiver. For any message to be send, there must be a channel like;

language, code, sound, symbols or any special signal capable of being understood and

interpreted by the receiver.(Unugo,2012)..

RECIEVER: This is the fourth components of communication. It is also known as the decoder.

A decoder is a listener or a communicatee. When the attention of the receiver is drawn,

interpretation of the message takes place. The receiver of the message could be an individual, a

group, or an organization that receives and respond to the message. (Unugo,2012)

FEEDBACK: this is the fifth and last component of communication and the reply of the

message that has been communicated. When the message gets to the decoder, it is interpreted.

When the message is not properly coded, interpreter become difficult. Whether the message is

understood or not, there is usually a feedback which may either be positive or negative.

(Unugo,2012).

2.1.3 Types Of Communication

There are two basic types of communication and a combination of the two forms the third group

as follows:

1) Verbal communication.

2) Non verbal communication.

3) Audio-visual communication.

Verbal communication: Refers to the use of those language symbols that are assumed to be

meaningful to all parties involved in communication. In this form of communication, there is

6
use of mouth and voice-speech, to speak out to the hearing of the receiver. In verbal

communication, there is organization, choice of words, use of emotions and logic to affect

message. Verbal message involves speaking-oral (Unugo,2012)

Non verbal communication: is any communication without words of mouth, spoken words,

conversation. It happens through written language, signs, symbols, colours, gestures, body

language or any facial expression(Unugo,2012.).

Audio-visual communication: this is the combination of both verbal and non verbal

communication. For this, both audio and visual communication are combined appropriately to

enhance effective communication, usually this is the most effective type of communication.

(Unugo,2012).

2.1.4 Objectives Of Communication

Every communication is suppose to have purposes. Some of the objectives of communication

are as follows:

A) To get things done.

B) To identify client's concerns and problems.

C) To learn more about one another.

D) To have mutual understanding between nurses and the patients.

E) To provides room for asking and answering questions.

F) To listen to others.

G) To effectively control programmes and activities.

H) To enhance decision making.

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2.1.5 Characteristics Of Effective Communication In Nursing

INTONATION : The pitch and volume of the sound, pattern of phrases and sentences from the

nurse should have appropriate variations in voice showing emotion, decisiveness or gentleness

during communication. Monotonous utterance with an expressionless body are boring to the

patients(Unugo,2012).

CALMNESS : agitation and excitement are avoided, rather the nurse should have self control

with a calm voice when talking to the patients.(Unugo,2012).

Confidence: there is the feeling of trust with self assurance so that the patient believes the

information being expressed.

SYMPATHY : To communicate effectively, the nurse shares the feelings, assess the situation

and provides closeness toward the patient before expressing the message.

Emphaty: here, the nurse develops understanding and imaginative feelings within the patient.

(Unugo,2012).

CLARITY: Here, the nurse avoids ambiguous and abstract statements. Rather the nurse

provides clear, precise expressions or information for easy comprehension and appropriate

action.

DILIGENCE :usually a good nurse is tolerant and enduring. It takes time to convince the

patient, especially when bit comes to replacing bad habits with good ones e.g smoking, as life

styles are not easy to change. A nurse should consciously obtain the above characteristics as

tool for effective communication.

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2.1.6 Barriers To Effective Communication

Any factor that partially or completely obstruct the smooth exchange of understandable

information, instructions or skills between a sender and receiver is barrier to effective

communication. In nursing communication, the barrier could be from the nurse or the patient, a

target group even a community. Such barriers are common and appear in an unlimited variety of

forms(Collins and Mattie).Some are obvious problems with obvious solutions. The following

are some of the barriers to effective communication:

A) Language differences.

B) Environment that is not conducive.

C) Workload and time imbalance.

D) Resistance to change

E) Socioeconomic and cultural status.

F) Ineffective communication skills.

G) Differences in perception.

H) Emotionality.

I) Age difference.

LANGUAGE DIFFERENCE : The words themselves create barrier to effective

communication even in thesame language. Many time, the same symbolic meaning is not shared

between the sender and the reciever. Nurses increase barrier by the use of medical jargons. For

example, a nurse may tell a mother in English "your child has high temperature" instead of

"your child has high fever" or "your child's body is very hot.

9
WORK LOAD AND TIME IMBALANCE : the large number of patients, the unstable

condition of the patients and shortage of nurses would lead to imbalance between workload and

time for nurses to interact with the patient. The nurses do not have enough time to interact with

their patients to support them emotionally.

INEFFECTIVE COMMUNICATION SKILLS :these are usually noticeable where there is

verbal and non verbal communication. We think language as a primary medium of

communication but the messages we send and recieve are influence by non verbal factors such

as body movement, clothing, facial expression, and eye contacts etc.

Environment :communication happens best when the environment facilitate easy exchange of

needed information. The nurse should ensure that there is no any distractions and he has to

ensure privacy.

AGE DIFFERENCES :it is a common to see a young health care provider e.g a nurse with

elders of the community. The elders may take him to be too young to give them the required

Health information.

2.1.7 IMPORTANCE OF EFFECTIVE COMMUNICATION

A) It gives patients confidence to play active role in his or her care.

B) Effective communication helps patients or clients to be in control.

C) It makes patients or clients to feel valued and belong.

D) It helps to provide proper documentation .

E) It helps to avoid delay in patient care and recovery.

F) Effective communication helps to avoid medical errors.

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G) It helps in reducing stress and severity of patient's illness. (Hicson A. S.)

2.1.8 IMPACT OF POOR COMMUNICATION IN RENDERING NURSING CARE

A) Poor documentation .

B) Ineffective communication about patient's condition.

C) Inadequate patient education.

D) Inadequate inform consent to the patients.

E) Medical errors.

F) Conflict in working place.

G) Increase in stress and severity of patient illness.

I) Poor decision making in the management of patients condition.

J) It leads to negative image of nursing profession.

K) It causes delay in patient care.

2.1.9 Possible Measures to Improve Effective Communication Skills in Patient Care.

OPENNESS AND RESPECT :one key factor to effective communication is to be open,

accepting, polite, respectful and without prejudice When patient feels that a nurse is

judgemental, he or she might withhold some significant information. A nurse have to develop

tolerance to any challenge presented by each patient.

CORRECTING BARRIERS TO COMMUNICATION :identify any barrier to

communication and take appropriate steps to address them. Example does the patient hear your

language well?, if no, provide an interpreter.

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PRIVACY :Nurse need to make an Effort to provide privacy and prevent conversation from

being over heard by others within the ward whenever necessary. Provision of screen while

carrying out a procedure is also important.

CONFIDENTIALITY :A nurse should share a patient's information only if it is beneficial to

the patients.

INCORPORATE EFFECTIVE COMMUNICATION SKILLS MANDATORY

TRAINING PROGRAM :it is hard to expect nurses to communicate effectively if they have

never been taught to it. During mandatory training sessions, instruct nurses how to ask

clarifying questions, validate and verify patient's thought and feelings and engage empathetic

listening. Make sure nurses understand two way communication dialogue, both with managers

and with the patients they care for. (Smith,2016).

IMPLEMENT PATIENT SATISFACTION SURVEY : receiving feedback from patients

give you insight into how the patient experience can be improve. Patient surveys can help you

determine reasons for complaints, questions, or concerns. Additionally they can shed more light

on how the nurses are doing right (Smith, 2016)

2.2 Theoretical Review

The research study used Hildegard Peplau's interpersonal theory. The Theory was established in

1952,the theory focuses on nurse-patient relationship and therapeutic process that take palce.

Peplau (1998) identified five overlapping phases in nurse-patient relationship, with each

12
having own specific definable characteristics which are orientation, working and termination.

These phases are therapeutic and focus on interpersonal interactions as established in Peplau’s

theory of interpersonal relations.

Phase 1: Orientation Phase

The orientation phase is important in building foundation for the therapeutic relationship. The

therapeutic nurse-patient relationship begins formally during this phase. This phase is

coordinated by the nurse and involves engaging patients in their treatment, provision of

explanation and information and answering of questions. On meeting a patient, the nurse

introduces his or herself by name and professional status, the nurse’s warmth of the welcome

words during this introductory stage can promote connection between the nurse and patient.

Patients can be addressed by their formal names first and then be inquired what they would

prefer to be called. The nurse’s major focus is the patient, therefore it is important for nurse to

listen attentively to what patient says and inquire who-, what-, why-, where-forms of question to

keep the patient motivated to be more opened with description of his or her stories.

After introduction/greeting phase, the nurses emphasize the goal and nature of the relationship.

Here the nurse provides information about the appointment, describes the nurse’s role, help the

patient provide relevant information and describe the purpose of the relationship. Each nurse

has a personified style, so the way the information is provided may vary. However, it is

important not to overlook this part of the relationship as the exterior part of the real work. Once

the patient knows what to expect and how participate in the establishment of the relationship,

anxiety levels decreases. At the orientation phase, data collection takes place. Obtaining data for

13
the nursing assessment demands for active involvement of the patient to identify health state

and functioning.

There is need for nurse to have open mind to be able to grasp and understanding the patients

perception of the problem and the need for the treatment, and respond appropriately. A

therapeutic contract ends an orientation phase. A verbal contract that explains the roles of

patient, nurse and goals of relationship. The nurse may also ask if the patient has any question.

(Peplau, 1992,1997).

Phase 2: Identification Phase

This phase is the beginning of the working segment. The patient and nurse work together to

clarify problems and set specific goal to each problem. Health issues are identified during data

collection; suitable nursing interventions are built in the nursing care plan.

Cordial goal setting enhances patients to be active participants in their nursing care. In this

phase, nurses can help patients; explore feelings and possible fears, helplessness and anxiety

regarding their situation; identify their personal strengths and resources; direct their energy

towards helpful actions; all these would help patients cope with the current health concerns and

actively be involved in their care (Pepla,1992,1997).

Phase 3: Exploitation Phase

During the exploitation phase, the nurse guides patient in the use of health services. The

practical work of nurse-patient relationship happens during exploitation. Alongside with

with the ongoing reassessment and reevaluation, appropriate intervention to the mutually

planned goals are carried out. At times, there might be possibility that, even an accurately

14
established intervention requires to be renewed, and new/more realistic goals to be put in place.

The therapeutic relationship permits the nurse and patient to collaborate together during

exploitation phase. The patient makes use of their identified strength and resources to regain

command and develop solutions (Peplau ,1992,1997).

Phase 4: Resolution Phase

A resolution phase is described by Peplau as the important period of decisions when about

ending a therapeutic relationship (Sheldon, 2013). The patients’ old needs are resolved while

more goal emerge. Most times, deep and meaningful sharing has occurred between the nurse

and patient during some challenging times. The relationship was originally established with a

purpose and a time frame. For instance, a perioperative nurse has a short time frame with the

patient who is undergoing an arthroscopy at the outpatient surgical ward. Whereas, the

oncology nurse has a long-term relationship with the patient who has been diagnosed with colon

cancer that might end with the patient dying. Both relationships, short and long-term

partnership, demands for the end or resolution (Peplau, 1992, 1997).

Phase 5: Termination Phase

This is the termination of professional relationship between the nurse and patient. The

termination phase is often overlooked due to the fact more emphasis is placed on the health

diagnosis and treatment, but endings are a time of review and growth (Sheldon, 2013). No

matter how brief, the proper endings of a therapeutic relationship, can be valuable time for both

the nurse and the patient to check the achievement of their goals and review their time together.

The nurse makes use of summarization skills to evaluate the progress of the care intervention

15
towards the established goal. Such review can boost a perception of achievement and closure

for both parties. Emotions are normally part of ending relationships. Caring attitude from nurse,

shared experiences particularly in a long-term relationship may bring about sadness and

uncertainty. Termination of therapeutic relationship can awaken feelings of past experiences of

lost relationships. Acceptance of these feelings that arise is benevolent to the dissolution of

sadness and learning healthy techniques to deal with ending and feeling of loss. During

termination phase, the nurse and patient identify possible unmet goals and some cases may

require

referral and follow-up care. When the relationship end is approaching, patients may encounter

regression, anxiety, and act strangely superficial to the nurse or even become

more dependent. The nurse may separate, by spending less time the patient in the preparation

for termination of the relationship. The therapeutic nurse-patient relationship between the nurse

and patient will end with a completeness and satisfaction that is rewarding for both the nurse

and the patient (Sheldon (2013) and Peplau (1997)).

2.3 Empirical Review

1. Studies Related To Communication

According to a research conducted by Abbas Ebadi to investigate nurse-patient and

environment-related communication barriers perceived by patients and nurses in Iranian

nursing. The method used was a descriptive survey was carried out in three randomly selected

educational hospitals in a large urban city in Iran. Data were collected by questionnaire; the

study sample consisted of 61 patients and 75 nurses. Participants were asked to rate the

16
importance of each communication barriers item. Finally, data were analyzed using descriptive

statistics, and to compare the perceived importance of communication barriers between patients

and nurses, item means were calculated and the t-test for independent samples was applied. The

result reveals similarities and differences between the two groups were identified. According to

nurses' views, 'heavy nursing workload', 'hard nursing tasks' and 'lack of welfare facilities for

nurses' were the main communication barriers. From patients' views, 'unfamiliarity of nurses

with dialect', 'having contagious diseases' and 'sex differences between nurses and patients' were

determined as the main communication barriers. The shared communication barriers were 'age

difference', 'social class difference' and 'having contagious diseases' It can be concluded that

nursing managers and healthcare system planners should focus on eliminating or modifying the

barriers stated by the two groups, particularly the shared ones.

A study to explore patient experiences of communication problems during ventilator

treatment .The method used was twenty-two consecutive patients treated in an intensive care

unit (ICU) were interviewed three times over a 2-month period about their experiences of

changes to their communication during ventilator treatment. Structured questionnaires,

including open-ended questions were used on each occasion. The registered nurse (RN) in

charge of each patient evaluated the extent of communication during the ventilator treatment in

a nurse protocol. The result was thirteen of the twenty-two patients reported that the registered

nurse were able to understand their needs and wishes during the ventilator treatment. The

registered nurse , however, reported functional communication in nineteen patients The results

suggest the need for detailed examination of patients' potential for effective communication,

17
evaluation of the communication skills of the RNs, and further investigation of devices that can

help facilitate communication between RNs and patients during ventilator treatment.

(Elisier,2010).

A Study was conducted to investigate the communication barriers perceived by older

hospitalized patients and nurses in Korea, with the aim of identifying disparities between the

two parties. The authors developed a 50-item communication-barrier questionnaire that includes

patient, nurse, and environmental factors. One hundred older hospitalized patients and 136

nurses were asked to rate the importance of each communication-barrier item. Nurses and

patients were found to perceive the importance of barriers differently: nurses reported higher

scores on patient-related communication barriers, whereas patients reported higher scores on the

nurse-related barriers. There were significant differences between patients and nurses in 57%,

62%, and 71% of the nurse-, patient-, and environment-related communication barriers,

respectively. Concluded was that it is necessary for nurses to understand older patients’

perceptions about communication barriers and acquire better communication skills and

attitudes. Finding time to talk with patients for a few minutes a day, outside of direct hands-on

care giving, requires further exploration.(Elisier,2010).

18
 CHAPTER THREE

METHODOLOGY

3.1 Research Design

The research design used was descriptive survey. This method was chosen because it permits to

carefully describe and explains the variables that exist in the study, based on the data collected.

Gay and Razaria (2003) see descriptive survey as a modern of research which allowed the

researcher to interrogate with the respondents and give adequate report as it existence in the

study area. Hence, this research study is designed to take a critical look into the “ the assessment

of the Impact of communication in rendering effective nursing care to patients" in general

hospital Katsina.

3.2 Research Setting

The study was conducted in General Hospital Katsina. The Hospital was built in 1930 by

missionaries and commissioned by governor Luggard in 1932. Furthermore the Hospital has

remained versatile training ground for nurses and midwives as well as doctors and pharmacists

on internship, and epitome of staff development and administration. The hospital is located

around Yarkutungu market. The hospital was boarded from north with Rahusa pharmacy, from

south with Yammawa, from east by former site of Yarkutungu, from west by Saulawa.

The hospital has many units and departments with health workers, comprising of nurses,

midwives, doctors, pharmacists, radiologists, physiotherapists, laboratory technicians, Chief

nursing officer, Medical director, etc. The Hospital is divided in towards and units namely; male

19
and female medical wards, male and female surgical wards, pediatric ward, Accident and

emergency unit, General outpatient department, Maternity unit, Main theater, Amenity,

Intensive care unit, Nursing department, Ear - Nose and throat clinic, and Heart- to - Haart.

Other departments include records department, laboratory department, dental and X-ray

departments. The Hospital is currently now on renovation by Katsina state government under

leadership of Right Honorable Aminu Bello Masari.

3.3 Target Population

The target population of the research study consist of patients admitted in female medical and

surgical wards and the nurses in female medical and surgical wards. The wards have a total

number of 40 patients and 15 nurses. Therefore the target population is 65 subjects.

3.4 Sample Size

The sample size will determine by using Morgan table. The sample size for 65 subjects is 56.

3.5 Sampling Technique

A random sampling technique was used to select 55 respondents out of the patients admitted in

the wards and their nurses. The researcher considers the patients that passes inclusion and

exclusion criteria. Also the researcher chooses the sample from each ward in proportion to the

number of its patients and base on their ability to provide data for the research study.

Inclusion criteria:

Nurses and Patients who are willing to participate

Nurses and Patients aged from 18 years to above

Fully conscious patient

20
Patients with ability to speak read and understand English language.

Exclusion criteria:

Disoriented or unconscious patient

Patient with hearing, visual, or speech defect

Patients less than 18years

Patients who cannot read, speak and understand English Language.

3.6 Instrument For Data Collection

Tool was developed by the researcher under the guidance of supervisor after study and review

of various books, and internet search. Questions were formulated to assess the impact of

therapeutic communication towards rendering effective nursing care to patients. The

questionnaire was designed into section A, B, C, and D . Section A contain respondent bio-data

while other sections are structured base on the objectives of the study.

3.7 Validity Of The Instrument

For validity of the instrument, a self-structured questionnaire was designed and taken to the

project supervisor for the necessary correction. The instrument was pilot tested using 5 patients

from the respondents in order to identify areas of difficulties and to ensure the instrument is

proved to be useful to the study.

3.8 Reliability Of The Instrument

As the instrument was tested to be valid through pilot study, it shows that the data obtained

using the instrument is reliable as it generates relevant information that is exactly needed for the

conducting of the study.

21
3.9 Method Of Data Collection

The data used in this study was collected through distribution of structured questionnaires after

conducting pilot study. The researcher and his assistant distributed the questionnaires to various

wards in general hospital Katsina.

A total of 56 questionnaires were distributed, and five days were given to the respondents to

respond. Luckily enough 50 questionnaires were retrieved successfully and only 6 were missed.

3.10 Method Of Data Analysis

The data collected in this research was analysed using frequency percentage tables, pie chart,

and bar chart.

3.11 Ethical Considerations

Informed consent was obtained from chief nursing officer (CNO) General Hospital Katsina

before starting the research study. Also informed consent was obtained from the respondents

and voluntarily give their maximum cooperation as name of respondents were not indicated and

information gathered were treated with strict confidentiality.

22
 CHAPTER FOUR

4. O Introduction

This chapter deals with the analysis of data, data presentation and answering research questions.

The collected data were analyzed in accordance with the research questions using tables and

charts.

4.1 Data Presentation

SECTION A: RESPONDENT'S BIO-DATA

Table 4.1: Age distribution of Respondents

Age range in years Frequency Percentage %

18-27 20 40%

27-36 15 36%

36-45 6 20%

45 and above 9 4%

Total 50 100%

From the above table, 40% of the respondents are within the age range of 18-27years, and 36%

are within the age range of 27-36 years, 20% were between 36-45 years while 4% were between

45years and above.

23
Table 4.2: sex distribution of the respondents

Sex Frequency Percentage %

Female in female medical 20 40 %

ward

Female in female surgical 30 60%

ward

Total 50 100 %

The above table shows that 40% of the respondents are female in female medical ward while

the remaining 60% are females I'm female surgical ward.

Table 4.3: Distribution of highest educational qualification of the respondents.

Educational qualification Frequency Percentage

S.S.C.E 24 48%

DIPLOMA 13 26%

DEGREE 10 20 %

Others 3 6%

Total 50 100 %

The above table shows that 48% of the respondents obtained SSCE, 26% were qualifications

DIPLOMA, 20% were DEGREE and 6% of the respondents obtained other.

24
Table 4.4 Distribution of occupational status of the respondents.

OCCUPATIONAL FREQUENCY PERCENTAGE

STATUS

STUDENT 15 30%

CIVIL SERVANT 13 26%

BUSINESS 20 40%

OTHERS 2 4%

TOTAL 50 100%

The above table shows that 48% of the respondents obtained SSCE, 26% were qualified with

DIPLOMA, 20% DEGREE and 6% of the respondents obtained others.

SECTION B: BARRIERS TO EFFECTIVE COMMUNICATION BETWEEN

PATIENTS AND NURSES

Table 4.5: Distribution of Respondents on large number of patient and shortage of nurses as a

barrier to effective communication.

Respondents Frequency Percentage

True 48 96%

False 2 4%

Total 50 100%

25
From the table above, majority of the respondents 96% said it is true that large number of

patients and shortage of nurses is a barrier to effective communication while only 4% disagree.

Figure 4.1: Distribution of Respondents on non-conducive environment as a barrier to effective

communication.

a. True
b. False

From the figure above Majority of the respondents said it is true that non conducive

environment is a barrier to effective therapeutic communication representing 324 degree of 45

respondents, while only 36 degree 5 of the respondents said it is false.

26
Table 4.6: Distribution of Respondents on language barrier as a factor responsible for poor

communication

Respondents Frequency Percentage

True 38 78%

False 12 24%

Total 50 100%

The table above shows that 78% of the respondents agree that language barrier is a factor

responsible for poor communication while 24% of the respondents said it is false.

Table 4.7: Distribution of Respondents on Socio-cultural differences as a factor that hinders

effective communication

Respondents Frequency Percentage

True 41 82%

False 9 18%

Total 50 100 %

The table above shows that majority of the respondents said it is true that sociocultural

differences is a factor that hinders effective communication presenting 82% while only 18% of

the respondents said it is false.

27
SECTION C:knowledge of effective communication among nurses in rendering an

effective nursing care.

Table 4.8: Distribution of respondents on sincere intention to understand what concern the

patient and show them kindness

Respondents Frequency Percentage

strongly agree. 40 80 %
Agree 8 16 %
Disagree 2 4%
Strongly disagree 0 0%
Total 50 100%

The table above shows that 80% of the respondents strongly agree sincere intention to

understand what concern the patient is among the knowledge of effective communication while

remaining 16% of the respondents agree while the remaining 4%disagree.

Table 4.9: Distribution of Respondents on good communication skills is one among the

knowledge of effective communication.

Respondents Frequency Percentage

Strongly agree 42 84%

Agree 6 12%

Disagree 1 2%

Strongly disagree 1 2%

Total 50 100%

28
The table above shows that 84% of the respondents strongly agree that good communication

skills is among the knowledge of effective nursing care while only 12% of the respondents

agree, and 2% of the respondent disagree and 2%strongly disagree.

Table 4.10: Distribution of Respondents on is through having the knowledge of effective

communication that you will be able to ask patient open ended questions in simply way and

simpler manner.

Respondents Frequency Percentage

Strongly agree 43 86%

Agree 7 14%

Disagree 0 0%

Strongly disagree 0 0%

Total 59 100%

The table above shows that majority of the respondents 86% strongly agree that is only when

you have a knowledge of communication that you will be able to ask the patient a open ended

question in simple way and simpler manner and only 14% of the respondents agree.

29
Table 4:11 Distribution on respondent on Providing time for the patient to ask questions is

among having knowledge of effective communication.

RESPONDENT FREQUENCY PERCENTAGE

Strongly agree 43 86%

Agree 7 14%

Disagree 0 0%

Strongly disagree 0 0%

Total 50 100%

the table shows that 86% of the respondent strongly agree that providing time for the patient to

ask question is among the knowledge of effective communication and 14% of the respondent

agree.

30
SECTION D: MEASURES TO IMPROVE THERAPEUTIC COMMUNICATION

BETWEEN NURSES AND PATIENTS

Table 4.12: Distribution of Respondents on provision of conducive environment as a measure to

improve effective communication.

Respondents Frequency Percentage

Strongly agree 25 50%

Agree 23 46%

Disagree 2 4%

Strongly disagree 0 0%

Total 50 100 %

The table above shows that 50% of the respondents strongly agree, 46% agree, 4% disagree, and

none of the respondent Strongly disagree that provision of conducive environment can help to

promote positive communication between nurses and patients.

31
Figure 4.2: Distribution of respondents on further training of Nurses on communication as a

measure to improve effective communication.

25

20

15

10

0
Strongly Agree Agree Disagree Strongly disagree

The figure above shows that 25 of the respondents strongly agree that further training of Nurses

as a measure to improve effective communication, 20 respondents agree, 5 respondents disagree

and none of the respondent strongly disagree.

Table 4.13: Distribution of Respondents on adequate Nursing staffing could complement the

faster improvement in effective communication.

Respondents Frequency Percentage

Strongly agree 25 50%
Agree 21 42%
Disagree 2 4%
Strongly disagree 2 4%
Total 50 100 %

32
The table above shows that 50% of the respondents strongly agree, 42% agree, 4% disagrees,

and 4% strongly disagree that adequate Nursing staffing could complement the faster

improvement in communication between nurses and patients.

4.2 Answering Research Question

Research question 1: what are the barriers to effective communication between nurses and

patient?

Answer: Reference to information obtained from table 4.5, 96% of the respondents agrees that

large number of patients and shortage of nurses is a barrier to effective communication between

nurses and patients. So also table 4.6, 324 or 45 respondents agree that non conducive

environment is a factor that hinders effective therapeutic communication. Also, in table 4.7,

78% agree that language barrier is a factor that hinders effective therapeutic communication.

More so, in table 4.8, 82% of the respondents agree that socio-cultural factors hinder effective

therapeutic communication.

Research question 2:What are the knowledge of effective communication among nurses in

rendering effective nursing care to patient?

Answer: Reference to the information obtained from the respondent in table 4.12, 86% of the

respondent strongly agree that is only when you have a knowledge of communication that u will

be able to ask the patient a open ended questions in a simpler way, so also on thesame table

84% of the respondent strongly agree that giving good time for patient to ask questions is

among the knowledge of effective communication.

33
Research question 3: what are the possible measures of improving communication between

nurses and patients?

Answer: Reference to the information obtained from respondents in table 4.12, 96% of the

respondents agrees that provision of conducive environment can help to improve effective

communication. So also, table 4.13 show that 45 of the respondents agree that further training of

nurses on communication can help to improve effective communication between nurses and

patients. In addition figure 4.14, show that 92% of the respondents agree that adequate nursing

staffing can help to improve communication between nurses and patients.

34
 CHAPTER FIVE

5.0 Discussion of Findings

5.1 Identification of Key Findings

With respect to the findings, different statistical tools were used to analyze the data such as

tables, charts as well as percentages in order to make accurate discussion of findings.

According to the findings, majority of the respondents are between the ages of 18-27 years with

a high percentage of 40% (table 4.1). Also the majority of the respondents are females with 60%

of the respondents (table 4.2). With regards to the educational qualification of the respondents,

the highest percentage of the respondents 48% obtained a SSCE holders, followed by those with

DIPLOMA holders (26%), followed by those with DEGREE qualifications (20%) and the least

are those with other certificates (6%)(table 4.3). Likewise with regard to the occupational status

of the respondents majority are students (30%), then civil servants (26%), Business people

40%,other 4% and as shown in figure(table 4.4) All these information show that, the

respondents are capable enough to provide credible information to the researcher.

However with regard to the barriers to effective communication among patients, it was

discovered that; Socio-cultural differences, large number of patients and shortage of nurses,

nonconductive environment, Inadequate knowledge of nurses on communication are all barriers

to effective communication between nurses and patients as shown in tables 4.4, 4.5, 4.6 and

figure 4.7,majority of the respondents agree. This also corresponds with the findings in

literature review 2.1.7.

35
However with respect to the benefits of effective communication, findings reveal that effective

communication helps to reduce level of patients anxiety during hospitalization, initiate nurse-

patient relationship, reduces patient’s personal stresses, majority of the respondents agree as in

table 4.7, 4.8, and in 4.9, this is also in line with 2.1.4 of my literature review, as the purposes of

effective communication, in 2.1.7 stated the importance of effective communication.

Considering measures to improve effective communication between nurses and patients, the

findings show that most of the respondents agree that provision of conducive environment,

adequate nursing staffing and further training of nurses on communication are all measures to

improve therapeutic communication between nurses and patients (Reference to table 4.10, 4.11

and figure 4.12).This is in line with the findings in 2.1.5 .

However with respect to the knowledge of effective communication finding reveals that having

knowledge of effective communication help in good communication skill and also provide time

for the patient to ask questions, majority of the respondents agree as in table 4.7, 4.8, and in 4.9,

this is also in line with 2.1.4 of my literature review, as the purposes of effective

communication, in 2.1.7 stated the importance of effective communication.

5.2 Implication Of Findings With Literature Support

From the findings of this study, the barriers to effective communication are large number of

patients and shortage of nurses, non conducive environment, language differences, and

sociocultural factors, in which 96% of the respondents said that it is true that large number of

patients and shortage of nurses is a barrier to effective communication. Majority of the

respondents also agree that non conducive environment, language differences, and sociocultural

36
factors are responsible for poor communication and this is in line with the results derived from

literature review by Collins and Matte in 2.1.6.

5.3 Align Findings With Findings Of Previous Studies

According to a research conducted by Abbas Ebadi to investigates the nurse patient and

environment related communication barriers where it reveals that heavy nursing work, hard

nursing tasks and lack of welfare to nurses were the main communication barriers from the

nurses views. From the patients views, unfamiliarity of nurses with other languages, having

contagious diseases, sex differences between nurses and patients were determined as main

communication barriers. The shared communication barriers were age differences, social class

differences, and having contagious disease which is almost in line with the findings of this

research study where large number of patients and shortage of nurses, non conducive

environment, language differences and sociocultural factors were the main communication

barriers.

5.4 Implications Of Findings To Nursing

This research study will help the nurses to determine the possible measures to be taken in

improving their knowledge in rendering nursing care to patients. Base on the findings of this

study, the nurses will understand some solutions to certain communication barriers to help them

in rendering effective nursing care to clients.

5.5 Limitation Of The Study

The study is limited only to the general hospital Katsina due to financial constraints, inadequate

materials and time factor.

37
5.6 Summary Of The Study

The research study was conducted in General Hospital Katsina in order to come-up with the

impact of communication in rendering nursing care to client.

Relevance with the objectives, three (3) questions serve as a guide for the study. Related

literature were reviewed and summarized.

A descriptive research design was used for the study. The target population for the study

consisted of all patients and nurses in female medical and surgical wards General Hospital

Katsina. The sample size of the study comprises of 55 patients. The main instrument for data

collection was structured questionnaire. Validity and reliability of the instrument were ensured.

Data collected was analyzed by using descriptive statistics of frequency distribution tables and

charts.

5.7 Conclusion Of The Findings

Conclusively, sound communication is essential for rendering effective nursing care to patients.

From the data obtained through the research work load, non conducive environment, language

barrier, socio-cultural difference are barriers to effective therapeutic communication. Liikewise

good communication skills, providing time for the patient are among the knowledge of effective

communication. The various measures of improving communication were also identified among

which include; provision of conducive environment, adequate Nursing staffing and further

training of Nurses on communication.

5.8 Recommendations

The recommendations below are made base on the basic of research findings.

38
The hospital management should organize workshops, seminars, and Continue educational

programmes for nurses to enable them to update and acquire sound communication skills for

rendering effective nursing care to the patients.

The government should employ more staff nurses to reduce workload on the nurses.

The government should ensure provision of conducive hospital environment for effective

nursing care of the patients.

Nurses need to be humble, share empathy and hope to the patients to make them feel secured,

satisfied and adhere to treatment regimens.

Hospital management should ensure supervision of attitudes of nurses toward their

clients/patients and punish those found to be wanting.

5.9 Suggestions For Further Studies

In view of the above findings, with reference to the results of this research study which shows

that Nurses are not utilizing effective communication skills and patients are not satisfied with

their nurses during communication, I suggest further studies on:

Assessment of Nurses Attitude toward their clients /patients

Benefit of therapeutic communication towards improving nursing profession.

39
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Basavanthappa, BT. (2009).fundamentals of Nursing. (2 ed.). Jaypee brother

medicalPublishers (p) ltd.

Collins and Mattie (2013) communication in health care.The human connection in life cycle.

Toronto C. V. Mosby company

Elisevier. (2009).effective communication. From https:medical-dictionary.thefreedictionary.

Com/therapeutic communication.

Hicson, A. S. (2015).what are the benefits of effective communication. From. https://

www.livestrong.com /article /144777.

Indian Journal of palliative care (20)(1),12-20. From

https://www.ncbi.nlm.gov/pmc/articles/PMC3931236/

Neese, B. (2015)Effective communication in nursing:theory and Best practice. From online.

Sue. Edu./effective-communication-in-nursing/

Taylor, C. R., Lillis, C., Lemone, P., Lynn, P., (2011).Fundamentals of

Nursing; The art And science of nursing care. (7 ed.).

unugo, A.M. Use of English in communication. Jos, Nigeria. Carik communication (2012)

40