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Journal of Nepal Health Research Council Vol.4 No.2 October                                                                                                   Patients’ Attitude Towards......
                                                                                                                                                           Occupational Health Hazards .......
.

                      Patients’ Attitude Towards Nursing Students of BPKIHS
                                                                                      Mehta RSa and Singh Ba
                                                                                                      Abstract
...................................................................................................................................................................................................................................
Introduction                          Health care is a social role relationship between a helping agent and a person needing help.
                                      This relationship is considered psychologically and socially as half cures treatment
                                      procedure. Therefore the nature of relationship between nurses and patient has some
                                      degree of significant impact on the overall quality of health care.
...................................................................................................................................................................................................................................
Objectives                            The objectives of this study were to assess the attitude of the patients regarding the
                                      presence and involvement of the nursing students in their clinical care in Medical–Surgical
                                      units of B.P. Koirala Institute of Health Sciences.
...................................................................................................................................................................................................................................
Methods                               It was hospital based cross sectional study. The clients admitted in Medical-Surgical units
                                      in the day of data collection constitute the population of the study. The stratified simple
                                      random sampling method was used to select the sample and 75subjects were selected from
                                      all the wards of Medical-Surgical units of BPKIHS out of 260 admitted patients, where as
                                      only 60 tools were returned back out of 75 tools. The collected data was entered in
                                      SPSS-10.5 software package and analyzed.
...................................................................................................................................................................................................................................
Results                               The respondents reported that, presence of student nurses in ward make the clients glad
                                      (96.6%), received information about own disease process (68.5%), can ask most trivial
                                      questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal
                                      questions (93.3%), devote more time for clients (51.7%), they examine in details (54.2%) and
                                      help very much in treatment process (84.86%). Students have knowledge about disease
                                      process (84.5%) and their behavior and temperament is good (93.2%).
...................................................................................................................................................................................................................................
Conclusions                           The development of technology has meant that hospital nurses are required to keep
                                      developing their skills to maintain professional standards and their understanding of new
                                      procedures and new equipment along with the need to develop the therapeutic relation
                                      with the patients to overcome the future challenges.
...................................................................................................................................................................................................................................
Key Words                             Patients, Attitude, Nursing Students
...................................................................................................................................................................................................................................
Introduction
Medical profession was considered to be a noble                                                                       high cost. The high cost or investment of the hospi-
profession from time immemorial. While a medical                                                                      tals compelled the management to increase the cost
student comes out of medical institution after the                                                                    of service. On the other hand the number of hospi-
Hypocrite’s Oath, it is his duty to look after any patient                                                            tals increased which made the sector competitive.
irrespective of caste, creed, sex or even remuneration.                                                               This intern forced the hospitals to employ reputed
In history we come across doctors and paramedical                                                                     doctors and Nurses to attract the patients. The
staff who spent their entire life for the prosperity of                                                               branches of specialization made available micro-or-
the patients and also the total health of the community.                                                              gan specialists. The superspecialists are demanded
One notable example is the story of Florence                                                                          by the hospitals. The concept of hygenity motivated
Nightingale who spent her entire life for nursing the                                                                 the hospitals to update the facilities to the status of
sick. In older days the primary objective of any                                                                      star hotels. The higher education and increased
medical institution was not to make exemplary profit1.                                                                awareness contributed the public to approach the
                                                                                                                      hospitals2.
Over the year’s technology advanced and the
hospitals became more technology oriented with a

Corresponding Authors: Ram Sharan Mehta, E-mail: ramsharanmehta@yahoo.com, aMedical-Surgical Nursing
Department, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.

                                                                                                              45
Journal of Nepal Health Research Council Vol.4 No.2 October                           Occupational Health Hazards .......
                                                                                         Patients’ Attitude Towards......
.

The nature of relationship between nurse and                       nursing the professional status it needed and
patient has some degree of significant impact on the               deserved.
overall quality of healthcare, the patient’s compliance
and satisfaction is greatly influenced by the appearance,          Till date, there has been no study of the attitude of
behavior and the communication skill of the nurses                 the patients in the hospital to the presence and
as nurses stay 24 hours with the clients3.                         involvement of the student in their nursing care in
                                                                   BPKIHS. So, we are trying to find out the real
With increasing in life expectancy and increasing                  scenario in our context.
numbers older patients utilizing the acute setting,
attitudes of registered nurses caring for older people             With the emerging nursing colleges in the country
may affect the quality of care. Many negative                      and the out flowing number of nursing students in
attitudes reflect against stereotypes and knowledge                many hospitals, this complex relationship has more
deficits that significantly influence registered nurses            importance and responsibility than even before. In
practice and older patients’ quality of care. In the               BPKIHS, patients are in contact with nursing
present setting, older patients experience reduced                 students and they must have developed some
independence, limited decision-making opportunities,               attitude towards student nurses during their social
increased probability of developing complications                  and nursing interaction. Hence, the investigators
little consideration so their aging-related needs,                 are decided to conduct the study on, “patient’s
limited health education and social isolation. Available           attitude towards nursing students of BPKIHS”.
instruments to outdated, country specific and do
not include either a patient focus or a caring perspective.        The objective of this study was to assess the
This paper argues for the development and utilization              attitude of the patients regarding the presence and
of a research instrument that includes both a patient’s            involvement of the nursing students in their clinical
focus and a caring dimension4.                                     care in Medical–Surgical units of BPKIHS.

The origins of nursing date back to when the first
mother or other close female, ministered to the sick               Methods
in the family. It was Florence Nightingale in the                  It was hospital based cross sectional study. The
mid-1800s who founded modern nursing and                           clients admitted in Medical-Surgical units in the day
structured professional duties into an orderly trained             of data collection constitute the population of the
fashion. Before this, so-called nurses were considered             study. The total bed strength of the selected units
untrained servants. Nightingale established the first              was 306 and 260 clients were admitted in the same
school of nursing in London, England in 1860, with                 day i.e. bed occupancy rate was 85 percent. Seventy
the first school in the United States established in               five subjects (29%) were selected for the study and
1872 in Boston, Massachusetts3.                                    tools were distributed to them. Finally 60 tools were
                                                                   only returned back i.e. total sample selected was 23
Throughout the next 130 years, nursing schools                     percent out of total population and the sample
flourished as mainly women were educated and                       mortality was 20 percent. The stratified simple
trained to take care of the sick. Nurses also                      random sampling method was used to select the
distinguished themselves on the battlefield in all of              sample and 10 subjects from Medical unit-1, 6 from
our conflicts. If you have watched reruns of the                   Medical Unit-2, 6 from Medical unit-3, 8 from
series Mash on TV, then you know that nurses were                  surgical unit-1, 12 from surgical unit-2, 5 from
there in those battlefield units trying to save lives              surgical unit-3, 5 from orthopedics, 3 from eye and 2
right alongside the doctors. They were, in fact,                   from ENT were included in the study based upon
ministering critical care to those wounded in battle,              bed occupancy rate of wards.
and they had to react quickly and make life and death
decisions under unbelievable pressure and make shift               Using pre-tested semi-structured Questionnaire the
operating conditions. In fact, nurses have been                    data was collected. The clients selected for study, if
responding to critical care situations from the times              unable to give response then the next bed client was
of Florence Nightingale3.                                          selected. During the course of filling tool the client’s
                                                                   nearest relative or caretaker was involved for
Nurses are still seeking respect for their profession.             appropriate response. Opinion was taken only when
In addition to education and training, nursing                     students were not posted in the wards, especially in
advocates sought for standards and regulations that                afternoon time to reduce the bias. The data was
would not only benefit patient care but also give                  collected by trained nurses of other wards in the

                                                              46
Journal of Nepal Health Research Council Vol.4 No.2 October                          Patients’ Attitude Towards......
                                                                                  Occupational Health Hazards .......
.

ordinary dress, to reduce the professional fear and             five tools were distributed to the subjects (i.e.
bias. The clients able to fill the Questionnaire, own           Medical– I =13, Medical–II =13, Medical–III =6,
self, they were encouraged to fill and submit it on             Surgical–I =12, Surgical–II =12, Surgical–III = 6, Or-
the same day or next day morning. For illiterate                thopedic= 6, Eye = 4 and ENT= 3) in all the selected
clients the help of literate/educated caretakers or side        wards using simple random sampling method
by client’s relatives’ was advised to consult to                (lottery method) and 60 tools were only collected
complete the questionnaire. The subjects were                   back (i.e. 10 from Medical –I, 9 from Medical –II, 6
assured that their responses were not seen by the               from Medical –III, 8 from Surgical –I, 12 from Surgical
students and will not affect their training in any way.         –II, 5 from Surgical –III, 5 from Orthopedics, 3 from
Explaining the purpose of study properly, the clients           Eye and 2 from ENT). Fifteen tools were lost due to
were assured about anonymity. The collected data                discharge, transfer and loosing the tool by patients.
was checked, and coding completed. Coded data
was entered in SPSS-10.5 package and analyzed.                  Demographic profile of the respondents: About 19
                                                                percent subjects were of age less than 20 yrs, 20-40
The Questionnaire was a kind of checklist with a                yrs. of 52.6 percent, 40-60 yrs of 24.6 percent and
dichotomonous rating scales (yes or no), will be                more than 60 yrs of 3.5 percent. The mean age is 32.6
relatively simple to construct, easy for respondents            yrs. Majority of the subjects were male i.e. 72.9
and fairly reliable. The Questionnaire consisted of             percent. Thirty one percent subjects were from
10 unambiguously positive and 10 unambiguously                  Sunsari district, where as 29.3 percent from Jhapa,
negative statements. Actually each positive                     8.6 percent from Morang, 5.2 percent from Dhankuta
statement was also asked negatively without                     and 22.4 percent from other district of Nepal. About
changing the main concept or meaning, so that                   half the subjects 57.6 percent were from village (VDC)
biasness could be reduced.                                      and 42.4 percent from town (NP). On the day of data
                                                                collection the duration of hospitalization of clients
                                                                were less than 3 day of 8.6 percent, 3-5 days of 33
Results                                                         percent, 5-7 days13.8, 7-15 days of 31 percent and
This study was conducted in medical-Surgical units              >15 days of 13.8 percent. The mean duration of
of BPKIHS: using stratified random sampling method              hospitalization was 8.793, SD = 7.2105 and Range=
based on bed occupancy rate of the units. Seventy               1-35 days.
Table 1: Attitude of Student Nurses Mentioned by Subjects (MR)

                                                                                                      N=60
S.N.                                          Attitude                                         Percentage (%)
1                                             Friendly/Social                                  66.7
2                                             Kind                                             45.0
3                                             Clever                                           41.7
4                                             Helpful                                          55.0
5                                             Gentle                                           47.6
6                                             Clean and Tidy                                   55.0
7                                             Empathetic                                       60.0
8                                             Soft spoken                                      60.0
9                                             Respectable                                      33.3
10                                            Unbiased                                         58.3




                                                           47
Journal of Nepal Health Research Council Vol.4 No.2 October                            Patients’ Attitude Towards......
                                                                                    Occupational Health Hazards .......
.

Table 2: Suggestions to improve attitude of nursing students (MR)

                                                                                                       N=60
S.N.                             Responses/Suggestions:                                           Percentage (%)
1                                No Response / No Suggestions:                                    32.5
2                                Suggestions Given:                                               67.5
a.                               Develop helping attitude                                         37
b.                               Perform equal behavior to all                                    29.6
c.                               Encourage clients                                                22.2
d.                               Counseling Clients and Relatives                                 18.5
e.                               Perform the duty without hesitancy                               14.8
f.                               Use Soft tone voice                                              14.8
g.                               Be polite and avoid anger                                        11.1
h.                               Provide information about hospital services                      11.1
I.                               Pay attention and Listen to clients problem                      7.4
j.                               Others: show maturity, provide prompt services,                  25.9
                                 learn language of clients etc.

Table 3: Association between opposite statements of same contents

                                                                                                             N=60
S.N. Statement                                                       True   False        Chi-Squire      Significant
                                                                     (%)    (%)          Va l u e        Difference
                                                                                         (Pearson/       with opposite
                                                                                         Fisher’s        statement
                                                                                         Exact test)
1      I am glad that there are student nurses in the hospital       96.7   3.3          0.037           S (with S10)
2      Because of the student nurses being around,
       you feel more in touch what is going on about your disease.   76.7   23.3         0.200           S (with S20)
3      Student nurses do not know anything about your disease.       96.6   3.4          0.707           NS (with S11)
4      Student nurses have good behavior and temperament.            68.5   31.5         0.273           S (with S12)
5      Student nurses are busy and always in hurry                   37.9   62.1         0.104           S (with S18)
6      You can ask Student nurses the most trivial questions.        93.2   6.8          0.264           S (with S17)
7      I would have preferred there to be no student Nurses in the
       hospital                                                      89.6   10.4         0.370           S (with S3)
8      Student nurses behave badly to the patients.                  62.1   37.9         0.602           NS (with S7)
9      You also get to learn something while the senior nurses
       are teaching students nurses in your presence                 95     5            0.521           NS (with S6)
10     You did not really benefit from Student nurses on your
       treatment process.                                            19.6   80.4         0.027           S (with S2)
11     You like Student nurses asking your every detail and
       personal questions concerning your disease.                   90     10           0.118           S (with S1)
12     You do not like Student nurses examining you repeatedly
       taking along time.                                            25.4   74.6         0.203           S (with S19)
13     Student nurses have more time to give                         96.7   3.3          0.104           S (with S8)
14     There is no point asking questions to students Nurses since
       they do not know anything.                                    16.9   83.1         0.264           S (with S9)
15     You like Student nurses examine you because they do it in
       detail                                                        93.3   6.7          0.284           S (with S16)
16     Although student Nurses being around, you did not get
       much to know about your treatment process                     57.9   42.1         0.249           S (with S4)
17     Student nurses helped very much in your treatment process     51.7   48.3         0.027           S (with S14)
18     When Student nurses are being taught in your presence,
       you rather feel left out or bored.                            59.3   4.7          0.521           NS (with S13)
19     Student nurses also know about your disease.                  54.2   45.8         0.707           NS (with S5)
20     You do not like student nurses asking you personal
       questions regarding your disease.                             47.5   52.5         0.118           S (with S15)

Note:         S       = Significant at 5 percent level of confidence (P < 0.005)
             NS       = Not Significant at 5 percent level f confidence (P<0.005)



                                                             48
Journal of Nepal Health Research Council Vol.4 No.2 October                          Patients’ Attitude Towards......
                                                                                  Occupational Health Hazards .......
.

Attitude of the patients towards nursing students:             opportunities in hospitals and health institutions.
There were 10 unambiguously positive (Q.No: 3, 4,              The number of people employed in this occupation
6, 9, 13, 15, 17, 19, 21,13) and 10 unambiguously              is expected to grow moderate to rapidly over the
negative (Q.No: 5, 8, 10, 12, 14, 16,18, 20, 22, 24)           next two to three years. Several factors are
statements. Actually each positive statement was also          contributing to the hospital nursing shortage,
asked negatively without changing the main concepts            including the ageing nursing workforce, which will
or meaning so that biasness could be reduced.                  lead to the retirement of senior nurses; entry
                                                               requirements for nursing courses; and competing
Positive statements: In responses to the positive              career opportunities, especially for nurses with
statements the respondents reported that, presence             degree qualifications. Most nursing vacancies are
of student nurses in ward make the clients glad                in public or private hospitals, both sectors offer
(96.6%), know about own disease process (68.5%),               different working conditions and remuneration
behavior and temperament is good (93.2%), can ask              packages. To alleviate the nursing shortages health
most trivial questions (95%), learn while teach by             authorities and hospitals are improving their
senior nurses (96.7%), like to ask details of personal         policies for recruitment and retention of hospital
questions (93.3%), have more time for clients (51.7%),         nurses.
they examine in details (54.2%), help very much in
treatment process (84.86%), and students also have             The development of technology has meant that
knowledge about disease process (84.5%).                       hospital nurses are required to keep developing their
                                                               skills to maintain professional standards and their
Negative statements: In response to the negative               understanding of new procedures and new
statement the subjects reported that, student nurses           equipment. Hospital nurses are now working more
do not have knowledge about disease process                    independently as their tasks have broadened to
(37.9%), busy and always in hurry (62.1%), they do             include technical procedures, such as intravenous
not like student nurse presence (19.6%), behave                (IV) therapy. Technology has also played an
badly to the patients (25.4%), not benefited by them           important role in caring for pre-term infants, who
(16.9%), repeated and long time examination (57.9%),           would not have survived in the past, and health care
no point to asking questions to them as they do not            for the elderly. Machinery, such as ventilators, can
know anything (59.3%), unable to get information               artificially prolong life of these groups. Hospital
about disease process in spite of presence of                  nurses need to be competent in using this
student nurse (47.5%), patient feel left out or bored          machinery.
(37.7%), and don’t like asking personal questions
(54.4%) .                                                      Attitude of the nursing students: It was found that
                                                               majority of nursing students (66.7%) had friendly
Discussion                                                     behavior and more than 50 percent subjects reported
B.P. Koirala institute of health sciences is a tertiary        student nurses are helpful, clean & tidy,
care hospital. Medical-Surgical Nursing Department             empathetic , soft spoken and unbiased. Regarding
is very useful for nursing students of certificate             Kindness, clever, gentle & respectable they reported
nursing as well as B.Sc. Nursing to learn                      the performance level below 50 percent. This
fundamental of nursing, Medical surgical Nursing               differences may be due to posting of the various
subjects and management practice. Most of the time             levels of nursing students from first year to forth
nursing students are posted in medical-Surgical                year. In early training days they are not well
units, where they contribute a lot for the patients as         prepared to adopt in the clinical situation and take
a nurse and clients are benefited a lot. During the            care of clients completely. Gradually nursing students
course of their clinical posting students’ nurses uses         gain confidence and their attitude will be improve.
nursing process properly to evaluate the needs and             No similar study was available to compare he findings.
provide care accordingly, so that the clients can
experiences better nursing care during their posting.          In this study there may be some bias as the tool was
About 80 students of certificate level and 60                  opinionnaire, each individual perceive the attitude
students of B. Sc. Nursing level are posted in                 in different ways, the responses of clients may vary
Medical-Surgical units for more than 6 months of a             with respondents, disease process and environment
year.                                                          of the units may interfere in the responses which
                                                               can not be totally eliminated. The results of this study
There is a national and international shortage of              showed that the attitude of patients towards
nurses, which means there are many employment                  nursing students who had been involved in the care

                                                          49
Journal of Nepal Health Research Council Vol.4 No.2 October                      Patients’ Attitude Towards......
                                                                              Occupational Health Hazards .......
.

during their hospital stays were on the whole, highly        2. Murray M, Chambers M. Effect of contact on
favorable.                                                      nursing student ‘s attitude to patients. Nurse
                                                                Educ Today. 1991; 11(5): 363-7.
Conclusions                                                  3. Dunn SV, Hansford B. Undergraduate nursing
                                                                student’s perception of their clinical learning
The development of technology has meant that                    environment. Journal of Advanced nursing. 1997;
hospital nurses are required to keep developing their           25 (6):1299-1306.
skills to maintain professional standards and their          4. Courtney M, Tongs S, Walsh S. Acute-care
understanding of new procedures and new                         nurse’s attitude towards older patients: A
equipment along with the need to develop the                    literature review. International Journal of
therapeutic relation with the patients to overcome              nursing Practice. 2000; 6(2): 62-69.
the future challenges. The nursing faculty must              5. Gates MF, Kaul M, Speece MW, Brent SB. The
prepare to teach the nursing students with modern               attitudes of beginning nursing and medical
approach so that they will be able to meet the future           students towards care of dying patients: a
challenges. This study helps nursing faculty as well            preliminary study. Hospital Journal. 1982; 8(4):
as the administrators to pay attention on the areas             17-32.
where the performances of students are poor.                 6. Majumadar B. Medical and Nursing students’
                                                                knowledge and attitudes towards violence
References                                                      against women in India. Educ. Health. 2004;
1. Richardson PH, Curzen P, Fonagy P. Patient’s                 17(3):354-64.
   attitude to student doctors. Medical-Education.
   1986; 20(4).




                                                        50

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Patients attitue nhrc article

  • 1. Journal of Nepal Health Research Council Vol.4 No.2 October Patients’ Attitude Towards...... Occupational Health Hazards ....... . Patients’ Attitude Towards Nursing Students of BPKIHS Mehta RSa and Singh Ba Abstract ................................................................................................................................................................................................................................... Introduction Health care is a social role relationship between a helping agent and a person needing help. This relationship is considered psychologically and socially as half cures treatment procedure. Therefore the nature of relationship between nurses and patient has some degree of significant impact on the overall quality of health care. ................................................................................................................................................................................................................................... Objectives The objectives of this study were to assess the attitude of the patients regarding the presence and involvement of the nursing students in their clinical care in Medical–Surgical units of B.P. Koirala Institute of Health Sciences. ................................................................................................................................................................................................................................... Methods It was hospital based cross sectional study. The clients admitted in Medical-Surgical units in the day of data collection constitute the population of the study. The stratified simple random sampling method was used to select the sample and 75subjects were selected from all the wards of Medical-Surgical units of BPKIHS out of 260 admitted patients, where as only 60 tools were returned back out of 75 tools. The collected data was entered in SPSS-10.5 software package and analyzed. ................................................................................................................................................................................................................................... Results The respondents reported that, presence of student nurses in ward make the clients glad (96.6%), received information about own disease process (68.5%), can ask most trivial questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal questions (93.3%), devote more time for clients (51.7%), they examine in details (54.2%) and help very much in treatment process (84.86%). Students have knowledge about disease process (84.5%) and their behavior and temperament is good (93.2%). ................................................................................................................................................................................................................................... Conclusions The development of technology has meant that hospital nurses are required to keep developing their skills to maintain professional standards and their understanding of new procedures and new equipment along with the need to develop the therapeutic relation with the patients to overcome the future challenges. ................................................................................................................................................................................................................................... Key Words Patients, Attitude, Nursing Students ................................................................................................................................................................................................................................... Introduction Medical profession was considered to be a noble high cost. The high cost or investment of the hospi- profession from time immemorial. While a medical tals compelled the management to increase the cost student comes out of medical institution after the of service. On the other hand the number of hospi- Hypocrite’s Oath, it is his duty to look after any patient tals increased which made the sector competitive. irrespective of caste, creed, sex or even remuneration. This intern forced the hospitals to employ reputed In history we come across doctors and paramedical doctors and Nurses to attract the patients. The staff who spent their entire life for the prosperity of branches of specialization made available micro-or- the patients and also the total health of the community. gan specialists. The superspecialists are demanded One notable example is the story of Florence by the hospitals. The concept of hygenity motivated Nightingale who spent her entire life for nursing the the hospitals to update the facilities to the status of sick. In older days the primary objective of any star hotels. The higher education and increased medical institution was not to make exemplary profit1. awareness contributed the public to approach the hospitals2. Over the year’s technology advanced and the hospitals became more technology oriented with a Corresponding Authors: Ram Sharan Mehta, E-mail: ramsharanmehta@yahoo.com, aMedical-Surgical Nursing Department, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. 45
  • 2. Journal of Nepal Health Research Council Vol.4 No.2 October Occupational Health Hazards ....... Patients’ Attitude Towards...... . The nature of relationship between nurse and nursing the professional status it needed and patient has some degree of significant impact on the deserved. overall quality of healthcare, the patient’s compliance and satisfaction is greatly influenced by the appearance, Till date, there has been no study of the attitude of behavior and the communication skill of the nurses the patients in the hospital to the presence and as nurses stay 24 hours with the clients3. involvement of the student in their nursing care in BPKIHS. So, we are trying to find out the real With increasing in life expectancy and increasing scenario in our context. numbers older patients utilizing the acute setting, attitudes of registered nurses caring for older people With the emerging nursing colleges in the country may affect the quality of care. Many negative and the out flowing number of nursing students in attitudes reflect against stereotypes and knowledge many hospitals, this complex relationship has more deficits that significantly influence registered nurses importance and responsibility than even before. In practice and older patients’ quality of care. In the BPKIHS, patients are in contact with nursing present setting, older patients experience reduced students and they must have developed some independence, limited decision-making opportunities, attitude towards student nurses during their social increased probability of developing complications and nursing interaction. Hence, the investigators little consideration so their aging-related needs, are decided to conduct the study on, “patient’s limited health education and social isolation. Available attitude towards nursing students of BPKIHS”. instruments to outdated, country specific and do not include either a patient focus or a caring perspective. The objective of this study was to assess the This paper argues for the development and utilization attitude of the patients regarding the presence and of a research instrument that includes both a patient’s involvement of the nursing students in their clinical focus and a caring dimension4. care in Medical–Surgical units of BPKIHS. The origins of nursing date back to when the first mother or other close female, ministered to the sick Methods in the family. It was Florence Nightingale in the It was hospital based cross sectional study. The mid-1800s who founded modern nursing and clients admitted in Medical-Surgical units in the day structured professional duties into an orderly trained of data collection constitute the population of the fashion. Before this, so-called nurses were considered study. The total bed strength of the selected units untrained servants. Nightingale established the first was 306 and 260 clients were admitted in the same school of nursing in London, England in 1860, with day i.e. bed occupancy rate was 85 percent. Seventy the first school in the United States established in five subjects (29%) were selected for the study and 1872 in Boston, Massachusetts3. tools were distributed to them. Finally 60 tools were only returned back i.e. total sample selected was 23 Throughout the next 130 years, nursing schools percent out of total population and the sample flourished as mainly women were educated and mortality was 20 percent. The stratified simple trained to take care of the sick. Nurses also random sampling method was used to select the distinguished themselves on the battlefield in all of sample and 10 subjects from Medical unit-1, 6 from our conflicts. If you have watched reruns of the Medical Unit-2, 6 from Medical unit-3, 8 from series Mash on TV, then you know that nurses were surgical unit-1, 12 from surgical unit-2, 5 from there in those battlefield units trying to save lives surgical unit-3, 5 from orthopedics, 3 from eye and 2 right alongside the doctors. They were, in fact, from ENT were included in the study based upon ministering critical care to those wounded in battle, bed occupancy rate of wards. and they had to react quickly and make life and death decisions under unbelievable pressure and make shift Using pre-tested semi-structured Questionnaire the operating conditions. In fact, nurses have been data was collected. The clients selected for study, if responding to critical care situations from the times unable to give response then the next bed client was of Florence Nightingale3. selected. During the course of filling tool the client’s nearest relative or caretaker was involved for Nurses are still seeking respect for their profession. appropriate response. Opinion was taken only when In addition to education and training, nursing students were not posted in the wards, especially in advocates sought for standards and regulations that afternoon time to reduce the bias. The data was would not only benefit patient care but also give collected by trained nurses of other wards in the 46
  • 3. Journal of Nepal Health Research Council Vol.4 No.2 October Patients’ Attitude Towards...... Occupational Health Hazards ....... . ordinary dress, to reduce the professional fear and five tools were distributed to the subjects (i.e. bias. The clients able to fill the Questionnaire, own Medical– I =13, Medical–II =13, Medical–III =6, self, they were encouraged to fill and submit it on Surgical–I =12, Surgical–II =12, Surgical–III = 6, Or- the same day or next day morning. For illiterate thopedic= 6, Eye = 4 and ENT= 3) in all the selected clients the help of literate/educated caretakers or side wards using simple random sampling method by client’s relatives’ was advised to consult to (lottery method) and 60 tools were only collected complete the questionnaire. The subjects were back (i.e. 10 from Medical –I, 9 from Medical –II, 6 assured that their responses were not seen by the from Medical –III, 8 from Surgical –I, 12 from Surgical students and will not affect their training in any way. –II, 5 from Surgical –III, 5 from Orthopedics, 3 from Explaining the purpose of study properly, the clients Eye and 2 from ENT). Fifteen tools were lost due to were assured about anonymity. The collected data discharge, transfer and loosing the tool by patients. was checked, and coding completed. Coded data was entered in SPSS-10.5 package and analyzed. Demographic profile of the respondents: About 19 percent subjects were of age less than 20 yrs, 20-40 The Questionnaire was a kind of checklist with a yrs. of 52.6 percent, 40-60 yrs of 24.6 percent and dichotomonous rating scales (yes or no), will be more than 60 yrs of 3.5 percent. The mean age is 32.6 relatively simple to construct, easy for respondents yrs. Majority of the subjects were male i.e. 72.9 and fairly reliable. The Questionnaire consisted of percent. Thirty one percent subjects were from 10 unambiguously positive and 10 unambiguously Sunsari district, where as 29.3 percent from Jhapa, negative statements. Actually each positive 8.6 percent from Morang, 5.2 percent from Dhankuta statement was also asked negatively without and 22.4 percent from other district of Nepal. About changing the main concept or meaning, so that half the subjects 57.6 percent were from village (VDC) biasness could be reduced. and 42.4 percent from town (NP). On the day of data collection the duration of hospitalization of clients were less than 3 day of 8.6 percent, 3-5 days of 33 Results percent, 5-7 days13.8, 7-15 days of 31 percent and This study was conducted in medical-Surgical units >15 days of 13.8 percent. The mean duration of of BPKIHS: using stratified random sampling method hospitalization was 8.793, SD = 7.2105 and Range= based on bed occupancy rate of the units. Seventy 1-35 days. Table 1: Attitude of Student Nurses Mentioned by Subjects (MR) N=60 S.N. Attitude Percentage (%) 1 Friendly/Social 66.7 2 Kind 45.0 3 Clever 41.7 4 Helpful 55.0 5 Gentle 47.6 6 Clean and Tidy 55.0 7 Empathetic 60.0 8 Soft spoken 60.0 9 Respectable 33.3 10 Unbiased 58.3 47
  • 4. Journal of Nepal Health Research Council Vol.4 No.2 October Patients’ Attitude Towards...... Occupational Health Hazards ....... . Table 2: Suggestions to improve attitude of nursing students (MR) N=60 S.N. Responses/Suggestions: Percentage (%) 1 No Response / No Suggestions: 32.5 2 Suggestions Given: 67.5 a. Develop helping attitude 37 b. Perform equal behavior to all 29.6 c. Encourage clients 22.2 d. Counseling Clients and Relatives 18.5 e. Perform the duty without hesitancy 14.8 f. Use Soft tone voice 14.8 g. Be polite and avoid anger 11.1 h. Provide information about hospital services 11.1 I. Pay attention and Listen to clients problem 7.4 j. Others: show maturity, provide prompt services, 25.9 learn language of clients etc. Table 3: Association between opposite statements of same contents N=60 S.N. Statement True False Chi-Squire Significant (%) (%) Va l u e Difference (Pearson/ with opposite Fisher’s statement Exact test) 1 I am glad that there are student nurses in the hospital 96.7 3.3 0.037 S (with S10) 2 Because of the student nurses being around, you feel more in touch what is going on about your disease. 76.7 23.3 0.200 S (with S20) 3 Student nurses do not know anything about your disease. 96.6 3.4 0.707 NS (with S11) 4 Student nurses have good behavior and temperament. 68.5 31.5 0.273 S (with S12) 5 Student nurses are busy and always in hurry 37.9 62.1 0.104 S (with S18) 6 You can ask Student nurses the most trivial questions. 93.2 6.8 0.264 S (with S17) 7 I would have preferred there to be no student Nurses in the hospital 89.6 10.4 0.370 S (with S3) 8 Student nurses behave badly to the patients. 62.1 37.9 0.602 NS (with S7) 9 You also get to learn something while the senior nurses are teaching students nurses in your presence 95 5 0.521 NS (with S6) 10 You did not really benefit from Student nurses on your treatment process. 19.6 80.4 0.027 S (with S2) 11 You like Student nurses asking your every detail and personal questions concerning your disease. 90 10 0.118 S (with S1) 12 You do not like Student nurses examining you repeatedly taking along time. 25.4 74.6 0.203 S (with S19) 13 Student nurses have more time to give 96.7 3.3 0.104 S (with S8) 14 There is no point asking questions to students Nurses since they do not know anything. 16.9 83.1 0.264 S (with S9) 15 You like Student nurses examine you because they do it in detail 93.3 6.7 0.284 S (with S16) 16 Although student Nurses being around, you did not get much to know about your treatment process 57.9 42.1 0.249 S (with S4) 17 Student nurses helped very much in your treatment process 51.7 48.3 0.027 S (with S14) 18 When Student nurses are being taught in your presence, you rather feel left out or bored. 59.3 4.7 0.521 NS (with S13) 19 Student nurses also know about your disease. 54.2 45.8 0.707 NS (with S5) 20 You do not like student nurses asking you personal questions regarding your disease. 47.5 52.5 0.118 S (with S15) Note: S = Significant at 5 percent level of confidence (P < 0.005) NS = Not Significant at 5 percent level f confidence (P<0.005) 48
  • 5. Journal of Nepal Health Research Council Vol.4 No.2 October Patients’ Attitude Towards...... Occupational Health Hazards ....... . Attitude of the patients towards nursing students: opportunities in hospitals and health institutions. There were 10 unambiguously positive (Q.No: 3, 4, The number of people employed in this occupation 6, 9, 13, 15, 17, 19, 21,13) and 10 unambiguously is expected to grow moderate to rapidly over the negative (Q.No: 5, 8, 10, 12, 14, 16,18, 20, 22, 24) next two to three years. Several factors are statements. Actually each positive statement was also contributing to the hospital nursing shortage, asked negatively without changing the main concepts including the ageing nursing workforce, which will or meaning so that biasness could be reduced. lead to the retirement of senior nurses; entry requirements for nursing courses; and competing Positive statements: In responses to the positive career opportunities, especially for nurses with statements the respondents reported that, presence degree qualifications. Most nursing vacancies are of student nurses in ward make the clients glad in public or private hospitals, both sectors offer (96.6%), know about own disease process (68.5%), different working conditions and remuneration behavior and temperament is good (93.2%), can ask packages. To alleviate the nursing shortages health most trivial questions (95%), learn while teach by authorities and hospitals are improving their senior nurses (96.7%), like to ask details of personal policies for recruitment and retention of hospital questions (93.3%), have more time for clients (51.7%), nurses. they examine in details (54.2%), help very much in treatment process (84.86%), and students also have The development of technology has meant that knowledge about disease process (84.5%). hospital nurses are required to keep developing their skills to maintain professional standards and their Negative statements: In response to the negative understanding of new procedures and new statement the subjects reported that, student nurses equipment. Hospital nurses are now working more do not have knowledge about disease process independently as their tasks have broadened to (37.9%), busy and always in hurry (62.1%), they do include technical procedures, such as intravenous not like student nurse presence (19.6%), behave (IV) therapy. Technology has also played an badly to the patients (25.4%), not benefited by them important role in caring for pre-term infants, who (16.9%), repeated and long time examination (57.9%), would not have survived in the past, and health care no point to asking questions to them as they do not for the elderly. Machinery, such as ventilators, can know anything (59.3%), unable to get information artificially prolong life of these groups. Hospital about disease process in spite of presence of nurses need to be competent in using this student nurse (47.5%), patient feel left out or bored machinery. (37.7%), and don’t like asking personal questions (54.4%) . Attitude of the nursing students: It was found that majority of nursing students (66.7%) had friendly Discussion behavior and more than 50 percent subjects reported B.P. Koirala institute of health sciences is a tertiary student nurses are helpful, clean & tidy, care hospital. Medical-Surgical Nursing Department empathetic , soft spoken and unbiased. Regarding is very useful for nursing students of certificate Kindness, clever, gentle & respectable they reported nursing as well as B.Sc. Nursing to learn the performance level below 50 percent. This fundamental of nursing, Medical surgical Nursing differences may be due to posting of the various subjects and management practice. Most of the time levels of nursing students from first year to forth nursing students are posted in medical-Surgical year. In early training days they are not well units, where they contribute a lot for the patients as prepared to adopt in the clinical situation and take a nurse and clients are benefited a lot. During the care of clients completely. Gradually nursing students course of their clinical posting students’ nurses uses gain confidence and their attitude will be improve. nursing process properly to evaluate the needs and No similar study was available to compare he findings. provide care accordingly, so that the clients can experiences better nursing care during their posting. In this study there may be some bias as the tool was About 80 students of certificate level and 60 opinionnaire, each individual perceive the attitude students of B. Sc. Nursing level are posted in in different ways, the responses of clients may vary Medical-Surgical units for more than 6 months of a with respondents, disease process and environment year. of the units may interfere in the responses which can not be totally eliminated. The results of this study There is a national and international shortage of showed that the attitude of patients towards nurses, which means there are many employment nursing students who had been involved in the care 49
  • 6. Journal of Nepal Health Research Council Vol.4 No.2 October Patients’ Attitude Towards...... Occupational Health Hazards ....... . during their hospital stays were on the whole, highly 2. Murray M, Chambers M. Effect of contact on favorable. nursing student ‘s attitude to patients. Nurse Educ Today. 1991; 11(5): 363-7. Conclusions 3. Dunn SV, Hansford B. Undergraduate nursing student’s perception of their clinical learning The development of technology has meant that environment. Journal of Advanced nursing. 1997; hospital nurses are required to keep developing their 25 (6):1299-1306. skills to maintain professional standards and their 4. Courtney M, Tongs S, Walsh S. Acute-care understanding of new procedures and new nurse’s attitude towards older patients: A equipment along with the need to develop the literature review. International Journal of therapeutic relation with the patients to overcome nursing Practice. 2000; 6(2): 62-69. the future challenges. The nursing faculty must 5. Gates MF, Kaul M, Speece MW, Brent SB. The prepare to teach the nursing students with modern attitudes of beginning nursing and medical approach so that they will be able to meet the future students towards care of dying patients: a challenges. This study helps nursing faculty as well preliminary study. Hospital Journal. 1982; 8(4): as the administrators to pay attention on the areas 17-32. where the performances of students are poor. 6. Majumadar B. Medical and Nursing students’ knowledge and attitudes towards violence References against women in India. Educ. Health. 2004; 1. Richardson PH, Curzen P, Fonagy P. Patient’s 17(3):354-64. attitude to student doctors. Medical-Education. 1986; 20(4). 50