The public perception

There is no doubt   that nursing is a profession with the essential ingredients of autonomy and accountability. It is true that the profession demands responsibilities than the past when the principle of a nurse was just to provide care and comfort. Today, a nurse is a client advocate, educator and manager. But little attention has been drawn to assess the real public perception about nurses. Although the patients seem to know better (than the past) about health care and demand more knowledge on their treatment options (Kubler – Ross, 1969), it is obvious that no common man thinks or does any analysis of a nurse until he needs one or is in a situation where he/she interacts with a nurse as in case of a hospital admission. Thus, there is little scope of the public staying updated on the professional developments in nursing practice. Hence, to the public, nursing is caring for someone in distress. They know that a caring nurse can give comfort and solace to someone in need. The public perceive a nurse as just someone who assists the doctor during and after treatment of the illness assisting the patient in keeping up his personal hygiene, giving the medications as prescribed by the doctor, dressing the wounds when there is a need ensuring the welfare of the patient. There are also people both male and female who are of the view that men have no business working in the field of nursing due to lack of capacity to care compared to a woman.

A Research Perspective

Patient satisfaction with nursing care is an indicator of quality care. A study to discover patients' perceptions of the nursing care they receive in a hospital setting using the Grounded theory method in eight medical-surgical patients recently discharged from an academic medical centre in the south-eastern United States of America has identified four categories of patient perceptions of their nursing care, namely, Seeing the individual patient, Explaining, Responding and Watching over. Seeing the individual explains the unique nature of the nursing care experience for each patient. 'Explaining' denotes the informal but essential explanations given by nurses. 'Responding' denotes the character and timeliness of nursing staff's responses to patient requests or symptoms. 'Watching over' represents the surveillance activities of nursing staff (Schmidt, 2003).The issue of accurate measurement of patient perception is a topic of interest. A patient satisfaction survey conducted in two acute care surgical wards, using the revised 28-item La Monica-Oberst patient satisfaction scale and descriptive statistics has revealed very high levels of patient satisfaction (O'Connell et.al, 1999). Thirty-five interviews conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases have shown that patient's preferences have a rational and a human aspect. The study has also identified four dimensions of patient perceptions namely, the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization ( Wilde et.al,1993)

A study designed to determine if demographic characteristics of patients such as age, gender and cultural background influence perceptions has shown that patients who were older, female and from aged care wards perceived that physical aspects of nursing care were more important than did patients who were younger, male and from medical wards (Chang et.al, 2003).A qualitative descriptive study aimed to evaluate surgical patient satisfaction with nursing care with a  sample of six general surgical patients has revealed patient satisfaction with the personal and professional nature of nurses. Participants have been shown to understand information from nurses. Minimal nurse contact, lack of personalized care and lack of information about the operation, recuperation and minor treatment options have been identified as factors that cause dissatisfaction (Hogan, 2000).A recent systematic review that utilized the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting has shown that the pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy are vital factors that bring about patient satisfaction (Rhodes, 2006).Nursing care is the process of “building a relationship” involving  patient’s goals, preferences and choices, attending to the medical, emotional, social and spiritual needs using strengths of interdisciplinary resource. Hence, to provide quality care, a nurse must know what patients expect from the nurse. All research activities on this aspect have been focusing on the nurse’s perspective rather than the patient.

Lynn et.al (1999) has ranked perceptions from patients perspective using 90 items from the Patient's Perception of Quality Scale-Acute Care Version, an instrument developed from qualitative interviews of patients. The study involving 448 patients from the medical surgical units in seven hospitals also has also shown that nurses consistently underestimated the extent to which patients valued most aspects of good nursing care. Another study to explore nurse’s prescribing from the patient's viewpoint has shown that nurse prescribers have the key skills in assessment, observation, diagnosing and providing information to the patients. The study has also affirmed that all the participant patients accept nurse prescribing as a practical and responsive method of service delivery in terms of  use of the nurse's and doctor's time, convenience and expertise ( Brooks et.al, 2001). A recent study to examine patients recall and perceptions of lifestyle counseling received from practice nurses (Duaso and Cheung, 2002) by a cross-sectional descriptive survey design with a total of 512 patients has shown that these patients were willing to receive health promotion advice from the nurses in areas such as stress, exercise and weight reduction. Further, published literature stress on the fact that patient preferences do influence practice guidelines.A recent study of the experiences of nurses with chronic non-malignant men patients has shown that the patients need better support and assurance from the nurses to disclose their pain honestly. A recent trend in nursing is the evidence based practice that takes patient’s perspective also into account. Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the case of individual patients (Sackett, 1996).

Conclusion

The role of nurse as a patient advocate is lucid only in some cases where the patients express their wishes and treatment options to the nurse. This is because of the fact that a nurse can protect patient’s rights only within the framework of the law and hence, patient education can play a key role in inducing the right public perception (Bonnel et.al, 1999). It is important to ensure that patients truly understand the complexity of choices before a nurse. The social models of nurse practice give more scope to understand this aspect of care. The National Cancer Institute has compiled a review of the literature published from 1979 to 1990 on information, education and communication needs of patients with cancer and their families in U.S.A stating that there is a need to maximize patient comprehension, minimize apprehension and encourage participation (Duaso and Cheung, 2002). It is important to note that information should be tailored to suit patient’s educational background, cultural orientation and level of comprehension. The science of nursing is a dynamic entity evolving with time. Hence, it is important to develop a systematic and scientific methodology to assess public or patient perceptions about nursing. It is also important for the nurses to understand the perceptions of the public to achieve their professional goal of quality nurse care. 

References

• Rhodes L, Miles G, Pearson A. (2006). Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review. Int J Nurs Pract. 12(4):178-92.

• Hogan B. (2000). Patient satisfaction: expectations and experiences of nursing care. Contemp Nurse. 9(3-4):275-83.

• Chang E, Hancock K, Chenoweth L, Jeon YH, Glasson J, Gradidge K, Graham E.(2003). The influence of demographic variables and ward type on elderly patients' perceptions of needs and satisfaction during acute hospitalization.Int J Nurs Pract. 9(3):191-201.

• O'Connell B, Young J, Twigg D. (1999). Patient satisfaction with nursing care: a measurement conundrum. Int J Nurs Pract. 5(2):72-7.

• Wilde B, Starrin B, Larsson G, Larsson M.(1993). Quality of care from a patient perspective--a grounded theory study. Scand J Caring Sci. 7(2):113-20.

• Schmidt LA. (2003). Patients' perceptions of nursing care in the hospital setting. J Adv Nurs. 44(4):393-9.

• Bonnel, Wanda Blaser (1999). Patient Teaching for Older Adults and Families in the Long-Term Care Setting. Journal for Nurses in Staff Development.15 (2):75-77.

• Patricia Flatley Brennan (1998). International Perspectives on the Roles of Clinical Guidelines and Patient Preferences in Patient Care. J Am Med Inform Assoc. 5(3): 317–318.

• Lynn, Mary R.McMillen, Bradley J. (1999). A Key to Improving Performance. Journal of Nursing Care Quality. 13(5):65-74.

• Maria Jose Duaso and Philip Cheung (2002). Issues and Innovations in Nursing Practice. Journal of Advanced Nursing. 39(5); 472-479.

• Brooks N, Otway C, Rashid C, Kilty L, Maggs C.(2001). Nurse prescribing: what do patients think? Nurs Stand. 10-16; 15(17):33-8.

• Patricia A Potter, Anne Griffin Perry (2005). Fundamentals of Nursing.6th edition, Mosby.

• Kubler – Ross E (1969). On death and dying, Macmillan New York.

• Sackett (1996).Evidence based medicine: what it is and what it isn't.? BMJ 312: 71-72.

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