| dc.description.abstract | The government of Kenya has initiated reforms in the health sector with a major intention
that in the coming years, health service provision will become humane, compassionate and
dignified.This is in line with the changing context of nursing that now includes home-based
care and counseling due to the upsurge of disease incidence. This situation calls for
competence in practical language use in the process of providing nursing care in order to
ensureclient satisfaction by maintaining their emotional well-being. Nurses interact longest
with clients and the communication strategies that they adopt determine the effectiveness
and acceptability of service. This study was motivated by the fact that despite their
systematic training, there has been a widespread perception that nurses in Kenya's public
health facilities are impolite towards their clients. Therefore, there was need to ascertain the
politeness strategies adopted by nurses and clients and the pragmatic constraints that
determined their choices. We also found it necessary to ascertain whether there was a
mismatch between the communication skills aspect of training and practice in the nursing
context.The impact of the dynamic social, cultural and economic realities faced by clients
also merited investigation. The objectives of this study were: to categorize and analyze the
nurse-client interaction patterns, describe the politeness strategies applied by nurses and
clients in their interactions in the nursing context, evaluate the relevance of the
communicationskills syllabus for trainee nurses in Kenya vis-a-vis the practical interaction
between them and their clients and to identify and explain the extralinguistic factors that
affect the interactions. We adopted the theory of politeness as propounded by Brown and
Levinson.Non-participant observation of practical nurse-client interactions was conducted
in sixteen randomly sampled health facilities in Nyanza province. Subsequently, systematic
randomsampling was used to identify a sample size of one hundred and twenty interactions
from the transcripts of the observations for analysis. The unit of analysis in this study was
the utterance. In order to seek insight into the factors that motivated nurses and clients to
choose the emerging patterns of interaction and politeness strategies, in-depth interviews
were conducted with key informants drawn from trainers at a public medical training college
and nurses' immediate supervisors. Randomly sampled and consented health facility clients
and practising nurses were also interviewed to gauge their perceptions of politeness in the
nursing encounters that they had experienced. The data was analyzed both qualitatively and
quantitatively by classifying the utterances into the various themes and categories of
politeness, defining the contexts in which they occurred and evaluating their impact on the
participants' face wants. The implications of the observed patterns to the expectations of the
nursing curriculum and how they portrayed the notion of patient needs and rights were then
determined. The analysis revealed that nurses initiated and controlled most of the
interactions and engaged in more acts of impolite utterances while clients preferred acts of
polite friendliness. Nurses exhibited awareness of the need for politeness in theory but few
of them could demonstrate polite utterances in practice. Both the Enrolled Community
Health Nursing and Kenya Registered Community Health Nursing syllabi were found to be
deficient in communication skills coverage by emphasizing politeness without
operationalizing it. We recommend a model for integrating politeness strategies into the
teaching of the core nursing values, extending the duration of communication skills lessons,
revamping the role of the customer care staff, and educating clients on their rights and
obligations. These would contribute to mutually cooperative interactions that minimize
conflict and ensure client satisfaction, an objective of the Ministry of Health reform agenda. | en_US |
