A study to determine patient satisfaction with nursing care

Satisfaction of intensive care unit patients linked to clinical and organisational factors: A cross-sectional multicentre study

BACKGROUND

The satisfaction of critical care patients with the nursing care they receive is a key indicator of the quality of hospital care.

OBJECTIVES

The objectives of this study were to analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and sociodemographic, clinical, and organisational variables.

DESIGN

This was a prospective, descriptive correlational study.

SETTING AND METHODS

The population consisted of all patients discharged from the intensive care units (ICUs) of 19 hospitals in Spain between December 2018 and December 2019. The level of satisfaction was measured using the validated Nursing Intensive Care Satisfaction Scale, and sociodemographic, clinical, and organisational data were collected.

RESULTS

Participants' mean age (n = 677) was 59.7 (standard deviation: 16.1), and 62.8% of them were men (n = 426). Satisfaction with the nursing care received was 5.66 (SD: 0.68) out of a possible 6. The score for overall satisfaction presented statistically significant relationships with the hours of mechanical ventilation (p = 0.034), with the participant's perception of own health status (p = 0.01), with the participant's perceived degree of own recovery (p = 0.01), with the hospital's complexity level (p = 0.002), with the type of hospital (p = 0.005), and with the type of ICU (p = 0.004). Finally, the logistic regression model shows that the Nursing Intensive Care Satisfaction Scale score was not linked to age or sex but did have a statistically significant relationship with the perceived degree of recovery (p < 0.001) and the type of ICU (p=<0.001). The variables that predicted satisfaction were age, degree of recovery, and the type of ICU.

CONCLUSION

Several studies show that patient satisfaction is related to the patient's perceived health status and perceived degree of recovery, a finding that is confirmed in our study. Our study moves beyond these outcomes to show that the hours of mechanical ventilation and the characteristics of the hospital also have a significant relationship with patients' satisfaction.

Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer

BACKGROUND

Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.

OBJECTIVE

The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.

METHODS

A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.

RESULTS

The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.

CONCLUSION

Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.

IMPLICATIONS FOR PRACTICE

Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.

National validation of the nursing Intensive-Care satisfaction scale: Research protocol

AIM

Validate the Nursing Intensive-Care Satisfaction Scale in ICUs throughout Spain. Identify the improvement strategies recommended by the patients and professionals.

DESIGN

Quantitative psychometric methodology and a cross-sectional descriptive correlational design.

METHODS

The study population will be all patients discharged from 19 participating ICUs in Spain. Consecutive sampling (n = 564). Once discharged from the ICUs, they will receive the questionnaire and then, after 48 hours it will be given to them again to analyse the temporal stability. To validate the questionnaire, the internal consistency (Cronbach's Alpha) and temporal stability (test-retest) will be analysed.

RESULTS

Improve the quality of nursing care by modifying, changing or strengthening behaviours, skills, attitudes or areas for improvement involved in the process.

An alarm device for mechanical compression device displacement at femoral artery puncture sites

OBJECTIVE

To develop an alarm device for the mechanical compression device displacement (MCD), and further evaluate its effectiveness in clinical use.

MATERIAL AND METHODS

The alarm device is mainly composed of buzzer, indicator light, magnetic sheet. This is a prospective randomized and controlled study. Four hundred patients who met the inclusion/exclusion criteria were included and randomly assigned to two groups (MCD group vs alarm + MCD group). The primary outcome measures were the sensitivity and specificity of the alarm device to detect MCD displacement, time to hemostasis (TTH), time to ambulation (TTA), time to hospital discharge (TTHD), hospital costs (HC), complication rates, and patient satisfaction.

RESULTS

The sensitivity and specificity of the alarm device in detecting MCD displacement were 94.44% and 88.46%, respectively. The study group achieved shorter TTH (p = .034), shorter TTA (p = .021), lower complication rates (p = .025), and better patients' satisfaction (p < .001) compared to the control group. However, no significant difference was observed in TTHD (p = .361) and HC (p = .583).

CONCLUSION

The alarm device is highly sensitive in detecting MCD displacement, while achieving better clinical outcomes compared with artificial monitoring.

Psychometric properties of the Nursing Intensive Care Satisfaction Scale: A multicentre cross-sectional study

BACKGROUND

Patient satisfaction with nursing care is an indicator of patient satisfaction with the hospital stay in general. The Nursing Intensive Care Satisfaction Scale is the only scale about patient satisfaction with nursing care received in an intensive care unit that incorporates the critically ill patient's perspective into its design and validation. We validated the scale nationally, incorporating intensive care units at public and private hospitals of different levels of complexity in Spain.

OBJECTIVES

The objective of this study was to validate in Spanish intensive care units the Nursing Intensive Care Satisfaction Scale, a patient-centred questionnaire that evaluates recently discharged intensive care patients' satisfaction with the nursing care they received.

DESIGN

We used a psychometric quantitative methodology and a descriptive cross-sectional design.

SETTING AND PARTICIPANTS

The study was conducted in intensive care units at level II and III public and private hospitals throughout Spain. The study population was all patients discharged from intensive care units from December 2018 to December 2019 from the 19 participating hospitals. We used consecutive sampling until reaching a sample size of 677 patients. The assessment instruments were given to patients at discharge and 48 h later to measure temporal stability.

METHODS

The validation process included the analysis of internal consistency (Cronbach's α coefficient), temporal stability (test-retest), construct validity through a confirmatory factor analysis, and criterion validity using the Pearson correlation coefficient and three criterion items that assessed similar constructs.

RESULTS

The reliability of the scale was 0.97, and the factors obtained values between 0.87 and 0.96. The intraclass correlation coefficient for the total scale was 0.83, indicating good temporal stability. Construct validity showed a good fit and a four-factor structure, in accordance with the theoretical model. Criterion validity presented a correlation that was between moderate and high (range: 0.46 to 0.57).

CONCLUSIONS

The Nursing Intensive Care Satisfaction Scale has good psychometric properties, demonstrating its ability to accurately measure patient satisfaction across a range of contexts in Spain. Continuous monitoring of satisfaction will allow nurses to identify areas for improvement that can increase the quality of care.

Evaluation of the psychometric properties of Hindi-translated Scale for Measuring Maternal Satisfaction among postnatal women in Chhattisgarh, India

Satisfaction with childbirth services is a multi-dimensional phenomenon, providing relevant insights into women's opinion on quality of services received. Research studies report a dearth of standardised scales that quantify this phenomenon; and none have been tested in India to the best of authors' knowledge. The current study was undertaken to evaluate psychometric properties of Hindi version of the Turkish Scale for Measuring Maternal Satisfaction: Normal and Caesarean Births versions in order to fill this gap. A cross-sectional survey was conducted in selected public health facilities in Chhattisgarh, India. Healthy women (n = 1004) who gave birth to a single, live neonate, vaginally or via Caesarean section participated. Psychometric assessment was carried out in four steps: 1) scales translated from Turkish to Hindi; 2) Content Validity Index scores calculated for Hindi scales; 3) data collection; 4) statistical analyses for Hindi scales (Normal and Caesarean Birth). A 10-factor model with 36 items emerged for both scales. The Hindi- translated Normal Birth and Caesarean Birth scales had good internal reliability (Cronbach's α coefficients of 0.85 and 0.80, respectively). The Hindi Scales for Measuring Maternal Satisfaction (Normal and Caesarean Birth) are valid and reliable tools for utilization in Indian health facilities. Their multi-dimensional nature presents an opportunity for the care providers and health administrators to incorporate women's opinions in intervention to improve quality of childbirth services. Having an international tool validated within India also provides a platform for comparing cross-country findings.

Level of satisfaction of critical care patients regarding the nursing care received: Correlation with sociodemographic and clinical variables

BACKGROUND

The satisfaction of critical care patients regarding the nursing care received is a key indicator of the quality of hospital care. It is, therefore, essential to identify the factors associated with the level of satisfaction of critical care patients.

OBJECTIVES

To analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and the sociodemographic and clinical variables.

METHODS

This is a prospective and descriptive correlational study. The population were all patients discharged (January 2013 to January 2015) from three intensive care units of a third-level hospital (n = 200). The data on the satisfaction level were collected using the previously validated Nursing Intensive-Care Satisfaction Scale, and the sociodemographic and clinical data were recorded by means of a questionnaire.

RESULTS

Mean participants' age in the study (n = 200) was 65.9 years (standard deviation 13.4 years), with a 66% proportion of men (n = 132). There was a very high level of satisfaction regarding the nursing care received during the patients' stay in the intensive care unit, with a rating of 5.73 (standard deviation 0.41). There is no correlation between the level of satisfaction and the sociodemographic variables collected. However, there were statistically significant differences in the average score of the overall level of satisfaction (rho = 0.182, p = 0.010) with respect to the perception of the state of health.

CONCLUSION

Critical care patients expressed very high rates of satisfaction, for both the scale as a whole and each of the factors. A high level of satisfaction is strongly influenced by the perception of the state of health.

Nursing Intensive-Care Satisfaction Scale [NICSS]: Development and validation of a patient-centred instrument

AIM

The aim of this study was to develop and validate the Nursing Intensive-Care Satisfaction Scale to measures satisfaction with nursing care from the critical care patient's perspective.

BACKGROUND

Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units.

DESIGN

Instrument development.

METHODS

The population were all discharged patients (January 2013 - January 2015) from three Intensive Care Units of a third level hospital (N = 200). All assessment instruments were given to discharged patients and 48 hours later, to analyse the temporal stability, only the questionnaire was given again. The validation process of the scale included the analysis of internal consistency, temporal stability; validity of construct through a confirmatory factor analysis; and criterion validity.

RESULTS

Reliability was 0.95. The intraclass correlation coefficient for the total scale was 0.83 indicating a good temporal stability. Construct validity showed an acceptable fit and factorial structure with four factors, in accordance with the theoretical model, being Consequences factor the best correlated with other factors. Criterion validity, presented a correlation between low and high (range: 0.42-0.68).

CONCLUSIONS

The scale has been designed and validated incorporating the perspective of critical care patients. Thanks to its reliability and validity, this questionnaire can be used both in research and in clinical practice. The scale offers a possibility to assess and develop interventions to improve patient satisfaction with nursing care.

Patients' experiences and satisfaction about care provided by male nurses in medical surgical units in Islamabad, Pakistan: A pilot study

BACKGROUND

Nursing is predominantly a female profession and caring has been considered an attribute of female nurses, which could imply a noncaring image of male nurses.

AIM

To determine patients' experiences and satisfaction from care provided by male nurses in a private hospital in Islamabad, Pakistan.

METHODS

This cross-sectional study included a purposive sample of 50 patients admitted to medical surgical units for at least 2 days and who had at least three professional interactions with a male nurse. The Newcastle Satisfaction with Nursing Scale was used for data collection. Descriptive statistics were used for data analysis.

RESULTS

The total score for experience and satisfaction was 81 and 51, respectively. A statistically significant difference existed between experience and satisfaction scores of male and female participants, indicating that males were more pleased and satisfied with their experience of receiving care from male nurses compared to the female participants.

CONCLUSION

The male nurses were concerned for their patients, they were knowledgeable about the patients' condition and care, and provided them with clear explanations of the medical and nursing procedures. However, they seem to lack interpersonal relationship with patients and did not take initiative in understanding their patients.

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.

A pilot study of a systematic method for translating patient satisfaction questionnaires

AIMS

This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems.

BACKGROUND

Patient satisfaction is an important indicator of the quality of healthcare services. In China, however, few good translations of patient satisfaction instruments sensitive to nursing services exist.

METHODS

The descriptive pilot study took place in 2009 and used content validity indexing techniques to evaluate the content, context and criterion relevance of a survey question. The expert raters were 10 nursing faculty and 10 patients who evaluated the two patient satisfaction questionnaires. The experts evaluated the relevance of each item on a scale of 1-4 and the research team compared their responses to choose the most appropriate. Only the nurse faculty experts, who were bilingual, evaluated the quality of the translation using a binary rating.

RESULTS

The 'Nurse Rater' relevance scores of the LaMonica-Oberst Patient Satisfaction Scale and the Hospital Consumer Assessment of Healthcare Providers and Systems were 0·96 and 0·95 respectively, whereas the patient's overall relevance scores were 0·89 and 0·95. A Mann-Whitney U-test demonstrated that results between the two groups were statistically significantly different (P = 0·0135).

CONCLUSIONS

Using content validity indexing simultaneously with translation processes was valuable for selecting and evaluating survey instruments in different contexts.

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.

Patients' Perceptions of Nurses' Bedside Use of PDAs

Despite emerging interest in PDA use in healthcare, few studies have explored patients' perceptions of this technology being incorporated into their care. The purpose of this study was to explore patients' perceptions of nurses' bedside use of PDAs. This descriptive, exploratory qualitative study used one-on-one, in-depth interviews to collect data from 14 patients at a medical center in Taiwan. Interview data were analyzed according to Miles and Hubermans' data reduction, data display, and conclusion verification process. The results indicate that patients perceived that PDA use could increase nurses' efficiency in data retrieval and calculation, were concerned about data accuracy and privacy, preferred that nurses explain the reasons for PDA use, suggested more functions for PDAs (eg, entertainment for pediatric patients, wireless paging for clinicians), and valued nursing care over technology use. These results can be used as a reference for clinicians implementing a point-of-care technology for patient care.

Does Patient Satisfaction Contribute to Nursing Care Quality?

The use of patient satisfaction tools is routine in healthcare facilities. What actually do the results of patient satisfaction surveys tell us about the quality of nursing care? The purpose of this article is to provide a discussion about patient satisfaction and nursing care. Recommendations are offered about how patient satisfaction may be used to improve nursing care and what changes may be needed to achieve a high level of patient satisfaction.

Nurses’ assessments and patients’ perceptions: development of the night nursing care instrument (NNCI), measuring nursing care at night

BACKGROUND

Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night.

AIMS AND OBJECTIVES

The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night.

DESIGN

The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'.

METHODS

Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha.

RESULTS

The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items.

RELEVANCE TO CLINICAL PRACTICE

These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Hospital service quality: a managerial challenge

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally.

Caring Behaviors As Perceived by Nurse Practitioners

PURPOSE

To investigate nurse pratctitioners' (NPs') perceptions of their own caring behaviors and to examine NPs' demographics as a function of their caring behaviors.

DATA SOURCES

Responses to the Caring Behaviors Inventory(CBI) and a demographic inquiry from 348 NPs in Louisiana.

CONCLUSIONS

CBI mean scores and subscale scores were high for all 348 NPs. No statistically significant difference was found between male NPs' and female NPs' total mean CBI scores or between urban or rural total mean CBI scores. The interaction between nurse gender and area o practice was not statistically significant.

IMPLICATIONS FOR PRACTICE

NPs often work in clinic situations where productivity is the most valued characteristic and where little time is afforded for identifying caring behaviors of the NP and/or establishing a caring relationship with the patient. NPs must be extremely conscious of the need not to "throw out the baby with the bathwater" and sacrifice characteristics that are inherent in nursing for those emphasized in primary care practice. As their responsibilities in the health care setting continue to expand, NPs must continually evaluate and validate their roles to ensure quality care that satisfies patients.

Nursing care at night: an evaluation using the Night Nursing Care Instrument

INTRODUCTION

Night nurses carry overall nursing responsibility for approximately half the time that patients spend in hospital. However, there is a paucity of literature that focuses on nursing care provided at night.

AIM

The aim of this study was to evaluate nursing care provided at night from the perspective of both nurses and patients.

METHODS

The study, which had an evaluative and a comparative design, was carried out using the Night Nursing Care Instrument at a hospital in southern Sweden. Nurses (n = 178) on night duty were consecutively selected, while the patients (n = 356) were selected by convenience sampling.

RESULTS

The results showed a statistically significant difference between nurses' assessments and patients' perceptions of the nursing care provided at night in nursing interventions (P < 0.0001). In the areas of medical interventions and evaluation, no statistically significant differences were found between nurses and patients. For eight of 11 items, patients reported that they were satisfied (> or =80%) with the nursing care provided at night.

CONCLUSIONS

These findings suggest that night nurses need to improve their ability to assess patients' needs for nursing care at night. A first step in this direction is for them to become aware of how patients perceive night nursing. As a second step, nurses need to increase their knowledge of which nursing actions promote patients' rest at night.

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.

Evaluating Emergency Nurse Practitioner services: a randomized controlled trial

BACKGROUND

Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial.

METHODS

A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care (n = 99) or Senior House Officer (SHO)-led care (n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a 'Documentation Audit Tool'. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.

RESULTS

Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to (P = 0.009); gave them information on accident and illness prevention (P = 0.001); and gave them enough information on their injury (P = 0.007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs (P < 0.001). ENPs' clinical documentation was of higher quality than SHOs (P < 0.001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow-up between groups. Missed injuries were the same for both groups (n = 1 in each group).

CONCLUSION

The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led than SHO-led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.

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.

Patient satisfaction measurement: current issues and implications

Healthcare consumers are demanding excellence in care and services from care providers, and payors are following in their expectations. Demonstration of quality outcomes and consumer satisfaction with services are now a priority and the primary competitive edge in healthcare. Hospitals and healthcare systems that invest in programs to determine how patients evaluate their experiences will have valuable information to make transformational changes in care delivery and services. The purpose of this article is to present an overview of consumer/patient satisfaction instruments, satisfaction measurement issues, research instruments, and commonly used vendor patient satisfaction survey programs.

Dilemmas of spiritual assessment: considerations for nursing practice

BACKGROUND

Interest in the spiritual dimension of nursing has resulted in a proliferation of published research internationally that is very prescriptive, suggesting that nurses should be providing spiritual care. However, little research has been published that provides nurses with a potential framework for the assessment and subsequent delivery of spiritual care. It would appear that there is a consensus of opinion that nurses can and should be able to undertake an assessment of their patients' spiritual needs. However, such assumptions may be unfounded, inaccurate, misguided and potentially detrimental to patient care.

AIM

This article explores the area of spiritual assessment, drawing on the international literature, highlighting potential dilemmas in conducting a spiritual assessment. A review of some of the currently available spiritual assessment tools is also undertaken.

DESIGN

A debate is presented based on the authors' experiences and opinions with regard to this aspect of care. The debate is informed by a review of the literature specifically addressing spiritual assessment. The authors use United Kingdom policy to illustrate drivers and provide a context for the debate. However the dilemmas presented and issues raised are of significance to a wider international audience.

CONCLUSION

It is argued that the area of spiritual assessment needs careful consideration, both nationally and internationally, by those professionals involved in the provision of spiritual care so that potential dilemmas can be identified and reviewed. Such consideration may prevent the construction and subsequent use of inappropriate assessment tools within practice. The article incorporates some considerations for practice.

Postacute stroke guideline compliance is associated with greater patient satisfaction

OBJECTIVE

To determine if the structure of care or the process of stroke care, as measured by compliance with stroke guidelines published by the Agency for Healthcare Research and Quality (AHRQ), is associated with patient satisfaction.

DESIGN

Prospective inception cohort study of new stroke admissions including postacute care with follow-up interviews at 6 months poststroke.

SETTING

Eleven Veterans Affairs medical centers (VAMCs).

PARTICIPANTS

A total of 288 new stroke patients admitted to VAMCs.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Compliance with AHRQ stroke guidelines and patient satisfaction with care using a stroke-specific instrument.

RESULTS

Process of care was positively and significantly associated with greater patient satisfaction even after controlling for patient functional outcome. The most visible (to the patient) process of care dimensions correlated most highly with patient satisfaction. Sixty-four percent (73/115) of patients expressed some dissatisfaction with 1 or more survey items.

CONCLUSIONS

"What we do" and "how we do it" while providing postacute care to stroke patients was associated with patient satisfaction. This linkage of process to outcome is an important validation of satisfaction as a significant patient outcome. This linkage is further evidence that compliance with AHRQ stroke guidelines may be a valid quality of care indicator.

Patient satisfaction with emergency nurse practitioners in A & E

In recent years the complex process of managing services for patients requiring emergency care has been increasingly under scrutiny and considerable diversity has arisen in the organization of emergency care in both hospital and community settings. One innovation which has been particularly widespread is the development of Emergency Nurse Practitioners (ENPs): experienced Accident and Emergency nurses who assume entire responsibility for patients with minor injuries, in emergency settings. The present paper reports on a study which compared patients' satisfaction with care given by Emergency Nurse Practitioners with that provided by doctors and nurses working together in a traditional A & E. Patients were significantly more likely to have received health education and first aid advice from an ENP than from a doctor. They were also significantly more likely to have been given written instructions to take home and told whom to contact if they needed more help and advice following discharge. Those seen by an ENP also reported that they were subsequently significantly less worried about their health, than did patients seen in a traditional A & E.

Ethical and policy considerations for centenarians--the oldest old

PURPOSE

To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system.

DESIGN

Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge.

METHODS

Case histories were constructed from interviews in 1997 to improve understanding of quality of care.

FINDINGS

Less-than-optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least-restrictive environments, appropriate restraint use, and options for community care.

CONCLUSIONS

Six policy reforms are suggested for meeting the needs of the oldest-old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.

Measuring patient satisfaction with nursing care: experience of using the Newcastle Satisfaction with Nursing Scale

Patient satisfaction with care has frequently been used as a measurement of quality, especially in attempts to demonstrate the benefits of changes in nursing practice. Unfortunately such attempts have frequently failed as patient satisfaction ratings have lacked sensitivity, consistently achieving very high scores. They have also failed to isolate the nursing component from the whole health care experience. The Newcastle Satisfaction with Nursing Scale (NSNS) has been developed after extensive research work as an attempt to establish reliable and valid measures of patients' experiences of and satisfaction with nursing care. This study evaluated the use of the NSNS in practice and found that it was readily understood by patients and easily administered by clinical staff. However, several lessons were learnt which could help its administration. The results demonstrated a very high degree of satisfaction with nursing care which left the discriminatory ability of the scale open to question, although its potential benefits in standard setting were demonstrated. Further evaluative studies are needed if the potential benefits of the NSNS are to be fully realised.