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A STUDY TO ASSESS THE PATIENT SATISFACTION WITH QUALITY NURSING
CARE IN NEURO MEDICAL UNIT, SCTIMST.
PROJECT REPORT
Submitted in partial fulfillment of the requirements
For the
DIPLOMA IN NEURONURSING
Submitted by
JUMY VARGHESE
Code No: 5896
SREE CHITRA TIRUNAL INSTITUTE OF MEDICAL SCIENCES AND TECHNOLOGY
MEDICAL COLLEGE TRIVANDRUM.
November 2009
/
CERTIFICATE FROM SUPERVISORY GUIDE
This is to certify that Miss. JUMY VARGHESE has completed the project work
on "A STUDY TO ASSESS PATIENT SATISFACTION WITH QUALITY
NURSING CARE IN NEURO MEDICAL UNIT, SCTIMST" under my direct
supervision and guidance for the partial fulfillment for the "Diploma in
NEURONURSING" in the University of Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Trivandrum. It is also certified that no part
of this work report has been included in any other thesis for procuring any
other degree by the candidate.
Trivandrum
November 2009
Dr. Saramma P.P
Senior Lecturer in Nursing,
SCTIMST,
Trivandrum
CERTIFICATE FROM CANDIDATE
This is to certify that the project report on "A STUDY TO ASSESS PATIENT
SATISFACTION WITH QUALITY NURSING CARE IN NEUROMEDICAL
UNIT, SCTIMST" is a genuine work done by me at the Sree Chitra Tirunal
Institute for Medical Sciences and Technology, Trivandrum under the
guidance of Dr Saramma P.P. It is also certified that this work has not been
presented previously to any university for award of degree, diploma,
fellowship or other recognition.
Trivandrum
November 2009
Jumy Varghese
Roll No: 5896
Sree Chitra Tirunal Institute for
Medical Sciences and Technology
· Trivandrum.
APPROVAL SHEET
This is to certify that Miss JUMY VARGHESE bearing Roll No. 5896 has
been admitted to the Diploma in Neuronursing in January 2009 and she has
undertaken the project entitled "A STUDY TO ASSESS PATIENT
SATISFACTION WITH QUALITY NURSING CARE IN NEUROMEDICAL
UNIT, SCTIMST" which is approved for the Diploma in Neuro Nursing
awarded by Sree Chitra Tirunal Institute for Medical Sciences and
Technology, Trivandrum, as it is found satisfactory.
Examiners
(1) ____ _
(2)
Guide(s)
(1) -----
(2) ____ _
Place:
Date :
ACKNOWLEDGEMENT
First of all let me thank Almighty God for unending love, care and blessing
especially during the tenure of this study.
I take this opportunity to express my sincere thanks to Dr. Saramma P.P,
Lecturer in nursing, Sree Chitra Tirunal Institute for Medical Sciences and
Technology, Trivandrum. For the guidance, she provided for executing this
study. Her advices regarding the concept, basic guidelines and analysis of
data were very much encouraging. Her contributions and suggestions have
been of great help for which I am extremely grateful. With profound
sentiments and gratitude the investigator acknowledge the encouragement
and help received from the following persons for the completion of this study.
I am thankful to Dr. M. D Nair, HOD, Neurology for this constant support and
encouragement.
All the staffs and departmental head of neurology unit, helped for completion
of this study at some time I am indebted to them.
JUMY VARGHESE
ABSTRACT
Topic: - A study to assess the satisfaction of patient with quality of nursing
care in neuromedical unit.
Background: - Patients have the right to expect Quality of care. Patient
satisfaction with nursing care is considered an important factor in explaining
patients' perceptions of service quality. Care assessed to be high qua'lity
according to clinical, economic or other provider-defined criteria is far from
ideal if as a result of that care the patient is unhappy or dissatisfied. There is,
then, a sound rationale for making the organization and delivery of health care
responsive to consumer opinion. Aim: -The objectives of the study were to
assess patient satisfaction with quality nursing care and to identify the
relationship of satisfaction with selected variables. Method: - A study was
conducted in Sree Chitra Tirunal Institute of Medical Sciences and
Technology,Trivandrum. A fifty patients were consecutively selected for this
study. Total period of study was from September 2009 to October 2009. The
study population was patient who were admitted into the neuromedical and
general medical unit of the hospital. A validated modified questionnaire of Dr.
Laschinger- Patient Satisfaction with Nursing Care Quality Questionnaire was
used to assess the satisfaction of the patient with quality of nursing care in
neuromedical unit. Results: - The data was analyzed by using Epi Info
version 3.2. In general satisfaction of patients with quality of nursing care in
neuromedical unit is above average. The study shows that there was no
significant difference between satisfaction of patient with quality nursing care
with regard to the age, sex, education and economic category of the patient.
Conclusion: - Satisfaction of patient with quality of nursing care in
neuromedical and general medical ward is above average. Studies using
more sample size may be useful to validate findings.
CONTENTS
I Chapter Titles Page No
1 INTRODUCTION. 1-9
2 REVIEW OF LITERATURE. 10-21
3 METHODOLOGY. 22-27
4 ANALYSIS AND INTERPRETATION. 28-37
5 SUMMARY, CONCLUSION 38-43
DISCUSSION, LIMITATION AND
RECOMMENDATIONS.
REFERENCES. 44-49
APPENDIX.
51. No.
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
CHAPTER -1
Introduction
Titles
Introduction.
Back ground of the study.
Need and Significance of the study.
Statement of the problem.
Objectives.
Operational definitions.
Methodology.
Tool.
Delimitations.
Organization of the report.
Page No
1
3
5
6
7
7
7
8
8
8
CHAPTER- 2
Review of Literature
51. No. Contents Page No.
2.1 Introduction 9
2.2 Studies on patient satisfaction with nursing 10
care.
2.3 Studies on factors influencing patient 15
satisfaction with nursing care.
2.4 Studies on quality nursing care. 17
2.5 Keywords. 19
Sl. No.
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12
3.13
3.14
CHAPTER- 3
Methodology
Contents
Introduction.
Research approach.
Research design.
Setting of the study.
Study population.
Sample and sampling technique.
Criteria for sample.
Sampling technique.
Development of tool.
Description of tool.
Pilot study.
Data collection.
Plan of analysis.
Summary.
Page No.
20
20
21
21
21
22
22
23
23
24
24
24
25
25
CHAPTER-4
Analysis and Interpretation of data
51. No. Contents Page No.
4.1 Introduction. 26
4.2 Distribution of sample by demographic data 26
4.3 Satisfaction of patients with quality nursing care. 31
4.4 Summary. 35
CHAPTER- 5
Summary, Conclusions, Discussion and
Recommendations
51. No. Contents Page No.
5.1 Introduction. 36
5.2 Summary. 36
5.3 Objectives of the study. 37
5.4 Limitation. 37
5.5 Major Findings. 37
5.6 Recommendation. 38
5.7 Discussion. 39
5.8 Conclusion. 40
Reference. 41
Appendix.
LIST OF TABLES
Table Titles Page No.
4.2a Distribution of sample according to age. 27
4.2b Distribution of sample according to sex. 28
4.2c Distribution of sample according to economic 29
category.
4.2d Distribution of sample according to educational 30
status.
4.3a Mean, standard deviation and p value of patient 32
satisfaction with quality nursing care by age.
4.3b Mean, standard deviation and p value of total 33
patient satisfaction with quality nursing care by sex.
..
4.3c Mean, standard deviation and p value of patient 33
satisfaction with quality nursing care by educational
status.
4.3d Mean, standard deviation and p value of patient 34s
satisfaction with quality nursing care by economical
category according to hospital protocol.
LIST OF FIGURES
I Figure Titles Page No.
4.2a Distribution of sample by age. 28
4.2b Distribution of sample according to sex. 29
4.2c Distribution of sample according to economic 30
category.
4.2d Distribution of sample according to educational 31
status.
1.1. Introduction
1
CHAPTER -1
INTRODUCTION
Satisfaction is the psychological state that results from confirmation or
disconfirmation of expectations with reality (Jackson 2001 ). Satisfaction of
patients and caregivers is an important indicator of quality of care and may be
particularly relevant for patients whose disease is not curable (Lynn 1997,
Morrison et al; 2000). Satisfaction with care is an important influence
determining whether a person seeks medical advice complies with treatment
and maintains a continuing relationship with practitioners (Larson and
Rootman 1976). Patient satisfaction is the patient's perception of care
received compared with the care expected and patients base their
expectations on their own encounters with behaviours of nurses (Aiello et al;
2003). The patient's perception of quality nursing care also includes caring,
compassion, competence, confidence, conscience and commitment in the
delivery of care (Gunther et al; 2002). During hospitalization, patient
satisfaction represents a balance between the patient's perception and
expectation of their nursing care and achieving optimum patient satisfaction
with quality nursing care has been the primary focus of nurses.
Organization must consistently include the latest guidelines and standards in
their rules, procedures and instructions to meet the demands of globalization
2
and evolution in nursing care (Han et al; 2003). Several studies in the USA
have documented that a higher ratios of registered nurses (RNs) to patients
contributes to better patient outcomes (Dang et al; 2002; Needleman et al;
2002).
In an investigation of the relationship of patient satisfaction to nursing care,
Mahon (1996) concluded, "Quality of care as measured by patient satisfaction
is most closely tied to patient satisfaction with the quality of nursing care
because most health care is nursing care". The concept of quality is always
expressed subjectively. We must accept the fact that someone is very
satisfied with an individual product or service performed, while at the same
time someone else may be very dissatisfied. Judging quality depends on an
individual's knowledge and awareness, experiences, expectations and
recognizable standards of quality. The patient evaluates quality primarily
according to how the service providers treat him, what attitude they had to
him, how much they fulfilled his expectations, or whether the service providers
are worthy of trust or he could receive the care he required (Kersnik 1998).
According to Walsh and Kowanko (2002) the aspects with which patients
were least satisfied (regardless of admitting ward) were the amount and type
of information they receive regarding their condition and treatment. The top
aspects that patients scored highest for their satisfaction with nursing care
were the feeling of privacy, nurses capability at their job, and nurses
helpfulness. It is generally believed that elements of privacy, respect, and
advocacy that nurses consider through their practice enhance patients'
satisfaction with the care.
3
Patient satisfaction is a term that can be interpreted differently by patients and
its meaning can also differ for one patient at different times (Larson et al;
1996; Shikiar et al; 1999). According to Uzun (2001), patients' aged ::: 50
years gave high scores for nursing care compared to patients aged <50 years.
Satisfaction with nursing care was found to increase when patients become
older in their age, have better functional health status, are in private rooms,
and are hospitalized in surgical wards (Jackson et al; 2001 ). Older age was
the strongest predictors of satisfaction and men tended to be more satisfied
than women, (Thi et al; 2002). Patient satisfaction is affected by knowledge of
health services (Bond and Thomas, 1992). Patients have expressed high
levels of satisfaction with the amount of information that nurses provide
(Kinnersley et a/., 2000). On the other hand, no correlations were found
between patients' satisfaction and age, gender, or education. ( Wallin et al;
2000).
1.2 Background of the study.
Nursing is an accountable profession guided by science, theory, a code of
ethics and the art of care and comfort to treat human responses to health and
illness. Florence Nightingale is considered the founder of modern nursing. Her
standards to assess the care of the soldiers has been established as one of
the first documented efforts of quality improvement work, and since then,
assurance of quality nursing care has remained a priority for nurses
throughout the world (Kahn, 987: 21) As nurses comprise the largest group of
health care providers (Brooten et al; 2004) and are legally liable and morally
4
responsible for the quality of care they provide to patients (Gunther and
Alligood, 2002), their perspectives on the definition of nursing quality is
important. Many studies have discussed the impact of nurse staffing on health
care outcomes flankshear et al; 2005, Bolton et al. 2003) and suggest that
positive patient outcomes depend more on the quality of nursing than on the
available technology (Navuluri, 1999).
ICN definition of nursing "It encompasses autonomous and collaborative care
of individuals of all ages, families, groups and communities, sick or well and in
all settings. Nursing includes the promotion of health, prevention of illness,
and the care of ill, disabled and dying people. Advocacy, promotion of a safe
environment, research, participation in shaping health policy and in patient
and health systems management, and education are also key nursing roles."
ANA'S Definition of Nursing "Nursing is the protection, promotion, and
optimization of health and abilities, prevention of illness and injury, alleviation
of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations".
(Nursing's Social Policy Statement 2004).
The healthcare team's goal is to provide the patient with the best health care
and service possible. The service providers are in constant effort to better
meet the patients' needs and expectations. Satisfaction is one of the core
outcome measures for health care. It is intuitively more appealing than
measures of health care effectiveness or efficiency that are more difficult to
5
understand. Satisfaction with health care is a measure with a long history in
the social sciences (Di palo 1997). Nursing care has a prominent role in
patient satisfaction. Patient satisfaction is an important indicator of quality of
care, and healthcare facilities are interested in maintaining high levels of
satisfaction in order to stay competitive in the healthcare market. (Wagnar et
al; 2009). Continuing education is a term used to describe the programmes or
courses that assist professional nurses in developing and maintaining the
clinical expertise that promotes quality-nursing care. In the past, a nurses role
consisted of providing care and comfort to clients and performing specific
nursing functions. The role of modern nursing has expanded to include a
heightened emphasis of illness prevention, health promotion and concern for
the clients holism. Today's nurse engages in approximately in eight
interrelated roles: caregiver, advocate, critical thinker, teacher, communicator,
manager, researcher and rehabilitator. (Harkreader and Hogan 2004)~
1.3 Need and significance of the study.
Patient satisfaction is an important component of health care industry in this
competitive era. 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 concern that is intertwined
with strategic decisions in the health services. Patient satisfaction should be
as indispensable to assessments of quality as to the design and management
6
of health care systems. Unless quality improvement becomes a priority, the
consequences are grim.
Nursing care is one of the major health care services. It contributes a lot to the
patient healing process. To improve the quality nursing care, the nurses need
to know what factors influence patient satisfaction. Even though there are
competent physicians present in a given health institution, it would not be
adequate without appropriate nursing care. Nurses have 24 hour contact with
patients as well as being near to them. Thus, as they are the frontline, the
patients expect more from them and nurses should also fulfill patients' needs
with competence and a compassionate approach. If the patient is denied
appropriate care the healing process is obviously compromised. Patient can
expect and demand satisfaction from nursing care and be allowed take an
active part in· decision-making regarding their care. Andaleeb (200 1) poor
patient satisfaction can lead to poor adherence to treatment with consequently
poor health outcomes. So satisfaction of patient has an impact on outcome of
treatment and to maintaining good interpersonal relationship. On this line,
assessing the satisfaction of patients with nursing care is crucial in order to
identify the area of dissatisfaction and at the same time improve the nursing
services.
1.4 Statement of problem.
A study to assess satisfaction of patients with quality of nursing care in
neuromedical unit.
7
1.5 Objectives of the study.
1. To assess the patient satisfaction with nursing care quality.
2. To identify the relationship of satisfaction with selected variables.
1.6 Operational definitions.
Patient satisfaction - It is defined as an expression of patients judgment on
quality of care in all aspects but particularly as concern the inter-personal
process.
Quality Nursing Care - It is defined the complete satisfaction of the needs of
those who are in most need of nursing care. Quality may be measured in
terms of outcomes; the end results of care and treatment, or it may be
evaluated in terms of process, the way in which the care is delivered.
1. 7 Methodology.
Settings
Study design
Sample technique
Exclusion criteria
Neuro medical ICU, Neuro medical and general
medical ward in SCTIMST.
The day of discharge includes all discharge
patients and all patients after of 4th day of
admisson.
Consecutive sampling
Children below 15years of age, patients
who are not fully awaked.
8
1.8 Tool
The investigator assessed the patient satisfaction with nursing care by using
a modified firm of Dr. Laschinger's - "Patient Satisfaction with Quality Nursing
Care Questionnaire, Malaya lam version". The· experts in neurology
department validated this content.
1.9 Delimitation.
The study is conducted in neuromedical ward and general medical ward
(patients under neurology and radiology department) of SCTIMST. The
sample size is 50 patients of above 15 years of age.
1.10 Organization of the report.
This chapter deals with introduction, background of the study, need and
significance of the study, statement of the problem, objective, operational
definitions, methodology and delimitations. Chapter 2 deals with review of
literature. Chapter 3 deals the methodology. Chapter 4 presents analysis and
interpretation of the data and chapter 5 include summary, discussion,
conclusion and recommendations. Reference and appendixes are given
towards the end.
9
CHAPTER- 2
REVIEW OF LITERATURE
2.1 Introduction
Review of literature is the keep step in research process. If refers to a broad,
comprehensive, in depth, systematic and critical review of scholarly,
publications, unpublished scholarly, print materials and audio visual materials
(Basvanthappa 2001 ).
According to Cooper (1988) 'a literature review uses as its database reports of
primary or original scholarship, and does not report new primary scholarship
itself. The primary reports used in the literature may be verbal, but in the vast
majority of cases reports are written documents. The types of scholarship may
be empirical, theoretical, critical/analytic, or methodological in nature. Second
a literature review seeks to describe, summaries, evaluate, clarify and/or
integrate the content of primary reports'.
A crucial element of all research degrees is the review of relevant literature.
So important is this chapter that its omission represents a void or absence of
a major element in research (Afolabi 1992).
2.2 Studies on patient satisfaction with nursing care.
10
2.3 Studies on factors influencing patient satisfaction
with nursing care.
2.4 Studies on quality nursing care.
2 .2 Studies on patient satisfaction with nursing care.
Khan et al;(2007) conducted a study on patient satisfaction with nursing care
in District Headquarters Hospital Dera Ismail Khan to examine the level of
satisfaction with specific dimensions of nursing care in an effort to provide
quality improvement knowledge that will lead to understand and identify the
principle drivers to patient satisfaction. The investigators done a cross
sectional study with Henderson's basic nursing care model. Six dimensions of
care were selected for examination. Total 153 patients were identified and
invited for interview through questionnaire. Out of these 122 patients agreed
to participate. Overall, patients had a variable experience of nursing care;
45% patients were satisfied with care provided, while 55% were partially
dissatisfied. Among 6 dimensions of care, 94% liked nursing practice of
keeping privacy of patients. When asked about the behavior, 90% patients
were not feeling comfortable to talking to nurses. Only 10% felt nurses were
excellent. 84% patients had negative experiences as they observed nurses
were not attentive to their needs, particularly at night. The same percentage
also had negative perception with respect to physical care. The investigators
suggests that patient's comments suggests that number of concerns must be
addressed. The nurses need to know what factors influence patient
11
satisfaction, if we must improve the quality of care.
Ozsoy et al; (1997) conducted a study of patient expectations and satisfaction
with nursing care in Turkey: a literature review- to review the national
literature on patient expectations and satisfaction with nursing care. The
researchers reviewed 3089 articles of which 27 where discussed in detail . Of
these 3089 articles, 1812 were from all issues of 14 Turkish nursing journels,
which has been published in the last 50 years, and 1277 articles, were from
24 nursing congress and symposium books. The results of the study are
divided into two categories: expectation concerning ' nursing care' and
'satisfaction with nursing care. The findings show that there exist conceptual
and philosophic deficiencies in the approaches to patient satisfaction and that
there is a need to use standardized instrument to study and assess patient
satisfaction in the future according to the researchers.
Chan et al; (2001) conducted a study of patient satisfaction with triage nursing
care in Hongkong to examine the relationship between patient satisfaction
and triage nursing care in order to assist nurses in defining more clearly their
roles, and ultimately to improve the quality of care delivered to emergency
patients . A descriptive co relational study was conducted in one urban acute
hospital in Hongkong using Consumer Emergency Care Satisfaction Scale
(CECSS) and patient and nurse demographic data were also collected.
Following a power calculation, systemic sampling was carried out and final
sample consisted of 56 urgent, semi-urgent and non-urgent patients triaged .
The response rate was 61%. The majority of participants were satisfied with
12
their triage nursing care and teaching. Co relational analysis revealed that
patient satisfaction with triage nursing care was statistically significantly
correlated with age and type of nursing intervention recieved. Older people
were more satisfied with the teaching offered by triage nurses and patients
who had received the specific nursing interventions gave more positive ratings
on the teaching subscale of the CECSS. There was no statistically significant
relationships between patient satisfaction with triage nursing care and nurse
characteristics, including gender, work experiences and educational level.
Johansson et al; (2002) done a literature study to describe the influences on
patient satisfaction with regard to nursing care in the context of health care.
In the literature study the researchers used Henderson's nursing care model.
The result of the study described eight domains that have an influence on
patient satisfaction with nursing care: the socio-demographic background of
the patients, patients expectations regarding nursing care, the physical
environment, communication and information, participation and involvement,
interpersonal relations between nurse and patient, nurses medical-technical
competence and the influence of the health care organization on both patients
and nurses. The bulk of literature included in the study came from the UK,
Sweden and USA. This means that the results should be applicable to health
care in western world.
Uzun (2001) conducted a study related to patient satisfaction with nursing
care in a university hospital in Turkey. The investigator used Service Quality
Scale (SERVQUAL) in 422 discharge patients to determine the patient
13
satisfaction with nursing care . According to study, the Service Quality (SO)
gap scores for five dimensions were negative to meet expectations. The
negative scores for tangibles, reliability, responsiveness, assurance and
empathy indicate areas needing improvement. The result of study support the
need for nurses to take steps to improve patient satisfaction with nursing care.
Lumby (2005) investigated patient satisfaction with nursing care as an
outcome measure for those patients undergoing colorectal surgery. The
study's relevance for nurses is the potential feed back for reviewing nursing
practice and health care delivery. The study was conducted through a
validated questionnaire, the Service Quality Scale (SERVQUAL), followed by
interviews with a percentage of the study population. The result of the study
confirmed the importance of measuring patient satisfaction through a
triangulated method, which investigates thoroughly, providing feedback for
continuous quality improvement. The in-depth interviews provided greater
insight into the results of the questionnaire, enabling clear feed back to
nursing staff at the different sites of study. Results of questionnaire revealed
age, sex and education levels of the patients were major influences on
individual perceptions of nursing care. Patients whose surgery resulted in
stomas were also less satisfied with health-care delivery.
Laschinger et al; (2005) conducted a study to test a newly developed patient
centered measure of patient satisfaction with nursing care quality within a
random sample of 14 hospitals in Ontario, Canada. Results of the study
revealed that the newly developed instrument had excellent psychometric
14
properties. Total scores on satisfaction with nursing care were strongly related
to overall satisfaction with the quality of care received during hospitalization.
The results of the study yielded actionable, patient-focused results that can be
used by managers to address areas requiring improvement.
Gonzalex-Valentin et al; (2005) evaluated patient satisfaction with nursing
care in a regional university hospital in Southern Spain. The
researchers evaluated and determined the relevant sociodemographic and
attendance characteristics. A crossectional descriptive study was undertaken
using the Service Quality Scale (SERVQUAL) questionnaire. The only
interaction considered was gender and education level. Analyses of
covariance showed that the only factors significantly associated with lower
patient satisfaction were female gender, higher educational level, lower
overall satisfaction with the hospital, and not knowing the name of the nurse.
Jawahar (2007) done a study to know the satisfaction level of patients and
also get a feedback about the services provided in the outpatient departments
in Sree Chitra Tirunal Institute for Medical Sciences and Technology,
Trivandrum, Kerala, India. The patients were randomly selected and a
questionnaire was developed to evaluate patient satisfaction about the
outpatient department services, logistic arrangement in the outpatient
departments, waiting time, facilities, perception about the performance of
staff, appointment system, behavior of staff, support service and any other
suggestions of patients. Out of 200 patients surveyed, 90-95% of patients
were satisfied with the service offered in the hospital. This study also showed
15
that some of the patient waiting time was prolonged and the friendliness of the
nursing staff needs to be improved.
2.3. Studies on factors influencing patient satisfaction with
nursing care.
Bruce et al (1999) conducted a descriptive correlation study to examine the
satisfaction levels of urgent and nonurgent patients in relation to nursing care,
the emergency department (ED) environment, ancillary services, and
information received. The sample consisted of 28 subjects, with the majority
of patients being very satisfied with nursing care. The primary area of concern
was information about the length of waiting time. According to the researchers
the satisfaction levels of ED patients with the care received had become
increasingly important in today's health care environment and ED nurses play
an important role in ensuring that patients were satisfied and received quality
care.
Lui et al; (2007) examined in-patient satisfaction with nursing care in a
teaching hospital in China. Patient satisfaction with nursing care was
assessed by a self-designed questionnaire administered to 320 in-patients
selected by a convenience sampling method. The patients had a relatively
high level of satisfaction with nursing care. Patients' age, educational
background, occupation, methods of payment, and hospital wards were main
factors influencing their satisfaction with nursing care. The study provided a
new tool for measuring patient satisfaction with nursing care in China.
16
Bautista et al; (2007) conducted a study related to factors associated with
care among patients with epilepsy was to determine those variables
associated with satisfaction with care among epilepsy patients. The
investigators interviewed patients followed at a tertiary epilepsy center.
Predictor variables included age, gender, race, education, income, insurance,
seizure frequency, and Quality of Life in Epilepsy--1 0 inventory (QOLIE-1 0)
results. Target variables were the subscales of the Short Form Patient]
Satisfaction Questionnaire (PSQ-18). The investigators used Univariate
analysis to identify those variables significantly associated with subscales and
multi linear regression to determine those independently significant. The study
population comprised 193 patients. The researcher concluded lower
educational level and better quality of life are the main variables associated
with higher general satisfaction with care among patients with epilepsy.
Tashjian et al; (2007) conducted study was to determine the factors that affect
patient satisfaction after Rotater Cuff Repair (RCR). The researcher assessed
112 patients (118 shoulders) with chronic rotator cuff tears preoperatively and
at a mean of 54 months (range, 34-85 months) after RCR by using several
functional outcome questionnaires and an evaluation of patient satisfaction.
95% were satisfied with the outcome of the surgery. Satisfaction was
significantly correlated with the improvement in functional outcomes and
general health status and absolute postoperative functional outcomes.
Married, currently working, and nondisabled patients had greater satisfaction.
High preoperative and postoperative met expectations were also positively
17
correlated with patient satisfaction. Patient satisfaction is most highly
correlated with the pain, function, and general health status of the patient after
RCR. The investigator concluded that aspects of treatment that maximize the
functional outcome are important in achieving patient satisfaction after RCR.
2.4 Studies on quality nursing care.
Ruth et al;(1993) conducted a quality nursing care survey in Israel, 1988-
1990, the four nursing process components were examined. The survey
covered 13 hospitals with 119 medical and surgical wards, in which the
nursing care quality for a sample of 2065 patients was assessed. Instruments
used were (a) the Patient Classification Form, to assess patient dependency
level, and (b) Monitor--an index of the quality of nursing care for acute medical
and surgical wards. The survey process involved orientation of the hospitals'
senior staff, and training of participants in the administration of patient
classification and of Monitor. Factors chosen for possible influence on quality
of nursing care were: patient dependency category, type of ward (medical,
surgical), ward size and hospital size According to the study the highest
quality nursing care was found in "Meeting the patient's physical needs"; the
lowest in "Assessment and planning of patient care". The most influential
factor was found to be the patient dependency category.
Ritz et al;(2000) conducted a study to evaluate quality of life (QOL) and cost
outcomes of advanced practice nurses' (APNs') interventions with women
diagnosed with breast cancer in a midwestern suburban community of 210
18
women with newly diagnosed breast cancer with an age range of 30-85 years.
The control group (n = 1 04) received standard medical care. The intervention
group (n = 1 06) received standard care plus APN interventions based on
Brooten's cost-quality model and the Oncology Nursing Society's standards of
advanced practice in oncology nursing. QOL was measured using the
Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness
Scale and Profile of Mood States at seven intervals over two years.
Information about costs (charges and reimbursement) was collected through
billing systemscharges. According to the study unmarried women and women
with no family history of breast cancer benefited from nurse interventions in
mood states and wellbeing. No significant cost differences were found. The
investigators concluded that APN interventions improved some QOL
indicators but did not raise or lower costs, the first six months after breast
cancer diagnosis is a critical time during which APN interventions can improve
QOL outcomes and more research is necessary to define cost-effective
interventions.
Hogston (1995) conducted a study to examine the everyday methods by
which nurses evaluate quality care. The method was qualitative; specifically, a
grounded theory approach was used. The sample comprised 18 registered
nurses from a large hospital in the south of England. Data was collected
through tape-recorded interviews and the constant comparative method used
to analyze the data. The findings revealed that although nurses used objective
methods such as evaluating planned care as part of the nursing process, the
investigator used more subjective methods such as peer review and intuition.
19
The study seeks to explain the value of these less formal methods of
evaluation and recognizes how difficult they may be to substantiate in light of
the recent health care reforms. It is suggested that the use of a more
formalized process of peer review using reflection as its foundation would
enable nurses to satisfy managerial concerns for a measurable outcome to
quality.
Chang et al;(2002) conducted a study to determine whether nursing practice,
as judged by nurse peer reviewers, varies by type or location of hospital and
to assess which aspects of practice tend to be most at variance with nursing
theory. The article provides a framework of continued quality assessment and
improvement that is based on prior research. Trained nurse peer reviewers
carried out structured implicit review, which utilized their professional
judgment to evaluate the process of nursing care for patients admitted to
acute hospitals with heart failure or cerebrovascular accident. According to
the investigators the study show significant variations in the quality of nursing
care and support the continued development of nursing quality assessment
and improvement initiatives directed at reducing the gap between nursing
theory and practice.
2.5 List of Key words
Keywords No. of Articles
Patient satisfaction with nursing care 272
Quality Nursing care 30
Factors influencing patient satisfaction with nursing 3,034
care . .
http://www.ncbl.nlm.nlh.gov\pubmed
20
CHAPTER- 3
RESEARCH METHODOLOGY
3.1 Introduction
Research methodology is the systemic way to solve the research problem. It
includes the step that researcher adopts to study his problem with the logic
behind. It indicates the general pattern of organizing the procedure of
gathering valid and reliable data for an investigation.
This chapter provides a brief description of the method adopted by the
investigator to conduct this study. This chapter includes the research
approach research design; setting of the study and sampling technique .It
further deals with the development of the tool, procedure for the data
collection and plan for data analysis.
3.2 Research approach
The survey approach was selected as the objectives of the study were (1) to
assess the patient satisfaction with quality nursing care and (2) to identify the
relationship between level of patient satisfaction and selected variables. More
over survey approach is suitable for educational fact finding in a relatively
small sample.
T 21
3.3 Research design
To accomplish the objectives of the study a survey design is used for data
collection and analysis of the data. In order to assess the satisfaction of the
patient with quality nursing care data were collected from patients by a
modified Dr Laschinger's Patient Satisfaction with Nursing Care Quality
Questionnaire Malayalam Version, including 18 question based on various
aspects such as nursing care, interpersonal relationship, nursing
responsibilities, follow up care etc
3.4 Settings of the study
This study was conducted in neuro medical units and general medical unit of
Sree Chitra Tirunal Institute for Medical science and technology, is an
institution of national importance where there is a separate department for
neuro (medical) unit, which include neurology medical wards, comprehensive
neuro medical intensive care unit.
3.5 Study population
The target population of the study was both male and female patient admitted
in the neurology medical unit and general medical unit.
22
3.6 Sample and sampling techniques
Consecutive sampling technique was used to select the samples for the
study. Two-stage random sampling was used for the present study .In the first
stage, 10 samples were selected for the pilot study. In the second stage the
50 people were selected for this study.
In these study approximately 100 populations is included. Out of this
investigator look 50 samples for study from four weeks duration .The duration
of study period included from 20 September 2009 to 20 October 2009.
3. 7 Criteria for sample selection
The samples selected were based on the following criteria.
Inclusion criteria
• Patient who can understand and read Malayalam I English
• Patient who are willing to participate.
• Patient who have age above 15years.
• Patient who are fully awake.
23
Exclusion criteria
+ Patient on ventilator and who cannot respond are excluded from the
study.
+ Patient who are not willing are excluded from the study.
+ Patient who are not fully conscious are excluded from the study.
+ Pafient who are under 15 years of age.
3.8 Sampling Technique
The patients who are admitted in the neurology medical units and general
medical units during the data collection period and who fulfilled the inclusion
criteria were selected as samples by consecutive sampling technique.
3.9 Data Collection Tool
Data collection tool refers to the instrument which was used by the
investigator to obtain relevant data. A modified questioner was prepared by
the investigator from Dr. Lachingers. The tool was examined by experts of
Sree Chitra Tirunal Institute For Medical science And Technology content
validity. The research tool was finalized according to expert's opinion.
24
3.10 Description of the tool
The structured questionnaire consist of two sections
Section-1: General information or Demographic data.
Section-2: It consists of a total 18 questions regarding patient satisfaction with
nursing care.
3.11 Pilot study
A pilot study was conducted from 15/9/2009 to 17/9/2009. The aim of the pilot
study was to find out the practicability and feasibility of the tool the study was
conducted among 10 samples the sampling technique used was consecutive
sampling informed consent wa~ from the samples. The finalized tool
was used to assess patient satisfaction with quality nursing care. The pilot
study findings reveled that the study was feasible and practicable.
3.12 Data collection procedure
Since there was no problem faced during pilot study, the same method data
collection was used for the final study.
25
3.13 Plan of analysis
A plan for data analysis was developed by the investigator after the data
collection. The data obtained from satisfaction questionnaire would be
analysed by descriptive statistics. Percentages would be used for describing
the sample.
3.14 Summary
This chapter presented the research approach used for the study, research
design of the study, setting of the study, sample and sampling techniques,
development of description of tool, pilot study, data collection procedure and
plan for analysis.
26
CHAPTER-4
Analysis and Interpretation
4.1 Introduction
Analysis is the categorizing, ordering, manipulating and summarizing the data
to an intelligible and interpretable form so that the research problem can be
studied and tested including relationship between variables.
Interpretation refers to the process of making sense of the results and
examining the implications of the findings with in a broad context.
4.2 Distribution of samples according to demographic data. ~
4.3 Satisfaction of patient with quality nursing care.
4.2 Distribution of samples according to demographic data.
4.2a Distribution of samples according to age.
The age of patients ranged from 15 to 74 years with a mean of 41.1,
median 43 and mode- 48. The age distribution is given in table 4.2a
27
Table No. 4.2a
Distribution of samples according to age.
Age Group Frequency Percentage
<20 6 12%
21-30 9 18%
31-40 8 16%
41-50 14 28%
51-60 9 18%
61-70 3 6%
71-80 1 2%
Total 50 100%
The data given in table 4.2~ws distribution of samples according to age
group. Majority (80%) of the patients were between the age group of 21 years
to 60 years. The same data is shown as bar diagram in the figure 4.2a
28
Figure 4.2a Distribution of samples according to age
16
14
12
10
2 -
15-20 21 -30 31 -40 41 -50 51 -60 61 -70 71 -80
Age group in year
• 15 -20
• 2 1 -30
• 31 -40
• 41 -50
• 51 -60
• 61 - 70
• 71 -80
Figure 4.2.a.
Table No 4.2b
Distribution of samples according to sex
Sex Frequency Percentage
Male 35 70%
Female 15 30%
Total 50 100%
The data given in table 4.2b shows distribution of samples according to sex.
Majority (70%) of the patients were males. The same data is given as pie
diagram in Figure 4.2b.
29
Distribution of samples according to sex
Female ^ \ 30% X
\ Male >^ 70%
Figure 4.2b
Table No 4.2c
Distribution of samples according to the economic category
Category Frequency Percentage
A<400 14 28%
B1 < 700 7 14%
B< 1000 8 16%
C > 1300 3 6%
D > 2000 18 36%
Total 50 100%
The data given in the table 4.2c shows the distribution of samples according
to economic category. Majority (36%) of patients were coming under D
category. The same data shown as cylindrical diagram in Figure 4.2c.
• Male
• Female
30
Figure 4.2c Distribution of samples according to economic category
Frequency
IB1
IB
IC
ID
Category
Figure 4.2c
Table No 4.2d
Distribution of samples according to the educational status
Educational Status Frequency Percentage
Below 9 t h standard 14 28%
10th-12th 18 36%
Degree 18 36%
Total 50 100%
The data given in the table 4.2d. shows distribution of samples according to
Educational Status. Majority (72%) of patients were passed 10 t h standard.
The same data shown as cone diagram in Figure 4.2d.
31
Distribution of samples according to educational level
<9th 10th-12th degree
education
Figure 4.2d
4.3. Satisfaction of patient with quality nursing care.
Satisfaction of 50 patients with quality nursing care ranged from 22 to 36
(maxmimum score 36) with a mean of 30.36 ± 3.03, median 30 and mode 29.
This shows that mean satisfaction of patients with quality nursing care is
above average. The relationship with patient satisfaction with quality nursing
care and selected variables are shown in Table 4.3a, 4.3b, 4.3c and
32
4.3dTable 4.3a Mean, standard deviation and p value of patient
satisfaction with quality nursing care by age.
Table 4.3a
Age in years Mean(S.D) P value
< 29 29.86(2.93)
30-49 30.13(3.16) 0.66
>50 30.87(3.05)
The Table 4.3a show the satisfaction of patients with quality nursing care less
than 29 years range from 25 to 34 with a mean of 29.86 ± 2.93, with age
between 30 to 49 years range from 22 to 34 with a mean of 30.13 ± 3.16 and
age more than 50 years from a range from 25 to 36 with mean of 30.87 ±
(3.05). There is a minimal increase in mean satisfaction with nursing care with
increase in age probably due to small sample. By doing unpaired t-test there
is no statistical difference in the mean satisfaction (p = 0.37) of patients with
quality nursing care with regard to age . •
- ----~--- ----- ------~-------~-~------ -~--
33
Table 4.3b Mean, standard deviation and p value of total patient
satisfaction with quality nursing care by sex.
Table 4.3b
Sex Mean(S.D) P value
Male 29.86(2.98)
Female 31.53(2.90) 0.07
The Table 4.3b show total satisfaction of patients with quality nursing care by
sex, in male patients satisfaction range from 22 to 35 with a meapn of 29.86 ±
2.98 and in female patients satisfaction range from 27 to 36 with a mean of
31.53 ± 2.90. Females have slight more satisfaction than males. By doing
student t test there is no statistical difference in the mean satisfaction (p =
0.07) of patients with quality nursing care.
Table 4.3c Mean, standard deviation and p value of patient satisfaction
with quality nursing care by educational status.
Table 4.3c
Education Mean(S.D) P value
Below 12th 30.42(2.99)
standard
Above 12th 30.24(3.19) 0.84
standard
-~---------------·---------~~ -~ ----------·----·--·~-~- ·---- --- - -"---~-.--~--- ·---
34
The Table 4.3c shows the total satisfaction of patients with quality nursing
care by educational level, below 12th standard range from 22 to 36 with a
mean of 30.42 ± 2.99 and above 12th standard range from 25 to 36 with a
mean of 30.24 ± 3.19. By doing student t test there is no statistical difference
in the mean satisfaction (p = 0.84) of patients with quality nursing care with
regard to educational status.
Table 4.3d Mean, standard deviation and p value of patient satisfaction
with quality nursing care by economical category according to hospital
protocol.
Table 4.3d
Economic category Mean(S.D) P value
A and B1 29.95(3.02)
B, C and D 30.66(3.05) 0.42
The Table 4.3d shows the total satisfaction of patients with quality nursing
care by economic category according to the hospital protocol. A and B 1
category range from 22 to 35 with a mean of 29.95 ± 3.02 and B, C and D
category range from 25 to 36 with a mean of 30.66 ± 3.05. There is more
satisfaction seen in more paying category with nursing care probably due to
small sample. By doing student t test there is no statistical difference in the
mean satisfaction (p = 0.42) of patients with quality nursing care with regard to
economic category according to hospital protocol.
--------------- ------:------c-- - -------------
35
4.4 Summary
This chapter deals with analyses and interpretation of data collected from fifty
patients of SCTIMST, Trivandrum. Descriptive statistics were used for
analysis. Bar and pie diagram were used to illustrate the findings of the study.
36
CHAPTER- 5
SUMMARY, CONCLUSION, LIMITATION RECOMMENDATION AND DISCUSSION
5.1 Introduction
A brief account of study is given in this chapter, which covers objectives,
findings of the study and possible application of the result. Recommendation
for future research and suggestions for improving the study are also
presented.
5.2 Summary
This study was conducted to assess the satisfaction of the patient with
nursing care and selected variables. A review of related research literature
helped the investigator for get a clear concept about the research topic
undertaken as well as to develop tools, methodology of the study and for
analysis. The prepared tool was given to experts for content validity. The pilot
study findings revealed that the study was feasible and practicable. This study
was conducted in neurology medical unit of SCTIMST. Consecutive sampling
technique was used for study. A modified satisfaction questionnaire was used
for collecting data from 50 samples. Questionnaire contains18 questions
regarding quality of nursing care and patient's demographic data's were also
collected. The data collection done in the month of September2009 to
October2009 analyzed and interpreted by using descriptive statistics.
37
5.3. Objectives of the study
1. To assess the patient satisfaction with nursing care quality.
2. To identify the relationship of satisfaction with selected variables.
5.4 Limitation
Patient on ventilator and who cannot respond are excluded from the
study.
~ Patient who are not willing are excluded from the study.
~ Patient who are not fully conscious are excluded from the study.
~ Patient who are less than 15 years of age.
5.5 Major findings of the study
Total satisfaction of fifty patients with quality nursing care ranged from 22 to
36 (maximum score 36) with a mean of 30.36 ± 3.03, median 30 and mode
29. This shows that mean satisfaction of patients with quality nursing care is
above average.
The satisfaction of patients with quality nursing care with regard to age less
than 29 years range from 25 to 34 with a mean of 29.86 ± 2.93, with age
between 30 to 49 years range from 22 to 34 with a mean of 30.13 ± 3.16 and
age more than 50 years from a range from 25 to 36 with mean of 30.87 ±
39
Similar study can be reported by increasing the size of the sample.
Similar study would be repeated in out patient department of this institute.
5.7. Discussion
Patient satisfaction is a popular way of evaluating nursing practice in most
developing countries. Satisfaction studies can function to give care providers
some idea of how they would have to modify their provision of services in
order to make their patients more satisfied. Satisfied patients usually trust
their health care providers, and as a return they comply with medical and
nursing orders. There are many studies related to the different aspects of
patient satisfaction. This present study emphasized to assess satisfaction of
patients with quality of nursing care in neuromedical unit using a modified Dr
·~ Laschinger's Patient satisfaction with Nursing Quality Questionnaire. The aim
of the study is to assess the patient satisfaction with. nursing care quality and
to identify the. relationship of satisfaction with selected variables. Khan et
al;(2007) conducted a study on patient satisfaction with nursing care with
Henderson's basic nursing care model. The study revealed that 45% patients
were satisfied with care provided, while 55% were partially dissatisfied and
90% patients were not feeling comfortable to talk to nurses. Lumby (2005)
and Gonzalex-Valentin et al; (2005) conduc_ted studies on patient satisfaction
with nursing care through a validated questionnaire, the Service Quality Scale
(SERVQUAL), followed by interviews with a percentage of the study
-··---,--~-------~ --~ -------------- ------------- -----~ --·---------~--~--- ·- --
40
population. The result of the studies revealed age, sex and education levels of
the patients were major influences on individual perceptions of nursing care.
In this study the questionnaire includes specific issues that affect the
satisfaction of the patients, including comfortable feeling to talk to nurses. The
results of the above studies were comparable. In the present study 84% of
patients were satisfied with nursing care and 54%of patients were not feeling
comfortable to talk to nurses. The present study revealed age, sex and
education levels of the patients had no significant influence of patient
satisfaction. To validate the findings more sample size is needed.
5. 8 Conclusion
Based on the findings of the study, the following conclusions were drawn.
The mean total satisfaction of patients with quality nursing care in
neuromedical unit is above average.
The study shows that there was no significant difference between mean
satisfaction of patient with quality nursing care with regard to the age of the
patient, sex, education and economic category.
1 41
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APPENDIX
I
I I
au.oe.Jo :
DEMOGRAPHIC DATA
NAME ( czo.Jro)
AGE (rum>'h\1)
GENDER (m)t<m"lczwo I o.J&«>&cil::lczmo)
HOSPITAL NO. (<ffi0UO&o.Jt<m1 mCTllro)
EDUCATION (ru113.lJOIS.lJOCTUo)
ECONOMIC CATEGORY
ANY OTHER SUGGESTIONS
DATE ( <m"lm><m1)
DEPARTMENT OF ADMISSION
PROCEDURE I INVESTIGATION DATE
SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES
AND TECHNOLOGY
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QUESTIONNAIRE
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PATIENT SATISFACTION WITH NURSING CARE QUALITY QUESTIONNAIRE
" (Laschinger, McGillis Hall, Pedersen & Almost, 2005)
Please rate some things about the nursing care during your hospital stay in terms of whether they were Excellent, Very Good, Good, Fair or Poor. Please check only one rating for each statement.
Excellent Very Good Good Fair Poor
INFORMATION YOU 0 0 0 0 0 WERE GIVEN: How clear and complete the nurses' explanations were about tests, treatments, and what to expect.
INSTRUCTIONS: How well D 0 D D D nurses explained how to prepare for tests and operations.
EASE OF GETTING 0 0 0 D D INFORMATION: Willingness of nurses to answer your questions.
INFORMATION GIVEN BY 0 0 0 0 0 NURSES: How well nurses communicated with patients, families, and doctors.
INFORMING FAMILY OR D 0 D 0 D FRIENDS: How well the nurses kept them informed about your condition and needs.
INVOLVING FAMILY OR 0 0 0 0 0 FRIENDS IN YOUR CARE: How much they were allowed to help in your care.
CONCERN AND CARING D 0 D 0 D BY NURSES: Courtesy and respect you were given; friendliness and kindness.
ATTENTION OF NURSES 0 0 0 0 D TO YOUR CONDITION: How often nurses checked on you and howwell they kept track of how you were doing.
RECOGNITION OF YOUR D 0 0 0 0 OPINIONS: How much nurses ask you what you think is important and give you choices.
"~-·---~-- .. ---------------- -------~ -- - -·· ------~~~~~~----
CONSIDERATION OF D D D D D YOUR NEEDS: Willingness of the nurses to be flexible in meeting your needs.
THE DAILY ROUTINE OF D D D D D THE NURSES: How well they adjusted their schedules to your needs.
HELPFULNESS: Ability of D D D D D the nurses to make you comfortable and reassure you.
NURSING STAFF D D D D D RESPONSE TO YOUR CALLS: How quick they were to help.
SKILL AND COMPETENCE D D D D D OF NURSES: How well things were done, like giving medicine and handling IVs.
COORDINATION OF CARE: D D D D D The teamwork between nurses and other hospital staff who took care of you.
RESTFUL ATMOSPHERE D D D D D PROVIDED BY NURSES: Amount of peace and quiet.
PRIVACY: Provisions for your D D D D D privacy by nurses.
DISCHARGE D D D D D INSTRUCTIONS: how clearly and completely the nurses told you what to do and what to expect when you left the hospital.
COORDINATION OF CARE 0 0 0 0 0 AFTER DISCHARGE: Nurses' efforts to provide for your needs after you left the hospital.
Overall quality of care and 0 0 D D 0 services you received during your hospital stay
Overall quality of nursing care 0 0 0 0 0 you received during your hospital stay.
In general, would you say your 0 0 0 0 0 health is:
Based on the nursing care I Strongly Somewhat Agree Somewhat Strongly
received, I would recommend agree agree disagree disagree
this hospital to my family and friends D D D D D
GENERAL
Gender: DMale D Female Age in years: ___ years
Marital Status: Single D Married/Cohabiting D Separated/Divorced D Widowed D Including this most recent hospital stay, how many times were you (the patient) hospitalized
in the past 2 years? D Only once D Twice D 3 Times D 4 Times D Over 4 Times
Overall, how would you rate your (the patient's) health before this most recent hospital stay?
D Excellent
Were you:
D Good D Fair D Poor D Very Poor
D Admitted through the Emergency Department
D Admitted through patient registration/to the unit directly
D Admitted after day procedure or test
For most of your hospital stay, were you in a room:
D Unsure
D Transferred from another facility
D Other
D By yourself D With 1 other person D With more than 1 other person
D Please check here if someone other than the patient completed this survey.
