Table 2 Contributors to poor nurse-client relationships
Nurse contributors | Client contributors | Healthcare sector contributors |
|---|---|---|
Poor reception and hospitality • Negative reception • Self-pride among nurses • Not greetings clients • Not responding to greetings | The ‘much know’ client • Clients who know everything-medicine, how to give injection etc • Clients basing their expectations on information from internet sources | Inadequate resources • Inadequate/shortage of nurses and other providers amidst high client loads • Inadequate medicines and medical supplies • Inadequate healthcare infrastructure • Dysfunctional service delivery HIS e.g., GoTHOMIS not sending patient information to departments timely • Non-dissemination of guidelines and SOPs to facilities |
Delayed clinic attendance/coming outside scheduled clinic hours (without emergency) Failure to adhere to established procedures for receiving care Harboring negative attitudes towards nurses • Negativity towards providers • Having negative information about nurses before facility visit • Having a negative experience with nurses in a similar or different facility • Believing that no better healthcare service without bride • Holding nurses in contempt | ||
Not expressing care and concern • Not conducting triage • Acting busy and ignoring patients • Doing personal activities instead of offering care (exchanging stories among fellows, chatting or preoccupation with phones) • Inadequate preparation for offering health care services | ||
Poor human resource for health management practices • Bullying and mistreatment of nurses by administrators and leaders • Inadequate financial incentives ad motivations • Small and delayed salaries • Delayed promotions and salary increments | ||
Poor communication • Bad and harsh language • Speaking with anger, shouting and verbal reprimands towards clients • Being or appearing naturally angry and troublesome • Not explaining things to clients clearly • Not listening to clients • Not making eye contacts when speaking • Not being able to speak local language (Sukuma) • Not setting adequate time to speak to clients • Lack of customer care skills | ||
Poor communication • Being troublesome/ with bad language towards nurses • Having self-pride and disrespect towards nurses • Portraying anger when explaining problems • Being naturally non-civilized and angry because of cultural upbringing from childhood • Not receiving information early about absence of a certainservice | Lack of client trust towards facilities and healthcare providers • Bad reputation of the healthcare facility among community members • Bad reputation of nurses in the community e.g., physical abuse of patients • Negative attitudes of community members towards nurses • Inadequate orientation of new employees on nurse-client relationship | |
Inadequate policy implementation • Delay in fund disbursement from central government for medicine and medical equipment which creates deficits that fuel client distrust towards nurses • Inadequate screening of nursing students in health training institutions leading to enrollment of those without nursing calling • Nonadherence to labor laws e.g., required working hours | ||
Negative attitudes towards clients • Thinking that clients are instructing or teaching them what to do when explaining what services/treatment they would like to receive • Nurses using phrases/language that may be perceived as humiliating/shaming e.g., ‘you are giving birth every year without resting’’ | Inadequate education, awareness, and poverty • Limited understanding among community members on health issues and process of care • Limited understanding of instructions • Nonadherence to instructions • Poor preparation before delivery • Failure to acknowledge many responsibilities nurses have • Non ownership of health insurance | |
Politicization of medicine for instance telling people that they would receive free care while no resources made available to fulfill such commitments High cost of care fueling complaints and dissatisfaction Ineffective complaints mechanism • Dysfunctional suggestion box system • Absence of an independent department or agency specifically responsible for gathering, analyzing, and communicating clients and providers complaints • Absence of specific individuals/agency for continued capacity building and mentorship of nurses on provider–client relationships • Inadequate mental health support for both nurses and clients | ||
Poor relationship among nurses for instance nurse discrediting fellows to patients Job dissatisfaction • Not being satisfied with nursing job (i.e., income, working tools and transport) • Low work morale because of delated promotions or low income • Not meeting personal life goals as expected • Lack of ‘nursing calling’ | ||
Hurrying/forcing to receive certain services • Lack of patience and wanting to receive care ahead of others who came early • Using social status or position to force faster treatment/care • Forcing to receive certain services that they do not deserve or contrary to nursing profession guides | ||
Poor quality of services • Inadequate technical competence on certain services (therefore become harsh as a defensive mechanisms) • Offering substandard and poor care • Offering care in a hurry • Not offering appropriate education about side effects • Not performing one’s duties effectively • Extreme tiredness because of high workload and multiple shifts • Multiple responsibilities in different departments | ||
Dissatisfaction with care • Coming with personal desires and expectations e.g., a nurse to receive care from or medications (lack of choices?) • Dissatisfaction with care when desires and expectations are not met | ||
Trust in traditional healers and traditional birth attendants than in formal healthcare Unstable mental health • Mental health problems resulting from stresses of life • Loss of hope because of prolonged suffering from a disease | ||
Unstable mental health • Mental health problems resulting from stresses of life • Inadequate mental health support |