DESCRIPTION

ABSTRACT

This study seeks to examine the effect of doctor-nurse relationship on patient care in Federal Medical Centre Owerri, Imo State. The null hypotheses were formulated to guide the study. They are: Medical teamwork; hospital administrative structure; and doctor-nurse value orientation. In order to generate data for testing these hypotheses, a 42 item questionnaire was developed by the researcher and validated by the supervisor. Survey research design was adopted while data collected from 200 randomly selected respondents (male & female). Purposive, stratified and simple random sampling procedures were variously applied at appropriate stages of the study. The generated data was statistically tested using chi-square analysis procedure. The analysis revealed that: there is a significant relationship between medical team work and patient care, hospital administrative structure, doctor-nurse value orientation and patient care. It was however recommended that collaborative work relationship between doctors and nurses should be encouraged for effective health care delivery system.

TABLE OF CONTECT

Title page

Certification

Dedication

Acknowledgement

Abstract

Table of contents

List of tables

List of figures

CHAPTER ONE: INTRODUCTION

1.1    Background of the study

1.2    Statement of the problem

1.3    Research questions

1.4    Research hypotheses

1.5    Objectives of the study

1.6    Significance of the study

1.7    Scope of the study

1.8    Definition of concepts

1.9    Brief history of Federal Medical Centre, Owerri Imo State

CHAPTER TWO: LITERATURE REVIEW AND THEORETICAL                         FRAMEWORK

2.1    Literature review

2.1.1 The effect of doctor-nurse relationship on patient care

2.1.2 Medical team work and patient care

2.1.3 Hospital administrative structure and patient care

2.1.4 Value orientation and patient care

2.1.5 Health care delivery system in Nigeria

2.1.6 Mortality rate in Nigeria

2.1.7 The health status of Nigerians

2.1.8 Motivation and work relationship among medical staff

2.2    Theoretical framework

2.2.1 Neo-functionalism theory

2.2.2 Role Theory

2.2.3 Conflict Theory

CHAPTER THREE: RESEARCH METHODOLOGY

3.1    Research design

3.2    Research setting/area

3.3    Population of the study

3.4    Sample

3.5    Sampling procedure

3.6    Instrument of data collection

3.6.1 Validity of the instrument

3.6.2 Reliability of the instrument

3.7    Procedure of data collection

3.8    Method of data analysis

CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND                                                         DISCUSSION OF FINDINGS

4.1    General description of variables

4.2    Socio-economic features of respondents

4.3    Data presentation and interpretation of results

4.4    Discussion of findings

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION

5.1    Summary of the study

5.2    Conclusion

5.3    Recommendation

5.4    Suggestions for further research

          References

          Appendix

LIST OF TABLES

Table 1:     Frequency distribution of respondents by sex

Table 2:     Frequency distribution of respondents by age

Table 3:     Distribution of respondents by marital status

Table 4:     Distribution of respondents by educational qualification

Table 5:     Distribution of respondents by religion

Table 6:     Chi-square analysis of the relationship between medical                             team           work and patient care

Table 7:     Contingency table showing the relationship between                          medical team work and patient care.

Table 8:     Chi-square analysis showing the relationship between                       hospital administrative structure and patient care

Table 9:     Contingency table showing the relationship between                          hospital administrative structure and patient care.

Table 10:   Chi-square analysis showing the doctor-nurse value                          orientation and patient care.

Table 11:   Contingency table showing the relationship between                          doctor-nurse value orientation and patient care.

CHAPTER ONE

INTRODUCTION

1.1    BACKGROUND OF THE STUDY

A system is made up of several parts which functions in various ways to work as an entity. An example of this is the health care service delivery system. In this, there are various categories of professionals and personnel who work hand in hand to perform various specialized duties for the effective dispensation of healthcare services.  These professionals include: doctors, nurses, pharmacists, radiographers, and medical laboratory scientists etc. they all carry out their duties which directly or indirectly are related to patients care (Kalish & Erb, 1987). Where there is friction between any components of a system, there is a drag. A sustained drag could cause a breakdown of the system. This research work will examine the inter-relationship between doctors and nurses as it affects patients care. Doctors and nurses are two major health workers in the hospital who have continued to attract attention. Nurses are closer to doctors than all other health workers. Wolinsky (1980), referred to other health workers as allied health workers. The closeness of doctors and nurses is brought about by their frequent contact with patients in the hospital.

According to Fagin and Garalick (2004), the relationship between doctors and nurses is a special one. This is because smooth working relationship between doctors and nurses is essential for effective and efficient delivery of health care services. Where this is overlooked, it is at the detriment of the patient’s care and increased cost to the health care system. This is sadly the trend in developing countries such as Nigeria (Albert, Goldman, Kilroy & Pikke, 1992). The relationship that exists between doctors and nurses has long been the focus of on going debate. In the past, it was assumed that there was clear agreement between the two professions that the relationship was hierarchical, with doctors being superior to nurses (Sheth & Mallipedi, 1997). This was further enforced by Mechanic and Aikan (1982), who stated that a nurse must begin her work with the idea that she is only the instrument to which the doctor gets his instructions carried out. He/she occupies no independent position in the treatment of the sick person.

Kafaru, (1994) argued that no matter how gifted a nurse may be, he/she will never be a reliable nurse until he/she can obey without questioning the instruction of the doctor. To her, a nurse is simply an intelligent machine for carrying out doctors orders. Rosenfield (1992), posits that, in many countries, doctors determine the scope of nursing practice and education, and can directly define the limits of nursing knowledge. Also, doctors head public health care institutions thus affording them additional opportunities to influence the training of nurses. However, so many others argue that these working relationships are changing and should be examined against prevailing development in the profession, society, and work (Ferger and Shitt, 1979).

Johnson (1983), argued that collaborated work among nurses and doctors has been found to be very rewarding. This is because some hospital managements have identified the unique roles each of them plays in the care of patients. Attempts have been made to change their designation in such a way that one complements the other. This study examines the form of relationship that exists between doctors and nurses, and how nurses are coping with the situation, bearing in mind the differences in status relationship. There may also be gender bias against the nurses which in turn have negative effect on their job performance and level of satisfaction which further affects their care for patients. Elaborating further, Rosenfield (1992) asserted that collaborative nurse-physician relationships are associated with improved patient, nurse and physician outcomes. Kohn (1996) asserted that modern nurse has come of age; hence should be given a rightful place in the health profession. The nurse’s role is significantly symbolized in “care” for the sick. Care according to Limm (1994), is the essence and the central unifying and dominant domain that characterized nursing. It is an essential human need for full development, health maintenance, and survival of human beings in all world culture; yet care has not received the same degree of attention by other professionals as has been given by nurses. As a matter of emphasis, there cannot be “cure” without “care” and curing is traditionally the doctor’s function while caring is regarded as primary function of the nurses. Kennedy and Garvin (2004), stated that the quality of product in the industrial sector and efficiency of production are dependent on successful teamwork. Therefore, one assumes that the efficiency and quality of patient care is dependent on the degree at which interdisciplinary relationships are collaborative and this shows the importance of teamwork.

Doctors and nurses possess individual expertise, make individual decisions, hold common purpose and function together in an egalitarian, cooperative and independent manner, thus, the combined effects of shared, cooperative decision making are of greater benefit to the patient than the individual effects on the disciplines on their own. Furthermore, communication and collaboration are essential elements of good doctor-nurse relationship. Kallish & Erb (1987) defined collaboration as “nurses and doctors working together cooperatively to archive shared problem solving, decision making, conflict resolution, communication and co-ordination”. The research is therefore motivated to help Federal Medical Centre (FMC) Owerri, find a way of examining “the effect of doctor-nurse relationship on patient care. It is for this reason that this research is carried out to determine if patient care has to do with doctor-nurse relationship and the factors considered here includes the following;

(a)     Medical Team Work

(b)     Hospital Administrative Structure

(c)     Value Orientations

The factors listed above will be elaborated upon in the course of this research work.  

1.2    STATEMENT OF THE PROBLEM

The lack of collaboration between doctors and nurses in the health care delivery system has assumed enormous attention. It indeed has posed great challenges to medical sociologists, medical social workers, health care designers and policy makers. Today, the health care delivery system is subjected to a state of social disaster because of the poor relationship that exists between the doctor and the nurse and this has adversely affected the level of production in the health care system.

Nurses and doctors who form the major workforce in the hospital do not see themselves as partners in progress. Over the years, the doctor-nurse relationship has tended to be unfriendly perhaps as a result of different value orientations of doctors and nurses, lower level of interaction between doctors and nurses, little motivation for them to work collaboratively with each other etc. these have all contributed to bring about negative influence on the health service delivery and the general job performance level. The doctors and nurses appear to have a ritualistic notion about team work. It is based on these note, that the researcher choose to research on the “The effect of doctor-nurse on patients care in Federal Medical Centre, Owerri Imo State Nigeria. Thus, the question that necessarily comes to mind is: To what extent is patient care influenced by doctor-nurse value orientation, teamwork and administrative structure?

1.3    RESEARCH QUESTIONS

          The following questions were posed to guide this study:

1.      Is there any existing relationship between medical team work and patient care?

2.      How does hospital administrative structure relate to patient care?

3.      What is the extent of the relationship existing between doctor-nurse value orientation and patient care?

1.4    RESEARCH HYPOTHESES

          The following hypotheses were formulated to guide the study.

i.        There is no significant relationship between medical team work and patient.

ii.       Hospital administrative structure has no significant relationship with patient care.

iii.      Doctor-nurse value orientation does not significantly relate to patient care.

1.5    OBJECTIVE OF THE STUDY

          The main objective of the study was to investigate the effect of doctor-nurse relationship on patient care. Specifically, the study seeks to:

(a)     To determine the relationship existing between medical team work and effect on patient care.

(b)     To investigate the relationship existing between hospitals administrative structure and effect on patient care.  

(c)     To examine the relationship existing between doctor-nurse value orientation and its effect on patient care.

1.6    SIGNIFICANCE OF THE STUDY

          The study and its findings will be of benefit to different classes of people including policy makers, medical doctors, sociologists, social workers, nurses, patients and researchers. The findings of this study will sensitize policy makers in the Ministry of Health on nurse-physician relationship. The policy makers will appreciate the need or goal of raising awareness of the importance of positive nurse-physician relationship throughout the health care system. The Ministry of Health will understand the need to inform policy and decision makers regarding initiatives and interventions that strengthens and optimize nurse-physician relationship. The medical sociologists will equally appreciate the findings of this study because it will help them to ensure that their clients in the hospital are receiving proper medical attention. The study will further reveal the importance of fostering nurse-physician relationship. The medical sociologists and medical social workers could encourage schools of nursing and other related allied professional bodies to develop curriculum for their health discipline programmes to build communication skills and foster optimal collaboration between nursing and medical faculties, students and graduates. The medical social workers on the hand will appreciate the findings of this study because it will make them to understand that for an effective patient care, there must exist good rapport between doctors and nurses for the overall well being of the patient.

The doctors and nurses may find the study useful having fully understood the importance of doctor-nurse relationship; they will be better placed to mount pressure on the government to incorporate education models and curriculum for nurses and physicians. No research is carried out for its own sake as every researcher is intended to solve one problem or the other in the society. Through this research, stakeholders in the health care delivery system may understand the predisposing factors towards poor service delivery.  They may understand the vital role effective doctor-nurse relationship plays in health care delivery system. Perhaps, little research may have been carried out in this area; this study will further open new grounds for more researchers to go into this area as well as adding to the existing knowledge in the field.

1.7    SCOPE OF THE STUDY

The study is restricted Federal Medical Centre (FMC) Owerri, Imo State. Therefore, any generalization of the result should be done in that context on the basis of other organization having similar characteristics. The study is also concerned with the ongoing relationship existing between doctors and nurses in hospitals. The study will not cover all aspects of the relationship rather the aspects that are covered are as follows:

(i)      Value Orientations

(ii)      Team work

(iii)     Administrative structure. Thus doctor-nurse relationship is       limited to these three (3) variables.

1.8    DEFINITION OF CONCEPTS

Doctor: This refers to a medical professional i.e a person who is skilled or specialized in healing acts licensed to practice his/her profession. E.g Surgeon, physician, dentist etc.

Nurse: This is any male or female who has the stipulated period of training in an institution approved by the Nursing and Midwifery Council of Nigeria and is duly registered and licensed to practice nursing in any hospital or place in Nigeria and all over the world.

Relationship: The way or manner in which two people, groups or countries behave towards each other or deal with each other.

Patient: This refers to a sick individual waiting or under the care and treatment of a physician.

Care: This has to do with responsibility for or attention to health, well being and safety.

Team work: This is referred to as that work done by a group of people who possess individual expertise, who are responsible for making individual decisions, who hold a common purpose and who meet together to communicate, share and consolidate knowledge from which plans are made, Calman (1994).

Health care: This refers to the maintenance and restoration of health by the treatment and prevention of disease by trained and licensed medical professionals. E.g doctors, nurse etc.

1.9    BRIEF HISTORY OF FEDERAL MEDICAL CENTRE, OWERRI

The evolution and development of Health Institution that is today known and called Federal Medical Centre, Owerri began rendering healthcare services in 1903 as a military hospital. The objective was to treat colonial soldiers, police and other colonial government officials. At inception, the hospital facilities included three wards: a male ward which accommodated both medical and surgical patients, a female ward and a maternity ward. Other facilities available in 1903 included General Out-Patient Department and a theatre. The staff complement comprises one doctor (general practitioner) and few nurses. Records show that the patient population of the hospital in 1905 when the Colonial Government of the Northern and Southern protectorate visited the hospital was between 5 to 15 patients and all were colonial officials. During the visit, the government observed that the hospital was underutilized due to the absence of African patronage of the hospital. Between 1905 to 1930, African or native population patronage was visible but still low for some obvious reasons.

First, there existed in the minds of Africans intrinsic fear that admission into the Whiteman’s hospital was a sure road towards one’s death. Secondly, there was a general lack of faith in the efficacy of the Whiteman’s medicine and there was fear that the hospital was a poly “catching” Africans to pay tax to the Whiteman’s government. However, the movement for political agitation for self-rule and self determination between the 1930’s and 1950’s resulted to the formation of government of Eastern Nigeria in 1940. This phenomenon began a transfer of ownership of the hospital. Furthermore, for unexplained reasons, Shell-Darcy Company, a major stakeholder in the Colonial Hospital and whose sole business in Eastern Nigeria was Oil exploration relocation from Owerri in the late fifties. The Colonial/Shell-Darcy hospital was handed over to the Eastern Regional Government. Following Nigeria Independence and under the premiership of Dr. M.I. Okpara, the hospital became a district hospital and the Shell-Darcy arm was converted to an amenity ward and known as “Okpara Nursing Home (ONH). The other arm of the colonial hospital became the ANC Clinics and Administrative block. Other areas of the hospital involved in this historic perspective include wards 2 and 3 as well as the main store building extending to the microbiology laboratory. The flower hedge between ward 2 and the store/microbiology building was the main first entrance gate into the hospital.

During the East Central State Government, the maternity unit was extended to accommodate all gynecological/obstetrics patients thereby bringing the wards in the hospital to four with bed compliment of 44 under a Divisional Hospital status. Following the creation of Imo State in 1976, the hospital witnessed further expansion as a result of increased patronage. The Imo State Government then changed the name of the hospital to General Hospital, Owerri. Under the Imo State Government, the hospital experienced extensive infrastructural development in the following areas; a modern Out-Patient Department, six new wards, Pharmacy Department, Chest Unit, Infant Welfare Clinic, Accident and Emergency Department, Hospital Canteen and an Mortuary. These infrastructural achievements brought the bed compliment of the General Hospital to four hundred and twenty seven (427) in thirteen wards. Since then, each successive  Imo Government have worked hard to improve the facilities and equipment needs in the hospital. Of note is the singular individual effort in private-public partnership manifested in the building of the Iwuanyanwu Blood Bank by Chief (Engr.) Emmanuel Iwuanyanwu and the Government with Mrs. Bridget Nwankwo as commissioner for health.

Following the National Health Policy, the Federal Government embarked upon the provision of tertiary medical facility in states where a Federal Teaching Hospital does not exist. Consequent upon  this policy implementation, the then Minister of Health and Social Service Alhaji (Dr.) Dalhatu Tafida accompanied by the then Minister of State for Health Chief Silas Ib after inspection of the then General Hospital Owerri on 21st March, 1994 announced Federal Government take over of the hospital. As a matter of fact, on the 1st January 1995, the legal life of the hospital as Federal Medical Centre, Owerri began (online available at: http:/www.fmco.com).