IN-PATIENT SATISFACTION WITH NURSING CARE: A CASE
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlIN-PATIENT SATISFACTION WITH NURSING CARE: A CASE STUDY ATKWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGYHOSPITAL*1Dzomeku, V. M; Atinga Ba-Etilayoo2; Tulukuu Perekuu3 and R. E. Mantey41Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana, West Africa2Physiotherapy Assistant and Orthotics Training School, Ghana;3Presbyterian Hospital, Dormaa Ahenkro, Brong Ahafo, Ghanavmdzomeku@gmail.comAbstractPatient satisfaction is an indispensable aspect of quality nursing care in any health setup today. Care assessed to beof high quality according to clinical, economic or other provider-defined criteria is not ideal if the patient feelsdissatisfied. There is a rationale to make the organization and delivery of health care more responsive to consumeropinion. The study sought to determine inpatient satisfaction with nursing care at the university hospital, KumasiGhana. Questionnaires were administered to 100 in-patients selected by convenience sampling in the male, femaleand maternity wards. The results revealed that 38% of male participants were very satisfied with nursing carecompared to 30% of female participants. Inadvertently, patients with high formal education were no less satisfiedwith nursing care than their counterparts with low or no formal education. Age was an important predictor ofpatient satisfaction of nursing care as 37% of patients below forty years were less satisfied compared to 46% ofthose above forty. Dignity, love, safe delivery and care were the expectations of most clients. There is a greater needto improve interpersonal relationship of nurses with their patients.Keywords: Nursing care, Patient satisfaction, patient dissatisfaction, in-patient, patient expectationIntroductiontype and level of the care they receive. Also, itdepends on the quality of the communication,behavior and information rendered to a patient duringthe period that extends from admittance to anddischarge from the hospital until the results ofdiagnosis and treatment are achieved (Wallace, et al.,1999).Nursing care is one of the major health care servicesthat contribute significantly to the patient healingprocess. Even though there may be competentphysicians present in a given health institution, itwould be inadequate without appropriate nursingcare. Nurses have 24 hour contact with patients aswell as being near to them. Patient satisfaction isoften determined by the nursing care in any healthsetup.The patients'/healthy individuals' role have changedover the past four decades from passive recipient ofservices to active participants. Patients increasinglywant to learn more about their health conditions andthey want to participate in the planning, organizationand decision-making of services related to theirhealth (Merkouris, et al., 1999). The changes thathave happened in the patient's role are also linked toToday, the Total Quality Management (TQM) is afavoured approach in the improvement of healthcareservices. It covers not only professional knowledge,competence and application of appropriatetechnology, but also the patients' perception about the19
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlthe developing interest in learning more about patientsatisfaction.approaches. The findings of the study showed thatmultifaceted staff interventions improved patients'satisfaction with nursing care.Patient satisfaction has been studied extensivelyusing quantitative and qualitative methods. Theresults of all these studies revealed that nursing carewas the major determinant of patient satisfaction.Physicians were not identified as major drivers ofpatient satisfaction with hospital care. Wallace et al,(1999) determined how patients and their relativesevaluate health care through focused groupinterviews. In their study, they categorized servicesreceived into several thematic areas. These includedthe quality and the quantity of healthcare services,individuality and partnership. The quality and thequantity of care services were studied under two subthemes: competence (coordinated and continuity, useof medication, and discharge planning) andenvironment (hygiene, daylight, comfort, etc.) Thesecond theme, individuality, included such elementsas respect for personal needs, reliability, privacy andconcern. The last theme, partnership, includedsharing information, accessibility and participation indecision-making.The way patients perceive nursing care largelydepends on their social status, age, educational level,cultural background and previous hospitalexperiences. Support and respect from nurses,constant availability of nurses and appropriatelygiven responses are the main indicators ofsatisfaction (Gilleard and Reed, 1998; Uzun, 2003).In their study on patient satisfaction, Johansson et d of the patients, their expectations ofnursing care, physical environment, communicationand information, contribution and participation,interpersonal relationship, technical competence, andstructural dimensions of healthcare organization. Thefindings showed that these eight factors affectedpatient satisfaction with the nursing care offered inhealth systems.The emerging health care literature suggests thatpatient satisfaction is a dominant concern that isintertwined with strategic decisions in the healthservices. Donabedian (1980) suggested that patientsatisfaction should be as indispensable to assessmentsof quality as to the design and management of healthcare systems. Unless quality improvement becomes apriority, the consequences are grim. In addition topreventing patients from quick recovery, therebyincreasing their costs, poor quality also elevates thepsychological barriers of using the system (Andaleeb,2001).In another study (Schmidt, 2003) divided perceptionof nursing care into four categories. The first twowere 'seeing the individual patient', which means thatnursing care experience is applied to each patientindividually, and 'explaining', which refers to theexplanations given by nurses. The 'responding'category represented the actions of nurses as a resultof a patient request or response to a symptom, andfinally the 'watching over' category defined thenurse's efforts to observe and to supervise his or herpatient. In Lebanon, Chaaya, et al., (2003) conducteda study on a patient-centred care model. They statedthat four dimensions of nursing care affect patientsatisfaction; these were competence, productivity,attitude and communication.Improving service in the health care require hospitalsto measure their own performance in order toimprove upon current system of service delivery.Well designed health care delivery system can reducere-hospitalization, improve quality of life and providepatient satisfaction. As regards patient satisfaction,they are often left out of the process in determiningwhat quality of care is suitable. The health careprovider used to make decisions they consider beingin the best interest of their patient; often withouttaking into consideration the views of patient orconsulting them. There is the need for a paradigmshift where the needs and preferences of the patientsmust drive the direction of the care. The objective ofthis study was to assess the patient satisfaction at theuniversity hospital.Patient satisfaction is the most important indicator ofhigh-quality health care and is used for theassessment and planning of health care (Schmidt,2003). There is a positive correlation between patientsatisfaction and nursing care. Patient satisfactionincreases in an organization where more personalizednursing care is given (Johansson, et al., 2002).Yeakel, et al. (2003), studied how to increase oaches. They gathered data by employing twoscales consisting of patient satisfaction and nursing20
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlWith respect to age and satisfaction, the resultsshowed that 37% and 46% of patient respondentsbelow 40 and above 40 years respectively were fullysatisfied with the care service rendered. In a study byWallin, et al., (2000), they did not find a correlationbetween age and patient satisfaction. However, otherstudies (Jackson et al., 2001; Ottosson et al., 2001)found age to be significant predictor of satisfaction.They found that older patients were generally moresatisfied than younger patients. In the Ghanaiancontext age and satisfaction could be due to culturalvalues as the elderly are respected and accordedspecial privileges than the young and this mightinfluence the nurses paying more attention to themthan younger ones, leading to more satisfactionamong the older patients than the younger ones. In asimilar study (Stimson and Webb, 1975), 85% ofthose over 65 were satisfied compared to 52% ofthose aged 15 – 39 years. They attributed this to olderrespondents expecting less information from theirnurses on their care as compared to the youngerpatients who had a lot of issues surrounding theircare. In addition, younger patients were less likely tocomply with nursing and medical advice and this isuncommon with the older folk who take allinstruction wholeheartedly.Materials and methodIn order to identify and classify the various indicatorsof satisfaction and dissatisfaction, a descriptive study(cross sectional survey) was used to assess clients’satisfaction with in-patient care at the KwameNkrumah University of Science and Technology(KNUST) hospital. The study population inclusioncriteria includes adult males and females of 18 yearsand above admitted into the medical, surgical andmaternity wards of the hospital for at least 24 hoursand are close to their discharge from the hospital.This category of patients was selected to avoid fear ofvictimization so that the correct information will begiven by patient. The consent of the patients wassought and those who met the inclusion criteria weregiven the questionnaires. The sample size for theresearch was one hundred (100) in-patients selectedusing spatial sampling technique. Structuredquestionnaires were designed, pre-tested twice andthe necessary corrections made before administration.Questionnaires administration was done by readingout and explaining the content to those who could notread and write. Those who could read and understandanswered the questions independently. Data collectedwas subjected to descriptive analysis.Respondents with limited educational status wereobserved to have had higher satisfaction, 32% ofrespondents who were illiterate and those with onlybasic education were fully satisfied compared to 31%who had tertiary education who were dissatisfied(Fig.1). This may be the result of in-patients withhigher education being able to access informationabout the duties of the nurse. They may also haveread about the patients’ charter and know about theresponsibilities of the nurse. If these responsibilitiesare not carried out to the letter they becomedissatisfied. Those with limited education have noaccess to this information and tend to be satisfiedwith the nursing care given since they have nothingto compare with. This is similar to a study by Alasadand Ahmed, (2003) who reported that less educatedpatients tended to have high satisfaction. This isfurther supported by a study by Minnick, et al.,(1997) which state that those who attained highereducational level were not satisfied with their care.Also according to Calnan (1988), clients with limitededucation are more passive and less critical abouthow they were treated by nurses.Results and discussionThe study revealed that about 33% of respondentswere fully satisfied with their nursing care. However,as regards gender, 38% of the male in-patients werefully satisfied compared to 30% female in-patients.The actual reasons for this is unknown, nonetheless,it could be attributed to the fact that females are moreconscious of hygiene and poor practical skills thanmen. This makes them more observant and critical ofaspects of quality when evaluating staff performance.Also females are mostly accompanied by maleattendants and most of the time all communicationabout investigations and treatment occur between thenurses and the attendants which may result in lessinformation to females and hence less satisfactionwith care (Linder-Pelz, 1982). A study by Jeffery etal., (2001) also reported that gender seemed to beunimportant in patient satisfaction. This findings isalso contrary to the study of Alasad and Ahmed(2003) but consistent with Ottoson et al., (1997)which reported higher satisfaction among males thanfemales.21
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlFig. 1. Educational background of in-patient satisfaction respondentsto the absence of a suggestion box where patients’grievances could be lodged. This agreed with thestudy of Tsegaye and Legesse (1999); Walsh andWalsh, (1999) that revealed that patients weresatisfied in areas of greetings and politeness of thenurses. Patients (41%) were satisfied with the amountof privacy given as each bed had a screen whichprovided maximum privacy.About 36% ofrespondents were satisfied with nurses’ capability intheir work and the amount of time nurses spent withthem. This finding agrees with that of Walsh andKowanko (2002) that privacy was among the highestsatisfaction ratings, supporting the general belief thatelements of privacy, respect and advocacy enhancepatients’ satisfaction with care.The results of client’s expectations of nursing careprior to their hospitalization revealed that majority(73%) were expecting to be treated with love anddignity. Others (18%) indicated that their expectationwas that the nurses would be polite to them in alltheir interactions (Table 1). This could be as result ofhow nurses are seen in the Ghanaian society.Ghanaians hold the perception that nurses are hostileto patients and their relatives. In the maternity ward9% of respondents indicated that they expected thenurses to help them deliver safely and have theirbabies. This showed that the pregnant women wereconcerned about the high maternal and infantmortality (560 deaths per 100,000 births and 51deaths per 1000 births respectively) in Ghana (WHO,2007); hence, having a live baby and being aliveherself was enough to satisfy them. In a similar study(Dzomeku, 2011) it was established that (a) multiplefactors influence mothers’ satisfaction with their carein labour, birth and the lying-in period; (b) maternalsatisfaction during this period is determined mostlyby the attitude of care givers; (c) dissatisfaction withcare leads to non-usage of the hospital in future orusing the hospital only as a last resort.The type and amount of information given to apatient about their condition and treatment are veryimportant in health care. Nurses at the universityhospital were scored very low (14%) for the type andamount of information given about their conditionand treatment. They were also ranked low (20%) forthe way they explained issues to patients. Also nurseswere ranked low (22%) for how they listened topatients’ worries and concerns. Furthermore, nurseswere rated low (24%) for how they related torelatives and friends of patients. In addition, theywere rated low (27% and 28%) respectively forchecking on the well-being and how much they knowabout the care of the patient. The amount and type ofinformation nurses gave to patients about theirThe overall rating of satisfaction in this study waslow compared to other studies. The high score of46% for patients’ satisfaction with nursing care wasthe attitude of nurses towards clients and their familywas recorded at the hospital. This may be attributed22
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlcondition and treatment were major causes ofdissatisfaction. Information is very important forevery patient and family to allay their fears about theunknown and if this information is withheld it causesanxiety among patients and their relatives. Quite agood number of respondents were highly educatedand expect more information from nurses and sincethis was not forth coming it caused a lot ofdissatisfaction. The workload excuse often used bynurses in Ghana may have attributed to these lowscores as nurses could not have enough time toconverse with patients. One study concluded that thegreatest single defect in hospital care was ‘the barrierto easy exchange of information’ (Locker and Dunt,1978).the patients enumerated were that the nurses wouldexplain all procedures to them, nurses would bepatient with them, and nurses would listen to theirconcern and act appropriately (Table 1). These itemswere among the lowest rated satisfaction items andthis is consistent with Chaayal, et al. (2003), whoconcluded from their study that attitude andcommunication affect patient satisfaction withnursing care. Among the items patients rank highestin their satisfaction were the attitude of nurses towardpatients and family; the amount of privacy. Mostpatients wanted to be treated with dignity and thisexpectation was met by the nurses and it was thesecond highest rank among the highest satisfactionitems (Table 1). When patients were asked whethertheir expectations before their admission into thehospital were met 67% had their expectation partiallymet, 30% fully met and 1% not met.The study found that patient expectation of care isinfluenced by his/her satisfaction with the perceivedactual nursing care. Among the expectations some ofTable 1: Criteria for satisfaction of in-patients respondentsCriteria for satisfactionNot Fully satisfied (%)Fully satisfied (%)The amount of time nurses spent with youHow capable nurses were at their jobThe attitude of nurses towards you and your familyHow quickly nurses came when you called for themThe way the nurses made you feel at homeThe amount of information nurses gave you about yourcondition and treatmentHow often nurses checked to see if you were okayThe way nurses explained things to youHow nurses helped put your relatives and friends minds atrestNurses manner in going about their workThe type of information nurses gave to you about yourcondition and treatmentNurses treatment of you as an individualHow nurses listened to your worries and concernsThe amount of freedom you were given on the wardHow willing nurses responds to your requestsThe amount of privacy nurses gave youNurses awareness of your 37872685966272228324134ConclusionThis study found that there was a communication gapbetween nurses and their patients that led to patientdissatisfaction. This is a common problem for all thehospital wards under study which requires urgent23
May 2013. Vol. 2, No.1ISSN 2307-2083International Journal of Research In Medical and Health Sciences 2012 IJRMHS & K.A.J. All rights reservedhttp://www.ijsk.org/ijrmhs.htmlattention to enhance patients’ satisfaction at the sametime to ensure quality of nursing care. The publichealth implication related to patient dissatisfaction ofcare may lead to patients patronising private healthcare providers and incur high cost as compared togovernment health care services. Thus, examining theitems with low patients’ satisfaction will enablenurses to identify the defects in nursing care andinstitute appropriate change. Patient assessmentsurvey should be carried out routinely by healthinstitutio
1Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana, West Africa 2Physiotherapy Assistant and Orthotics Training School, Ghana; 3Presbyterian Hospital, Dormaa Ahenkro, Brong Ahafo, Ghana vmdzomeku@gmail.com Abstract Patient satisfaction is an indispensable aspect of quality
Patient satisfaction has been given a lot of importance in recent years but still a lot more should be done in this field. Out Patient Department (OPD) is considered to be the first point of contact of hospital with patients that's why it has significant influence on patient satisfaction level. Patient satisfaction has become a
Summarize degree of satisfaction (overall and by subgroups) Compare satisfaction (or performance) to some standard Expectations Ratings of competitors Analyze determinants of satisfaction Overall satisfaction as a function of satisfaction with particular components of satisfaction
for Nursing (69) Delaware Board of Nursing (12) District of Columbia Board of Nursing (75) Florida Board of Nursing (70) Georgia Board of Nursing (31) Guam Board of Nurse Examiners (87) Hawaii Board of Nursing (37) Idaho Board of Nursing (82) Illinois Board of Nursing (49) Indiana State Board of Nursing (48) Iowa Board of Nursing (60)
Sep 04, 2017 · Catalyst’s strategy and products in this lecture, but only by necessity . NRC Picker - Patient Satisfaction 4. PRC - Patient Satisfaction 5. Press Ganey - Patient Satisfaction 6. Sullivan Luallin - Patient Satisfaction. Master Reference & Terminology Dat
Apr 22, 2017 · NRC Picker - Patient Satisfaction 4. PRC - Patient Satisfaction 5. Press Ganey - Patient Satisfaction 6. Sullivan Luallin - Patient Satisfaction. Pat. Sat. 1. AHRQ Clinical Classification . Catalyst Analytics Platform. Fabric Data Services. Real time Processing. Health Catalyst Application
this low patient satisfaction [3–8]. However, a “gold standard” questionnaire or tool for the assessment of pa-tient satisfaction is lacking, meaning that there are vari-able results in terms of preoperative predictors [2, 7]. In recent decades, patient satisfaction and patient-reported outcome measures have become increasingly
Patient satisfaction leads to drift in both new and old patients, which hinders the sustainability of any hospital in long run. Patient satisfaction surveys are useful in gaining and understanding of the user needs and their perception of the service received. The emerging health care literature suggests that patient satisfaction is a dominant .
medical costs, and increased patient satisfaction scores. Appropriate nursing care during the preoperative, intraop-erative, and postoperative phases is essential. The purpose of this article is to describe the nursing care for a patient undergoing a direct anterior approach to hip arthroplasty. Nursing Care of the Patient Undergoing
