Open Journal of Nursing, 2011, 1, 1-9 OJN
doi:10.4236/ojn.2011.11001 Published Online June 2011 (http://www.SciRP.org/journal/OJN/).
Published Online June 2011 in SciRes. http://www.scirp.org/journal/OJN
Nurses’ stories about their interactions with patients at the
Holy Family Hospital, Techiman, Ghana
Kwadwo Ameyaw Korsah
School of Nursing, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
Received 5 April 2011; revised 17 May 2011; accepted 27 May 2011.
ABSTRACT
Factors, which induced positive nurse-client interac-
tions and barriers to positive nurse-client interactions
from the perspective of nurses at Holy Family Hos-
pital, were explored. In all, twelve State Registered
Nurses participated in semi-structured interviews.
Factors which induced positive nurse-client interac-
tion included availability of adequate time, showing
empathy, giving prompt care, considering nursing as
a call (spiritual interpretation) and rendering holistic
care. Factors which induced negative nurse-client
interaction included differences in beliefs between the
nurse and the client, perceptions of unfair treatment,
payment requirement and processes, issues with cli-
ents’ relatives, client issues, miscommunications and
misunderstandings about treatment needs, coercion,
forced dependence, human resource issues, profes-
sional nursing issues, issues with work environment,
nurse issues, lack of communication and good inter-
action, and dropping of professional ethics. Sugges-
tions for nursing education, practice and administra-
tion have been outlined. Among them is the need to
use role-play as a major teaching method for nursing
students to develop empathic behaviours so that they
can put themselves in clients’ situations. This under-
standing will allow them to practise quality nursing
after completing their educational programs. There is
also the need for policy makers in nursing to institute
measures to hold nurses accountable if they abuse
clients or clients’ relatives. Lastly, as an important
tool, nurses and other health care workers can make
use of reflective practice to evaluate their profes-
sional interactions with clients and their relatives.
This will foster positive nurse-client interaction in
future.
Keywords: Nurses; Factors; Positive Nurse-Client
Interactions; Barriers to Positive Nurse-Client
Interactions; Role-Play
1. INTRODUCTION
High quality nurse-client communication is the back-
bone of the art and science of nursing [1]. It has a sig-
nificant impact on patient well-being as well as the qual-
ity and outcome of nursing care [2], and is related to
patients’ overall satisfaction with their care [3]. The
maintenance of high nurse-patient communication also
depends on the nurse and patient. The quality of care in a
hospital, has been shown to be influenced by several
factors [4] including: inadequate nursing staff, lack of
regular water supply on wards, too much nursing docu-
mentation, too long waiting time, and lack of specialised
nurses. In Ghana, there is crisis in nurse-client commu-
nication evidence from four sources. These are personal
observation, anecdotes from client and their families,
media reports, and official health reports.
1.1. Problem Statement
There is public outcry about the behaviour of nurses
during interaction s with their clients. Th e crisis in nurse-
client interactions remains a serious problem in Ghana,
despite criticism and concern expressed by the public,
Ghana Ministry of Health, Ghana Health Service, and
the Nurses and Midwives Council for Ghana. Personally,
as a researcher, I have observed nurses who were ver-
bally abusing clients and their relatives in the hospital
where I practised. I have also observed nurses who pay
little attention to their clients’ requests. In one instance a
nurse told a male client in the researcher ’s ward that, “If
you could treat yourself at home, you would not have
come here to see us, so keep quiet …” Such behaviours
on the part of nurses are unfortunately a common occur-
rence at the hospital. It is important and helpful to note
that these negative interactions between nurses and their
clients do occur at any time irrespective of either early
after admission or are more frequent after a long period
of hospital care. It is also important to know that doctors
do their wards rounds once per day and are available to
see seriously ill patients only on call basis and so some

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 2
of these poor nurse-client interactions may happen dur-
ing their absence.
In an attempt to find more about this problem and
what could be done to help reverse the trend of negative
nurse-client interactions, the Ministry of Health and
other stakeholders in the health sector (e.g., Ghana Pre-
vention of Maternal Mortality,
GPMM) have organized workshops and in-service
training for various categories of nurses. It is wondered
whether those training activities and programmes are
yielding the expected results, especially in the area of
nurse-client interactions. It was based on these that the
following research questions were posed to address the
problem.
1) What factors facilitated positive nurse-client inter-
actions?
2) What factors were barriers to positive nurse-client
interactions?
1.2. Purpose of the Study
The purpose of the study was to describe factors that
facilitated or enhanced effective nurse-client interactions
and factors that were barriers to facilitating effective
nurse-client interactions.
1.3. Significance of the Study
Identifying factors believed to facilitate positive interac-
tions between nurses and their clients or clients’ families
as well as barriers to these positive interactions will do
much to promote the well being of those seeking health
care in Ghana. The increased insight about nurse-client
experiences in this study should help nurses and other
health care workers establish positive and appropriate
therapeutic relationships with their clients. Study find-
ings can also be used to inform decision makers in health
and nursing about what needs to be done to improve
communications patterns between health providers and
their clients. Areas for future research in nurse-client
interactions were also identified. It would also be of help
to other educational institutions especially those in-
volved in health education, health research and health
training prog rammes.
2. LITERATURE REVIEW
In a qualitative study, Morrison [5] described nurses’
perceptions of the concept of caring as central to nursing
practice. It involves meeting needs of patients in nurse-
client interactions. In all 7 categories emerged from the
analysis that provided a detailed description of caring.
These included interpersonal approach, clinical work
style, concern for others, time management, attitudes,
personal qualities and level of motivation. Other de-
scriptions by the nurses related to the physical aspects of
care.
Positive interpersonal relationships between the nurse
and the client were considered to be caring and caring
for clients was optimum when nurses were motivated in
the form of rewards by managers. Caring also depended
on the skill and the competence of the nurses. Competent
and skilled nurses delivered high quality nursing care to
clients at the right time. Caring practices of these nurses
were also demonstrated by positive facial expressions
and closeness to clients.
In another study on caring and interacting with pa-
tients, Younge and Molzahn [6], using a ground ed th eory
method interviewed 18 nurses who were identified as
exceptional in caring from two regions in Western Can-
ada. The core process was giving and involved gift giv-
ing, teaching, preserving dignity, caring with and for
co-workers, being truly present, finding a way, being
responsible, choosing, and vulnerability. It was observed
that there were many gifts that the nurses gave or
re-quested for their clients. These included night-gowns,
cloth bags with holders for insulin syringes, medical
equipment, used clothes, bread and having breakfast
together. It was noticed that all the nurses talked about
teaching their clients. The nurses explicitly outlined the
interventions they used to heal their clients and then en-
sured that they taught clients about the interventions.
The nurses saw teaching as happening anytime and
anywhere. There was recognition on the part of these
nurses that a client must be ready to learn.
Nurses in their study described a number of situations
where they went to lengths to preserve client dignity.
They did not challenge clients who made mistakes and
accepted the clients for who they were. The nurses
talked about their nurse-client relationships with co-
workers. Some co-workers were supportive and helped
the nurses provide exceptional care where as others had
to be taught how to give care. Co-workers were men-
tored or coached by th e nurses to give high quality care.
The caring nurses were truly present with clients and
families. It was noticed that they were thoughtful, con-
siderate, empathic, decisive and practised holistically.
They did not view the clients as being in isolated from
their families, and in turn, viewed the families as part of
the community. They validated their perceptions using
therapeutic touch and physical assessment. They shifted
their thoughts to become conscious of what the clients
were experiencing. For the nurses to be truly present that
they needed to know their clients. They worked to find
solutions to each problem, which at times involved pro-
viding hope in hopeless situations. These nurses also
expected accountability from their clients and were very
clear about their roles and responsibilities.
Nursing researchers generally agree that the mainte-

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 3
nance of patient dignity is highly valued by clients. They
also agree that a lack of dignity may lead to poorer
health outcomes.
A phenomenological investigation of dignity as ex-
perienced by nurses during their interactions with clients
was conducted [7]. Nurses were asked to describe ex-
periences where client dignity had been maintained and
where it had been compromised. The interviews were
unstructured and experiential in nature. In all four (4)
nurses were int e rviewed.
It was noted that nurses need to respect clients and
accord them privacy. It was also reported that clients
should not be seen as an object or body alone. Clients
needed to be seen to possess an innate right to be treated
with dignity and respect in all situations and at all times
whether the client was conscious or unconscious, alive
or dead. Respect would appear to these nurses to mean
treating a person with respect to th eir personhood, that is,
the nature of the person, their feelings, their individuality
and their wishes.
The body and its treatment was a central theme in
nurses’ accounts. It was noticed that much about client
dignity revolved around the exposure of the body and
the gaze of others. Nurse’s spoke of the importance of
screening the bed area while performing procedures and
covering the parts of the client’s body that did not need
to be exposed while washing the client or performing
other aspects of care. It was also identified that protect-
ing patients from involuntarily viewing other clients in
undignified situatio ns was another means to maintain the
dignity of all concerned. Nurses believed that clients
need space and privacy to express emotions and share
with family members. Dignity also meant having some
forethought about the emotional reaction that clients
might experience if procedures, information or diagno-
ses were not explained adequately or without thought
about how best to help clients manage the emotional
impact of such thin gs.
The nature of care provided and interpersonal aspects
of caring emerged as key quality issue for clients in At-
tree’s [8] study. Good quality care was characterised as
individualised, patient focused and related to need; it
was provided humanistically through the presence of a
caring relationship by staff who demonstrated involve-
ment, commitment and concern. Positive comments
were made about staff who provided care where clients
were the central focus. Staff who showed an interest in,
feeling for and value of clients as individuals provided
good quality care. Individualised care was also viewed
as good care. Showing respect for individual’s rights,
dignity and privacy were commended. It was also ob-
served that clients who were included and involved in
decisions and choices about their care and treatment ac-
knowledged this as quality care. Nurses who anticipated
clients’ care needs were specifically praised, as were
those who gave help freely and were willing and pre-
pared to do anything.
Good quality care encounters were also characterised
as being practised by nurses who were friendly, warm,
sociable and approachable and who developed a bond or
rapport as opposed to adopting more formal, distant tra-
ditional ‘professional’ staff-client relationships. Nurses
who encouraged social conversation, social relationships
and contact with clients were commended. Social con-
tact with nurses was seen as the way to form bonds and
friendly social relationships, which enabled them to feel
capable. Quality care was also acknowledged when
nurses showed an interest in clients as people. Nursing
practices, which gave clients this impression, included
nurses listening to and talking with them. Knowing the
client was not seen as a single process; patients appreci-
ated nurses who shared personal details about them-
selves and their family. Nurses who got to know clients
as people were seen to encourage more social contact
between clients and their relatives. Attree [8] identified
nurses who showed good humour as delivering quality
nursing care.
Open communication was also seen as one of the most
important characteristics of good quality care, as well as
being necessary for the development of good cli-
ent-nurse relationships. Engaging in conversation with
clients, both talkin g with and listening to th em is seen as
essential for good and effective communication and un-
derstanding. Clients see effective communication as be-
ing necessary for nurses to find out about their needs and
problems as well as to explain what is going on and to
provide information and advice.
Nurses who demonstrated a caring attitude evidenced
by showing kindness, concern, compassion, sensitivity
and sympathy were identified as giving good quality
care. It was also observed that nurses who had a calm,
gentle, kind and unhurried approach to client care were
recognised as good nurses. Attree [8] reported that cli-
ents and relatives were comfortable with nurses who
were available, accessible, and approachable and these
were demonstrated through nurses who had time for
clients and relatives. These are the type of nurses clients
require, “who come when called, come back when they
say and are there wh en needed or w anted”.
3. METHODOLOGY
The study was conducted at the Holy Family Hospital,
Techiman, Ghana. Techiman is a town in the Brong
Ahafo Region of Ghana. It is a newly created municipal-
ity with a census of 131,269 [9]. Inhabitants are pre-
dominantly farmers and traders. Holy Family Hospital is

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 4
a Roman Catholic Mission hospital and serves as a mu-
nicipal hospital for Techiman. The hospital has a bed
capacity of 140 and the total number of nurses is 65.
Most of the clients who attend Holy Family Hosp ital are
farmers and traders. The various nursing units in the
hospital include paediatrics, medical, surgical, emer-
gency, maternity and labour wards. The other units are
the outpatient and the primary health care departments.
The spectrum of medical cases which necessitate ad-
missions in this hospital include pneumonia, hyperten-
sion, diabetes mellitus, typhoid fever, malaria, and men-
ingitis to mention a few. The nursing population includes
30 State Registered Nurses (SRN); 31 Enrolled Nurses
(EN); 3 Community Health Nurses (CHN) and 1 Public
Health Nurse (PHN). A qualitative exploratory descrip-
tive design was used for this study.
3.1. Sample and Sampling Procedure
A convenience or volunteer sample of State Registered
Nurses who worked in either outpatient or in-patient
departments at Holy Family Hospital were recruited for
the study. Nurses who had worked for a minimum of 3
years at the hospital and were willing to tell about their
experiences were eligible for inclusion in the study. By
working for 3 years, participants had ample opportunity
to observe and participate well in nurse-client interac-
tions in the hospital. In addition, all participants were
full time registered nurses in the hospital and had their
nursing training in Ghana. The 12 State Registered
Nurses who participated in th is study were all Ghanaians.
Their ages ranged between 26 and 49 years. Four were
males and eight were females. They had worked in the
hospital for 3 to 27 years. Each nurse received a letter
that was personally addressed to her. The purpose of the
study was briefly explained in the letter an d an invitation
was extended to each participant to attend one of two
information meetings where detailed information about
the purpose and objectives of the study were given. It
was explained that the interviews would be recorded and
that they were free to opt out if they did not want to con-
tinue. Consent form was then offered. If the potential
participant read the information letter and signed the
consent form, the one was considered for the study.
3.2. Data Collection
Data were collected by interviewing participants. The
interview consisted of guiding question s with underlying
prompting questions, which were used if information
was not forthcoming. In the study the participants were
asked to describe instances of positive and negative in-
teractions with patients/clients to discuss factors that
facilitated or reduced each type of interaction.
3.3. Data Analysis
Data collection and analysis proceeded simultaneously.
After each interview, the tape was transcribed manually
by the researcher. The accuracy of the transcripts was
checked by listening to the audiotape and reading the
transcripts simultaneously. The data was coded by hand
using different colours. In all, 10 major files were cre-
ated based on the colour codes. A print out of these files
was also made and categories were formed from them.
Finally, higher-level categorisation was constructed from
the initial categories. That is, categories which fit into
common files were also brought together to form final
and major categories. The analysis of the interview tran -
scripts was guided by content analysis, which has been
identified as appropriate for analysis of interviews [10].
4. FINDINGS
Findings of the study were grouped under two main
headings with their respective subheadings.
4.1. Facilitative Factors for Effective or Positive
Nurse-Client Interactions
4.1.1. Availability of Time
The amount of time available for nursing care is found to
influence the type of interaction and amount of care
given. Many of the activities undertaken by nurses are
dependent on availability of sufficient time in which to
execute them. In this research study, various reasons
were given by 9 (75%) nurses for the availability of time
mainly relating to the number of nurses on duty and cli-
ent workload. Having sufficient time to meet clients’
needs was considered a major factor facilitating positive
nurse-client interaction. A nurse stated:
“So… I had time; I was able to listen to the client,
found some solution to the problem, involving the hus-
band to be supportive … because I had time for the cli-
ent as an individual”.
4.1.2. Empathy
Most 10 (83.3%) of the nurses in this research study
described their interactions with clien ts as positive when
the nurse was empathic. One of the nurses said:
“I kept myself in his shoes “supposing I am sick and I
don’t have anything to eat. My wound is draining, the
gauze is soiled and nobody to dress it, how will I feel?”
So because of th at I had to take that step to help the cli-
ent”.
Another nurse also said:
“I always see and put myself in their place; I would
also be reacting in the same way, so I put myself into the
situation of the client… But if you have not neglected
them and have put yourself in their shoes, you will real-
ise how important they are. We provide them a place to

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 5
eat… and also give them a sheet to lie on…”
4.1.3. Prompt Treat ment
All (12) (100%) nurses defined positive nurse-client
interaction as when clients received prompt nursing care.
One of the nurses stated:
“Prompt care means the right person [nurse] seeing
the client at the right time and giving the appropriate
nursing care, including medication, promotes positive
nurse-client interaction”.
In the process, nurse recognises the client as an indi-
vidual with dignity and deserves to be respected.
4.1.4. Renderi ng Hol i sti c C a re
Six (6) (50%) participants perceived that they had posi-
tive interactions with clients and their relatives when
they were able to render holistic care. A nurse stated:
“When we are treating the patient, we don’t limit o ur-
selves to the disease alone…. We treat him as a social
being with relations back home…”
Another one sai d:
“I was very proud of myself. I felt proud because I was
able to… at least, through a client I have been able to
educate sort of a whole family, because wh en I go t to th e
house, they all, almost everybody was around and I
educated them, so they were all very happy”.
4.1.5. Nursin g as a Cal l
Five (5) (41.6%) r esearch participants perceived nursing
as a call. These participants explained that nurses do not
have to work for money alone but they must see nur sing
as a call to help the needy and that nurses who perceive
nursing as a call are likely to encounter positive interac-
tions and relationships with clients and their relatives. A
participant said:
“If it is because of money, nurses will not work, be-
cause the service that we are rendering, it doesn’t match
the money that we receive, but we are only doing it as a
call. We are only doing service to God. It is not because
of money”.
4.2. Barriers to Positive Nurse-Client
Interactions
4.2.1. Differences in Beliefs between Nurses and
Clients
One source of conflict between nurses and their clients
was a difference in beliefs about western and traditional
medicine. A major factor was reported by 10 (83.3%)
nurses at the Holy Family Hospital. In one instance, a
participant stated:
“Whatever that you tell the client, he will not listen
because… he believes in traditional medicine, sometimes
the relatives will come and tell you that they prefer a
local healer, in spite of having explained to them the
implications of their actions.”
4.2.2. Perceptions o f Unf ai r Treatment
A conflict occurs when client perceives that a nurse has
treated her unfairly. This tends to generate poor interac-
tions betwee n the two. Percept i o ns o f u nfa i r ne ss f eat ured
prominently in this study. In some cases the nurses
reported that they provided priority services to patients
with more serious conditions and were insulted by cli-
ents with less serious conditions who wanted prompt
care. Using their professional judgement 9 (75%) nurses
reported that they thought critically ill clien ts were more
in need of urgent attention. A nurse quoted her client as
saying:
“Oh we can’t sit here and somebody will just come
and take our place”
4.2.3. Payment Requirements and Pr ocesses
Ten (10) (83.3%) participants mentioned that the pay-
ment requirements and processes in the hospital inter-
fered with the nurse-client interactions and relationships.
In some instances the clients refused to be ad mitted even
when it was strongly advised. Such professional advice
was resisted by the clients for financial reasons. One of
the nurses quoted her client as saying:
“My husband is not in town; if my child goes on ad-
mission, who will help me to pay for the bill?”
4.2.4. Conflicts with Clients’ Relatives
Nurses’ interactions with clients’ relatives featured pro-
minently in negative nurse-client interactions. Often
nurses reported confrontations with clients’ relatives.
Non-observance of visiting hours by clients’ relatives
resulted in negative interactions between nurses and cli-
ents’ relatives. Seven (7) (58.3%) nurses complained that
visitation by relatives outside the stipulated visiting
hours disrupted their work, disturbed other clients and
threatened their privacy. Relatives’ failure to observe
visiting hours elicited negative responses from the
nurses. A nurse stated:
“We tried to send them out because they came earlier
than the scheduled visitation hour. We told them to leav e
as we were then doing ward rounds but they refused to
leave the ward.”
4.2.5. Clie nt Is sues
At times clients do not do what is recommended or re-
quired by the nurses. One (1) (8.3%) of the participants
mentioned that a client found fault with everything the
nurse did for her. She stated:
“So I had this client in my ward and I can really say
that she was one of the very, very difficult patients I have
ever come across in my nursing career because no mat-
ter what I did for this woman, she always found fault. If
she rang the bell calling you and if you didn’t appear
within a minute or two it was all hell.”

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 6
4.2.6. Misc ommunications and Misu nderstandings
about Treatments Needs
Negative interactions between nurses and their clients
occurred when information given by nurses was not
properly understood. Clients misunderstood what the
nurses said and this resulted in an adverse health out-
come.
For example, one (1) (8.3%) participant reported that
a client did not receive the right information from the
nurse about his treatment needs and took his medication
at the wrong time which later resulted in poor interaction
between the nurse and the client.
4.2.7. Coercion
In their interactions with clients, nurses applied force to
make their clients comply with instructio ns. Nurses were
perceived as the powerful and the clients as the power-
less. This unequal relationship was seen as a barrier to
effective nurse-client interactions. Some of the nurses
used their power in an unacceptable manner by com-
manding their clients to comply with whatever instruc-
tions they issued. In this sort of relationship, the client
was powerless and had to “trust and obey” the nurse in
all situations. Nine (9) (91.6%) nurses in their interac-
tions with clients demonstrated a hierarchical relation-
ship. For example, a nurse was observed shouting au-
thoritatively at a client:
“Madam would you mind your speech”.
4.2.8. Forced Dependence
Forced dependence is defined, as use of force by the
nurse to condition the client. In situations where the
nurses perceived the clients as difficult, four (4) (33.3%)
nurses applied forced dependent measures to compel
their clients to o bey orders. A nurse whose ‘orders’ were
disregarded by a lady in labour was quoted as saying:
“But we told her it was very dangerous for her and for
the foetus. She couldn’t understand, so we told her, if
you don’t help us we are going to tie you up”.
4.2.9. Hum an Resource Issues
There were human resource factors, which undermined
effective nurse-client interactions. Staffing shortages
were such that nurses d id not have enough time for their
clients. Few nurses coupled with high workload lead to
inadequate interaction with clients. Ten (10) (83.3%)
nurses attributed the shortage of nurses to the exodus of
nurses to other countries like the United Kingdom and
the United States of America. Reflecting on nursing
shortages, one participant stated:
“We don’t have sufficient nurses, I don’t think it is
good enough for two nurses to work on twenty clients
during a shift. I don’t think it is proper. That is happen-
ing and in the night, a nurse will attend to about thirty
children with one ward aide. You can well imagine the
workload and the frustratio n tha t goes with it under such
circumstances.”
4.3. Professional Nursing Issues
Task orientation and organisation made it difficult for
nurses to give holistic care to their clients. All the twelve
(12) (100%) nurses mentioned that they had to combine
tasks in order to complete them and that thwarted their
efforts to render holistic care to clients. The nurses were
busy and not able to communicate effectively with their
clients. They have become so habituated to the situation
that they forget to teach and communicate with clients
even when they are less busy.
4.3.1. Work Envi ro nment
Managerial influences to a large extent determined the
type of interactions between nurses and their clients.
Lack of concern about staff by managers interfered with
nurse-client interactions. Five (5) (41.6%) nurses re-
ported that managers were unsupportive and unrespon-
sive to nurses’ needs. Many of the nurses who left the
hospital sought employment elsewhere in Ghana. One of
the nurse stated:
“Yeah, if legitimate requests to the officials are treated
with contempt, confusion will always reign.”
4.3.2. Nurs e Is sue s
Nurses who stay in rented premises outside the hospital
cannot effectively respond to emergency calls. Stress,
tiredness, frustration and long working hours without a
break affects nursing attitudes, which has serious nega-
tive implications for clients and their relatives. The
nurses noted that stress and overwork lead to frustration
and anger in the work place. Personal life issues of some
of the nurses affected their interactions with clients. In
some case, seven (7) (58.3%) nurses identified personal
issues as justification for how nurses interacted with
their clients and the families of their clients. As one of
the nurses stated:
“I must be very frank here, some nurses carry along
with them their personal problems to the work place, so
just a slight provocation, they are always annoyed”.
4.3.3. Lack of Communication and Good Interaction
Participants perceived their failure to provide informa-
tion to their clients as negative. Lack of explaining dis-
ease conditions, explaining institutional processes re-
sulted in negative nurse-client encounters. According to
all the twelve (12) (100%) participants, nurses who were
perceived to have ignored their clients were not highly
regarded by their clients.
4.3.4. Ignoring Professional Ethics
Although professional ethics is part of professional
nursing curricula, lap ses accord ing to the participan ts led

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 7
to negative nurse-client interaction. These lapses repre-
sented a breach of clients’ rights and constituted neglect
of clients. Negligence by nurses or failure to take proper
care of clients by nurses emerged strongly in this re-
search. All the twelve (12) (100%) participants ac-
knowledged this fact. As one nurse said:
“Half of negative nurse-client interactions are caused
by negligence of dut y”.
Other examples of lapses in professional ethics oc-
curred when research participants reported moving their
clients up and down between the emergency room and
the outpatients department to look for their doctors and
“sacking” or expelling clients when they did not report
to the clinic on time.
5. DISCUSSION AND CONCLUSIONS
From this study having sufficient time to meet clients’
needs was considered a major factor supportive of posi-
tive nurse-client interactions and relationships. Eighty
five percent (85%) of nurses in O’Malley [11] work in-
dicated that they were able to meet clients and their
families’ needs due to availability of time. According to
Irurita [12], an effective nurse-client relationship was
considered to be central to quality nursing and this re-
quired time. McNamara [13] supported clients’ needs
had to be met, whether they were conscious or uncon-
scious. The nurses in her study described the essential
structure of caring as the establishment of a human care
relationship and provision of needs of clients. Dryden
[14] acknowledged that there is need for healthcare in-
stitutions to care for their nurses and health profession-
als’ private and professional needs in order to render
quality care. Redfern and Norman [15] acknowledged
that good facilities and adequate resources in terms of
workforce, eq uipment and supplies, suppo rt services and
time to do a good job were identified as important for
nurses to give comprehensive nursing care. The analy-
sis of the experience of nurses highlighted a theme of
“Management Environment”. The respondents were en-
thusiastic about promoting horizontal relationships be-
tween nurses and managers to find solution to problems
affecting the institution. The nurses were also concerned
about the institutional education and accommodation
policies. These observations from the study are sup-
ported by other investigators who acknowledged that a
major predictor of job satisfaction for nurses was nurse-
manager collaboration [16]. In this Ghanaian study when
the nurse participants were empathetic, they described
their interactions with clients as positive. Empathic
nurses absorb the negativ ity of their clients [1 7]. Most of
the nurses said effective communication occurred when
they listened with sympathy and used appropriate
non-verbal behaviours .
Geanellos [18] studied friendliness and friendship
within the nurse-client relationsh ip and identified nurses’
who smiled, joked, spoke in warm tones of voice and
showed interest in clients as promoting nurse-client
communication.
Redfern and Norman [15] found that exceptional
nurses are those who raise clients’ morale by responding
promptly to their treatment needs and promoting their
autonomy. In this research, five (5) (41.6%) nurse par-
ticipants perceived nursing as a call which served as a
catalyst for them to interact positively with clients. This
finding is in line with Kritek [19] who acknowledged
that nursing is a call, and that nurses who are able to
recognize this fact in the course of client care, get to the
roots of nursing care. O’Brien [20] also found a different
dimension of nursing as a call. She acknowledged that
nurses are called to lay down their lives for clients as
Jesus Christ died on the cross for sinners. In this study
conflict arose over and treatment choices. Interpersonal
conflict occurs between individuals, especially between
people who differ with regard to beliefs, values and
goals [21]. Hupcey [22] emphasizes that teamwork and
cooperation b etween nurses an d family members benefit
the client. However, nurse participants’ interactions with
clients’ relatives strongly influenced the development of
negative interactions in this Ghanaian study. Non-ob-
servance of visiting hours by relatives and family dis-
agreement with the choice of treatment was the source of
much conflict. In this Ghanaian study, nine (9) (91.6%)
participants used their power in unacceptable ways. The
literature is replete with research on the power differen-
tial between nurses and clients. Th e unequal relationship
is a significant barrier to effective nurse-client interac-
tions [23]. Staffing problems did not allow nurses to
have enough time for their clients and their clients’ fami-
lies in this study. Meilman [24] also acknowledged that
to provide first-rate services to students and other health
consumers in and around a large university hospital, the
university health service needs best possible staff.
A task-orientation toward providing nursing care
made it difficult for nurses to give quality care to clients
in this study. The nurses were always busy and unable to
communicate with their clients effectively. The majority
of nurse-client interactions are related to tasks and rou-
tines [25]. Lapses in professional ethics and adherence to
professional nursing standards affected nursing interac-
tions with clients. Findings from this study support an-
other African study where pregnant women were found
to be abused by midwives in an obstetric unit in a South
African hospital [26]. Midwives in the hospitals were
described as rude, inhuman and uncaring and reported to
be speaking to clients harshly for breaking the rules in
the midwife unit. In conclusion, from the perspectives of

K. A. Korsah / Open Journal of Nursing 1 (2011) 1-9 8
nurses factors that facilitate positive n urse-client interac-
tions and as well as those that are barriers to positive
interactions were illuminated.
6. STUDY LIMITATIONS
It is difficult to assess the degree to which participants
may have felt obliged to participate or respond to ques-
tions in a particular way. However with the researcher’s
background as a nurse and previous experiences in
nurse-client interactions, participants were probed ex-
tensively and deeply about their responses in an effort to
reduce bias.
7. RECOMMENDATIONS
The findings of this study and their analyses provide
some direction.
1) Nurses need to be prepared to put themselves in
clients’ situations. This will enable them practice and
render good quality care to their clients and their fami-
lies. Through role-play nursing students will understand
how to put themselves in clients’ situations. In view of
this, curriculum for nursing education needs to have
role-play or simulation exercises as a major method of
teaching students how to function appropriately in client
encounters.
2) Workshops that address client’s total needs, reflec-
tive practice with the support of managers, and incen-
tives are possible interventions that could bring about
changes in nursin g attitudes and behaviours.
3) The findings, especially with regard to the nurses’
poor attitudes to clients and their families suggest that a
code of ethics needs to be enforced, using disciplinary
procedures if necessary, so that nurses are aware that
abuse of clients is sanctioned by their professional or-
ganization.
4) Finally, nurses should know that as health profes-
sionals their beliefs should not affect their ability to es-
tablish positive interactions with clients and clients’
families. They can explain their professional point of
view in a therapeutic manner while hearing and valuing
their client’s point-of-view.
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