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Abstract
Objective This study aimed to investigate patients’ perceptions of nurse caring behaviours and their determinant factors at Debre Tabor Comprehensive Specialised Hospital (DTCSH) in Debre Tabor city, Ethiopia.
Design A facility-based cross-sectional study was conducted among 474 patients admitted to the inpatient ward.
Setting The study was conducted at DTCSH in Debre Tabor city.
Participants Patients were admitted to the inpatient ward at DTCSH.
Intervention No intervention was needed in this study.
Primary and secondary outcome measures Binary logistic regression was performed to identify factors associated with patients’ perceptions of nurse caring behaviours. The OR with a 95% CI and a p value of <0.05 was used to determine statistical significance.
Results Overall, 37.4% of patients had poor perceptions of nurse caring behaviours. Waiting day in the ward (adjusted odds ratio (AOR)=2.3; 95% CI (1.6 to 6.4) and (3.4; 95% CI (2.1 to 10.7)), residence (AOR=2; 95% CI (1.3 to 4.4)), education level (AOR=1.2; 95% CI (1.12 to 3.42)), and spent time with nurses (AOR=1.7; 95% CI (1.38 to 5.31)) were identified as determinants of patients’ perceptions of nurse caring behaviours.
Conclusion The proportions of patients’ perceptions of nurse caring behaviours were poor. Waiting time in the wards, being an urban resident, educational level and time spent with nurses were identified as determinant factors of poor perceptions of patients on nurse caring behaviours. Therefore, hospital management, nursing directors and nursing staff should collaborate to foster better interactions between patients and nurses.
- Nurses
- Nursing Care
- Behavior
- Ethiopia
Data availability statement
Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The strength of the study was that primary data were used.
Due to the nature of a cross-sectional study, it is difficult to determine cause and effect between dependent and independent variables. The study was also limited to one institution due to limited resources.
The study acknowledges the possibility of social desirability bias and recall bias as limitations.
Introduction
Care is a central element that is holistic and individualised, encompassing a process of therapeutic interventions designed to meet the unique needs of patients and their families.1 Nurse caring behaviours are defined as the acts, conduct and mannerisms enacted by professional nurses that convey concern, safety and attention to the patient.2 A good nurse’s caring behaviours can improve the quality of care, leading to a sense of security, a reduction in anxiety and a consensus between the caregiver and the care recipient, which may subsequently enhance patient satisfaction.3 Patient perception in nursing care refers to patients’ feelings or views about the nursing care they received during their hospital stay.4 Nurses are the foundation of patient care endeavours and are trustworthy to provide high-quality care to patients.5 And also, nurses have the most significant patient contact time, and nursing care is performed 24 hours a day, which plays a crucial role in improving patient outcomes.6 However, heavy workloads, inappropriate tasks, insufficient resources, poor management and shortages of nursing staff are the main challenges to providing quality nursing care in developing countries.7
Caring is the essence of nursing and a fundamental characteristic that distinguishes nurses from other healthcare professionals.8 9 Caring behaviours are a distinct feature of nursing and have a significant impact on patient outcomes and patient satisfaction.10 Because nurses are involved practically in every area of patient care in a hospital.11
In this regard, studies conducted in Jordan revealed that 27% of participants had a poor perception of nurses’ caring behaviours.12 Additionally, a study conducted in Ghana showed that 11% of patients had a poor experience with nurse caring behaviour.13 Similarly, studies conducted in Ethiopia, specifically in Nagele Borena (19%) and Debre Markos (36%), reported that a significant proportion of patients had a poor perception of nurses’ caring behaviours.14 15 Different studies from different literatures have shown that residence, sex, age, educational level, employment status, waiting days in the wards and time spent with nurses are determinant factors that affect patients’ perceptions of nurse caring behaviours.14–18
Therefore, nurses must ensure that their caring behaviours are medical, surgical and orthopaedic wards, as these behaviours are crucial for achieving positive patient outcomes.19
Ethiopian hospitals face a shortage of employed nurses, despite nurses making up the largest proportion of healthcare staff and playing a critical role in patient care. Examining patients’ perception of nurse caring behaviours has the potential to improve patient care in wards, which may ultimately influence patient outcomes. However, there is a limitation to the findings on patients’ perceptions of nurse caring behaviour, and the previous finding inclined towards nurses’ perception of caring behaviour. Therefore, this study aimed to measure patients’ perceptions of nurse caring behaviours and determinant factors among admitted patients.
Methods and materials
Study setting, study design and study period
The study was conducted in southern Gondar zone of the Amhara regional state, which is 665 km from Addis Ababa, the capital city of Ethiopia. It was conducted at Debre Tabor Comprehensive Specialised Hospital (DTCSH) in selected medical, surgical and orthopaedic wards. The hospital, the largest healthcare facility in the South Gondar zone, serves for more than 2.5 million people. A hospital-based cross-sectional study was conducted from May 8 to 15 June 2023.
Source population
All patients were admitted to DTCSH.
Study population
All the selected patients were admitted to the DTCSH in medical, surgical and orthopaedics wards during the data collection period.
Inclusion and exclusion criteria
At the time of data collection, all adult patients aged >18 years who were present in the selected ward were included in the study. In contrast, all patients who were absent from their bed, severely ill, unwilling to participate, or had stayed in the selected ward for less than 24 hours were excluded from the interviews.
Operational definition and terms
Patients’ perceptions of nurse caring behaviours
Patients’ perceptions of nurse caring behaviours refer to the experience of patients regarding nursing practice in the hospital and are measured by the caring behaviour inventory tool, which has four subscales: knowledge and skill, respectfulness, assurance and connectedness. Respondents who scored above the mean were considered to have a good perception, while those who scored below the mean had a poor perception.
Sample size determination and sampling methods
Sample size determination
The needed sample size was determined using the single population proportion formula by taking the magnitude of patient experience with caring behaviour as 53.3%1 with a 95% CI, a 5% margin of error, and a non-response rate of 10%. The final sample size was 474.
Sampling methods
A systematic random sampling technique was used. The sample size was allocated proportionally based on the previous month’s average number of patients in the three wards: surgical (880), medical (1110) and orthopaedic (510). The interval was calculated by dividing the total number of admissions from the previous month by the sample size, resulting in an interval of every fifth patient. After calculating the interval, the first patient was randomly selected. Subsequently, every fifth patient was selected until a sufficient sample size was achieved. Patients who were not present during data collection were excluded, and the next number was included.
Data collection tools and procedure
An interviewer-administered structured questionnaire was used to collect data from study participants during the study period. Three diploma nurses performed the data collection. The questionnaire has two parts, sociodemographic data and the Caring Behaviours Inventory (CBI), which are used to measure patients’ perceptions of nurse caring behaviours. It has four dimensions: assurance (to be available to meet a patient’s needs and safety), knowledge and skill (to demonstrate their proficiency and competence), respectfulness (engaging the person’s dignity) and connectedness (to be constantly ready to be able to assist the patient). The scale consists of 24 items, and all items are scored on a 6-point Likert scale (1=never, 2=almost never, 3=sometimes, 4=usually, 5=often, 6=always). Mean scales were calculated for both subscales and the overall scale. The highest possible score was 144 points, which indicated that the higher the score was, the greater the degree of nursing care behaviour.
Data quality assurance and control
The structured questionnaire was translated into the local language (Amharic) and then back to English for consistency. To ensure the quality of the data, three diploma nurses were recruited for data collection out of the study area, and training was given for 2 days on how to collect the data, exclusion and inclusion criteria, and objectives. The questionnaires were also pretested on 30 patients from the Woreta Primary Hospital before data collection to assess the questionnaire’s reliability, consistency and appropriateness, with subsequent correction and modification. The reliability of the tool was assessed using Cronbach’s α for CBI-24, which was 0.89, indicating good reliability.
Data analysis and presentation
After the data were checked for completeness and consistency, the data were cleaned, coded and entered into Epidata V.4.6 and then exported to SPSS V.25 for analysis. Descriptive statistical analysis, including mean, SD, frequency distribution and proportion, was performed. All explanatory variables with a p value of 0.25 from the binary logistic regression model were fitted into the multivariable logistic regression model. Finally, the variables that had been independently associated with the dependent variable were identified based on a 95% CI and a p value less than 0.05.
Patient and public involvement
Patients and/or the public were not involved in this study.
Results
Sociodemographic characteristics of the respondents
A total of 474 admitted patients were included in this study, for a response rate of 100%. The mean±SD age of the study participants was 42.29±25.84 years and 240 (50.6%) of the total study participants were women. Of the total study participants, 247 (52.2%) were from rural areas. Among the study participants, 260 (54.8%) stayed in the hospital for 1–5 days. Additionally, 222 (46.8%) study participants could not read or write. A total of 215 (45%) study participants were admitted to the medical ward. More than half 287 (60.5%) of the study participants provided free service at the hospitals (table 1).
Sociodemographic characteristics of the respondents in DTCSH
Prevalence of patients’ perceptions of nurse caring behaviours
Of 474 respondents, 177 (37.4%) (95% CI: 29.5 to 40.3%) had poor perceptions of nurse caring behaviours with the overall mean scores of 4.55. The lowest mean score was for the item measuring ‘connectedness (mean (SD)=4.2 (0.68))’. However, the lowest mean score for items measuring ‘knowledge and skills (mean (SD)=4.8 (0.68))’ (table 2). On the other hand, based on the computed mean score, the subscales were dichotomised into good and poor caring behaviour. The results showed that 40.1%, 42.2%, 36.1% and 30% of patients perceived poor caring behaviours in the areas of assurance, knowledge and skills, respectfulness, and connectedness, respectively (table 3).
Mean score of CBI subscale
Perceived patients’ nurse caring behaviours at Debre Tabor Comprehensive Specialised Hospital, 2023
Factors related to patients’ perceptions of nurse caring behaviours
Of the study participants, 167 (56.7%) men had poor perceptions of nurse caring behaviours. In addition, over half of the 196 (65.3%) study participants aged 35–64 years had poor perceptions of nurse caring behaviours. Furthermore, over half of the urban residents, 234 (78%), had poor perceptions of nurse caring behaviours, whereas 162 (54%) participants who cannot read and write demonstrated poor perceptions of nurse caring behaviours. Of the study participants, 112 (23.6%) admitted to the medical ward had poor perceptions of nurse caring behaviours (table 4).
Determinant factors that might affect patients’ perceptions of nurse caring behaviours at Debre Tabor Comprehensive Specialised Hospital, 2023
Determinant factors of patients’ perceptions of nurse caring behaviours
In the multivariable analysis, four variables were identified as determinants of patients’ perceptions of nurse caring behaviours: waiting day in the ward (adjusted odds ratio (AOR)=2.3; 95% CI (1.6 to 6.4) and 3.4 (2.1–10.7)); residence (AOR=2; 95% CI: 1.3 to 4.4); education status (AOR=1.2; 95% CI (1.12 to 3.42)); and time spent with nurses (AOR=1.7; 95% CI: 1.38 to 5.31).
Patients who spent less than 30 min with the nurse during shifting hours were 1.7 times more likely to perceive poor nurse caring behaviours than those who spent greater than 30 min. And also, study participants whose educational level was secondary school were 1.2 times more likely to perceive poor nurse caring behaviour than those who cannot read and write (AOR=1.2; 95% CI: 1.12 to 3.42). In addition, study participants whose waiting day in the ward was between 6 and 10 days were 2.3 times more likely to have perceived poor nurse caring behaviour than those who waited for less than 5 days (AOR=2.3; 95% CI: 1.6 to 6.4). Finally, study participants who were in urban areas were two times more likely to perceive poor nurse caring behaviours as compared to rural residents (AOR=2; 95% CI: 1.3 to 4.4) (table 5).
Bivariable and multivariable logistic regression analysis of determinant factors of patients’ perceptions of nurse caring behaviours at DTCSH, 2023
Discussion
This study aimed to provide patients’ perceptions of nurse caring behaviours at DTCSH, Ethiopia. In addition, this study aimed to identify determinant factors of patients’ perceptions of nurse caring behaviours. The current findings revealed that 37.4% of patients perceived poor nurse caring behaviours, which is higher than the study done in Ghana,20 Pakistan1 and India.21 However, this finding was lower than the study conducted in Debre Markos.15 The discrepancy might be due to the use of different tools, such as the 26-item Newcastle Patient Experience with Nursing Care Scale used in the previous study.22 The discrepancy in Ghana might be due to differences in sociodemographic characteristics and infrastructure. The inconsistency in Pakistan might be due to differences in sociodemographics and sample sizes, with the former having a small sample size. This finding indicates a high proportion of patients perceived poor nurse caring behaviours, highlighting the need for nurses to improve their practice and uphold nursing standards to achieve better patient outcomes.
We found that patients who stayed in the wards for more than 6 days were more likely to perceive poor nurse caring behaviours compared to those who stayed for less than 5 days. This study was similar to that performed in South Wollo,23 Debre Markos15 and India.21 This might be due to prolonged hospital stays, which can negatively impact patient care, increase the risk of violence and aggression, and cause stress for patients requiring unscheduled time off.24 On the other hand, patients whose educational level was secondary school had poor perceptions of nurse caring behaviours as compared to those who were unable to read and write. This could be because people with higher educational levels have high expectations of standardising nursing service.
In addition, times spent with nurses were significantly associated with patients’ perceptions of nurse caring behaviours. Patients who spent less than 30 min with nurses were two times more likely to be perceived as poor as compared to patients who spent more than 30 min with them. This finding supports the idea that poor nurse-patient interactions contribute to dissatisfaction and negatively influence patients’ perceptions of nurse caring behaviours.25 26
In this study, the residence of the patient was significantly associated with patients’ perceptions of nurse caring behaviours. The odds of poor perceptions of nurse caring behaviours among urban residents were more likely compared to rural residents. This study was similar to the study done in South Wollo.23 Given the availability of mass media among urban residents, this may relate to awareness and access to health information.
Limitations of the study
Due to the cross-sectional nature of the study, it is difficult to establish cause-and-effect relationships between the independent and dependent variables. Social desirability bias might be a limitation due to patients’ rating their previous interaction with nurses, which could lead to bias due to fear of getting service for the future. Data collectors were selected from the study area to reduce this bias.
Conclusion
This study showed that 37.4% of patients perceived poor nurse caring behaviours. Waiting days in wards, educational level, resident status and time spent with nurses were determinants of patients’ perceptions of nurse caring behaviours. Nurse caring behaviour is a cornerstone of quality healthcare, reflecting the essence of nursing practice and significantly influencing patient outcomes and satisfaction. This research has the potential to raise nurses’ consciousness and promote patient-centred care.
Recommendations
Hospital management should place greater emphasis on the nursing profession because nurses encounter all aspects of patient problems. They should provide appropriate strategies to increase patients’ positive perception towards nursing care by filling gaps and providing scheduled training for nurse professionals. Future researchers should consider a qualitative method to gain deeper insights into patients’ perceptions of nurse caring behaviour.
Supplemental material
Data availability statement
Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by Debre Tabor University’s ethical review committee with Ref.No RP/ 278/23 Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We would like to acknowledge Debre Tabor University. We also acknowledge the hospital administrator and ward coordinators for their help during the data collection. Finally, special gratitude goes to the study participants who shared their ideas
Footnotes
Contributors ME, YA, AAB and YTK worked on developing the research idea; designing the study; writing, training and supervising the data collectors; analysing and interpreting the results; and preparing the manuscript. MKH, SFT, BMB, GBM and MK critically revised the proposal, participated in its design, analysis and interpretation of the results, and wrote the manuscript. All the authors were involved in reading and approving the final manuscript. ME is the guarantor of this study and takes full responsibility for its accuracy and integrity. The study was conducted in accordance with ethical guidelines, ensuring the validity of data collection, analysis and interpretation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.