5 Records out of 22207 Records

An evaluation of doctor-patient communication : a case of study of Meridian Medical Clinic at the Nation Centre in Nairobi

Author: Ochuodho, Jedida

Awarding University: Daystar University, Kenya

Level : MsC

Year: 2011

Holding Libraries: Daystar University Library ;

Subject Terms: Communication ; Patients ; Physicians ; Physician patient relationships ; Meridian Medical Clinic, Nairobi, Kenya ;

Abstract:

In Kenya, cases of patients accusing medical practitioners of negligence resulting in damage to health or even death are on the rise. These complaints are not necessarily due to professional incompetence but some result from improper diagnosis or incorrect adherence to prescribed treatment due to ineffective communication. This study comprised three research objectives, namely, to evaluate factors that affected doctor-patient communication, to determine barriers to effective doctor-patient communication, and to establish ways of improving doctor-patient communication. Uncertainty Reduction Theory (1975) and Social Penetration Theory (1973) were the theoretical basis of this research to evaluate doctor-patient communication.The research used both qualitative and quantitative approaches to collect data that was analyzed to get findings. Questionnaires were administered to 200 patients. Subsequently, in-depth interviews were conducted with four doctors and six patients. Secondary sources were also used to strengthen the research. A content analysis of the transcribed interviews was performed while the responses from the questionnaires were analyzed using SPSS 17. Findings revealed that 89% of the patients were satisfied with the way the doctors communicated with them. The major elements of communication the respondents highlighted were effective listening, trust, doctors? communication style and self-disclosure. A lot of factors such as use of jargon, differences in age, gender and culture and length of interaction also hindered effective communication. It was observed that doctor patient communication can be improved by training doctors in communication

Factors influencing doctor-patient communication : A case study of surviviors of gender based violence at Nairobi Women's Hospital

Author: Otachi, Janet Kerubo

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2010

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Patients ; Physician patient relationships ; Women ; Sex crimes ; Psychological aspects ;

Abstract:

The main objective of this study was to examine the factors influencing the interaction between doctors and the survivors of gender based violence. The study was conducted at The Nairobi Women's Hospital and focused on female survivors of Gender Based Violence, mainly those assaulted sexually. Data was collected through direct observation of the hospital's casualty area, interviewing of 10 doctors, 50 survivors of gender based violence and 4 key informants. The study found that majority of the survivors were youth aged between 18-24 years, had acquired basic education, were married, resided in middle and low class areas and had some form of income whether employed or owned businesses. The factors influencing doctor-patient communication were found to include, doctor's friendliness, non-judgmental attitude, good listening skills and concern. Majority of the doctors reported that they negotiated the treatment plan with their patients depending on their condition. Some patients needed urgent attention and had to be rushed to theatre therefore, they had no time to explain diagnosis. Doctor-patient communication gaps were reflected through such reports as doctor's reception was poor; he/she looked stem and rushed through the procedures. On the other hand, those who felt that the doctor explained procedures before undertaking them reported having asked before the explanation was given. They also reported that their doctor did not take time to explain diagnosis but instead wrote in a card and referred them for further tests. Majority of the doctors reported major challenges to doctor-patient interaction as language barrier, patient's illiteracy, trauma, time constraints and patient's personality. According to the key informants there is a communication gap in doctor patient interaction and a lot is attributed to the trauma faced by the survivors of sexual assault. When the patient feels understood and the care giver is empathetic and understanding, they feel satisfied with the intervention. The study concluded that having good communication skills is essential for doctors to establish good doctor patient interaction. There is a gap in doctor-patient interaction and extra effort to improve communication and relationship with patients would help reduce complaints due to dissatisfaction and improve compliance. Effective doctor-patient interaction and communication is central to doctor and patient satisfaction, to the clinical competence of doctors and to the health outcomes of their patients. The key recommendations were that doctors should have training in basic counseling skills since they are the initial contact persons with the survivors of sexual assault. They should also be empowered with communication skills to address patient's socio-cultural beliefs in a satisfactory manner.

An investigation of informed consent in clinical practice in Kenya

Author: Shieshia-Odwori, Mildred

Awarding University: Kenyatta University, Kenya

Level : MPH

Year: 2008

Holding Libraries: Kenyatta University Moi Library ;

Subject Terms: Physician patient relationships/Informed consent ;

Abstract:

Consent to medical treatment is considered essential in a doctor-patient relationship. However, cases of breaches abound. Informed consent involves the elements of information, comprehension and volition. The information provided must be sufficient, understandable and there must be no coercion or undue influence in its procurement. The purpose of this study was to investigate the extent to which informed consent is applied in clinical practice in Kenya. Aga Khan University Hospital (private) and Kenyatta National Hospital (public) were purposively selected for the study. The study sample consisted of 401 inpatients and 46 doctors drawn from the Surgical, Paediatric and Obstetrics and Gynaecology departments. Data was collected using a pre-tested interview schedule for patients and a semi-structured questionnaire for doctors. The independent variables in the study were age, sex, marital status, occupation, income, languages spoken and education level. The dependent variables were information, comprehension and volition. The Statistical Package for Social Sciences (SPSS) was used to treat data. Data was presented using graphs, pie charts, frequency tables and percentages. The Pearson Chi Square test was used to test for relationships between variables. The findings of the study showed that the information provided to patients was not sufficient to procure informed consent since it focused mainly on diagnosis (82.7%). There was a disparity in the responses of information provided on risks (patients 23.1%, doctors, 76.1%) and benefits (patients 31.1%, doctors 91.3%). The Pearson chi square test showed a significant association between marital status and whether any information was provided or not (x2= 8.569, df =1 p=0.003). The oral method (words) was predominantly (80%) used to provide information to patients. Although a majority (84.2%) of patients said they understood the information provided only 58.7% of the doctors' concurred. The use of technical language was identified as a major barrier (patients 21%, doctors 33%) to comprehension. The Pearson chi square test showed a significant association between marital status and whether one asked questions on medical treatment or not (x2 = 14.633, df = 1, p=0.0001). Although most (92%) patients provided consent voluntarily, 55.4% of the patients did not know they had an option to accept or decline treatment. The Pearson Chi-square test showed a significant association between volition and marital status (x2 = 7.702, df =1, p=0.006). The Pearson Chi square test also showed a significant association between department and type of consent given ((x2 = 81.9, df =2, p=0.000). Written consent was more likely to be provided in the surgical department where invasive procedures are carried out. The study concludes that information provided to patients prior to obtaining consent is insufficient, findings on comprehension are inconclusive and patients provide consent without coercion or undue influence. The results of this study lead to the inexorable conclusion that although consent is obtained in clinical practice in the two hospitals under study, it is not informed and comprehensible. The study recommends training of medical doctors on the art of communication in order to enhance the doctor-patient relationship. It also recommends that the Ministry of Health enhance public education and awareness on medical rights and develop National guidelines for the process of obtaining informed consent.

Clinician-client communication in outpatient clinics in Nyanza provincial general hospital, Kisumu, Kenya

Author: Magara, Jack H O

Awarding University: Moi University, Kenya

Level : MPH

Year: 2008

Holding Libraries: Moi University Margaret Thatcher Library ;

Subject Terms: Nyanza Provincial General Hospital, Kisumu ; Physician patient relationships ; Communication ; Outpatient care facilities ; Patients ;

Abstract:

Background: Effective clinician-client communication is the hallmark of a mutually beneficial clinician-client relationship but not much is known about this in developing countries like Kenya. Study area: ANC, ENT, EYE and OPD filter clinics, Nyanza PGH, Kisumu Study design: Cross sectional survey Objectives: To determine satisfaction among clinicians and clients in regard to clinicianclientcommunication, factors that influence clinician-client communication, relationship betweenclinician-client communication and facility utilization and assess knowledge of cliniciansand clients on role of communication in healthcare. Methods: Exit interviews were conducted on 384 randomly selected clients and 17 clinicians responded to a self administered semi structured questionnaire modeled on the 4Es communication model. Non participant observation was also done. Results: Of the respondents, 87.8% clients and 76.4% clinicians were satisfied with the status of clinician-client communication in the outpatient clinics. There was a strong association between empathy, health education and client satisfaction (i =26.04, p=O.OOOi, =14.05, p=O.OOO)respectively. Gender, level of education of client and satisfaction were independent (i =0.0952, p=0.758, xJ =0.5181, p=0.472) respectively. The age of clients was an important factor in satisfaction (p=0.0001), Clinician-client communication affects utilization of the facility. Structural, processes and behavioral related factors affect clinician-client communication in the clinics surveyed. Overall qualityof clinician-client communication in the OPD clinics was good. Conclusion: Clinician-client communication affects healthcare delivery and that it can be used to improve the clinician-client relationship, quality of care and the utilization of the health facilities.

The outpatient and the staff satisfaction with the treatment provided in a District Hospital Kiambu

Author: Maina-Githinji, Elizabeth

Awarding University: University of Dar es Salaam, Tanzania

Level : MA

Year: 1977

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Outpatient care facilities ; Patients ; Attitude surveys ; Physician patient relationships ; Nurse patient relationships ; Kiambu District Hospital, Kenya ;

Abstract:

Satisfaction studies with the outpatient Services have been done in the developed countries e.g. in America and Britain but few if any exist in the developing countries. The aim of this research was to do a study in the Outpatients and the Staff satisfaction with the treatment provided in a District Hospital Kiambu. In Chapter one, we introduce the history of medical services in Kenya in order to inform the readers about the provision and the statue of health services in this country emphasizing the historical development. In Chapter two, we examine the Kikuyu Cultural attitude towards health and disease in comparison with the Western Culture. This will help us in understanding the patients t 'attitude in the Outpatient Department. their satisfaction and dissatisfaction. In Chapter three, we discuss the theoretical framework of the study which will enable us to present the collected data systematically. In particular we examine Parsons sick role theory. In Chapter four, WE review literature en the study of satisfaction for both the Outpatient and the staff. In Chapter five, we look into various findings which are a result of four different surveys in a community study and satisfaction studies in the hospital. The first study will give us the peoples impressions about Kiambu Hospital and their expectations when they visit the Outpatient Department. The second study will enable us to measure the patients and the staff satisfaction with the introduction of administrative and medical procedures in the Outpatient Department (OPD). The third study will gives us information concerning the out patients and the Staff satisfaction with the treatment in the OPD. The fourth study will enable us to measure the acceptability of the Integrated Clinics for both the patients and the staff. Chepter six consists of D7scussions and Conclusions as a result of the findings in the study. The data was collected by means of survey methods. ?The main methods used were: Administration .of questionnaires to the community, the outpatients and the staff. Participant observation of patients and the staff. Informal discussions with the outpatients and the staff. In the data analysis correlation coefficients between relevant variables were calculated and tables were made to illustrate findings. It was found that the social demographic characteristics of the patients do not influence their satisfaction with the treatment in the OPD. The patients expectations of their waiting time in the OPD influences their satisfaction with the treatment. If patients are positive about particular aspects of the treatment like the staff-patient relationship they are likely to have positive attitudes towards other aspects of the OPD e.g. they will be satisfied with the medicine provided and will PP. happy with the waiting time. The patients experience of the treatment process in the OPD influences their attitude towards the hospital.