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CHAPTER 1
THE PROBLEM AND REVIEW OF RELATED LITERATURE AND STUDIES
Introduction
Patient-centered communication is a basic component of nursing which facilitates
the development of a positive nurse-patient relationship and along with other
organizational factors, results in the delivery of quality nursing care.
In most instances, a nurse plays an essential role in the life of a patient. The
concerns and cares they give to their patients is a big factor that uplifts each one‟s spirit,
therefore the goal of the nurses of Olivarez College BSN IV is to create a harmonious
relationship between their patients through a well organize and meaningful interactions.
The study of the relationship between patient and nurse is important to see how
efficient a patient recovers, to understand his illness fully; whether there‟s a chance of
recovery or nothing to expect at all. Moreover, the role of the nurse is to lessen the
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doubts, fears and the anxieties of the patients who come to them for treatment. It is
equally important to talk in an understanding tone to those who have not voiced their
fears but are obviously scared.
Patience is also essential in dealing with hard headed and unbeliever patients
especially when the patient is suffering and in pain during medication and they tend to
refuse taking medicines anymore. Nurses feel a sense of accomplishment when they
give a positive influence on their client‟s health status. Learning experiences with
simulation offer the nursing student an opportunity to further develop knowledge, skills
and critical thinking abilities prior to practicing in the clinical setting.
Role play, as well as manikin use, can enhance the nursing student‟s ability to
respond to a variety of patient care scenarios before actually encountering them in the
clinical setting (Billings & Halstead, 2005). Active learning with immediate feedback
reinforces the nursing student‟s performance and confidence in relating to patients and
other professionals in the healthcare setting (Billings & Halstead, 2005). A student nurse
can easily relate to the situation of their patients in terms of their know-how and further
sturdy of their illnesses. This study aims to know how patients can perceive and
cooperate for the fulfilment of their rehabilitation.
Cutcliffe and McKenna (2005) reported that during treatment, hospital and
community patients interact more with nurses than with any other health professional in
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the multidisciplinary team. These authors also highlighted that nurses are continuing to
expand their role into medical and even surgical practice.
Nurse‟s expanding practical role and its consequent negative impact on the
interpersonal dimension of the patient care has also been well documented I recent
years (Northouse and Northouse, 2004). These authors said that nurses are only too
willing to accept changes to their role from outside the profession which, it can be
argued, undermines the sense of ownership they have in relation to their own unique
interpersonal patient contact.
According to McMahon (2002), Florence Nightingale once complained that her
concept of nursing has been turned into nothing more than the administration of
medicines. McMahon expressed concern that the nurses themselves perceive nursing
as some form of comfort-giving or providing assistance towards the patient‟s self -care,
claiming that nurses themselves find it difficult to define what the nature of nursing is.
Nursing proves as difficult to define as „care‟, which means that the role of the
nurse and how it is differentiated from other health professions is often misunderstood.
Perhaps nurses provide care and doctors provide treatment, but McMahon (2002)
argues that neither addresses the skills and knowledge needed in modern nursing to
provide good-quality „care‟, nor explains why students take three years to train before
they become qualified nurses.
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Since Florence Nightingale‟s time, nursing could be seen as having moved from
a task-oriented practice towards a therapeutic process that encompasses a wide range
of nursing roles, focused on the individual patient and his or her health and well-being.
McMahon (2007:7) attempts to define therapeutic nursing abilities as being
characterized by six skills: developing the nurse-patient relationship; caring and
comforting; using evidence-based physical interventions; teaching; manipulating the
environment; adopting complementary health practices.
These are all the skills developed by nurses during their pre-registration
education; all of them demand good communication skills for effectiveness. It appears
that this argument supports the notion that „nursing‟, in addition to the applied
knowledge and attitude, is underpinned essentially by communication skills.
The therapeutic effect of good communication delivered through good care is
supported by evidence. Social support appears to have a role in providing reassurance
and can even lower blood pressure (Kamarck et al., 1998). Health professionals who
can communicate at an emotional level are seen as warm, caring and emphatic, and
engender trust in their patients, which encourages disclosure of worries and concerns
that the patients might otherwise not reveal (Bensing, 1991; Letvak, 1995). Additionally,
informative and useful communication between the practitioner and the patient is shown
to encourage patients to take more interest in their condition, ask questions, and
develop greater understanding and self-care (Crow et al., 1999). This is particularly so
when the patient is given time and encouragement to ask questions and be involved in
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treatment decisions. It is also shown that patients can experience measurable health
benefits when nurses provide a good environment, use therapeutic communication, give
accurate information and encourage positive motivation in patients (Kwekkeboom,
1997).
So, good communication in the nurse-patient encounter is itself a beneficial and
therapeutic intervention as well as the vehicle for good care, and can be regarded as
important as other care or treatment. In brief, evidence suggests that the health
communication helps patients to: express their physical and emotional needs; ask
questions and be more involved in their care; gain a sense of control over their condition
and treatment; develop trust and confidence in the process and so comply with
treatment; gain physical health benefits such as reduced pain and lowered blood
pressure.
As we can see in the models and examples, effective communication relies a
great deal on the skills of the message sender and the ability of the receiver to interpret
what is being communicated. These aspects of communication epitomize the
interpersonal skills of a good communicator. The skilled communicator has information-
presenting abilities and good listening skills. In addition, a skilled communicator is
aware of and make allowances for barriers to communication such as cultural
differences, emotional and cognitive states of others, and external distractions. Michael
Argyle (1983) suggests that skilful interpersonal behavior includes the following.
Perception of others‟ reactions: The communicator is attuned to the other‟s behaviorand
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signs of understanding or misunderstanding. Attention to feedback and corrective
action: the communicator has learnt what kind of response is needed according to the
feedback from the other.
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Review of Related Literature and Studies
The relationship between the nurse and the patient is often seen as a therapeutic
relationship in itself that is based on partnership, intimacy, and reciprocity (McMahon,
2002). Its purpose is different from a social relationship in that it has a focus on the
patient‟s well-being as a priority, and the nurse and the patient do not need to have
anything in common or even like each other (Arnold and Boggs, 2006). This relationship
can last only five minutes in an accident and emergency department or primary care
practice, or can continue and develop for months or years during chronic illness
management. It can be intensely personal when breaking bad news, or quite superficial
such as when directing a patient to the appropriate clinic room. However, all of these
scenarios are nurse-patient encounters that impart to the patient something of the
support and meaningfulness of their engagement with health care. They tell the patient
whether they are viewed as important and valued, and whether they will be listed to or
discriminated against.
According to McMahon (2002), Florence Nightingale once complained that her
concept of nursing had been turned into nothing more than the administration of
medicines. McMahon expressed concern that nurses themselves perceives nursing as
some form of comfort-giving, or providing assistance towards the patient‟s self -care,
claiming that nurses themselves find it difficult to define what the nature of nursing is.
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Nursing proves as difficult to define as „care‟, which means that the role of the
nurse and how it is differentiated from other health professions is often misunderstood.
Perhaps nurses provide care and doctors provide treatment, but McMahon (2002)
argues that this neither addresses the skills and knowledge needed in modern nursing
to provide good-quality „care‟, nor explains why students take three years to train before
they become qualified nurses.
Since Florence Nightingale‟s time, nursing could be seen as having moved from
a task-oriented practice towards a therapeutic process that encompasses a wide range
of nursing roles, focused on the individual patient and his or her health and well-being.
McManhon (2002:7) attempts to define therapeutic nursing abilities as being
characterized by six skills: developing the nurse-patient relationship; caring and
comforting; using evidence-based physical interventions; teaching; manipulating the
environment; adopting complementary health practices.
These skills are developed by nurses during their pre-registration education; all
of them demand good communication skills for effectiveness. It appears that this
argument supports the notion that „nursing‟, in addition to the applied knowledge and
attitude, is underpinned essentially by communication skills.
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The therapeutic effect of good communication delivered through good care is supported
by evidence. Social support appears to have a role in providing reassurance and can
even lower blood pressure (Kamarck et al., 1998). Health professionals who can
communicate at an emotional level are seen as warm, caring, and empathic, and
engender trust in their parents, which encourages disclosure of worries and concerns
that patients might otherwise not reveal (Bensing, 1991; Letvak, 1995). Additionally,
informative and useful communication between the practitioner and the patient is shown
to encourage patients to take more interest in their condition, ask questions, and
develop greater understanding and self-care (Crow et al., 1999). This is particularly so
when the patient is given time and encouragement to ask questions and be involved in
treatment decisions. It is also shown that patients can experience measurable health
benefits when nurses provide a good environment, use therapeutic communication, give
accurate information, and encourage positive motivation in patients (Kwekkeboom,
1997).
So good communication in the nurse-patient encounter is itself a beneficial and
therapeutic intervention as well as the vehicle for good care, and can be regarded as
important as other care or treatment. In brief, evidence suggests that health
communication helps patients to: express their physical and emotional needs; ask
questions and be more involved in their care, gain a sense of control over their condition
and treatment; develop trust and confidence in the process and so comply with
treatment; gain physical health benefits such as reduced pain and lowered blood
pressure.
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As we can see in the models and example, effective communication relies a
great deal on the skills of the message sender and the ability of the receiver to interpret
what is being communicated. These aspects of communication epitomize the
interpersonal skills of a good communicator. The skilled communicator has information-
presenting abilities and good listening skills. In addition, a skilled communicator is
aware of and makes allowances for barriers to communication such as cultural
differences, the emotional and cognitive states of others, and external distractions.
Michael Argyle (1983) suggest that skilful interpersonal behaviour includes the
following. Perception of others‟ reactions: the communicator is attuned to the other‟s
behaviour and signs of understanding or misunderstanding. Attention to feedback and
corrective action: the communicators has learnt what kind of response is needed
according to the feedback from the other.
For instance, reticence from the others may prompt encouraging remarks of
prompt questioning timing of social responses: This requires the communicator to know
when to speak, when to listen, when to interrupt or prompt, or when to take the lead or
be led. Self-presentation: A good communicator has self-awareness and is able to use
this self-knowledge to present themselves to the other. This gives the other feedback
about who the communicator is and therefore how to interpret and respond to them. For
instance, sitting in a forward-leaning position assures the other that they are being
listened to. Rewardingness: This is the ability to engage the other in the communication
and know how to reward communication behaviour. For instance, using nods, smiles,
and eye contact encourages someone to talk about themselves.
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Taking the role of the other: Here, the communicator can put themselves in the
shoes of the other in order to understand how they are seen. For instance, if they
realize that being dressed formally is off putting to a young teenager, they can respond
by removing a tie or rolling up their sleeves. Argyle breaks communication skills down
into behavioural skills rather than skills of insight, understanding, and cognition. Another
definition of good communication comes from Becker et al. (1987: 9), who suggest that
skilful communicator „must be able to identify the emotions or intent expressed by the
other person and make sophisticated judgements about the form and timing of the
appropriate response „. In this definition, the skilled communicator uses accurate
perception and good judgement to understand the interactions and know how to make
appropriate judgements. It may be that all of these factors are part of the skills of a
good communicator--that skills are made up of a good sense of reality, awareness of
self and others, accurate reading of situations, good timing, and ability to use the self to
facilitate meaningful and positive communication. Many of these skills can be learnt and
developed through the practice and through personal development by improving self-
awareness, and awareness and understanding of other people and heir cognitive and
emotional states.
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Synthesis
Hamilton, S.J., Martin, D.J. (2007) A framework for effective communication
skills. Extended version of Nursing Times; 103: 48, 30-31 outlines a framework for
nurses to further improve and develop their communication skills during interaction with
patients. It also shows how to implement this framework in nursing practice, and nurses‟
role in communication skills is further outlined through the use of an acronym.
The nurse-patient therapeutic relationship is the psychosocial bond that fosters
and nurtures the healing of a patient. The therapeutic relationship between a patient
and his psychiatric nurse is a special bond between human beings that possesses
several unique attributes, from the development of trust, providing a safe retreat from
the world where the patient will not be judged or directed, but encouraged to learn and
participate in his/her own healing (Charnofsky; 2001).
According to researchers, patient-centered communication is a basic component
of nursing which facilitates the development of a positive nurse-patient relationship and
along with other organizational factors, results in the delivery of quality nursing care. In
most instances, a nurse plays an essential role in the life of a patient. The concerns and
cares they give to their patients is a big factor that uplifts each one‟s spirit, therefore the
goal of nurses of Olivarez College BSN IV is to create a harmonious relationship
between their patients through a well-organized and meaningful interactions.
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Conceptual Framework
Nursing is a significant, therapeutic interpersonal process; it functions
cooperatively with other human processes that make health possible for individuals in
communities. In specific situations in which a professional health team offers health
services, nurses participate in the organization of conditions that facilitate natural on
going tendencies in human organisms.
Nursing is an educative instrument, a maturing force that aims to promote
forward movement of personality in the direction of creative, constructive, productive,
personal, and community living.
It is likely that the nursing process is educative and therapeutic when nurse and
patient can come to know and to respect others, as persons who are alike, and yet,
different, as persons who share in the solution of problems. In general, personal
relationships with patient have been tabooed in nursing. Perhaps one reason for this
injunction has been misunderstanding of what is a personal relationship. For the
purposes of nursing practice, a personal relationship is one in which two persons come
to know one another well enough to face the problem at hand in a cooperative way.
According to Peplau, there are two general categories of interacting conditions
that is essential for experiencing health, that is, (1) Physiological demands that is the
required material conditions and (2) Interpersonal conditions, that are individual and
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social, and that meet personality need and allow the expression and use of capacities in
a productive way. As these conditions are fully known and are provided and used by
individuals and communities, more and more individuals will be enabled to experience
greater health.
Peplau identifies four phases in the nurse-patient relationship. In the first phase,
orientation, nurse and patient are strangers; they meet because of the patient‟s “felt
need”, and work together to recognize, clarify and define facts connected to the need.
During the second phase, identification, the patient participates in the setting of the
goals and has a feeling belonging, selectively responding to those who can meet his or
her needs. The third phase, exploitation, sees the patient actively seeking and drawing
knowledge and expertise of those who can help him or her. The final phase, resolution,
which occurs after the successful completion of the other phases, leads to the
termination of the nurse-patient relationship.
According to Intervention in Psychiatric Nursing by Joyce Travelbee, the nurse-
patient relationship has a number of goals. The nurse helps the patient cope with his or
her problems and also help him or her to understand them. The nurse helps the patient
understand his or her active participation in the experience, while also helping in the
realistic identification of emerging problems. The nurse helps the patient find a new
alternative for the problem and try out new patients of behavior. The nurse also helps
the patient with communication and in finding meaning in his or her illness.
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On the basis of these goals, the therapeutic relationship can be divided into
several types. In the immediate relationship, the nurse and patient do not know each
other and the nurse has to interact or intervene to help the patient with an immediate
severe difficulty. In the short-term relationship the nurse may know the patient but is not
responsible for him or her. In the long term relationship the nurse interacts with the
patient and tries to provide a corrective emotional experience, while supporting him or
her and giving care.
The nurse patient relationship, according to research by Press Ganey Associates
Inc., sets the tone of the care experience and has a powerful impact on patient
satisfaction. Nurses spend the most time with patients. Patients see nurses‟ interactions
with others on the care team and draw conclusions about the hospital based on their
observations. Also, nurses‟ attitudes toward their work, their co-workers and the
organization affect patient and family judgement of all the things they don‟t see behind
the scenes.
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Statement of the Problem
The study will determine the patient‟s perception on the effectiveness of
interpersonal relations among BSN Level IV of Olivarez College S.Y. 2011-2012 to
enhance the interpersonal nursing skills of the students in a clinical setting.
Specifically, it seeks to answer the following questions;
1. What is the demographic profile of the respondent in terms of:
1.1 Patient/Client
1.1.1 Gender
1.1.2 Age
1.1.3 Civil Status
2. What is the patient‟s perception on the effectiveness of interpersonal relationship
among BSN Level IV?
3. Is there a significant relationship between Profile and Interpersonal relations
among BSN Level IV?
4. Is there a significant relationship between patient‟s perception on the
effectiveness and Interpersonal relations among BSN Level IV?
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Significance of the Study
This study discusses the patient‟s perception on the effectiveness of
interpersonal relations among BSN Level IV of Olivarez College S.Y. 2011-2012.
The result of the study will benefit the following:
Nursing Students: This study helps us on how to improve the interpersonal skills of the
nursing students through nurse-patient interaction.
Clients: This helps us to understand why interpersonal relations are very important to
enhance and helps on the patient‟s process of healing.
Nursing Researchers: Studying and exploring the broad meaning and importance of
interpersonal relations during nurse-patient interaction can give more learning
objectives to enhance the interpersonal skills.
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Scope and Delimitation of the Study
This research will only focus on the patients of Medical Center Paranaque on
their perception on the effectiveness of interpersonal relations among BSN Level IV of
Olivarez College S.Y. 2011-2012.
To determine how is the interpersonal relations are essential components in
delivering good quality nursing care. Helping the patient to gain trust and feel
comfortable during their stay in the hospital.
Definition of Terms
This study helps define some terms:
Communication – the sending of one‟s information to another that may be done
verbally or no-verbally. It is identified as one of the essential skills that students must
acquire in order to make progress through their education and training to become
qualified nurses.
Interpersonal Relationship – association between two or more people like nurse-
patient interaction.
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Nurse – is a highly skilled health care professional who combines the art of caring with
scientific knowledge and skills developed through their education and career.
Nursing - is a science and an art that focus on promoting quality of life throughout their
life experiences from birth to care at the end of life. It is a profession on assisting
individuals, families and communities to achieve and maintain optimal health and
functioning.
Nurse-Patient Relationship –
series of experiences between the nurse and patient or
on individual, or his family, in need of the presence of the nurse.
Patient – any person who receives medical attention, care or treatment.
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Chapter II
Methodology
Research Design
Research design is a systematic subjective approach used to describe life
experiences and give them meaning also considered as a “blueprint” for research,
dealing with the least four problems: which questions to study, which data are relevant,
what data to collect, and how to analyse the results. Research design use in this study
is qualitative research.
Qualitative research is a method of inquiry employed in many different academic
disciplines, traditionally in the social sciences, but also in market research and further
contexts. Qualitative researchers aim to gather an in-depth understanding of human
behavior and the reason that govern such behavior. The qualitative methods
investigates the why and how of decision making, not just what, where, when. Hence,
smaller but focused samples are more often needed than the large samples.
The researchers focused on the objective reality seen as singular, the process of
discovering reality was reductionist, and was believed that the knowledge of the whole
can be gained through the knowledge of the parts.
Subjects/Respondents
The respondents were individually contracted by the researchers and the data
were collected by means of personal interview.
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Research Locale
Medical Center Paranaque is the largest tertiary hospital in the City of
Paranaque. It is known to be one of the city‟s reputable hospitals, situated in a 7,800
square meter prime lot along Dr. A. Santos Ave., Sucat, Paranaque City. The hospital
has a 95-bed capacity which provides a wide range of medical and health services,
such as Surgery, Pediatrics, Obstetrics & Gynecology, Internal Medicine and other
related medical services. MCP is a private Corporation with 450 Stockholders mostly
well-known physicians in their various specializations.
History of Medical Center Paranaque
MCP was founded by a group of enterprising physicians and businessmen in
1977. The inauguration of the hospital took place on November 12, 1978. It started with
a capacity of 50 beds and offered services such as Operating and Delivery Room,
Diagnostic X-ray, Laboratory Examination, Nursery, Dental Clinic, Pharmacy, ICU and
ambulance services.
On July 31, 1981, the Security and Exchange Commission approved the
Incorporation of the hospital. As the years passed, the hospital steadily expanded with
its present authorized bed capacity of 95. As more hospitals were established in the City
to meet the growing number of patients. The MCP is continuously improving and
upgrading their facilities to cope up with the modern demands of the hospital industry in
upholding their commitment to provide a high quality health and medical services to the
City of Paranaque. During their 21st year anniversary, they received achievement
awards as one of the famous reputable hospital in the City.
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Materials
The researchers will gather information through interviews and documentations.
Intrumentation
The tools used in this study for data collection were: Personal and demographic
information from the patient and structure interview questions which will utilize the type
of question.
Data Gathering Procedure
The researcher will make a face to face interview with the patient/respondents
and talk with them about their insights, outlooks and perceptions on the interpersonal
relations of the student nurses, using voice recorder with the respondent‟s permission,
questions will be asked spontaneously in a friendly conversation.
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References
1. Arnold, E. and Boggs, K. (2006) Interpersonal Relationships: Professional
Communication Skills for Nurses, London: Elsevier
2. Becker, R. Heimberg, R., and Bellack, A. (1987) Social Skills Training for
Treament of Depression. New York: Pergamon Press
3. Bensing, J (1991) Doctor-Patient Communication and the Quality of Care: An
Observastio Study into Affective and Instrumental Behaviour in General
Practice. Utrecht: Nivel/Utrecht University. (2000) „Bringing the Gap: The
Separate Worlds of Evidence-based Medicine and Patient-Centered
Medicine‟, Patient Education and Counseling, 39: 17-25.
4. Cruz, JA (2010) The Effectiveness of Therapeutic Relationship Provided the
Psychiatric Nurse in Contrast with the Psychiatrist As Perceived by
Schizophrenic Patients, Our Lady of Fatima University, Antipolo City,
Philippines.
5. Kamarck, T., Peterman, A., and Raynor, D. (1998) „The Effects of Social
Environment on Stress-related Cardiovascular Activation: Current Findings,
Prospects and Implications‟, Annals of Behavioural Medicine, 20: 247-56.
6. Kwekkeboom, K. (1997) „The Placebo Effect in Symptom Management‟,
Oncological Nursing Forum, 24(8): 1393-9.
7. NMC (2010) The Nursing and Midwifery Council
8. McMahon, R. (2002) „Therapeutic Nursing: Theory Issues and Pactice‟, in R.
McMahon and A. Pearson (eds) Nursing as Therapy. Cheltenham: Nelson
Thornes.
Internet
1. http:/www.nursingtimes.net/nursing-practise/leadership/clinical-development-a-
framework-for-effective=communication-skills/296359.article
2. The Therapeutic Relationship” 01 December 2007. Web. 08 October, 2012.
http://www.academon.com/term-paper/the-therapeutic-relationship-133749/
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PATIENT‟S PERCEPTION ON THE EFFECTIVENESS OF INTERPERSONALRELATIONS AMONG BSN LEVEL IV OF OLIVAREZ COLLEGE SY. 2011-2012
Questionaire
Name ___________________________________ Gender _________ Age _______
Civil Status ________________ Name of the Hosapital _______________________
Department/Ward _____________________________________________________
Date of Interview _____________________________
Orientation phase:
1. What are your common fears and expectations at the time you were confinedin the hospital?
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Letter to the Hospital Director
Mr. Giovani Rebeta
Director
Medical Center Paranaque
Dear Sir,
We are currently working on our thesis entitled “Patient‟s Perception on the
Effectiveness of Interpersonal Relationship among BSN IV of Olivarez College S.Y.
2011-2012”. It aims to help the student nurses gain more knowledge and enhance their
skills to develop better rapport with their patient during RLE duty.
In line with this, we would like to ask your permission to conduct the pre-survey in the
hospital especially the patients handled by the Level IV nursing students of Olivarez
College, S.Y. 2011-2012.
Your approval to this endeavour will be highly appreciated.
Respectfully yours,
Jacquelyn A. Javier
Group Leader
Noted by: Approved by:
Joy Olendres Mr. Rebeta