Download PROFORMA FOR REGISTRATION OF SUBJECT FOR

PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms. KRUPA ELIZABETH JOY
FIRST YEAR M.Sc NURSING
PSYCHIATRIC NURSING
YEAR 2011-2013
EAST WEST COLLEGE OF NURSING, NO 63
OFF MAGADI MAIN ROAD, VISHVANEEDAM POST
BENGALURU-560091
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES.
BANGALORE. KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION.
Ms. KRUPA ELIZABETH JOY
1. NAME OF THE CANDIDATE AND 1ST YEAR M.Sc. NURSING
ADDRESS
EAST WEST COLLEGE OF NURSING
#63,BEL LAYOUT,OFF.MAGADI
ROAD,
VISWANEEDAM POST,
BANGALORE-91.
2. NAME OF THE INSTITUTION
EAST WEST COLLEGE OF NURSING.
BANGALORE.
3. COURSE OF THE STUDY AND M.Sc NURSING
SUBJECT
PSYCHIATRY NURSING
4. DATE OF ADMISSION
01/07/2011
“ASSERTIVE
COMMUNICATION
AND ITS BENEFITS IN NURSE
PATIENT RELATIONSHIP” AMONG
IV YEAR B.SC NURSING STUDENTS.
5. TITLE OF THE STUDY
2
6. A BRIEF RESUME OF THE INTENDED WORK
6.1. INTRODUCTION
If you just communicate you can get by, but if you skillfully communicate, you can
work miracles .- Jim Rohn.
Communication is an activity of conveying meaningful information; it is
exchanging information in the form of messages, symbols, thoughts, signs and opinion. It
is a process by which meaning is assigned and conveyed in an attempt to create shared
understanding.1
Communication is defined as the exchange of thoughts, ideas, feelings,
information, opinions, and knowledge. It is also defined as an act by which one person
gives or receives from person information about that person’s needs, desires, perceptions,
knowledge or affective status2.
Communication process is classified into different types based on certain criteria
like the channels used for communication, style of communication, and relationship of
the communicators. One such communication is therapeutic communication. It is a
process in which the nurse consciously influences a client or helps the client to a better
understanding3.
Therapeutic communication is defined as the face to face process of interaction
that focuses on advancing the physical and emotional well being of a patient4.
According to a research by Press Ganey Associates Inc. The nurse patient
relationship sets the tone of the care experience and has powerful impact on patient
satisfaction. Nurses spend the most time with patients. Patients see nurses’ interactions
with others on the care team and draw conclusions about the hospital based on their
observations. Without a positive nurse patient relationship, there cannot be patient and
family satisfaction. Quality of communication in nursing has the highest impact on the
life of the patients5.
3
Communication is a life long learning process for the nurse. Nurses make the
intimate journey with clients and their families from the miracle of birth to the mystery of
death. It is necessary to build therapeutic communication for this journey. Like any
therapeutic agents, the nurse’s communication can result in both harm and good3.
Communication style is defined as how people communicate. Every posture,
every small expression and gestures, every word spoken, every attitude held all have the
potential to hurt or heal. This gives a tremendous ethical responsibility to each one to
communicate effectively. 6
Communication must be respected for its potential power and not carelessly
misused to hurt, or manipulate others. Good communication empowers others and
enables people to know themselves and make their own choices, an essential aspect of the
healing process. Nurses have wonderful opportunities to bring about good things for
themselves, their clients and their colleagues through proper communication. According
to Patient Care Seeking Communication (PCSM) there are nine sub constructs and
assertive communication is one among them7.
Assertive communication is defined as a communication in which individuals
clearly state their opinions and feelings and firmly advocate for their rights and needs
without violating the rights of others. Assertive communication is as a type of
communication which helps the communicator to feel good about oneself and increases
his or her self esteem. It helps to feel good about other people and increases the ability to
develop a satisfying relationship with others. Assertive communication style such as
open, dramatic, contentious are very essential for a nurse8.
Patients and families count on nurses to keep them informed, to connect them to
their physicians and other caregivers, to listen to them, to ease their anxiety, and protect
and watch over them during their healthcare experience. Because of these high
expectations of nurses, it’s no wonder that nursing performance, and more specifically,
the nurse patient relationship, is so central to patient satisfaction and a quality patient
experience for which assertive communication is very much required.5
4
Lack of assertive communication in nurses while caring for a patient causes
anxiety, frustration, discontentment, discouragement in the patient and thus affects the
health of the patient. Prioritizing all these issues it’s the need of the hour to focus more on
the aspect of educating the budding nurses about assertive communication and its benefits
in nurse patient relationship thus the quality of nursing care can be increased7
6.2 NEED FOR STUDY
Society views nurses favorably, often as benevolent, virtuous and admirable.
Nurses have been positively stereotyped as ‘ministering angels’ or ‘angels of mercy’.
And there is an increasing need for nurses to wok more in order to experience this
positive view of the profession first hand in clinical practice. It is important for the nurse
to become aware of and recognize their own behavioral responses.9
The ability to respond assertively is especially important to nurses who are
committed to further development of the profession. Assertive communication skills
facilitate the implementation of change- change that is required if the image of nursing is
to be upgraded to the level of professionalism that most nurses desire10.
Assertive communication is useful in the political arena for budding nurses who
chose to become involved at both state and national levels in striving to influence
legislation and ultimately improve the system of health care provision and automatically
the health of our country7.
According to an article by Wendy Leebov’s in AMERICAN NURSE TODAY he
defines a much more relevant goal for nurses- a goal to help nurses communicate
expertly. A study like this helps the budding nurses to remove the barriers and create the
conditions that make it possible for them to serve their patients and families with diligent
and compassionate care. And finally, to engage nurses’ hearts and minds in strengthening
their communication with patients and families11.
Nurses are so swamped. Their multiple responsibilities has become task-oriented,
not people oriented. Seeing nurses focus on the tasks and activities of their jobs, patients
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and families wonder, “Where has all the care gone?’’The caring is still there, but it might
as well not be if patients and families don’t see or feel it. That’s why there is a crying
need today to help the future nurses speak the language of caring, love, acceptance and
understanding so that their caring reaches the people they serve, and thus easing their
patients’ anxiety. Most of the research on nurse-patient interaction focuses entirely on the
nurse’s communication in the encounter, assuming the power position in the
relationship.12
In a study of social judgment and the social process of care experienced by
patients in a medical hospital setting, Johnson and Webb in 1995 found that nurses
exerted power over patients and that interactions were filled with conflict and struggle,
resulting in ‘acquiescence of patients to the nursing and medical goals of care’13.
According to a study conducted by Harrison in 1989, he found that a difference in
communication behaviors based on nursing related work experience. His study
emphasized on nursing students who had nursing related work experience and those with
no nursing related work experience. It was concluded that as nursing students gain more
experience and education, communication behaviors become less desirable. He
postulated that students may have learned appropriate communication skills but did not
fully incorporate the into their usual communication patterns. It has been suggested that
the health care environment prevents the integration and utilization of assertive
communication behavior. Further research in this area is warranted to deepen our
understanding of these processes and help the nursing students to know its benefits on
them as well as those entrusted to their care14.
Based on the researcher’s personal experience when working as a clinical
instructor, students in the final year of there studies became less sensitive to others
feelings and used threats to gain compliance or cooperation, disagreed frequently and
interrupted more and were unaware of the patients view. Being aware of the patients
desire to be respected and valued as a person, researcher identified that knowledge of
assertive communication and its benefits in nurse patient relationship is very necessary
for the fourth year nursing students so that they can treat the patient with respect.. As a
6
valued person, displaying understanding and holding normal conversation with the
patients and enabling them to have meaningful control over their care.
Researcher personally feels that assertive communication will indeed help the
nurse to understand patient’s personal experience of health and illness and to relay
meaningful information to the patients, which in turn will promote their wellbeing.
Keeping in view the above fact, the investigator planned to conduct a structured
teaching programme to the fourth year nursing students after assessing their knowledge
level in that area, which will find some information for further studies.
6.3 CONCEPTUAL FRAMEWORK
The conceptual framework Ludwig Von- Bertalanflyy (1968) theory has been
selected for this study. It is based on concept of general systems theory with input,
throughput, output and feedback.
6.4 REVIEW OF LITERATURE
Review of literature refers to the activities involved in identifying, searching for
information on a topic and developing an understanding of the state of knowledge on that
topic15.
Knowing what data are available often serve to narrow the problem itself as well as
the techniques that might be used. Literature reviews allows the researcher to acquaint
himself with current knowledge in the field or area before delving into area of study16.
In this study review literature has been divided into following:
1.
Studies and literature related to assertive communication.
2. Studies and literature related to nurse patient relationship.
3. Studies and literature related to knowledge of assertive communication and
its benefits in nurse patient relationship among nursing students.
7
1. Studies and literature related to assertive communication:
A descriptive study was conducted to analyze the concept of assertive
communication in Pusan National University. The purpose of this study was to analyze
and clarify the concept of assertiveness. This study used walker and Avant’s process of
concept analysis. The study was conducted on 100 students from Pusan National
University in Korea. The findings of the study were definition of assertiveness such as
self esteem, comprehension to others, and clarification of the subject, verbal
communication, and non verbal communication. The study concluded that assertiveness
is a core human behavior and is key to interpersonal relationships. Using the concept of
assertiveness many conflicts in any situation can be effectively prevented.17
A quasi experimental study was designed to assess the effects of assertive
communication in interpersonal relations and social behaviors. The objective of the study
was to examine the effects of assertive communication in interpersonal relations. The
sample included 44 students from college of nursing Korea University, Seoul, Korea. 20
in the experimental group, and 24 in the control group. Data was collected using
structured questionnaires over a 3 month period. There were greater significant increases
in scores of interpersonal relations and content of communication in the experimental
group than the control group. Also there was a significant decrease in the score of
interpersonal conflicts in the experimental group than the control group. Thus the study
concluded that assertive communication has an effect on increasing content of
communication and decreasing interpersonal conflicts.18
A study was patterned to assess the effectiveness of assertiveness training in
communication related behaviors among nurses. The purpose of the study was to
investigate the effects of assertiveness training on nurses’ assertive behaviors,
interpersonal relations and communication conflicts. A non- equivalent control group
pretest posttest design was used in this study. 39 nurses were assigned into experimental
or control groups. An assertiveness training program for nurses designed by Park was
used for the study. The assertiveness training program was effective in improving the
8
nurses’ assertive behavior. The study concluded that a significant contribution in
attempting such an intervention from nursing management perspectives is needed19.
2. Studies and literature related to nurse patient relationship:
A descriptive study was fashioned to assess the knowledge of effective nurse
patient relationship. The purpose of the study was to assess the knowledge of nurses
about nurse patient interaction, patient communication, nurse patient relationship and its
effects on patient. The study was descriptive in nature. 100 nurses from Brant community
health care system, Brantford, Canada were taken as samples and structured
questionnaire was used for the assessment. The study found that the way a nurse interacts
with the patient influences the health of the patient. The study concluded that a
significant study be carried out in this area gives quality to nursing profession20.
A study was conducted to assess the nurse patient relationship in the context of
life threatening or terminal illness, in patient chronic illness and primary care. The
purpose of study was to assess the behavior of nurse and the patient in all the above said
areas. Interviewing method was used on both nurses and patients to assess their
experiences of a nurse patient relationship.50 nurses and 50 patients from a psychiatric
unit from United Kingdom participated in the study. The study found that patient in nurse
patient relationship believes that these relationships were therapeutic however nurses
frequently expressed doubt about the value of their relationship with the patient. The
study concluded that time and attitude of both patient and nurse is essential in order to
develop a satisfying nurse patient relationship.21
A descriptive study to examines social judgment and social processes of care as
experienced by nurses and patient was conducted in a medical hospital setting in Egypt
the purpose of the study was to assess the social skills, awareness and previous
experience enabled him to successfully manage his social standing in this environment of
care.80 hospitalized patients participated in the study and it’s found that patients acted
purposefully and knowledgably in his interaction with the nursing staffs base on their
9
previous experience. The study concluded that the ability to assess and negotiate the
social environment of care is limited to patient and the interaction of the nursing staff22.
3. Studies and literature related to knowledge of assertive communication and its
benefits in nurse patient relationship among nursing students.
A study was conducted to evaluate the multiple component intervention to
support the implementation of a 'Therapeutic Relationships' best practice guideline on
nurses' communication skills among nursing students in school of nursing, university of
Ottawa, Canada. The purpose of the study was to determine if there was an improvement
in nurses' communication skills 5 months after a multiple component intervention to
implement the Registered Nurses' Association of Ontario best practice guideline
'Establishing Therapeutic Relationships'. A matched pair, before and after design was
used. Eight client scenarios with corresponding client comments were read aloud to
nursing students who were asked to respond verbally, as though they were interacting
with the client. Responses were audio-taped and transcribed. The frequency and quality
of nursing students' active listening, initiating and assertiveness skills were measured preand post-implementation of the guideline. Twenty-two nursing students responded at
both time points. Active listening skills were most frequently used. There was a
statistically significant decrease in the number of active listening skills used, but a
statistically significant improvement in the quality of active listening and initiating
statements and frequency of initiating skills. Nursing students demonstrated
improvements in selected communication skills following the implementation of a
multiple component intervention that included a best practice guideline. The study
concluded that improvements in communication skill are essential to the establishment of
therapeutic nurse patient relationship23.
A study was formulated to evaluate an assertiveness training program on
nursing and medical students' Nursing Department, Tri-Service General Hospital, Taiwan
on assertiveness, self-esteem, and interpersonal communication satisfaction. This study's
objective was to evaluate the effect of an assertiveness training program on nursing and
medical
students'
assertiveness,
self-esteem,
10
and
interpersonal
communication
satisfaction. Using a longitudinal research design,69 participants whose scores on the
Assertive Scale were < or = 50% (i.e., low assertiveness) and who were willing to
participate were included and assigned to an experimental group (33 subjects) or
comparison group (36 participants; participants were matched with the experimental
group by grade and sex).Participants in the experimental group received eight 2-h
sessions of assertiveness training once a week. Data were collected before and after
training and again one month after the end of the training using the Rotter's Internal
versus External Control of Reinforcement Scale, Sex Role Inventory, Assertive Scale,
Esteem Scale, and Interpersonal Communication Satisfaction Inventory. The generalized
estimated equation (GEE) method was used for statistical analysis. The assertiveness and
self-esteem of the experimental group were significantly improved in nursing and
medical students after assertiveness training, although interpersonal communication
satisfaction of the experimental group was not significantly improved after the training
program24.
A study was designed to assess the effects of assertive communication in
interpersonal relations and social behaviors. The objective of the study was to examine
the effects of assertive communication in interpersonal relations. The study employed a
quasi experimental design. The sample included 44 students from college of nursing
Korea University, Seoul, Korea. 20 in the experimental group, and 24 in the control
group. Data was collected using structured questionnaires over a 3 month period. There
were greater significant increases in scores of interpersonal relations and content of
communication in the experimental group than the control group. Also there was a
significant decrease in the score of interpersonal conflicts in the experimental group than
the control group. Thus the study concluded that assertive communication has an effect
on increasing content of communication and decreasing interpersonal conflicts18.
A study was done to assess the factors Essential for effective communication in
nursing students such as assertiveness, conflict management, delegation, and motivation
for their future practice. The purpose of the study was to assess the ability to
communicate effectively with a multidisciplinary team in an assertive manner to resolve
conflict, motivate others, and delegate tasks among nursing students to promote a
11
harmonious work environment.70 nursing students from Memorial Sloan Kettering Care
Centre, New York, USA were taken as sample. The study found that Acquisition of this
skill is often a combination of inherent attributes and learned experiences. Nursing
students are encouraged to seek expertise from other departments (e.g., Human
Resources) to help them develop similar programs.25
6.5. STATEMENT OF PROBLEM
‘
A
Study To Assess The Effectiveness Of Structured Teaching Programme on
“Knowledge on Assertive Communication And Its Benefits In Nurse Patient
Relationship” Among IV Year B.Sc Nursing Students In Selected Nursing Colleges At
Bangalore’.
6.6. OBJECTIVES OF THE STUDY
1. To assess the pre test levels of knowledge on assertive communication and its benefits
in nurse patient relationship of IV year B.Sc nursing students.
2. To assess the post test levels of knowledge on assertive communication and its benefits
in nurse patient relationship of the study participants.
3. To evaluate the effectiveness of structured teaching programme on assertive
communication and its benefits in nurse patient relationship by comparing the differences
between the pre test and post test knowledge scores.
4. To associate the pre tests mean knowledge score with selected socio demographic
variables of the study participants.
6.7. OPERATIONAL DEFINITION
Effectiveness:
It refers to the outcome of structured teaching programme in
increasing the knowledge of IV year B.Sc nursing students regarding assertive
communication and its benefits in nurse patient relationship.
12
Knowledge: Awareness of information or understanding regarding assertive
communication and its benefits in nurse patient relationship among IV year B.Sc
nursing students which is obtained through structured knowledge questionnaire.
Structured Teaching Programme: It refers to a well planned and organized
contents on assertive communication and its benefits in nurse patient relationship for
IV year B.Sc nursing students.
Assertive communication: It refers to positive and confident way of communication
by a nurse in nurse patient relationship.
Nurse Patient relationship: It refers to the therapeutic relationship between the
nurse and a client on a series of interacting and developing overtime.
Nursing students: Male and female individuals studying in IV year B.Sc nursing
course in selected recognized nursing colleges at Bangalore.
6.8. HYPOTHESIS
H1: There will be significant difference between the mean pre-test and post-test
knowledge scores.
H2: There will be significant association between pre-test knowledge scores and posttest
knowledge scores with selected demographic variables.
6.9. ASSUMPTION
IV year B.Sc nursing students may not have much knowledge on assertive
communication.
7. METHODOLOGY
7.1.Research approach:
Quantitative research approach.
7.2. Research design:
Pre-experimental research design.
13
7.3. Setting:
The study will be conducted in selected Nursing Colleges Bangalore.
7.4. Population:
All IV year B.Sc nursing students from Rajajinagar, Bangalore.
7.5. Sample size:
N= 60
7.6. Sampling techniques:
In this study Simple randomization technique will be adopted.
7.7. Sampling criteria:
Inclusion criteria

Both male and female fourth year B.Sc nursing students

Students who are willing to participate in the study.

Students who are available at the time of data collection.
Exclusion criteria

Students who are not available at the time of study.

Students who are not willing to participate.
7.8. Tools for data collection:
Tool I: Socio demographic data sheet.
Tool II: Structured questionnaire to assess the knowledge on
Assertive communication and its benefits in nurse patient relationship among
nursing students.
14
7.9. VARIABLES:
Dependent variables:
Knowledge of IV year B.Sc nursing students regarding assertive
communication and its benefits in nurse patient relationship.
Independent variables:
Structured teaching programme on assertive communication and its
benefits in nurse patient relationship.
Extraneous variable:
Age, gender, religion, socio economic status, occupation and source of
information on assertive communication.
7.10. Method of collection of data:
After obtaining permission from the concerned authorities and informed consent
from the samples, the investigator will collect the data. Pretest will be conducted to assess
the knowledge of fourth year B.Sc nursing students on assertive communication and its
benefits in nurse patient relationship with the help of structured questionnaire. On the
same day structured teaching will be conducted. Post test will be conducted with the
same questionnaire after 7days of structured teaching programme.
7.11. Methods of data analysis:
The data collected will be analyzed by using descriptive and inferential statistics.
Frequency, percentage, mean and standard deviation will be used to assess the level of
knowledge and paired-t test will be used to compare knowledge. Chi square test will be
used to find the association between selected demographic variables with level of
knowledge among the study participants.
7.12. Duration of data collection:
6 – 8 weeks.
15
7.13.Projected outcome:
This study helps the nursing students to be clear in their duty role in all working
relationship in their future carrier.
7.14. Delimitation:
Study is delimited to IV year B.Sc nursing students in selected nursing colleges
at Bangalore.
7.15. Does the study require any investigation to be conducted on patient or other
human or animals? If so please describe briefly.
Yes, only information collection and delivery of information. No invasive or trial
of drug, procedure included.
7.16. Has the ethical clearance has been obtained from your institution in case of
7.15?
Yes, the copy has been enclosed.
16
8. LIST OF REFERENCES:
1. Sr. Nancy. Text book of principles and practices of nursing;5thed; N R
publications; NewDelhi; 2005; p:452-59
2. Caur Mahinder .Text book of nursing education;2nd ed; V publications; New
Delhi;2000;
3. Potter .A. Patricia and Perry Anne Griffin; Text book of fundamentals of nursing,
6th ed; Elseiver publication; New Delhi; p: 168-71.
4.
Gupta R.K. Text book of new approach to mental health nursing;
P.V.Publications; 2000;p:142-3
5. Articles related to nurse patient relationship the free encyclopedia available from
URL:http://www.quality patient experience.com.
6.
Clement I.Text book on communication and educational technology. 1st ed;
EMMESS medical publishers; 2008.
7. Articles related to communication, the free encyclopedia. Available from:
URL:http://www.en.wikipedia.org
8. Dr. Mrs. Lalitha K. Mental Health and Psychiatric Nursing An Indian
Prospective; I ed; V M G Book House publications; Bangalore; 2007;p: 498
9. Becker.H.S, outsiders: studies in the sociology of deviance, free press, New York;
URL:http://www.medline.com
10. Gibb.H and o’brien B,journal of advanced nursing. URL:http://www.medline.com
11. Wencly
leeboys
,article
on
American
nurses
today,
new
York.
URL:http://www.pubmed.com
12. Alt schul A, international journal of nursing studiesURL:http://www.google.com
13. Carveth J A perceived patient deviance and avoidance by nurses, nursing
research. URL:http://www.en.wikipedia
14. Harrison T, assessing nurses communication a cross sectional relationship,
western journal of nursing research. URL:http://www.en.wikipedia
15. Poilt D F and Hungler B P nursing research; Text book of principles and practice;
Lippincott publications;Philadelpia;1999;p:657-58.
17
16. Dr. Mr. Kothari. Research methodology: method and technique. Google result.
2008. Available from: URL: http//www.books.google.co.in
17.
Tachan Kanho Hakhoe Chi. Article in Korea; College of nursing; Pusan
national university URL: http://www.wikidoc.org/index.php
18.
URL: http://www.wikidoc.org/index.php
19.
Kang M.J Pusan national university hospital, department of nursing, Pusan
Korea. URL: http://www.wikidoc.org/index.php
20.
Mathew S P measurement of psychological aspects of the nurse patient
relationship, nursing research. URL:http://www.google.com
21.
Trojan l and yonge o.developing caring relationships,home care nurses and
elderly clients, journal of advanced nursing. URL:http://www.pubmed.com
22.
Parson t the social system the free press glance. URL:http://www.medline.com
23.
Edwards
N,Peterson,Davies
bc
patient
educ
couns,epub,2006URL:http://www.pubmed.com
24.
Lin
YR,shiah
IS,
Chou
K
R,nurse
educ
today,2004.URL:http://www.pubmed.com
25.Walzak mb,absolon PL,J .nuses staff DEV memorial sloan kettering care centre
new York,USA. URL:http://www.pubmed.com.
18
9.
Signature Of The Candidate:
10.
Remarks Of The Guide:
11.
Name And Designation Of (In Block
Letters):
11.1
The Guide:
11.2
Signature:
11.3
Co-Guide:
11.4
Signature:
11.5
Head Of The Department:
11.6
Signature
12.1
Remarks Of The Principal:
12.2
Signature
19