For instance, in emergency cases where there will be little time for verbal interaction, the use of non-verbal cues such as the holding of hand could carry much more words to patients [ 8 ].
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Even in cases where nurses are much experienced in therapeutic communication, there can still be a gap in communication as sometimes it becomes difficult to understand patients from their own viewpoints [ 8 ]. Therefore, this study sought to investigate the barriers to effective therapeutic communication among patients and nurses at the Komfo Anokye Teaching Hospital in Kumasi. Komfo Anokye Teaching Hospital KATH has a bed capacity of about with twelve 12 clinical directorates providing healthcare services to the people within the region as well as handling referrals from other closer regions.
This meant that participants would have communicated regularly with the nurses during their stay. Registered nurses employed full-time and having worked for four months or more at KATH were also included. An in-depth interview guide was used as the data collection instrument to gather in-depth information from participants.
The interview guide allowed the researcher to probe further in order to understand and explore participant contributions in as much depth as possible. An unstructured interview guide which followed an open-ended approach permitted the in-depth investigation of experiences and views regarding nurse-patient communication.
The interview guide contained interview questions on the demographic profile of nurses and patients as well as interview questions on Nurse-related barriers; Patient-related barriers and Environmental-related barriers to Therapeutic Communication. The interview days and time were discussed with participants and each interview was scheduled at their convenience. Participants were informed about the time before commencement. The data collected was then transcribed verbatim and analyzed through thematic content analysis.
This was done by listening to tape recordings and transcribing the content. The transcript was coded by going through the transcript line by line and paragraph by paragraph, to find significant statements and codes according to the topics addressed. The similarities and contrast within the data were compared by the investigators and data that seemed to cluster together were sorted into categories.
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The participants were purposively selected to participate in the study based on the characteristics they exhibited which were of interest to the researchers and were able to provide the needed information. According to Patton [ 9 ], the logic and power of purposeful sampling lie in selecting information-rich cases for in-depth study. A sample of 13 participants was used for the study which was made up of 6 nurses and 7 patients.
The interviews were conducted till a saturation point was reached after interviewing the 13th participant.
Saturation refers to the point at which new data collected and analyzed does not provide further meaning to the research question [ 10 ]. To ensure rigour, or the integrity in which the study was conducted, and ensure the credibility of findings in relation to qualitative research, several steps were taken to enhance the validity and reliability of the study [ 11 ].
Firstly, comparisons were done to find out similarities and differences across accounts to ensure that all different perspectives were represented. The context of the research and assumptions central to the study were thoroughly described to achieve transferability. The criteria applied were made explicit, according to the purpose and orientation of the study [ 12 ]. Furthermore, other researchers were engaged to reduce research bias and the researchers and supervisor again ensured that the findings, conclusions, and recommendations were braced by the data collected and that the interpretation of the data was meaningful and relevant to the study.
The study was conducted at Komfo Anokye Teaching Hospital which is a single facility and therefore the findings cannot be generalized. Some of the participants were not willing to respond to some of the interview questions due to its sensitive nature.
However, these limitations did not influence the findings of this study in any negative way. Thematic content analysis was used to analyze data collected based on the aims of the study. The results included background characteristics of study participants as well as the main and sub-themes of the study.
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Three main themes were derived from the data collected. The nurse related barriers came with sub-themes such as availability of nurses; inadequate knowledge; all-knowing attitude; dissatisfaction as well as the disease state and family interference. The environmental barriers included sub-themes such as noisy environment; new to the hospital environment and unconducive environment. From the table,five 5 of the study participants were females whiles eight 8 were males. Moreover, six of the participants were married and seven were single.
Most of the patient participants have attained their tertiary education while most of the nurses have attained their degree in nursing. Patient-related barriers are those obstacles directly from patients that inhibit effective therapeutic communication. These included characteristics such as age, religion, ethnicity among others that have the tendency of influencing communication. Those at the extremes of age will have difficulty as compared to those who are in their middle ages. Sometimes the younger ones act like they understand what we tell them and they are okay but in actual sense, they do not understand Participant 2.
Some patients are Muslims and would not want females to attend to them but they prefer males. People from different parts of Ghana have different cultures thus, culture and religion, patient status, all do count to add up to the personal barriers. There are also patients who would say no to blood but as a nurse, you have to use your discretion and this can alter effective communication between you and the patient Participant One echoed;. Patient-Nurse Relationship is essential for effective healthcare delivery. In this study, patients complained about their relationship with the nurses and the way the nurses attend to them when they are in need.
The nurses also admitted that the kind of relationship between the client and them also influences the level of effective communication. Misconceptions can distort effective communication. One individual may perceive another to be of a certain trait, character or of a certain attitude. I think we come with preconceived ideas because of what we hear about the nurses Participant 2. Some of us have misconceptions about nurses that they are rude and disrespectful so we already have something in mind before coming to the ward Participant 3.
Participants verbalized how pain act as a barrier to effective therapeutic communication;. In fact, whiles you are in pains and someone tries to even communicate with you, you sometimes get angry Participant 2. Language can act as a barrier to any form of communication and effective therapeutic communication is not an exception. Some of the patients complained that nurses mostly resorted to the Twi language when most of the patients have difficulties in understanding Twi. I am a Voltarian and would like the nurses to speak English because I do not understand Twi but they always speak Twi. Therefore, if a patient cannot speak English, it will be difficult communicating.
Majority of the nurses commented on how language was a problem to effective therapeutic communication. This category includes barriers related to attributes of the nurse. These attributes can be barriers in establishing a therapeutic nurse-patient relationship in the hospital. Six sub-themes emerged from it and they are inadequate knowledge, disease state, availability of nurses, all-knowing attitude, family interference, and dissatisfaction.
The Nurses complained that due to the small number of nurses and the workload it becomes difficult attending to all patients as and when they call. So you have to wait for quite some time and at times due to stress they end up forgetting that you called them Participant So most at times the nurses here, lets say patients are 31 and only 4 nurses are taking care of us.
Anytime you call the nurse, she will be busy doing something else and will tell you that she will be back soon. And as a human being, you can forget about things so easily.
So as the nurse is attending to a sick patient, she may also come to your direction and another sick person will also call the nurse so hardly do we communicate with them as often. They are always busy Participant 6. Most nurses admitted and verbalized that, some nurses had little knowledge on how to communicate with others. Lack of knowledge on therapeutic communication on the part of some nurses also contributed to ineffective therapeutic communication.
If there is a close relationship between the patient and the nurse, a patient can speak out all their problems to the nurse. I will say ignorance or nurse is not well abreast of what effective therapeutic communication is. A nurse who knows what effective therapeutic communication is will use it, especially if the nurse knows what it does to the healing process Participant Ethics and pain management in hospitalized patients.
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Pharmacogenomic considerations in the opioid management of pain.