Perceptions and perceived challenges of nursing students in maintaining interpersonal relationship with the healthcare team: a cross-sectional study

INTRODUCTION

Interpersonal relationship (IPR) in nursing care is the interaction between two or more people who communicate, and transfer values and energy from their roles in society.¹ An individual having strong interpersonal skills is more likely to be successful in their professional and personal life.

Among the various HCT members, nurses represent the larger workforce and act as a link between various healthcare professionals. So, nursing students, who are the future of nursing, should develop and possess interpersonal skills characterized by knowledge, attitudes, and values expressed in their relationships with colleagues, other members of HCT, patients, and their families.²

The learning process of nursing students can also be affected by deficiencies in IPRs, such as a lack of preparation and receptivity of HCT within the institutions where they undergo clinical experience. Doubts related to either theoretical knowledge or practical skills can be cleared by communicating with the members of HCT. Effective communication, confidence, and knowledge are required both while dealing with patients, as well as with the other members of the HCT.² Strong Interpersonal skills help student nurses in enhancing their leadership and teamwork quality. A student nurse needs to have a sense of cooperation and tolerance for others which moulds them into a better individual. This boosts their self-confidence and self-esteem which in turn helps in shaping their personality.

The study aimed to investigate the perception of IPRs by student nurses with the members of the HCT and the barriers they faced in maintaining IPR with them in the clinical setting from the point of view of student nurses.

METHODS

Study design

A descriptive cross-sectional study was conducted among the participants.

Materials and subjects

The study was conducted among 202 BSc (Hons) nursing students studying in 2^nd, 3^rd and 4^th year of the college of nursing, All India institute of medical sciences, Bhubaneswar. Purposive sampling technique was used to select the samples. All B. Sc. (Hons) nursing students who were exposed to clinical area were the part of the study. The data was collected between December 12, 2022, to December 22, 2022.

Data collection was done using socio-demographic proforma, a Likert scale to assess nursing student's perception of IPR with HCT, and a checklist to assess the challenges faced by nursing students in maintaining IPR with the health care team. The Likert scale to assess nursing students' perception of IPR with HCT included 27 items consisting of a five-point Likert rating scale asking respondents to indicate their responses from the following five choices: “strongly disagree, disagree, neutral, agree, strongly agree” that are scored one to five or five to one for negatively scored items with a maximum score of 125. The scoring category has been done as per pilot study findings and is as follows. For low IPR the score is <78, for moderate IPR the score lies between 79-87, a good IPR score is 88-102 and for very good IPR the score is >102. The checklist to assess the challenges faced by nursing students consists of 13 items which the participants responded to and marked. The content validity of the tool was done by experts. The instrument takes an average of 20-25 minutes to complete data.

The data was collected and entered in Microsoft excel. Descriptive analysis was done to assess socio-demographic profile, perception of nursing students’ IPR with members of HCT, and challenges faced by nursing students in maintaining IPR with HCT, The Chi-square test was used to find out the association among levels of IPR with seniority of nursing students. A p value less than 0.05 was considered statistically significant.

RII was assessed to find out the most to the least perception about IPR with HCT regarding nursing students' experience of interaction with them. Each of the twenty-seven items in this section was graded on a five-point rating scale. A maximum score of five for each of the items, if the participants were very satisfied with the IPR with HCT. A score of one was assigned, if the participant was very dissatisfied with their IPR with HCT. RII was calculated using the formula [RII=∑W/(A*n)], wherein W=weighting for each item, A=highest weight, and n=number of participants. The item with the highest RII would be interpreted as the item with the most importance in IPR with HCT and vice versa.

Ethical statement

The study was approved by the institutional ethical committee (IEC/AIIMS BBSR/Nursing/2022-23/25) and informed consent was taken from each participant before conducting the study.

RESULTS

The median age of the subjects was 21 (20-22) years. Of these 202 participants, 36.6% were from the 3^rd year, 35.6% were from the 2^nd year and 27.7% were from the 4^th year. The majority of the students (63.4%) belong to the Eastern states of India. The most common mother tongue was Bengali, spoken by 43.6% of students. The 56.4% of students have been schooled in English medium in higher secondary classes, which happens to be the majority. Of the total subjects, 82.2% belong to the nuclear family and 83.7 have siblings. The most prevalent schooling type among subjects was co-educational, with 66.3% of students (Table 1).

About 30% of participants identified themselves as extroverted personality, 35.6% as introverted and 34.2% identified themselves as ambivert personality among 202 participants.

Out of 202 participants, 43.56% perceived they had good IPR with the HCT, 24.25% had moderate IPR with HCT, 20.29% perceived they had very good IPR with HCT and 11.88% perceived low IPR with HCT (Table 2).

In the 2^nd year batch, 24 students perceived they had very good IPR and 8 students perceived low IPR. In 3^rd year batch 6 students reported a perception of very good IPR and 12 students had low IPR. In 4^th year batch, 11 students had very good IPR and 10 students had low IPR.

Most of the students perceived that their IPR with HCT enabled the ward to be regarded as a good learning environment (RII: 0.8) and that good IPR with HCT helped them to reduce the gap between their theoretical knowledge and practical skills (RII: 0.8) (Table 3).

There is a significant association between the level of IPR and with seniority of nursing students (χ²=21.523, p=0.001) at 0.05 level of significance (Table 4).

No significant association was found between the levels of IPR with domicile state, mother tongue, medium of higher secondary education, siblings, family type, family value and belief, type of personality, schooling type, (p>0.05).

Out of 202 students, 84.7% admitted language difference as a barrier while communicating with HCT. The 80.7% of students feel that the lack of respect shown towards them by the members of HCT proves to be a barrier for maintaining IPR. 69.8% of students believed that inadequate professional knowledge of nurses was a barrier. Inferiority complex faced by students and inability to accept criticism turned out to be other barriers that were faced by 42.6% and 49% of students respectively (Table 5).

#Median age (Q1, Q3), ^-Domicile state-East (West Bengal, Bihar, Odisha, Arunachal Pradesh, Manipur, Assam, Jharkhand), West (Rajasthan), North (Haryana, Himachal Pradesh, Punjab), South (Kerala), Central (Delhi, Madhya Pradesh, Uttar Pradesh).^$Mother tongue-Others (Rajasthani, Manipuri, Haryanvi, Punjabi, Assamese, Urdu, Bhoti).

DISCUSSION

This study was conducted among 202 nursing students to assess the nursing students’ perception of their IPR with the members of HCT. The median age of the participants was 21 (20 and 22) years. The majority of the students are from Eastern states of India (63.4%). The 56.4% of students have been schooled in English medium in higher secondary classes, which happens to be the majority.

Most of the participants were educated in co-educational type (66.3%, 134 participants) schools. Peers in the school play an important role in building confidence and career intentions among adolescent girls and boys. Previous studies have reported that girls leaving single-gender schools tend to be on average more confident than those leaving co-ed schools, but in our study, we found no relation between schooling type and level of IPR.³

Of the total subjects, 88.2% belonged to nuclear families. The 31.2% (63 students) reported being from liberal families, 18.8% (38 students) belonged to conservative families and 50% (101 students) belonged to families having mixed values and beliefs. A study conducted in the United States showed that profiles of liberals are relatively high on openness and low on conscientiousness and conservatives are relatively high on conscientiousness and low on openness.⁴ But in our study, we did not find any significant relation between family type and values with the level of IPR.

The 83.7% of the participants had siblings in our study. A study was conducted in Cape Town, South Africa to explore the IPR s among young adults.⁵ The participants all stated that being an only child did not affect their ability to make friends. However, in our study, there is no relation between the number of siblings and the level of IPR.

In our study, 43.56% of the nursing students perceived their IPR with the HCT as ‘good’, 24.25% reported ‘moderate’ IPR, 20.29% with ‘very good IPR’ and 11.88% had ‘low IPR’. The present study showed that there is an association between the level of IPR and the seniority of nursing students. The level of IPR of the nursing students with the members of the HCT can have a direct impact on the learning outcomes of students. A correlational study conducted on the effect of IPRs between nursing students and lecturers noted an association between the students’ ratings of IPRs with lecturers and their reported use of critical thinking skills.⁶

The challenges revealed by the nursing students in maintaining IPR with HCT in our study include language difference (84.7%), lack of respect (80.7%), blaming culture of HCT towards students (75.2%), inadequate professional knowledge of nurses (69.8%), gadgets use by HCT (58.9%), partiality shown by HCT towards students from their domicile state (57.9%), previous bad experiences (53.5%), lack of knowledge of student nurses (53.5%), lack of clinical skills (50.0%), shy nature of students(49.0%), inability to accept criticism (49.0%) and inferiority complex of students (42.6%). A descriptive study conducted on communication problems experienced by nursing students with nurses, physicians, patients, instructors, and fellows in clinical settings at a state hospital in Turkey revealed that students were having communication problems with clinical nurses (68%), patients (66%), instructors (59%) and physicians (44%).⁷

Most of the students in our study perceived that good IPR with HCT helped them to reduce the gap between their theoretical knowledge and practical skills (RII: 0.8) which is supported by other studies which revealed the importance of proper communication among the health care team.^8,9,11

A qualitative study done to assess challenges faced by nursing students to work with nursing personnel revealed a lack of support for each other, student humiliation by nurses, putting your own mistakes on students, low literacy of nurses, lack of work ethics, low staffing in nursing and lack of training facilities as challenges.¹⁰

Limitations

The study was done among three batches of BSc (Hons) nursing students in a single nursing college. This restricts the variety of data. Multiple colleges with a larger number of students may be done for more generalization. The perceptions of only BSc (Hons) nursing students were assessed in the current study. The view of health care team members towards nursing students in maintaining IPR may vary and can be assessed in further studies.

CONCLUSION

IPR with HCT affects the anxiety, self-confidence, learning outcomes of the students, and their performance in the clinical environment. In this study on the perception of nursing students' IPR with members of HCT, even though the majority reported good IPR, low IPR is also reported by some student nurses. They also revealed many challenges in maintaining IPR with HCT which need to be addressed properly. Good IPR in the clinical setting is very important for student nurses to get clinical experience as well as to improve patient care.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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