Hum Resour Health. 2009 Jun 23;7:50. doi: 10.1186/1478-4491-7-50.
Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward.
Human resources for health
Rachel N Manongi, Fortunata R Nasuwa, Rose Mwangi, Hugh Reyburn, Anja Poulsen, Clare I R Chandler
PMID: 19549319
PMCID: PMC2706791 DOI: 10.1186/1478-4491-7-50
Abstract
BACKGROUND: Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania.
METHODS: The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention.
RESULTS: During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs.
CONCLUSION: The intended outcome of the intervention was not met. The priorities of the intervention--to improve nurse-parent relationships--did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions that were unsatisfactory to nurses.
References
- Int J Qual Health Care. 1999 Aug;11(4):319-28 - PubMed
- J Med Liban. 2001 Jan-Feb;49(1):22-4 - PubMed
- East Afr Med J. 2004 Jun;81(6):293-9 - PubMed
- Health Policy Plan. 2001 Sep;16 Suppl 1:19-23 - PubMed
- Health Econ. 2005 Jul;14(7):687-701 - PubMed
- Soc Sci Med. 1995 Dec;41(12):1667-76 - PubMed
- Health Policy Plan. 1998 Mar;13(1):94-102 - PubMed
- Soc Sci Med. 2004 Nov;59(10):2003-12 - PubMed
- Soc Sci Med. 1994 Sep;39(6):767-80 - PubMed
- Qual Saf Health Care. 2002 Dec;11(4):335-9 - PubMed
- Bull World Health Organ. 2008 Jan;86(1):52-6 - PubMed
- Soc Sci Med. 1993 Jun;36(11):1397-405 - PubMed
- Trans R Soc Trop Med Hyg. 2008 Aug;102(8):805-10 - PubMed
- J Pediatr Nurs. 2002 Dec;17(6):442-9 - PubMed
- Health Policy Plan. 2001 Sep;16 Suppl 1:24-32 - PubMed
- East Afr Med J. 2000 May;77(5):250-5 - PubMed
- Soc Sci Med. 2009 Jun;68(11):2078-88 - PubMed
- Sociol Health Illn. 1983 Nov;5(3):297-311 - PubMed
- BMC Public Health. 2005 Dec 22;5:140 - PubMed
- Soc Sci Med. 2002 Apr;54(8):1255-66 - PubMed
- Health Policy Plan. 2001 Sep;16 Suppl 1:1-6 - PubMed
- Hum Resour Health. 2006 Feb 09;4:2 - PubMed
- Int J Qual Health Care. 2002 Oct;14(5):353-8 - PubMed
- Educ Health (Abingdon). 2006 Nov;19(3):385-7 - PubMed
- Bull World Health Organ. 2008 Feb;86(2):132-9 - PubMed
- Med Care. 1980 Nov;18(11):1146-57 - PubMed
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