Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania

Isangula, Kahabi; Pallangyo, Eunice; Mbekenga, Columba; Ndirangu-Mugo, Eunice; Shumba, Constance

doi:10.1186/s12912-022-01021-x

“…This paper examines the ndings of 9 FGDs and 12KIIs [33][34] whose accounts included issues pertaining to PFS. Among the participants 90% were Female, 50% were aged 31-40 years and the majority of clients (61%) had primary or no formal education (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The paper draws from the ndings of a recent qualitative descriptive study on patient-provider relationships in rural Tanzania. The study employed a human-centred design approach to co-create an intervention package for improving nursepatient relationships between January and September 2022 [33][34]. A qualitative descriptive approach is appropriate for this inquiry as it aimed to develop an understanding and describe nurse-patient relationships without testing an existing theory [35].…”

Section: Designmentioning

confidence: 99%

The role and effectiveness of patient feedback system in strengthening patient-provider relationships in rural Tanzania

Isangula¹

2022

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Introduction: Patient feedback system forms an important entry point for medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on patient feedback systems in rural primary healthcare settings appears limited. Objective The paper builds on recent research on patient-provider relationships in rural Tanzania to examine the role and effectiveness of patient feedback systems in improving therapeutic relationships. Methods The paper examines the findings of qualitative descriptive research in rural Tanzania that employed a human-centred design approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili with purposefully selected providers, patients, and administrators to explore drivers of poor provider-patient relationships in the Shinyanga region of rural Tanzania. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a thematic analysis approach. Findings related to patient feedback systems are used for this paper. Findings: Most participants cited the benefits of an effective Patient feedback system as reducing patients’ confusion around the complaints process, promoting patients’ positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes were the most cited Patient feedback system however, there were widespread concerns about their accessibility and effectiveness. While the providers (nurses) and administrators described suggestion boxes as widely available, they affirmed not receiving feedback or complaints from patients for a very long time. Contrastingly, most patients described suggestion boxes as largely unavailable and ineffective, with concerns of non-user friendliness and non-responsiveness dominating. Conclusion Despite their potential benefits in healthcare service quality improvements, the availability, user-friendliness, and responsiveness of patient feedback systems continue to be challenging. A call is made to providers, health administrators and researchers to prioritise the patient feedback system as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity with care and satisfaction.

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“…This paper draws from a study that utilised a human-centred design approach to co-design an intervention package for improving nurse-client relationships in which examining the factors shaping therapeutic relationships in MCH care was one of its objectives [33][34]. Issues related to PFS emerged as some of the ndings in this study but were not examined in detail in previous publications emerging from the study.…”

Section: Discussionmentioning

confidence: 99%

The perceived role and effectiveness of patient feedback system in strengthening therapeutic relationships in rural Tanzania

Isangula¹

2022

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Introduction: Patient feedback system forms an important entry point for medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on patient feedback systems in rural primary healthcare settings appears limited. Objective The paper builds on recent research on patient-provider relationships in rural Tanzania to examine the role and effectiveness of patient feedback systems in improving therapeutic relationships. Methods The paper examines the findings of qualitative descriptive research in rural Tanzania that employed a human-centred design approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili with purposefully selected providers, patients, and administrators to explore drivers of poor provider-patient relationships in the Shinyanga region of rural Tanzania. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a thematic analysis approach. Findings related to patient feedback systems are used for this paper. Findings: Most participants cited the benefits of an effective Patient feedback system as reducing patients’ confusion around the complaints process, promoting patients’ positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes were the most cited Patient feedback system however, there were widespread concerns about their accessibility and effectiveness. While the providers (nurses) and administrators described suggestion boxes as widely available, they affirmed not receiving feedback or complaints from patients for a very long time. Contrastingly, most patients described suggestion boxes as largely unavailable and ineffective, with concerns of non-user friendliness and non-responsiveness dominating. Conclusion Despite their potential benefits in healthcare service quality improvements, the availability, user-friendliness, and responsiveness of patient feedback systems continue to be challenging. A call is made to providers, health administrators and researchers to prioritise the patient feedback system as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity with care and satisfaction.

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“…The problem with these efforts, however, is that they have failed to consider the complexities of provider-client relationships within MCH care. Evidence on therapeutic relationships from rural Tanzania indicates that provider-clients relationship is complex and interventions to strengthen such relationships may be impacted not only by patients' socioeconomic status, literacy, and behaviors but also by provider interpersonal skills and health system challenges (17)(18)(19)(20)(21)(22). A key health system challenge that is more likely to negatively impact nurse-client relationships is the quality of graduates of nursing training institutions.…”

Section: Conclusion: Improving the Nursing Curriculum Was Considered ...mentioning

confidence: 99%

Improving nursing education curriculum as a tool for strengthening the nurse–client relationships in maternal and child healthcare: Insights from a human-centered design study in rural Tanzania

Isangula

¹

,

Pallangyo²,

Ndirangu-Mugo³

2023

Front. Public Health

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BackgroundThere are growing evidence of poor nurse–client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes.ObjectiveMCH nurses and clients were invited to design an intervention package (prototype) to improve nurse–client relationships using a human-centered design (HCD) approach.MethodsA multi-step HCD approach was employed to first examine the contributors of poor nurse–client relationships using nine focus group discussions with nurses and clients and 12 key informant interviews with MCH administrators. Then, three meetings were held with 10 nurses, 10 clients, and 10 administrators to co-develop an intervention package to address the identified contributors. The solutions were validated by collecting qualitative information through six focus groups with nurses and MCH clients who were not involved in the initial HCD stages. Finally, refinement and adaptation meetings were held with 15 nurses, 15 clients, and 10 administrators. The data were managed with NVivo 12 software and analyzed thematically.ResultsNursing curriculum challenges contributing to poor nurse–client relationships in MCH care included inadequate content on nurse–client relationships specifically topics of customer care, communication skills, and patient-centered care; an inadequate practice on communication skills within nursing schools; and the absence of specific trainers on interpersonal relationships. Consequently, improving the nursing curriculum was one of the interventions proposed during the co-design and rated by participants as highly acceptable during validation and refinement meetings. Suggested improvements to the curriculum included increasing hours and credits on communication skills and patient-centered care, including customer care courses in the curriculum and creating a friendly learning environment for clinical practice on strengthening interpersonal relationships.ConclusionImproving the nursing curriculum was considered by nurses and clients as one of the acceptable interventions to strengthen nurse–client relations in MCH care in rural Tanzania. Nursing education policy and curriculum developers need to ensure the curriculum facilitates the development of much-needed interpersonal skills among nursing graduates for them to have positive therapeutic interactions with their clients.

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Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania

Cited by 15 publications

References 36 publications

The role and effectiveness of patient feedback system in strengthening patient-provider relationships in rural Tanzania

The role and effectiveness of patient feedback system in strengthening patient-provider relationships in rural Tanzania

The perceived role and effectiveness of patient feedback system in strengthening therapeutic relationships in rural Tanzania

Improving nursing education curriculum as a tool for strengthening the nurse–client relationships in maternal and child healthcare: Insights from a human-centered design study in rural Tanzania

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