Table 3 Suggestions for strengthening nurse-client relationships

Awards and recognition of good nurses

Continued professional development on:

• Customer care skills

• Skills for improving nurse-client relationship

• Time management skills

• Communication skills

• Nursing service delivery competences

• Respective nursing care skills

• Counseling skills

• Delivery of health education session for low literacy clients

• Develop a habit of updating one’s nursing skills

• Basic clients’ rights in MCH care

• Induction course for new employees on nurse- client relationships

Education and community sensitization on:

• The importance of early healthcare seeking

• The type of services they deserve

• Swahili language (in rural areas) or coming with interpreters

• Communication skills in healthcare settings

• Reputable sources of information

• Basic clients’ rights within healthcare settings

Insisting on the followings on different platforms

• The importance of coming early to the clinic (within scheduled time)

• Reducing anger in order to receive good care

• Being respectful and thankful to nurse’s efforts

• Using good language and using civilized communication

• Reliance on reputable health information sources

• Adherence to instructions from nurses

Promoting peer to peer learning and mentorship

• Training nurses as peer mentors on nurse-client relationship

• Pairing good and/or experienced nurses with bad or junior nurses when planning for working shifts

• Nurse to develop a habit of sharing/giving feedback to peers what they have learnt in seminars and workshops

• Learning from best performing private sectors

• Improving relationship and cooperation among nurses

Insisting on personal devotion to nursing professional in different platforms on these aspects:

• Valuing nursing work

• Reminding nurses to fulfil their responsibilities, adherence to nursing ethics and having a nursing call

• Respect of clients’ views

• Respect of client’s rights including choice of a nurse to receive care from

• Willingness to receive feedback and improve oneself

• Learning local language (Sukuma)

Others

• Peer policing- a tendency of nurses to monitor and warn fellow nurses

• Linking nurses’ performance evaluation to renumeration

• Nursing leaders to fulfil their responsibilities

Strategies focusing on health facilities/health sector

Improving quality of services and working conditions

• Improving availability of medicine and medical equipment

• Improving friendliness of working environment

• Improving MCH infrastructure

• Ensuring availability of medicine and medical supplies for exemption groups

• Establishing health service grades (based on ability to pay) without compromising the basic quality of care

• Expanding formal healthcare service options in rural areas to promote patient choice

Increasing and better management of nursing workforce

• Employing more nurses

• Increasing facility income to generate funds needed to recruit more nurses

• Ensuring nurses are paid as per their job contracts

• Employing volunteers’ nurses to cover for deficits

• Ensuring nurses work within hours stipulated in labor laws

Feedback and punishments

• Leaders to offer feedback to nurses on their quality of services

• Demotion of nurses with bad reputation or moving them to rural areas

Improving renumeration and incentives for nurses

• Improving salary of nurses/ salary increments

• Timely salary and oncall/overtime payments

• Offering financial incentives for nurses to reach clients at different levels

• Financial motivation to those performing well

Extended Mentorship

• CHMT to frequently visit facilities for extended onsite mentorship (e.g., full day mentorship)

• The Ministry of health to visit facilities for mentorship and developing solutions to existing challenges

• Establishment of a specific agency/ focal persons for continued capacity building and mentorship of nurses on provider–client relationships

Reducing politicization of medicine

• Politicians to avoid making unrealistic healthcare commitment and promises to people

• Politicians to avoid interference with nurses’ work

Debates, conferences, seminars and workshops

• Holding debates among nurses to identify challenges they face

• Meetings bringing together nurses and clients to identify challenges in their relationship and generating joint solutions

• Conferences, seminars and workshops of nurses at different levels (e.g., districts and regions) to sensitize and remind nurses about nursing ethics and nursing care

Improving complaints mechanisms

• Establishment of independent system or agency for tracking, gathering, analyzing and publishing clients and nurses’ complaints. The agency could share with responsible authorities, track implementation and give feedback to people who made the complaints

• Giving timely feedback to clients about their complaints and suggestions

Nursing school student screening and curriculum

• Adequate screening of students joining nursing schools to maximize enrollment of those with nursing call

• Strenghethern nursing school curriculum by including topics on nurse-client relationships and patient centered care

• Ensure availability of trainers of nurse-client relationships in nursing schools

Improving efficiency of the Nursing Professional Council

• Nursing council to develop and implement customer care training programs (seminars and workshops)

• Nursing councils to remind nurses their work ethics, take actions to those with no work ethics and congratulating (letters) those with better performance on work ethics

Community education and sensitization

• Use of TVs and Radio to offer health education to the community

• Educating community on early health care seeking and male engagement, and adherence to medical advice and medications

• Educating community on service delivery process

• Engagement of CHWs in community sensitization and education

• Educating community on clients’ rights

MCH leaders to be responsible

• MCH leaders to lead by example i.e., participate in service delivery not just sitting in offices

• Leaders to channel nurses’ concerns to the MoH, make follow up and give feedback to nurses

• Leaders to follow up closely and timely on requests for medicine and medical supplies

Others

• Establishing a system to monitor, control and regulate the quality of health information in internet platforms and social media

• Establishing a public relations department/focal person in every facility and charge it with community education and sensitization

• Reducing the cost of care

• More research on how to strengthen nurse -client relationships

• Making use of the findings of this research for improvement

• Stakeholder (clients and nurses) engagement in developing health service delivery policies

• Ensure adequate implementation of existing policies to create positive image of health sector among community members

• Improving cooperation between the facility and local governance in surrounding communities