Qualitative Nursing Study

Several years ago, my research focused on improving health and healthcare in Appalachia. I conducted a qualitative research study where I interviewed native Appalachian nurses to try and determine if native Appalachian patients experienced the health care system differently than non-native Appalachian patients. Several questions concerned communication issues with Appalachian patients. I asked the question, “How do  native Appalachian patients respoond to being told what to do, or in other words being treated in an authoritarian manner?” All of the nurses had very strong responses to this question. For instance, one nurse said, “Hell NO, THAT doesn’t work!” Another nurse responded, “If you start out your day telling your patient what they must do, you are in for a bad day. It is not going to go well for you!” Every nurse had many examples of communication issues with native Appalachian patients and felt that if providers received some type of education concerning this it would be very helpful.

Relationships Are Important To Build Trust

Many people are aware of this trait and attribute it to independence, stubbornness, or just being hard to get along with. Most people never stop to think that it stems from the early days of the settlement of the Appalachian region. Small family groups moved in and attempted to tame some very wild and rough mountain land. Most individual families were very self-sufficient. However, there were still times  they needed the help of their community members. Appalachian people have a reputation of being very neighborly and willing to go out of their way to help their neighbors. Many people are just not that concerned with social hierarchy. Frequently, they want to relate to other people on a more even or equal basis. Relationships are of utmost importance in order to build trust.

Outsiders Telling What To Do

There are a lot of historical reasons, that Appalachian people don’t like to be “told” what to do. Appalachia has a long history of outsiders coming into the region and telling people who live in Appalachia what they need to do to fix their problems. Rarely have outsiders stopped and asked what the people think needs to be changed or what would help their situations to improve.

Importance of Relationships


Within the health and human service care setting, taking a little extra time to form a relationship with a client is so very important. Finding something to relate to and engaging in some small talk, before launching into asking clinical questions is very important. Therefore, it is crucial to realize how important taking time to listen is. For instance, ask the client how they feel or what they think is the cause of their problem. Furthermore, asking clients what they think will bring improvement is a great way to  improve communication. Consequently, improving  communication between provider and client will improve health and human service outcomes.