CHAPTER ONE

INTRODUCTION

Background of the Study

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

Caring which has been identified as the essence of nursing, the dominant, distinctive and underlying feature of nursing practice (Leininger, 1979in Erb and Kozier, 2008), has traditionally been at the core of nursing (Larrabee, Putman and Wu, 2006). Nursing as a profession places the greatest demands specific to the development and refinement of the caring component of nursing (Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010). Thus, the study of human caring as an essential characteristic of nursing practice has gradually expanded from early definitional, philosophical and cultural writings on the meaning of caring to evidence-based care (Boykin and Schoenhofer, 2000). To be meaningful, Azimzadeh, Rahmani, Valinzaadeh and Zamanzadeh (2010), maintained that nurse caring must be based upon mutual agreement between nurses and patients as to what constitutes nurse caring behaviours.

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Nurses cannot be certain that their behaviour is consistent with patients’ perception and expectations of their care. Nurses cannot therefore assume that patients perceive their caring efforts as they are intended. To avoid this problem, it is imperative that nurses validate with the patients that their care needs are being met (Azimzadeh, Rahmani, Valizadeh and Zamanzadeh, 2010).

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

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

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

Statement of Problem

Although the concept of nurse caring behaviour is central to the practice of nursing, there is, discrepancies as to a single definition of nurse caring behaviour. Patients and nurses differ in their perceptions of what they consider to be caring behaviour (Patistea, Siamanta, 1999). Major sources of information regarding patient’s perception of nurse caring behaviour are hospital satisfaction surveys conducted in United States of America. However, there may be some relationship between patients’ satisfaction and a patients’ perception of “very good care”, but they do not necessarily mean the same thing (Sossony and Poirier, 2007). Also surveying nurses’ satisfaction equally does not address nurses’ perceptions of what constitutes caring behaviour.

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Further comparism of what constitutes caring from both the patients’ and nurses’ perspectives will help patients, nurses and organizations as they continually seek to improve patient care.

In Nigeria care of patients has encountered several serious challenges that suggest a large disparity with international standards which must be filled. The perception of nurses’ caring behaviours varies from culture to culture as well as the setting of their practice. Complaints of poor attitude of nurses towards patients are rife and appear to be increasing. In Jos such complaints were observed on daily basis but escalated since the incessant civil unrest, emanating from the Boko Haram mayhem, with unprecedented casualties and subsequent increase in hospital admissions. This has led to the perception that nurses are increasingly distancing themselves from patients, and giving care that is not meeting patients’ expectations.

The researcher having stayed in the wards for not less than fifteen years of his clinical practice been in frequent contact with professional nurses and patients have observed that there are discrepancies in nurses’ and patients’ perception of the nurse caring behaviours from certain incidents. The nurse intends communicating caring, but the patients views the nurses action as uncaring (not indicative of caring). For instance, increase in workload which makes nurses prioritize care to the most seriously ill-patients with the tendency of leaving some patients unattended to is regarded as neglect by patients. Inattention or neglect however is unacceptable to both nurses and patients (Baldusdotti and Jonsdottier, 2002). A night nurse may order all patients to go to bed and sleep and consequently put off the bright light. The patients and her

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relatives may view the nurse’s action as doing that to pave way for her to go and sleep herself, and not purely having the interest of patients at heart etc.

In these instances, the nurse caring behaviours that the nurse perceived as indicative of caring is not perceived as such by the patient. These discrepancies may result in patients’ needs not being met leading to patients’ unsatisfaction with the care being rendered by the nurses. In the midst of these discrepancies, one therefore wonders whether there are congruencies in the nurses’ and patients’ perception of nurse caring behaviours as much as there are differences. The understanding is that emphasizing on nurse caring behaviours identified by both patients and nurses, may enhance patients’ positive response to care and hence win their cooperation in ensuring compliance to prescribed regimen or procedures of management. Based on the foregoing, the present study is designed to have a comparative analysis of patients’ and nurses perceptions of nurse caring behaviours in two tertiary hospitals in Jos.

Purpose of the Study

The purpose of the study was to have comparative analysis of patients and nurses’ perceptions of nurse caring behaviours in two tertiary hospitals in Jos, North-central Nigeria.

The following specific objectives were set for the study.

1.                 To determine nurse caring behaviour statements that patients perceived as indicators of care.

2.                 To determine the most and least important nurse caring behaviours as perceived by patients.

3.                 To determine nurse caring behaviour statements that nurses perceive as indicators of care.

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4.                 To determine the most and least important nurse caring behaviours as perceived by nurses.