Patient satisfaction: a key concept for evaluating and improving nursing services

Hemodialysis patients' satisfaction with dialysis care: a cross-sectional prospective study conducted in a non-profitable care facility, Minia Egypt

BACKGROUND

The prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing continuously as a result of the dramatic growth in the prevalence of two main causes of ESKD which are diabetes mellitus (DM) and hypertension, hence, ESKD represents a global concern. Based on the sixth annual report of the Egyptian society of nephrology, the prevalence of ESKD in Egypt is estimated to be 375 per 1000,000. Meanwhile, other studies estimated the prevalence in El-Minia governorate to be around 308 per 1000,000. Hemodialysis (HD) represents the main modality of Kidney replacement therapy (KRT) for sufferers of ESKD in El-Minia governorate. Patients treated with in-center HD attend dialysis care usually three times per week for several hours each time, hence, their experiences during dialysis care will likely have a major impact on living with chronic illness. Hence, measuring patient satisfaction is very important as it is not only an outcome but also a contributor to other outcomes and objectives, it can provide valuable information about problem areas that can be modified to improve patient experience and outcomes.

METHODS

A single-center cross-sectional prospective study was conducted in the HD unit, Minia nephrology and urology university hospital. Demographic data were obtained through face-to-face interviews, Patients received a questionnaire to assess satisfaction with medical staff interactions, as well as care before, during, and after dialysis. An observational checklist of healthcare staff and equipment in the dialysis unit was also given to the patients.

RESULTS

One hundred nineteen patients participated in the study; patients were generally satisfied with the care provided in the dialysis unit (mean = 2.64), patients were most satisfied with aspects of care related to nurses, while they were neutral about aspects related to physicians, and were dissatisfied with nutritional care.

CONCLUSION

There are multiple problem areas in the HD unit affecting patients' experience, and further improvement in the care provided in the dialysis unit is required.

The Newcastle satisfaction with nursing scales in a Mexican Oncology Hospital

OBJECTIVES

The principal aim of this study was to identify whether the Newcastle Satisfaction with Nursing Scales (NSNS) could be used on cancer patients.

METHODS

This was a descriptive, cross-sectional study carried out on cancer patients (n = 298).

RESULTS

We found that a majority of cancer patients were around 50 years old (hospitalized patients [HP]: 49.5 ± 14.9; chemotherapy outpatients [COP]: 49.4 ± 12.7), were female (HP: 74%; COP: 63.5%), and had received education at least up to elementary level (HP: 70%; COP: 80%). Breast cancer was the principal type of cancer (>34%) in both groups (HP and COP). The groups were comparable in age, sex distribution, place of origin, educational qualification, and type of cancer. Among HP, the experience and satisfaction scales of the NSNS showed good internal consistency (n = 235, α >0.9, r > 0.7), while among COP, only the satisfaction scale showed good internal consistency (n = 62, α = 1.00). Most patients' perceptions (level of satisfaction) of hospitalization and chemotherapy services were positive (98% and 97%, respectively).

CONCLUSION

An NSNS instrument specifically designed for ambulatory care cancer patients is necessary for it to be useful in assessing cancer patients' perception of nursing care. This will help improve the quality of care in Mexico.The presence of cancer by itself could modify the patients' satisfaction level. Further large-scale studies are required to investigate the patients' perceptions of nursing care using the NSNS on different cancer patient groups.

Patient Satisfaction in Medicine and Dentistry

Health professionals, such as medical and dental clinicians, have scant understanding of patients' experiences and perceptions of satisfaction. Nevertheless, implementing a patient-reported outcome measures (PROMs) research practice in surgical sciences is necessary. Hence, the objective of this article was to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. A literature review was conducted using both EMBASE and Medline databases up to July 12, 2020, by combining keywords and terms related to “satisfaction theories” and “patient satisfaction,” and “medicine” or “dentistry/stomatology/odontology.” Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of treatment influence participant satisfaction at different stages of the intervention process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. Lastly, the consumerist method may misrepresent the still undertheorized concept of satisfaction in health service.

Patient satisfaction: Concept analysis in the healthcare context

OBJECTIVE

Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.

METHODS

The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.

RESULTS

The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.

CONCLUSION

As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.

PRACTICE IMPLICATIONS

To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction.

"To See With My Own Eyes": Experiences of Family Visits During Phase 1 Recovery

PURPOSE

Long separations are a characteristic of the day of surgery, keeping patients and their family members waiting and apart. At a time of high vulnerability, these separations can cause anxiety and worry. The purpose of this study was to identify the outcomes and experiences of patients and family members who engaged in a 5- to 10-minute supervised family visit during phase I postanesthesia recovery.

DESIGN

This was a descriptive, single-group, mixed-methods study.

METHODS

Quantitative data, gathered on the day of surgery, was obtained from patients (vital signs, state anxiety scores) and their designated family members (state anxiety scores); satisfaction with the visit was also measured. An optional second, qualitative phase included a semi-structured interview examining the remembered experiences of patients and family members.

FINDING

A statistically significant drop in state anxiety was discovered after the visit, and satisfaction with the visit was exceedingly high. Qualitatively, patients and family members described their overwhelming relief to be able "to see with my own eyes" how well each was doing.

CONCLUSIONS

This study supports that family visits in the postanesthesia care unit are safe and profoundly important as an independent nursing intervention. Recommendations include implementation of family visits during postanesthesia care unit recovery for all patients and family members who desire them.

A Scale for Evaluating Employee Satisfaction with Nursing Care

Occupational health nurses should evaluate employee satisfaction with and expectations of occupational health services offered. Reliable and valid measurement tools should be used to determine what employees think of offered services. Occupational health nurses should reconstruct services in accordance with the results of evaluations.

The Meaning of ‘Satisfaction’ for People with Dermatological Problems: Reassessing Approaches to Qualitative Health Psychology Research

A qualitative study was undertaken to explore descriptions of satisfaction with health care, with 30 dermatology patients. The relevance and usefulness of the approach chosen to analyse the data-interpretative phenomenological analysis (IPA) was also retrospectively evaluated. The findings suggest that ‘satisfaction’ is a complex and fluid construct, which is defined, redefined and re-evaluated by participants throughout the interview process. IPA was useful in guiding the analysis. However, in order to build upon this approach, it is suggested that more attention be paid to the sequential nature of an individual account/interview, which might lead to a more informed understanding of the meaning of patient satisfaction.

Nurses' Perspectives on Patient Satisfaction and Expectations: An International Cross-Sectional Multicenter Study With Implications for Evidence-Based Practice

BACKGROUND

Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction.

OBJECTIVES

This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge.

METHODS

A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed.

RESULTS

A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p < .001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p < .05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4).

LINKING EVIDENCE TO ACTION

These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.

Conceptualisation of patient satisfaction: a systematic narrative literature review

Aim:

Patient satisfaction concept is widely measured due to its appropriateness to health service; however, evidence suggests that it is a poorly developed concept. This article is a first part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction and to bring the concept for further operationalisation procedures. The current article aimed to review a theoretical framework that helps the next article to review determinants of patient satisfaction for designing a measurement system.

Method:

The study used a systematic review method, meta-narrative review, based on the RAMESES guideline with the phases of screening evidence, appraisal evidence, data extraction and synthesis. Patient satisfaction theoretical articles were searched on the two databases MEDLINE and CINAHL. Inclusion criteria were articles published between 1980 and 2014, and English language papers only. There were 36 articles selected for the synthesis.

Results:

Results showed that most of the patient satisfaction theories and formulations are based on marketing theories and defined as how well health service fulfils patient expectations. However, review demonstrated that a relationship between expectation and satisfaction is unclear and the concept expectation itself is not distinctly theorised as well.

Conclusions:

Researchers brought satisfaction theories from other fields to the current healthcare literature without much adaptation. Thus, there is a need to attempt to define the patient satisfaction concept from other perspectives or to learn how patients evaluate the care rather than struggling to describe it by consumerist theories.

[Perception of UCI nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients]

OBJECTIVE

Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received.

METHODS

It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants.

RESULTS

Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found.

CONCLUSIONS

Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care.

Evaluation of barriers contributing in the demonstration of an effective nurse-patient communication in educational hospitals of Jahrom, 2014

INTRODUCTION

Establishing an effective communication with patients is an essential aspect of nursing care. Nurse-patient communication has a key role in improving nursing care and increasing patient's satisfaction of health care system. The study aimed at evaluation of barriers contributing in the demonstration of an effective nurse-patient communication from their viewpoint.

METHODS

This was cross-sectional study, carried out in 2014, with a sample of 200 nurses and patients drawn from two educational hospitals in jahrom city. Data were collected by using two questionnaire structured by the researchers. Data were analyzed using SPSS software (version 16).

RESULTS

The results of this study showed that the greatest barriers of nurse-patient communication were characteristics of nursing job with an average score of 71.05 ± 10.18. The most communication barriers from patients viewpoint including: heavy work load of the nurses, age , sex and language difference between patient and nurse and the spicy morality of nurses.

CONCLUSION

It is concluded that overcome barriers to communication and support are needed to enable nurses to communicate therapeutically with patients in order to achieve care that is effective and responsive to their needs.

The relationship between cancer patients' perception of nursing care and nursing attitudes towards nursing profession

Objective:

The aim of this study is to evaluate the patients’ perceptions of nursing care with different types of cancer in Turkey and its relationship with nursing attitudes towards nursing profession.

Methods:

An exploratory approach utilizing cross-sectional design with a structured questionnaire, administered to patients nurses a face-to-face, with specific questions about demographic and health status and two standardized scales: Patient Perception of Hospital Experience with Nursing Care (PPHEN) and Attitude Scale for Nursing Profession (ASNP). This study was conducted at the Research and Application Hospital of Ataturk University in Erzurum, Turkey with a convenience sample of 100 patients who were discharged from medical and radiation oncology clinics and 30 nurses that give care to these patients.

Results:

It was found that patients’ satisfaction had low levels with nursing care and similarly the nurses’ attitudes from nursing profession were negative. There was a high correlation between the scales.

Conclusion:

The nurses’ attitudes towards nursing profession are affecting the nursing care of patients’ perception with cancer. We suggest that the researchers must be evaluating nurse's attitudes when they determine the patient perceptions of nursing care.

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol

AIM

To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of 'satisfaction' from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients.

BACKGROUND

There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context.

DESIGN

A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire.

METHODS

Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010.

DISCUSSION

Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients.

Risser patient satisfaction scale: a validation study in Greek cancer patients

Background

The current healthcare climate is characterized by a constant battle for the provision of quality care with limited resources and with patient satisfaction receiving increased attention, there is a need for reliable and valid assessment measures. This study describes the adaptation, testing and validation of the Risser Patient satisfaction Scale in an oncology care setting in Greece. The rationale for this study lies in the scarcity of such measures in the Greek language.

Methods

This is a test retest validation study in Greece. Data were collected from 298 hospitalized cancer patients. The validation methodology included the assessment of the item internal consistency, using the Cronbach alpha coefficient. The test-retest reliability was tested by the Kappa correlation coefficient.

Results

The scale demonstrated very good psychometric properties. The internal consistency of the instrument was good, Cronbach’s alpha was found to be 0.78 (p<0.001) and Kappa coefficient for reproducibility was found to be K=0.89 (95% CI: 0.83-0.91 p<0.0001).

Conclusion

The findings demonstrated strong agreement of the scale, suggesting that the Greek version offers substantial reliability. This study provides a valid and reliable tool to assess patient satisfaction in oncology settings. Means to monitor patient satisfaction, a key aspect of the policy agenda for quality care remain important for nurse leaders to develop better care in oncology settings.

[Perception of the critical patient on nursing cares: an approach to the concept of satisfaction]

INTRODUCTION

Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context.

OBJECTIVES

To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view.

MATERIAL AND METHODS

A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients.

RESULTS

Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares.

CONCLUSIONS

The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception.

A seven country comparison of nurses' perceptions of their professional practice environment

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims  To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background  There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods  A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results  Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions  Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management  The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Abuse in health care: a concept analysis

AIMS AND OBJECTIVES

To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat.

BACKGROUND

Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated.

DESIGN

Concept analysis as developed by Walker and Avant.

METHOD

The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat.

RESULTS

Abuse in health care is defined by patients' subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients' perspective, and patient satisfaction does not offer room for patients' abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon.

CONCLUSIONS

Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.

Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth

OBJECTIVE

to develop a scale to measure maternal satisfaction with birth to evaluate women's experiences in labour and the early postpartum period.

DESIGN

development and psychometric assessment of a multidimensional maternal satisfaction questionnaire.

SETTING

maternity unit of a university hospital in Istanbul.

PARTICIPANTS

500 healthy postpartum women.

METHODS

five steps were taken in development of the scale: literature review, generating item pool, content validity testing, administration of draft scale and psychometric testing. Two versions of the scale were developed: the Scale for Measuring Maternal Satisfaction-normal birth and the Scale for Measuring Maternal Satisfaction-caesarean birth. Content validity was evaluated by experts. The appropriate draft scale and the Newcastle Satisfaction with Nursing Scale were administered to postpartum women before hospital discharge.

FINDINGS

content validity index scores for the vaginal and caesarean birth scales were 0.91 and 0.89, respectively. Item-total and subscale-total scores correlated significantly for each scale. Evaluation of construct validity through factor analysis yielded 10 subscales: 'perception of health professionals', 'nursing/midwifery care in labour (in caesarean version: preparation for caesarean)', 'comforting', 'information and involvement in decision making', 'meeting baby', 'postpartum care', 'hospital room', 'hospital facilities', 'respect for privacy' and 'meeting expectations'. Both scales had good internal reliability, with Cronbach's α coefficients of 0.91. The scales established their convergent validity with significant correlations with the Newcastle Satisfaction with Nursing Scale.

CONCLUSION

the scales are valid and reliable tools for evaluating Turkish women's experiences in labour and the early postpartum period.

IMPLICATIONS FOR PRACTICE

the scales can contribute to the assessment of women's satisfaction with different aspects of care, the quality of care and developments in maternity services.

Satisfação da puérpera com os cuidados de enfermagem recebidos em um alojamento conjunto

Estudo descritivo que objetivou avaliar a satisfação das puérperas com os cuidados de enfermagem recebidos em um alojamento conjunto e verificar se a mesma difere com relação a algumas variáveis demográficas e obstétricas. Para a coleta de dados utilizou-se o Instrumento de Satisfação do Paciente e a ficha sócio-demográfica e obstétrica. Participaram 187 puérperas com idade média de 26,1 anos. Dessas, 27,8% eram primíparas, 34,8% secundíparas e 37,4% multíparas, com predomínio de parto vaginal. As puérperas relataram satisfação com os cuidados recebidos para todos os domínios do instrumento e àquelas com três ou mais gestações relataram maior nível de satisfação para o domínio educacional em relação àquelas com duas gestações. As mulheres com parto vaginal também estavam mais satisfeitas quanto aos domínios técnico-profissional e educacional em relação às mulheres com parto cesáreo. Conhecer o nível de satisfação das puérperas com os cuidados de enfermagem possibilita ao enfermeiro planejar e implementar uma assistência com qualidade.

Satisfação do paciente em uma unidade de gastroenterologia

OBJETIVOS: Avaliar a satisfação do paciente com os cuidados de enfermagem recebidos e verificar se existem diferenças em relação às variáveis do estudo. MÉTODOS: Trata-se de um estudo descritivo de abordagem quantitativa, uma amostra convencional de 63 pacientes, realizado na unidade de gastroenterologia de um hospital de ensino do interior do Estado de São Paulo. Para a coleta de dados, utilizou-se o Instrumento de Satisfação do Paciente (ISP). RESULTADOS: Os pacientes relataram alto nível de satisfação para todos os itens e domínios do ISP, resultando em consistência interna satisfatória em todos os domínios. As variáveis sexo, nível de escolaridade e tempo de permanência na unidade influenciaram positivamente a satisfação do paciente. CONCLUSÃO: Destaca-se a importância de se conhecer a satisfação do paciente com os cuidados de enfermagem, o que possibilita ao enfermeiro avaliar e planejar a assistência no sentido de atender as necessidades da clientela atendida.

Patient expectation and satisfaction with nursing care in Turkey: a literature review

BACKGROUND

Patient satisfaction is used as an important indicator of care quality and is frequently included in healthcare planning and evaluation. This study presents a review of research on patient expectation and satisfaction with nursing care in Turkey.

AIM

To review the national literature on patient expectations and satisfaction with nursing care.

METHODS

The researchers reviewed 3,089 articles of which 27 were discussed in detail. Of these 3,089 articles, 1,812 were from all issues of 14 Turkish nursing journals which have been published in the last 50 years, and 1,277 articles were from 24 nursing congress and symposium books.

RESULTS

The results of this study are divided into two categories: expectations 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 instruments to study and assess patient satisfaction in the future.

CONCLUSION

Over the last 20 years, studies of patient expectation and satisfaction with nursing care have been gaining high importance, but it is also noticed that in a national and philosophical approach the studies are not based on clearly defined concepts. Moreover, it has been concluded that there is a need for valid and reliable tools in the evaluation of satisfaction.

Information to the relatives of people with ostomies: is it satisfactory and adequate?

PURPOSE

The aim of this study was to evaluate how relatives of patients with an ostomy rated the various aspects of care, how they perceived the quality of the care provided, and how they ranked their involvement in the care. Patients' satisfaction was also sought, particularly their perception of relatives' involvement.

DESIGN

Descriptive cross-sectional.

SETTINGS AND SUBJECTS

The study comprised a colostomy group (32 pairs) and an ileostomy group (28 pairs). All patients attended a stoma outpatient clinic.

METHODS

Quality of care was assessed using the identity-oriented dimension of the validated questionnaire Qualityof Care from the Patient's Perspective. Questionnaires were mailed to patients and their relatives.

RESULTS

Relatives and patients in both study groups considered most topics covered by the questionnaire to be important. Half of the patients with an ileostomy and their relatives and approximately 30% of those in the colostomy group were dissatisfied with the information they received, however. Moreover, a greater proportion (41-89%) of the patients were unhappy with the opportunities they were offered to participate in the decision-making process. Patients with an ileostomy and their relatives tended to be more dissatisfied with the quality of care than the colostomy group, but the difference was not statistically significant.

CONCLUSION

The topics covered by the questionnaire were considered important to both patients and their relatives. Information and counseling offered by the ET nurses and the colorectal surgeons were judged to be unsatisfactory, indicating the need for frequently assessing and improving general standards of quality of care.

The Turkish version of the Newcastle Satisfaction with Nursing Care Scale used on medical and surgical patients

AIM AND OBJECTIVES

The aim of this study is to test the validity and reliability of the modified version of the Newcastle Satisfaction with Nursing Care Scale on medical and surgical patients.

BACKGROUND

Measuring patient satisfaction with nursing care is important in evaluating the extent to which patients' needs are met and for determining the appropriate nursing care. In recent years there has been increasing interest in patient satisfaction with nursing care in Turkey, but there are no validated scales available to measure this.

DESIGN

It is an evaluative study.

METHODS

The data were collected using the Newcastle Satisfaction with Nursing Care Scale and by a demographic information questionnaire. After translinguistic study, the content validity of the scale was confirmed and tested on 200 patients who were recruited at Istanbul University Hospital on the day of discharge. Internal consistency of the scale was tested by Cronbach's alpha. Demographic variables related to the satisfaction scores were analysed using the Spearmen correlation, the Mann-Whitney U- and Kruskal-Wallis tests.

RESULTS

The Turkish version of the Satisfaction with Nursing Care Scale, with a total of 19 items, was determined to be suitable for measuring patient satisfaction with nursing care. Patients were generally satisfied with the nursing care received. The items with the most positive rating were respectively: the amount of freedom they were given on the ward, the amount of privacy they were given by nurses and how quickly nurses responded to their requests. The study found that female patients, older patients and those who had health insurance were the most satisfied.

CONCLUSION

The Turkish version of the Satisfaction with Nursing Care Scale showed an adequate reliability and validity for its use on adult Turkish patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses can use the Satisfaction with Nursing Care Scale of Newcastle Satisfaction with Nursing Scales in evaluating and improving the nursing care in clinical practice.

The Patient Satisfaction Scale--an empirical investigation into the Finnish adaptation

RATIONALE AND AIMS

The aim of this paper is to empirically investigate the performance characteristics of the Finnish adaptation PSS-Fin of the Patient Satisfaction Scale (PSS) intended to measure patient satisfaction with nursing care. The PSS-Fin includes three sub-scales: technical-scientific, informational and interaction/support care-needs.

METHODS

The PSS-Fin was used in a cross-sectional survey measuring the satisfaction of Finnish surgical patients (n=454) with the nursing care they received. The feasibility, internal consistency, stability, equivalence and construct validity of the measure were investigated. Evaluation was based on statistical methods.

RESULTS

The PSS is brief and easy to use, and it produced low missing data. Cronbach's alpha coefficient ranged from 0.79 to 0.89 for the sub-scales. The items correlated strongly with the sub-scales and the sub-scales with the total PSS as well. Test-retest reliability of 0.7 showed reasonable stability over time. Three factor analytic procedures supported for the three-factor solution with a technical-scientific, informational and interaction/support factors, explaining approximately 77% of the variance. The PSS had some equivalence with another satisfaction instrument, but also exhibited the ability to discriminate between each other. In multiple regression analysis the informational care-needs sub-scale was the most significant factor explaining patient satisfaction.

CONCLUSION

The PSS-Fin demonstrated good psychometric properties and conceptual rigour and is thus reliable tool for examining patient satisfaction with nursing care.

Predictors of patients' experiences of nursing care in medical-surgical wards

The purposes of this study were to explore patients' opinions of nursing care and to identify predictors of patients' experiences of nursing care in medical-surgical wards. The sample of the study was 225 adult patients in medical-surgical wards in a major teaching hospital in Jordan. The experiences of nursing care total score in this study was relatively high. The findings showed that the majority of the participants had positive experiences regarding the time nurses spent with them as well as the respect nurses provided to patients' relatives and friends. Although the amount of information nurses provided to patients was found to be a significant predictor of patients' experiences, the provided information was perceived by the majority of the patients as inadequate. Identifying factors that enhance patients' experiences of nursing care is crucial as it assists nurses to provide better care.

How can experiences of patients and carers influence the clinical care of large bowel cancer?

A qualitative project was designed to investigate the care of large bowel cancer from patients' and carers' perspectives using semi-structured interviews; tape-recorded, transcribed and analysed; to identify recurrent themes. Forty-nine patients treated surgically for bowel cancer from three hospital trusts in West Surrey were visited at home, and eight of their carers attended a focus group from a choice of three geographical locations. Five main themes identified: experience of symptoms; general practitioner (GP) management; impact of diagnosis; perceptions of clinical care and treatment; information needs. Results showed that patients and carers were ignorant of the symptoms and signs of large bowel cancer and wanted more information. They were satisfied when the GP took symptoms seriously and referred promptly. Three groups of patients were particularly vulnerable: those requiring stomas (25), those diagnosed with polyps initially (11) and patients admitted as an emergency (7). Specialist nurses were seen as the main source of written information and support, which was most needed at the time of diagnosis and discharge. The public needs more accessible information about the symptoms and signs of bowel cancer. Referral to multiprofessional bowel cancer teams is essential to provide appropriate support and clear information from the time of diagnosis throughout the care pathway. Recommended strategies for improving clinical care are outlined.

Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach?

The purpose of this study was to assess the results, along with the feasibility, applicability and relative merits of paradigm triangulation in the field of nursing care quality by conducting, concurrently, a quantitative and a qualitative study of patient satisfaction. The sample consisted of 200 randomly selected in-patients from two large Greek metropolitan hospitals. Highest ratings were assigned to the technical aspects of care, whilst information delivery items were associated with the lowest ratings. Qualitative analysis revealed a perception of nurses as weak against organisational limitations as the core theme underlying all categories of patients' complaints with nursing care. Seven more common themes were identified. The interpersonal aspect of care was central to patients' experience. The combination of qualitative and quantitative methodology appeared to contribute to the completeness of description and understanding of the phenomenon.

Quality improvement measures based on patient data: Some psychometric issues

Existing methods for handling patients' opinions as a basis for quality improvement measures tend to be too sophisticated for practical nursing and/or weak psychometrically. An Index of Measures was developed by combining patients' perceptions of actual care conditions with the subjective importance they ascribed to these conditions. Data from Swedish somatic inpatients (n = 4002) indicated that this index gave added value compared to patients' ratings of actual care conditions only. Interpretation of the Index of Measures focused on the proportion of patients who receive the value "deficiency." This value is obtained if a given patient has a subjective importance rating on a given item which is higher than the mean subjective importance score for the whole patient group on that item, as well as a perceived reality rating on the item in question which is lower than the mean perceived reality rating for the whole group on that item. Guidelines are suggested on when improvement actions are necessary and when they are not necessary.

Using satisfaction to measure the quality of palliative care: a review of the literature

BACKGROUND

The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions.

AIMS

Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built.

METHODS

Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed.

FINDINGS

There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure.

CONCLUSIONS

Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.

Assessing the unmet information, support and care delivery needs of men with prostate cancer

This study identified the key Unmet Needs of men with localized prostate cancer. A series of Nominal Groups were used to identify needs, from which a 135-item survey was developed to assess both the Importance and Unmet Need of each item. An Importance-Weighted Unmet Need score was calculated for each item, incorporating both the Importance and the degree to which the need was unmet. Surveys (n=500) were distributed in four geographically distinct areas, with a response rate of 46%. Respondents were 90% Caucasian, 80% married, with a mean age of 66 years, and mean education of 14 years. Care delivery needs were most important and least unmet, while Support needs were least important and most unmet. However, when degree to which needs were unmet was weighted by Importance, information needs had the highest Importance-Weighted Unmet Need scores. The greatest Unmet Needs for information were in knowledge of recurrence issues and in side effects of the illness and its treatment.

Evaluation of satisfaction with midwifery care

OBJECTIVE

to determine if there were differences in women's satisfaction with maternity care given by doctors and midwives. In addition a simple, six-question, satisfaction questionnaire was to be tested.

DESIGN

a randomised controlled trial comparing two models of maternity care.

SETTING

a tertiary referral centre in Alberta, Canada.

PARTICIPANTS

one hundred and ninety four women with a low-risk pregnancy were randomly assigned to either the midwife care, experimental group (n = 101), or the doctor care, control group (n = 93).

INTERVENTIONS

a pilot midwifery programme was introduced into a maternity services delivery system that did not have established midwifery.

MEASUREMENTS

women's satisfaction was measured, at two weeks postpartum, with the Labour and Delivery Satisfaction Index (LADSI), general attitudes toward the birth experience, also at two weeks postpartum; with the Attitudes about Labour and Delivery Experience (ADLE) questionnaire. Fluctuations in satisfaction were measured with a Six Simple Questions (SSQ) questionnaire at 36 weeks gestation and 48 hours, two and six weeks postpartum.

FINDINGS

women in the midwife group reported significantly greater satisfaction and a more positive attitude toward their childbirth experience than women in the doctor group (p < 0.001). The SSQ demonstrated scores similar to the LADSI. Satisfaction in both groups was lowest at 36 weeks gestation and highest immediately postpartum.

KEY CONCLUSIONS

women experiencing low-risk pregnancies were more satisfied with care by midwives than with care provided by doctors. Satisfaction scores were high for both groups and may have been lower for women in the doctor group as a result of disappointment with caregiver assignment as all women had sought midwifery care. The SSQ measures similar dimensions to the LADSI but the agreement is not strong enough to recommend its use as a substitute at this time.

IMPLICATIONS FOR PRACTICE

the significantly higher satisfaction of the women with the care provided by the midwives together with better clinical outcomes reported elsewhere suggest that the option of midwifery care should be accessible as an option for all women in Canada. Further research is suggested to determine the usefulness of the SSQ.

Patient satisfaction with nursing care in the context of health care: a literature study

To evaluate and improve the quality of care provided, it is of vital importance to investigate the quality of care in the context of health care. Patient satisfaction is a significant indicator of the quality of care. Consequently, quality work includes investigations that map out patient satisfaction with nursing care. To improve the quality of nursing care, the nurse needs to know what factors influence patient satisfaction. The aim of this literature study was to describe the influences on patient satisfaction with regard to nursing care in the context of health care. In the description of nursing care, we have used Henderson's nursing care model. The results describe 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 the literature included in the study came from the UK, Sweden and the USA. This means that the results should be applicable to health care in the western world. An important implication for future research is to continue to elucidate the factors that influence satisfaction with nursing care, as seen from the patient's perspective.

Development of a short form of the Quality from the Patient's Perspective (QPP) questionnaire

Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments. The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP). Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study. Pearson correlations were computed between the long and short forms and differences between means were analysed with t-tests. Reliability was estimated by computing Cronbach alpha coefficients. Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients. The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as "What do you think about your care?" have been avoided; the short format should make the questionnaire more attractive for many patients to respond to. Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two-step procedure is suggested, where a follow-up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.