Which Psychophysiologic Factors Can Influence Communication Between a Nurse and a Client?

Heliyon. 2022 Oct; 5(x): e02665.

Predictors of therapeutic communication betwixt nurses and hospitalized patients

Robera Olana Fite

^aSection of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Federal democratic republic of ethiopia

Masresha Assefa

^aDepartment of Nursing, Higher of Health Sciences and Medicine, Wolaita Sodo Academy, Wolaita Sodo, Ethiopia

Asresash Demissie

^bSection of Nursing, College of Wellness Sciences, Jimma University, Federal democratic republic of ethiopia

Tefera Belachew

^cSection of Reproductive Health and Family unit Policy, College of Health Sciences, Jimma University, Ethiopia

Received 2022 Feb three; Revised 2022 May ane; Accepted 2022 October xi.

Abstract

Background

Therapeutic communication is a purposeful interaction betwixt health professionals and patients that helps to achieve positive wellness outcomes. There is a pressing need for enquiry examining factors influencing effective implementation of therapeutic advice in relation to patient-centered care and satisfaction.

Objective

This study was aimed at determining the effective implementation of therapeutic advice and its predictors.

Methods

Institution based cantankerous-sectional report was conducted at the Jimma University Specialized Hospital from March 21 to April ix, 2016. Ane hundred 90 ii patients were recruited using stratified sampling. A questionnaire was used to collect data. One-way ANOVA for mean departure past socio-demographic characteristics, simple and multivariable linear regressions were conducted.

Results

The report revealed that 67(34.9%) of the patients rated high level of therapeutic communication. Significant predictors of therapeutic communication implementation were educational status (β = 5.87, P = 0.011), language departure (β = -half dozen, P = 0.014), instruction divergence (β = 5.21, P = 0.010) and perceived patient view score (β = 3.57, P˂0.001).

Decision

Therapeutic communication was poorly implemented. Education, language divergence, teaching difference and perceived patient view scores were significant predictors of therapeutic communication.

Keywords: Health profession, Public health, Surgery, Disquisitional care, Evidence-based medicine, Clinical research, Nursing, Therapeutic, Advice, Predictors, Admitted patients, Nurses

1. Introduction

Nursing do is related to the interrelationships of people. Hildegard E. Peplau'south theory of interpersonal relations stated that the relationship has orientation, identification, exploitation, and resolution phases (Peplau, 1952). This interactive relationship is a powerful medicinal tool (Peplau, 1952; Hemsley et al., 2011). Therapeutic communication is a central chemical element of the nurse-patient interaction, which helps to reach positive health outcomes (Lima et al., 2012; Rezende et al., 2013). Younis et al. (2015). The importance of nurse-patient advice in the nursing profession has been stated since the 19th century (Fleischer et al., 2009). An essential nursing skill is providing care by showing concern and supporting the patient with a good give-and-take (Włoszczak-szubzda and Jarosz, 2013).

The nursing process is accomplished through an interpersonal environment. Each interaction relied on the principle that promotes well-beingness and enhances satisfaction (Younis et al., 2015; Henson, 2007). According to the Globe Health Arrangement (WHO) report, communication serves an instrumental function that is at the heart of who nosotros are every bit homo beings (WHO, 2010). Co-ordinate to the Ethiopian Federal Ministry of Health reference manual for nurses and health care managers, nurses' advice should be authentic, timely and effective (Ministry building of Health, 2011). Faye Glenn Abdellah has described that communication incorporates verbal and non-exact aspects (Abdellah et al., 1960). Nonverbal communication is expressed through body motions, touch, facial expressions, reflexes, gestures, center contact, postures, groaning, grunting, crying, cultural artifacts and appearances (Roberts and Bucksey, 2007).

Therapeutic communication is a purposeful interpersonal interaction. Information technology allows an efficient exchange of information (United kingdom Essays, 2015). According to Health as Expanding Consciousness theory, the human relationship has a purpose of identifying meaningful patterns and facilitating customer's determination-making (Newman, 1997).

Nurses spend xx%–thirty% of their time for providing direct care at medical-surgical care unit of measurement (Hendrich et al., 2008). Regardless of the employment setting, there is consensus inside the nursing field that effective therapeutic communication is integral to good practice (Webster, 2013; Molla et al., 2014; Finke et al., 2008; Bridges et al., 2013). Nevertheless, nurses working in the general wards often do non consider advice as a key component of nursing service commitment (Bridges et al., 2013; Cristhiane et al., 2013; Chapman, 2009). This has an impact on the patient's satisfaction (Mcgilton et al., 2012; Haugan, 2014; Hemsley et al., 2011; Lasiter, 2014). Information technology also increases the length of hospital staythat accounts for 53% of hospitals' total waste (Agarwal et al., 2010).

Therapeutic communication is based on trust, respect, faith, hope, fulfillment of emotional, physical and spiritual needs (Pullen and Mathias, 2010, 2011; Travelbee, 1964). Virginia Henderson stated that nurses should deed equally a substitute for the patient, helper to the patient and a partner with the patient (Henderson, 1964). Furthermore, nurses should utilize articulate, simple, and objective questions (Dewar and Nolan, 2013; Moser et al., 2010). According to Watson, a nurse-patient relationship implies congruence, empathy, non-possessiveness, warmth, and effective communication. Effective advice has cognitive, melancholia, and behavior response components (Watson, 1997).

Nurse characteristics, time, organizational values, and socio-demographic characteristics affected nurses' ability to establish interaction (Madula, 2013; Ojwang et al., 2010; Berry, 2009; Sheldon et al., 2008; Anoosheh et al., 2009; Peters et al., 2013; Rasheed, 2015; Zamanzadeh et al., 2014; Chapman, 2009). Furthermore, specific patient characteristics, sensory harm, personality, inability, and psychological barriers touch the therapeutic communication (Bakhtiari and Moshtagh, 2007; Anoosheh et al., 2009; Albagawi, 2014).

To ameliorate patient satisfaction towards the nursing care, researchers must identify factors influencing the effective implementation of therapeutic communication between nurses and patients (Devi and Victoria, 2013; Balandin, 2007). Therefore, this written report tries to quantify the relationship between therapeutic communication and its predictors using linear regression. The finding is likewise important in strengthening the concept incorporated in the Hildegard East. Peplau Theory of Interpersonal Relations. To the all-time of our knowledge, there is no documented bear witness regarding the constructive implementation of therapeutic communication and its predictors in Federal democratic republic of ethiopia. Identifying factors that influence the therapeutic communication might exist supportive for the successful accomplishment of a policy aimed at creating compassionate, respectful and caring health professionals.

2. Materials and methods

ii.ane. Study setting

The report was conducted at the Jimma University Specialized Hospital (JUSH), which is plant in Jimma town. It is the only teaching and referral hospital in the southwestern role of the state. Information technology provides services for about fifteen million people. Annually, it delivers service for 15,000 inpatient, 160,000 outpatient, xi,000 emergency and 4500 obstetrics cases.

2.ii. Study flow, pattern and population

The study was conducted from March 21–April 9, 2016. An institution based cross-sectional written report blueprint was used.

The source population was admitted patients and the study population was sampled patients who fulfilled the inclusion criteria. Patients who were at least 18 years old and hospitalized for at least three days were included in the study.

2.3. Sample size and sampling technique

The sample size was determined using single population proportion formula with the following assumptions: 50 % proportion, Z a/2 is the Z value at 95% Confidence level (1.96) and 0.05 margin of error (d). Since the source population was 344 (˂10,000), finite population correction formula was used. Adding 10% for the non-response rate, the last sample size was 200.

A stratified sampling technique was employed. The ward was considered equally a stratum and samples were selected inside each stratum by using unproblematic random sampling method.

2.iv. Written report variables

two.4.1. Dependent variable

Effective implementation of therapeutic communication.

ii.four.two. Independent variables

Age, sex, language, educational condition, religion, emotional change, familiarity to the nurses' responsibilities, previous hospitalization, disease-related change, nurses' willingness to share information, understanding patients' needs, intimacy, attitude towards therapeutic communication, taking consent before procedures, unfamiliar medical terms use, ward and rooms condition, visitors presence, caretakers presence, working time, communicating other health professionals.

ii.5. Measures

2.5.1. Therapeutic communication

According to Peplaus' theory, nursing is a therapeutic process that involves a therapeutic human relationship between the nurse and patient. Therapeutic relationship involves a therapeutic communication (Peplau, 1997). There are three dimensions of therapeutic advice. These dimensions are Expressions group, Clarify group and Validation group techniques (Rezende et al., 2013; Lima et al., 2012). It was measured based on the five betoken calibration in the response choice, i.e. one = Never, 2 = Rarely 3 = Sometimes, iv = often and five = Always. The total scores range from 18-90. Sum scores were used for computing the overall therapeutic communication score. A tertiale assay used to classify the level of therapeutic advice. The dimensions of therapeutic communications are defined as:

Expression group techniques: are methods that facilitate the expression of thoughts.
Analyze grouping techniques: are methods that enable clarifying what is expressed by the patient.
Validation grouping techniques: are methods that enable the establishment of a common meaning of what is expressed by the patient.
Linguistic communication difference: It implies spoken language difference between the nurse and patient.
Education difference: It implies an educational status divergence between the nurse and the patient.
Perceived patient view score: It was assessed through a question asking whether the nurses gave adequate description concerning the disease and procedures. The response included the two categories: (1) No (2) Yes.
Patient related factor: It refers to familiarity to the nurse'south duties.

2.vi. Information drove

two.6.1. Structured questionnaire

The structured questionnaire was adapted after a review of different literatures (Cristhiane et al., 2013; Webster, 2013; Anoosheh et al., 2009; Albagawi, 2014). The questionnaire sought data on respondents' socio-demographic characteristics, perceived implementation of expression techniques (α = 0.732), perceived implementation of clarify techniques (α = 0.739), perceived implementation of validation techniques (α = 0.829), overall patient agreement on the effectiveness of therapeutic advice technique implementation (α = 0.704), patient agreement on patients, nurses and system related factors (α = 0.829). The validity of the questionnaire was also considered. A valid questionnaire was adapted and opinion from the experts working in the Jimma University and nurses working in the Shenen Gibe Hospital was obtained. A pre-exam and modification of vague concepts was washed.

3 laboratory technologists working in JUSH, who were fluent speakers of the Afan Oromo and Amharic languages, were recruited as the data collector. One supervisor was supervising the data collection. Training was provided for the data collectors and the supervisor for two days. The training focused on the study objective, meaning of each question and interview techniques. In addition, the part of data collectors and supervisor was covered.

2.7. Data quality

The English version of the data-collection tool was translated to Afan oromo and Amharic language, so re-translated in the English version to evaluate its consistency. Pretesting of the information collection tools was conducted at the Shenen Gibe Hospital using, 5% of the total sample. Training and supervision were provided for the information collectors and the supervisor. Code was given on the questionnaires. Data collectors and supervisor checked the filled questionnaire for completeness every day. Reckoner frequencies and data sorting were used to check for missed variables, outliers or other errors during data entry.

2.8. Data processing and analysis

Data were checked for completeness, and and so each completed questionnaire was assigned a unique lawmaking. Subsequently, the data was entered using EpiData Director (V2.0.0.25) and EpiData Entry Client (V2. 0.7.22). The generated information were exported to SPSS version 20. The data were cleaned by visualizing, calculating frequencies and sorting. 1-way ANOVA for mean divergence by socio-demographic characteristics was done. Bivariate analyses between dependent and independent variables were performed using simple linear regression. Enter method was used to enter variables during the bivariate analysis. All explanatory variables that had clan in simple linear regression analysis with p-value less than 0.25 was entered into multvariable linear regression model. Enter method was used to enter variables into the final model. Linearity was checked. Normality of the information was assessed using a normality plots with tests, Kolmogorov-Smirnov test and Shapiro-wilk test. Outliers were checked. Levene's Test for Equality of variance was used to check homogeneity of variance. Co-linearity between predictor variables were checked using Tolerance and variance aggrandizement cistron (VIF). A P-value less than 0.05 was taken equally meaning association. Results were presented in text, effigy, and tables.

2.9. Upstanding considerations

Ethical clearance was obtained from the institutional Review board of Jimma University (RPGC/40739/2076). Verbal informed consent was taken from respondents and the participants assured that their participation recorded anonymously.

three. Results

In the report, 192 admitted patients participated obtaining a response rate of 96%.

iii.1. Socio-demographic characteristics

Majority (54.ii%) were female and 113 (58.nine%) were betwixt the ages of 25 and 34. The hateful age was 32.23 ± six.94 with a range of 19–52. More than two-thirds (72.9%) were married (Table 1).

Table 1

Socio-demographic characteristics of patients.

Variables		Frequency	Percent
Sex	Female	104	54.2
Sex	Male	88	45.8
Age	18–24	26	thirteen.5
	25–34	113	58.9
	35–44	40	twenty.8
	≥45	13	6.8
Marital status	Married	140	72.9
Marital status	Not married	52	27.1
Religion	Muslim	113	58.9
	Orthodox	58	thirty.2
	Protestant	17	8.ix
	Catholic	2	1.0
	Others	ii	1.0
Education	No formal education	63	32.viii
	Primary(grade one–8)	64	33.3
	Secondary(course ix–12)	53	27.6
	Mail-secondary(12+)	12	half-dozen.3
Ethnicity	Oromo	120	62.five
	Amhara	31	16.1
	Dawro	xviii	9.iv
	Keffa	12	6.2
	Tigrie	3	i.6
	Others	8	4.2
Occupation	Unemployed	66	34.4
	Private	45	23.4
	Farmer	43	22.four
	Government employed	25	thirteen.0
	Others	13	half-dozen.viii

three.ii. Effective implementation of therapeutic advice techniques

Expression, clarification and validation group techniques had mean scores of 35.24(SD = 9.72), 12.75 (SD = 3.32) and nine.53(SD = 2.xc), respectively (Table 2).

Tabular array 2

Descriptive statistics of constructive implementation of therapeutic communication techniques.

Techniques	Items	Range	Hateful (SD)
Techniques of expression group	xi	xi–55	35.24(9.72)
Techniques of description group	4	four–xx	12.75(3.32)
Techniques of validation group	iii	3–fifteen	9.53(2.xc)

3.3. Patient agreement on effectiveness of therapeutic advice

Patients admitted in Gynecology ward rated higher therapeutic communication mean score (mean = 4.18, SD = 1.04) as compared with patients admitted in Surgical ward (mean = 3.55, SD = 1.24), Obstetrics ward (mean = 3.53, SD = ane.12), Medical ward (mean = 3.78, SD = 1.03) and Ophthalmology ward (mean = iii.24, SD = ane.49). In surgical ward, the highest ranking was participation in decision-making (hateful = iii.65, SD = 1.26) and having word with the nurse on self-care beliefs and cocky-reliance (mean = 3.66, SD = 1.25). In obstetrics ward, the highest ranking was having word with the nurse on self-care behavior and self-reliance (mean = iii.73, SD = 1.23). Acceptable and clear description was the highest ranking in gynecology ward (hateful = iv.30, SD = 0.97) and medical ward (hateful = iv.00, SD = i.05).In ophthalmology ward the highest ranking was having adequate fourth dimension to express patients' feeling and worries (mean = three.90, SD = 1.02) (Table iii).

Table 3

Descriptive statistics of overall patient agreement on the implementation of therapeutic communication.

Detail	Wards
	Surgical	Obstetrics	Gynecology	Medical	Ophthalmology
	Mean(SD)	Mean(SD)	Hateful(SD)	Mean(SD)	Mean(SD)
Had adequate time to express my feeling and worries	three.48(one.12)	iii.63(0.76)	four.00(1.09)	3.97(0.99)	three.90(1.02)
Had adequate and articulate description concerning the disease and procedures	3.48(1.31)	3.27(1.20)	4.xxx(0.97)	four.00(ane.05)	3.xxx(1.38)
Participated in determination making	3.65(i.26)	3.40(1.22)	4.22(0.95)	three.76(0.86)	2.l(one.47
Discussed me on self-intendance behavior	3.51(1.26)	three.73(1.23)	4.17(1.11)	three.49(1.xv)	3.fifteen(1.72)
The nurse allowed me to ask questions	3.66(1.25)	three.63(1.19)	4.22(1.08)	iii.70(ane.10)	three.35(i.89)
Average	3.55(1.24)	3.53(1.12)	4.18(i.04)	iii.78(1.03)	3.24(ane.49)

three.iv. Therapeutic advice score of unlike categories

The therapeutic communication mean score differed significantly among the age groups and the 4 educational status groups (Tabular array four).

Table 4

ANOVA table showing the relationship betwixt unlike categories and therapeutic advice mean score.

Variables		Therapeutic Communication
Variables		N	Mean ± SD	F	P
Age	18–24	26	60.88 ± 12.16	ii.763	0.043
	25–34	113	57.88 ± 13.31
	35–44	twoscore	57.55 ± 15.54
	≥45	thirteen	47.54 ± 16.87
Teaching	No formal educational activity	63	61.71 ± xi.30	3.535	0.016
	Principal(ane–eight)	64	57.06 ± xiii.64
	Secondary(ix–12)	53	53.47 ± 15.91
	Post-secondary(12+)	12	55.75 ± 16.89
Religion	Orthodox	58	57.83 ± 11.25	0.293	0.882
	Muslim	113	57.09 ± fifteen.79
	Protestant	17	60.29 ± 11.85
	Catholic	2	54.50 ± 7.78
	Others	2	52.00 ± 16.97
Ethnicity	Oromo	120	58.34 ± 15.thirteen	0.237	0.946
	Amhara	31	56.29 ± viii.89
	Tigrie	3	53.67 ± 20.03
	Dawro	eighteen	56.eleven ± xiii.83
	Keffa	12	56.58 ± 16.03
	Others	eight	55.88 ± 13.23
Occupation	Government employed	25	56.84 ± 14.39	0.409	0.802
	Private job	45	58.29 ± xi.99
	Farmer	43	59.09 ± 12.89
	Unemployed	66	55.95 ± 16.32
	Others	13	58.85 ± 13.x

3.5. Level of constructive therapeutic communication

Mean score of effective implementation of therapeutic communication level was 57.52 ± xiv.x. Sixty-five (33.9%), threescore(31.3%) and 67(34.ix%) of the respondents reported low, moderate and high level of therapeutic communication (Fig. 1).

Level of therapeutic communication between nurses and admitted patients.

three.6. Predictors of effective implantation of therapeutic advice

Patients who had no formal pedagogy had on boilerplate five.870 higher therapeutic communication as compared to those who attended master education at p = 0.011. Language deviation had a negative association with the therapeutic communication. Accordingly, patients who had reported language divergence equally a factor influencing the constructive implementation of therapeutic communication had on average 6.002 lower therapeutic communication as compared to those who hadn't reported at p = 0.014. Patients who had reported educational difference as a factor influencing the effective implementation of therapeutic communication had on average 5.208 higher therapeutic advice as compared to those who hadn't reported educational departure as a cistron influencing the effective implementation of therapeutic advice at p = 0.010. In addition, perceived patient view score had a positive association with the effective implementation of therapeutic advice (Table 5).

Table 5

Predictors of effective therapeutic communication implementation between nurses and admitted patients.

Variables	Unstandardized coefficients		Standardized coefficients	P	95% CI
Variables	B	SD	Beta	P	95% CI
(constant)	61.85	5.53		0.000	(50.943,72.754)
Historic period	-0.26	0.14	-0.thirteen	0.060	(-0.521,0.010)
Education
No formal education	five.87	2.28	0.nineteen	0.011	(1.378,10.361)
primary(one–8)*
Secondary(9–12)	-ane.ane	2.43	-0.03	0.651	(-five.887,3.685)
Post-secondary(12+)	one.84	4.14	0.03	0.656	(-6.324,ten.015)
Language difference
Yes	-half-dozen	2.42	-0.16	0.014	(-10.786,-1.219)
No*
Education deviation
Yeah	5.21	ii	0.18	0.010	(1.262,nine.154)
No*
Perceived patient view score	3.57	0.95	0.25	<0.001	(1.698,5.448)
Patient related factor	0.14	0.29	0.03	0.634	(-0.440,0.720)

iv. Discussion

The study revealed 33.nine% of the nurses had low level of therapeutic communication, This implies that the communication skills they acquired through education was non adequate. It could be related to the lack of recurrent training therapeutic communication techniques.

Ineffective advice is reported as a significant factor in medical errors and inadvertent patient harm (Devi and Victoria, 2013). Current health system is aimed at creating competent and responsible health professionals (Ministry building of Health, 2011).With this depression level of therapeutic communication, information technology is hard to deliver the expected and high quality care. Hence, educational curriculum development near therapeutic advice is needed in all specializations and practice settings.

The report showed that the patients who had no formal education had on average 5.870 college therapeutic communications equally compared to those patients who attended chief educational activity. Patients' communication with nurses is directly influenced past their educational status. Furthermore, patients who had no formal didactics accept lowered capacity of obtaining and processing basic health information. The nurses might elaborate issues for those patients by because their inability to understand the information easily (Jahromi and Ramezanli, 2014).

Patients who had reported educational difference equally a factor influencing the therapeutic communication had on average 5.208 higher therapeutic communications as compared to those who had non reported educational difference every bit a factor influencing therapeutic advice. Patients who mentioned educational background difference as a factor influencing therapeutic advice might ask and interact effectively with the nurse.

Madeleine M. Leininger theory of culture intendance multifariousness and universality stated that nurses must meet the language demands of the patients (Leininger, 1985). In the study, patients who had reported language deviation as a factor influencing the therapeutic communication had on boilerplate vi.002 lower therapeutic communications equally compared to those who had not. This finding is consistent with other report results (Anoosheh et al., 2009; Fleischer et al., 2009; Bakhtiari et al., 2009), which indicated that patients who perceived language difference as a factor influencing the therapeutic communication faced a problem while communicating.

The customer who is in pain or preoccupied with their status might have difficulty of communicating effectively. In our written report, 41.6% of the patients reported that therapeutic advice was affected by their emotions. This finding is consequent with results reported by Zamanzadeh et al. (2014), who stated 73.6% of the patients felt that depression, fear and anxiety affected the therapeutic communication. Elderly patients emphasize mainly emotional change during their interaction (Lima et al., 2012).

In this report, 42.2% of the patients agreed that the presence of visitors afflicted the therapeutic communication. This is college than finding from a written report conducted in Iran, on barriers of nurse-patient communication, in which 21% of the patients reported the presence of the patients' visitors affected the nurse-patient communication (Bakhtiari et al., 2009). The discrepancy could exist due to socio-cultural, socio-economic and written report area difference. In addition, in our study area patient visitors were immune to enter into the infirmary despite the regular time of visits. This might increment the impact of the visitors on the therapeutic communication, equally they are available during nursing intendance and procedure.

In this study, 26% of the patients agreed that sexual practice departure affected the therapeutic communication, which is consistent with Bakhtiari et al. (2009) who reported that 34% of patients believed gender deviation affected therapeutic communication. This might be related to the community civilization and conventionalities.

Regarding available time for care, 36% of admitted patients agreed that information technology affects the therapeutic advice. Whereas, a report conducted in Iran showed that 56.4% of the patients described that nurses' lack of time influences the human relationship (Zamanzadeh et al., 2014). The discrepancy might be due to a difference in the workload of the nurses in the two areas. Workload affects fourth dimension available for therapeutic communication.

The finding from this study mainly reflects the state of affairs in Jimma University Specialized Hospital. Therefore, the findings should exist interpreted with circumspection. The result might be affected by social desirability bias. This in turn might overestimate the effective implementation therapeutic advice.

five. Decision

Therapeutic advice is ane part of nursing assessment and care. To provide high-quality intendance, predictors of effective implementation of therapeutic advice should exist recognized. In this report, constructive implementation therapeutic advice and its predictors were identified. The study has conspicuously shown low level of therapeutic advice implementation. The main factors influencing the therapeutic communication related to the patient, nurse and the organization were affliction-related change, use of an unfamiliar medical term and ward's status, respectively. Educational status, language divergence, education divergence and perceived patient view scores were found as significant predictors of therapeutic communication betwixt nurses and admitted patients.

Declarations

Author contribution statement

Robera Olana Fite: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, assay tools or data; Wrote the paper.

Masresha Assefa, Asresash Demissie, Tefera Belachew: Analyzed and interpreted the data.

Funding argument

This inquiry did non receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Competing involvement statement

The authors declare no disharmonize of interest.

Boosted data

No additional data is bachelor for this newspaper.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838810/