A STUDY TO ASSESS THE PATIENT SATISFACTION WITH

NURSING CARE IN NEURO MEDICAL UNITS, SCTIMST.

PROJECT REPORT

Submitted in partial fulfillment of the requirements

For the

Diploma in Neuro Nursing

Submitted by

LALUJOY

Code No: 6064

Sree Chitra Tirunal Institute for Medical Science and Technology Trivandrumo

(October 2011)

CERTIFICATE FROM CANDIDATE

This is to certify that the project report on "A study to assess patient satisfaction

wit nursing care in neuromedical units, SCTIMST" is a genuine work done by me

at the Sree Chitra Tirunal Institute for Medical Sciences and Technology,

Trivandrum under the guidance of Dr Saramrt:la P .P. It is also certified that this

work has not been presented previously to any university for award of ~egree,

diploma, fellowship or any other recognition.

Trivandrum,

October 2011

LALUJOY

Roll No: 6064

Sree Chitra Tirunal Institute for

Medical Sciences and Technology

Trivandrum.

APPROVAL SHEET

This is to certify that Mr. LALU JOY bearing Roll No. 6064 has been

admitted to the Diploma in Neuro Nursing in January 2010 and he has

undertaken the project entitled "A study to assess patient "satisfaction with

nursing care in neuromedical units, SCTIMST" which is approved for the

Diploma in N euro Nursing awarded by Sree Chitra Tirunal Institute for

Medical Sciences and Technology, Trivandrum, as it is found

satisfactory.

Examiners

(1) ____ _

(2)

Guide(s)

(1) ____ _

(2) ____ _

Place:

Date:

ACKNOWLEDGEMENT

First of all let me thank Almighty God for unending love, care and blessing

especially during the tenure of this study.

I take this opportunity to express my sincere thanks to Dr. Saramma P .P,

senior Lecturer in nursing, Sree Chitra Tirunal Institute for Medical Sciences

and Technology, Trivandrum, for the guidance, she provided for executing

this study. Her advices regarding the concept, basic guidelines and analysis

of data were very much encouraging. Her contributions and suggestions

have been of great help for which I am extremely grateful. With profound

sentiments and gratitude the investigator acknowledges the encouragement

and help received from the following persons for the completion of this

study.

I am thankful to Dr. M. D Nair, HOD, Neurology for his constant support

and encouragement.

All the staff and departmental head of neurology unit, helped for completion

of this study, I am indebted to them.

LALUJOY

ABSTRACT

Topic: - A study to assess the satisfaction of patient with nursmg care in

neuromedical units.

Background of the study: - Patients have the right to expect quality of care.

Patient satisfaction with nursing care is considered an important factor in

explaining patients' perceptions of service quality. Care assessed to be high quality .,_,

according to clinical, economic or other provider-defined criteria is far from ideal

if as a result of that care the patient is unhappy or dissatisfied. There is, then, a

sound rationale for making the organization and delivery of health care responsive

to consumer opinion. Aim: -The objectives of the study were to assess patient

satisfaction with quality nursing care and to identify the relationship of satisfaction

with selected variables. Method: - A study was conducted in Sree Chitra Tirunal

Institute for Medical Sciences and Technology,Trivandrum. Twenty five patients

were consecutively selected for this study. Total period of study was from

September 2010 to December 2010. The study population was patients who were

admitted in the neuromedical units of the hospital. A validated modified

questionnaire of Dr. Laschinger - Patient Satisfaction with Nursing Care Quality

Questionnaire was used to assess the satisfaction of the patient with quality of

nursing care in neuromedical unit. Results: - The data was analyzed by using Bpi

Info version 3.2. In general satisfaction of patients with quality of nursing care in

neuromedical units is average. The study showed that there was no significant

difference between satisfaction of patient with quality nursing care with regard to

the age, and economic category of the patients. However female patients less

satisfied than male ( p-0.007) Conclusion: - Satisfaction of patient with quality of

nursing care in neuromedical units , shows that there is significant relationship

between sex and patient satisfaction but there is no significant relationship

between age and economic category and patient satisfaction. Studies using more

sample size may be useful to validate fmdings.

CONTENTS

CHAPT TITLES PAGE NO

ERNO.

I INTRODUCTION

1.1 Introduction. 1

1.2 Back ground of the study. 4

1.3 Need and Significance of the study. 5

1.4 Statement of the problem. 7

1.5 Objectives. 7

1.6 Operational definitions. 7

$

1.7 Methodology. 7

1.8 TooL 8

1.9 Delimitations. 8

1.10 Organization report 9

II REVIEW OF LITERATURE

2.1 Introduction 10

2.2 Studies on factors influencing patient 11-23

satisfaction with nursing care.

2.3 Studies on quality nursing care. 23-27

2.4 Summary 27

III METHODOLOGY

3.1 Introduction. 28

3.2 Research approach. 28

3.3 Research design. 29

3.4 Setting of the study. 29

3.5 Study population. 30

3.6 Criteria for sample collection. 30

3.7 Sampling technique. 30

3.8 Data collection tool 31

3.9 Development of tool. 31

3.10 Pilot study. 32

3.11 Data collection. 32

3.12 Plan of analysis. 33

3.13 Summary. 33

IV ANALYSIS AND

INTERPRETATION OF DATA

4.1 Introduction. 34

4.2 Distribution of sample by demographic 34

data

4.3 Satisfaction of patients with nursmg 40

care~

4.4 Summary. 43

v SUMMARY, CONCLUSIONS, DISCUSSION

AND RECOMMENDATIONS

5.1 Introduction. 44

5.2 Summary. 44

5.3 Objectives of the study. 45

5.4 Limitation. 45

5.5 Major Findings. 46

5.5 Major Findings. 46

5.6 Recommendation. 46

5.7 Discussion. 47

5.8 Conclusion. 48

Reference

Appendix

LIST OF TABLES

Table Titles Page No.

4.1 Distribution of sample according to age. 35

4.2 Distribution of sample according to sex. 36

4.3 Distribution of sample according to . 38 econom.tc

category.

4.4 Distribution of sample according to educational 39

status.

4.5 Mean, standard deviation and p value of patient 41 satisfaction with quality nursing care by age.

5.6 Recommendation. 46

5.7 Discussion. 47

5.8 Conclusion. 48

Reference

Appendix

LIST OF TABLES

Table Titles Page No.

4.1 Distribution of sample according to age. 35

4.2 Distribution of sample according to sex. 36

4.3 Distribution of sample according to economic 38

category. .

4.4 Distribution of sample according to educational 39

status.

4.5 Mean, standard deviation and p value of patient 41 satisfaction with quality nursing care by age.

4.6 Mean, standard deviation and p value of total 41

patient satisfaction with quality nursing care by

sex.

4.7 Mean, standard deviation and p value of patient 42

satisfaction with nursmg care by economic

category.

LIST OF FIGURES

Figure Title Page no 4.1 Distribution of samples 36

according to age 4.2 Distribution of samples 37

according to sex 4.3 Distribution of samples 39

according to education 4.4 Distribution of samples 40

according to economic category

1.1. Introduction

1

CHAPTER-I

INTRODUCTION

Satisfaction is the psychological state that results from confirmation or

disconfirmation of expectations with reality (Jackson 2001). Satisfaction of

patients and caregivers is an important indicator of quality of care and may

be particularly relevant for patients whose disease is not curable (Lynn 1997,

Morrison et al; 2000). Satisfaction with care is an important influence

determining whether a person seeks medical advice complies with treatment

and maintains a continuing relationship with practitioners (Larson and

Rootman 1976). Patient satisfaction is the patient's perception of care

received compared with the care expected and patients base their

expectations on their own encounters with behaviors of nurses (Aiello et al;

2003). The patient's perception of quality nursing care also includes caring,

compassion, competence, confidence, conscience and commitment in the

delivery of care (Gunther et al; 2002). During hospitalization, patient

satisfaction represents a balance between the patient's perception and

-~---~ -----~------ -- - ----------

1 I .. I

I i I

2

expectation of their nursing care and achieving optimum patient satisfaction

with quality nursing care has been the primary focus of nurses.

Organization must consistently include the latest guidelines and standards in

their rules, procedures and instructions to meet the demands of globalization

and evolution in nursing care (Han et al; 2003). Several studies in the USA

have documented that a higher ratios of registered nurses (RN s) to patients

contributes to better patient outcomes (Dang et al; 2002; Needleman et al;

2002).

In an investigation of the relationship of patient satisfaction to nursing care,

Mahon (1996) concluded, "Quality of care as measured by patient

satisfaction is most closely tied to patient satisfaction with the quality of

nursing care because most health care is nursing care". The concept of

quality is always expressed subjectively. We must accept the fact that

someone is very satisfied with an individual product or service performed,

while at the same time someone else may be very dissatisfied. Judging

quality depends on an individual's knowledge and awareness, experiences,

expectations and recognizable standards of quality. The patient evaluates

quality primarily according to how the service providers treat him, what

3

attitude they had to him, how much they fulfilled his expectations, or

whether the service providers are through their practice enhance patients'

satisfaction with the care.

Patient satisfaction is a term that can be interpreted differently by patients

and its meaning can also differ for one patient at different times (Larson et

al; 1996; Shikiar et al; 1999). According to Uzun (2001), patients' aged~ 50

years gave high scores for nursing care compared to patients aged <50 years.

Satisfaction with nursing care was found to increase when patients become

older in their age, have better functional health status, are in private rooms,

and are hospitalized in surgical wards (Jackson et al; 2001). Older age was

the strongest predictors of satisfaction and men tended to be more satisfied

than women, (Thi et al; 2002). Patient satisfaction is affected by knowledge

of health services (Bond and Thomas, 1992). Patients have expressed high

levels of satisfaction with the amount of information that nurses provide

(Kinnersley et al., 2000). On the other hand, no correlations were found

between patients' satisfaction and age, gender, or education. (Wallin et al;

2000).

4

1.2 Background of the study.

Nursing is .an accountable profession guided by science, theory, a code of

ethics and the art of care and comfort to treat human responses to health and

illness. Florence Nightingale is considered the founder of modem nursing.

Her standards to assess the care of the soldiers has been established as one of

the first documented efforts of quality improvement work, and since then,

assurance of quality nursing care has remained a priority for nurses

throughout the world (Khan et al; 2007). Many studies have discussed the

impact of nurse staffing on health care outcomes (Lankshear et al; 2005,

Bolton et al. 2003) and suggest that positive patient outcomes depend more

on the quality of nursing than on the available technology (Navuluri, 1999).

The healthcare team's goal is to provide the patient with the best health care

and service possible. The service providers are in constant effort to better

meet the patients' needs and expectations. Satisfaction is one of the core

outcome measures for health care. It is intuitively more appealing than

measures of health care effectiveness or efficiency that are more difficult to

understand. Satisfaction with health care is a measure with a long history in

the social sciences (Di palo 1997). Nursing care has a prominent role in

patient satisfaction. Patient satisfaction is an important indicator of quality of

care, and healthcare facilities are interested in maintaining high levels of

5

satisfaction in order to stay competitive in the healthcare market. (Wagnar et

al; 2009). In the past, a nurse's role consisted of providing care and comfort

to clients and performing specific nursing functions. The role of modem

nursing has expanded to include a heightened emphasis of illness prevention,

health promotion and concern for the client's holism. Today's nurse engages

in approximately in eight interrelated roles: caregiver, advocate, critical

thinker, teacher, communicator, manager, researcher and rehabilitator.

(Harkreader and Hogan 2004).

1.3 Need and significance of the study.

Patient satisfaction is an important component of health care industry in this

competitive era. Patient satisfaction leads to drift in both new and old

patients, which hinders the sustainability of any hospital in long run. Patient

satisfaction surveys are useful in gaining and understanding of the user

needs and their perception of the service received. The emerging health care

literature suggests that patient satisfaction is a dominant concern that is

intertwined with strategic decisions in the health services. Patient

satisfaction should be as indispensable to assessments of quality as to the

design and management of health care systems. Unless quality improvement

becomes a priority, the consequences are grim.

6

Nursing care is one of the major health care services. It contributes a lot to

the patient healing process. To improve the quality nursing care, the nurses

need to know what factors influence patient satisfaction. Even though there

are competent physicians present in a given health institution, it would not

be adequate without appropriate nursing care. Nurses have 24 hour contact

with patients as well as being near to them. Thus, as they are the frontline,

the patients expect more from them and nurses should also fulfill patients'

needs with competence and a compassionate approach. If the patient is

denied appropriate care the healing process is obviously compromised.

Patient can expect and demand satisfaction from nursing care and be allowed

take an active part in decision-making regarding their care. Andaleeb (2001)

poor patient satisfaction can lead to poor adherence to treatment with

consequently poor health outcomes. So satisfaction of patient has an impact

on outcome of treatment and to maintaining good interpersonal relationship.

On this line, assessing the satisfaction of patients with nursing care is crucial

in order to identify the area of dissatisfaction and at the same time improve

the nursing services.

1.4 Statement of problem.

- ------ ------~-------------

7

A study to assess the satisfaction of patients with nursmg care m

neuromedical units.

1.5 Objectives of the study.

1. To assess the patient satisfaction with nursing care in neuromedical

units.

2. To identify the relationship of patient satisfaction with selected variables

- in neuromedical units.

1.6 Operational definitions.

Patient satisfaction - It is defined as an expression of patients judgment on

quality. of nursing care measured by a self reported questionnaire on patient

satisfaction.

Nursing care-In this study questionnaire of the nursing care means the

positive responses to 23 items, 5 point rating scale.

1. 7 Methodology.

Settings

Research approach

Sample technique

Exclusion criteria

1.8 Tool

8

Neuro medical ICU, Neuro medical and general

medical ward in SCTIMST.

Survey

Convenient sampling

Children below 15years of age, patients

who are not fully awaked.

The investigator assessed the patient satisfaction with nursing care by using

a modified firm of Dr. Laschinger's - "Patient Satisfaction with Quality

Nursing Care Questionnaire, Malayalam version". The subject experts are

validated this content.

1.9 Delimitation.

The study is limited to conscious patients only in neuro medical units of

SCTIMST .The sample size are 25.

9

1.10 Organization of the report.

This chapter deals with introduction, background of the study, need and

Significance of the study, statement of the problem, objective, operational

definitions, methodology and delimitations. Chapter 2 deals with review of

literature. Chapter 3 deals the methodology. Chapter 4 presents analysis and

interpretation of the data and chapter 5 include summary, discussion,

conclusion and recommendations. Reference and appendixes are given

towards the end.

I

Introduction

10

CHAPTER-2

REVIEW OF LITERATURE

Review of literature is the keep step in research process. If refers to a broad,

comprehensive, in depth, systematic and critical review of scholarly,

publications, unpublished scholarly, print materials and audio visual

materials (Basvanthappa 2001 ).

A crucial element of all research degrees is the review of relevant literature.

So important is this chapter that its omission represents a void or absence of

a major element in research (Afolabi .1992).

The studies are based on the following factors,

2.1 Studies on factors influencing patient satisfaction with nursing care.

2 .2 Studies on quality nursing care.

2.3 Summary

11

2.1 Studies on factors influencing patient satisfaction

with nursing care.

Khan et al;(2007) conducted a study on patient satisfaction with nursing care

in District Headquarters Hospital Dera Ismail Khan to examine the level of

satisfaction with specific dimensions of nursing care in an effort to provide

quality improvement knowledge that will lead to understand and identify the

principle drivers to patient satisfaction. The investigators done a cross­

sectional study with Henderson's basic nursing care model. Six dimensions

of care were selected for examination. Total 153 patients were identified and

invited for interview through questionnaire. Out of these 122 patients agreed

to participate. Overall, patients had a variable experience of nursing care;

45% patients were satisfied with care provided, while 55% were partially

dissatisfied. Among 6 dimensions of care, 94% liked nursing practice of

keeping privacy of patients. When asked about the behavior, 90% patients

were not feeling comfortable to talking to nurses. Only 10% felt nurses were

excellent. 84% patients had negative experiences as they observed nurses

were not attentive to their needs, particularly at night. The same percentage

also had negative perception with respect to physical care. The investigators

suggested that, patient's comments that number of concerns must be

r J 12

I addressed. The nurses need to know what factors influence patient

satisfaction, if we must improve the quality of care.

Kutney (2009) conducted a study on Nursing: a key to patient satisfaction.

This study reveals that Patient satisfaction is receiving greater attention as a

result of the rise in pay-for-performance (P4P) and the public release of data

from the Hospital Consumer Assessment of Healthcare Providers and

Systems (HCAHPS) survey. This paper examines the relationship between

nursing and patient satisfaction across 430 hospitals. The nurse work

environment was significantly related to all HCAHPS patient satisfaction

measures. Additionally, patient-to-nurse workloads were significantly

associated with patients' ratings and recommendation of the hospital to

others, and with their satisfaction with the receipt of discharge information.

Improving nurses' work environments, including nurse staffmg, may

improve the patient experience and quality of care.

Muntlin (2006) conducted a study on Patients' perceptions of quality of care

at an emergency department and identification of areas for quality

improvement. They say that patients estimated quality of care at the

emergency department as fairly good, but there were areas in need of

improvement. A high percent of inadequate quality was related to the

13

I environment in the emergency department. About 20% of patients reported

that they did not receive effective pain relief. More than 20% estimated that

nurses did not show an interest in their life situation and patients did not

receive useful information on self-care and about which physician was

responsible for their medical care.

Ozsoy et al; (1997) conducted a study of patient expectations and

satisfaction with nursing care in Turkey to review the national literature on

patient expectations and satisfaction with nursing care. The researchers

reviewed 3089 articles of which 27 were discussed in detail . Of these 3089

articles, 1812 were from all issues of 14 Turkish nursing journals, which has

been published in the last 50 years, and 1277 articles, were from 24 nursing

congress and symposium books. The results of the study are divided into two

categories: expectation concerning ' nursing care' and 'satisfaction with

nursing care. The findings showed that there existed conceptual and

philosophic deficiencies in the approaches to patient satisfaction and that

there was a need to use standardized instrument to study and assess patient

satisfaction in the future according to the researchers.

Pamela ( 1996) conducted a study on an analysis of the concept 'patient

satisfaction' as it relates to contemporary nursing care. In this study patient

I

14

satisfaction has become an established indicator of the quality of health care

yet, despite the abundance of measurement surveys reported in the literature,

there are few theoretical underpinnings for this important concept An

analysis of the concept of patient satisfaction, specifically as it relates to

contemporary nursing care, provides an excellent vantage point to more

closely examine this key measure of health care quality A review of

pertinent literature is presented, followed by examination of the uses of the

concept in professional literature as well as more general sources Denning

attributes cited throughout the literature are identified along with the

concept's antecedents and consequences Empirical referents, definitions, and

measurements are also presented The analysis concludes with re­

examination of some of the assumptions underlying patient satisfaction

literature in general, and thoughts regarding the significance of patient

satisfaction with nursing care in particular Suggestions for future inquiry are

offered

Chan et al; (200 I) conducted a study of patient satisfaction with triage

nursing care in Hongkong to examine the relationship between patient

satisfaction and triage nursing care in order to assist nurses in defining more

clearly their roles, and ultimately to improve the quality of care delivered to

15

I emergency patients. A descriptive co relational study was conducted in one

urban acute hospital in Hongkong using Consumer Emergency Care

Satisfaction Scale (CECSS) and patient and nurse demographic data were

also collected. Following a power calculation, systematic sampling was

carried out and final sample consisted of 56 urgent, semi-urgent and non­

urgent patients triaged. The response rate · was 61%. The majority of

participants were satisfied with their triage nursing care and teaching. Co

relational analysis revealed that patient satisfaction with triage nursing care

was statistically significantly correlated with age and type of nursing

intervention received. Older people were more satisfied with the teaching

offered by triage nurses and patients who had received the specific nursing

interventions gave more positive ratings on the teaching subscale of the

CECSS. There were no statistically significant relationships between patient

satisfaction with triage nursing care and nurse characteristics, including

gender, work experiences and educational level.

Johansson et al; (2002) done a literature study to describe the influences on

patient satisfaction with regard to nursing care in the context of health care.

In the literature study the researchers used Henderson's nursing care model.

The result of the study described eight domains that have an influence on

r J 16

I patient satisfaction with nursing care: the socio-demographic background of

the patients, patients expectations regarding nursing care, the physical

environment, communication and information, participation and

involvement, interpersonal relations between nurse and patient, nurses

medical-technical competence and the influence of the health care

organization on both patients and nurses. The bulk of literature included in

the study came from the UK, Sweden and USA. This means that the results

should be applicable to health care in western world.

Uzun (2001) conducted a study related to patient satisfaction with nursing

care in a university hospital in Turkey. The investigator used Service Quality

Scale (SERVQUAL) in 422 discharge patients to determine the patient

satisfaction with nursing care . According to study, the Service Quality (SQ)

gap scores for five dimensions were negative to meet expectations. The

negative scores for tangibles, reliability, responsiveness, assurance and

empathy indicated areas needing improvement. The result of study

supported the need for nurses to take steps to improve patient satisfaction

with nursing care.

17

Lumby (2005) investigated patient satisfaction with nursing care as an

outcome measure for those patients undergoing colorectal surgery. The

study's relevance for nurses is the potential feed back for reviewing nursing

practice and health care delivery. The study was conducted through a

validated questionnaire, the Service Quality Scale (SERVQUAL), followed

by interviews with a percentage of the study population. The result of the

study confirmed the importance of measuring patient satisfaction through a

triangulated method, which investigates thoroughly, providing feedback for

continuous quality improvement. The in-depth interviews provided greater

insight into the results of the questionnaire, enabling clear feed back to

nursing staff at the different sites of study. Results of questionnaire revealed

age, sex and education levels of the patients were major influences on

individual perceptions of nursing care. Patients whose surgery resulted in

stomas were also less satisfied with health-care delivery.

Laschinger et al; (2005) conducted a study to test a newly developed patient­

centered measure of patient satisfaction with nursing care quality within a

random sample of 14 hospitals in Ontario, Canada. Results of the study

revealed that the newly developed instrument had excellent psychometric

properties. Total scores on satisfaction with nursing care were strongly

18

related to overall satisfaction with the quality of care received during

hospitalization. The results of the study yielded actionable, patient-focused

results that can be used by managers to address areas requiring

improvement.

(SERVQUAL) questionnaire. The only interaction considered was gender

Gonzalex-Valentin et al; (2005) evaluated patient satisfaction with nursing

care in a regional university hospital in Southern Spain. The

researchers evaluated and determined the relevant sociodemographic and

attendance characteristics. A crossectional descriptive study was undertaken

using the Service Quality Scale and education level. Analyses of covariance

showed that the only factors significantly associated with lower patient

satisfaction were female gender, higher educational level, lower overall

satisfaction with the hospital, and not knowing the name of the nurse.

Jawahar (2007) done a study to know the satisfaction level of patients and

also get a feedback about the services provided in the outpatient departments

in Sree Chitra Tirunal Institute for Medical Sciences and Technology,

Trivandrum, Kerala, India. The patients were randomly selected and a

questionnaire was developed to evaluate patient satisfaction about the

outpatient department services, logistic arrangement in the outpatient

f .. ··· :I

19

departments, waiting time, facilities, perception about the performance of

staff, appointment system, behavior of staff, support service and any other

suggestions of patients. Out of 200 patients surveyed, 90-95% of patients

were satisfied with the service offered in the hospital. This study also

showed that some of the patient waiting time was prolonged and the

friendliness of the nursing staff needs to be improved.

Bruce et al (1999) conducted a descriptive correlation study to examine the

satisfaction levels of urgent and nonurgent patients in relation to nursing

care, the emergency department (ED) environment, ancillary services, and

information received. The sample consisted of 28 subjects, with the majority

of patients being very satisfied with nursing care. The primary area of

concern was information about the length of waiting time.

Fulton (2011) conducted a study on Patient satisfaction with hospitalists:

facility-level analyses. _This study examined hospitalists' impact on patient

satisfaction, considering a host of characteristics. Findings suggest that

facilities with hospitalists may have an advantage regarding satisfaction with

nursing and personal issues ( eg, privacy, emotional needs, response to

f 20

complaints), both of which may be related to broader communication issues.

Moreover, teaching (overall satisfaction) and large facilities (satisfaction

with admissions, nursing, and tests/treatments) might especially benefit from

the presence of hospitalists. Exploring how specific hospitalist functions

influence patient satisfaction may reap rewards.

Cho SH (2005) conducted a study on Inpatient satisfaction and dissatisfaction in

relation to socio-demographics and utilization characteristics. In this study about

a quarter of the respondents were discharged from tertiary hospitals and 21%

from clinics. The majority of patients (58%) were satisfied with inpatient care

received, whereas 11% were dissatisfied. Greater satisfaction was found in

patients aged 45-64 years and those having formal education, discharge from

tertiary hospitals, national health insurance as a payer, medical expenses not

being burdensome, good self-rated health status, and neoplasm. Living in non­

metropolitan urban areas, shorter length of stay, and musculoskeletal diseases

were associated with greater dissatisfaction. So different factors were related to

patient satisfaction and dissatisfaction with care. Those factors need to be taken

into account when evaluating and comparing satisfaction levels between health

care institutions.

21

Otani K (2009) conducted a study on Patient satisfaction: focusing on

"excellent". This study revealed that staff care is the most influential

attribute, followed by nursing care. These two attributes are distinctively

stronger drivers of overall satisfaction than the other attributes stud.ied

(i.e., physician care, admission process, room, and food). Staff care and

nursing care are under the control of healthcare managers. If

improvements are needed, they can be accomplished through training

programs such as total· quality management or continuous quality

improvement, through which staff employees and nurses learn to be

sensitive to patients' needs. Satisfying patients' needs is the first step

toward having loyal patients, so hospitals that strive to ensure their

patients are completely satisfied are more likely to prosper.

Veenstra M (2003) conducted a . study on Patient experiences with

information in a hospital. This study has illustrated the use of multilevel

methods in analyzing patient perceptions of hospital care. Ward-level

factors are at most modestly related to patients' experiences with

information. The effect of hospital, department, and ward characteristics is

likely to be mediated through the existence of microunits within hospital

wards. Quality of contact with nursing staff may be a characteristic of the

I

22

microunit rather than an organizational characteristic related to hospital

wards.

James (2003) conducted a study on Patients' satisfaction with nursing care in

Jordan. This study reveals that patients need for more information from

nurses regarding their health problems was found to be a major defect in

nursing care. Therefore, nurses have to consider the importance of this issue

on improving the quality of care ·and try to find out strategies to be more

efficient on the quality and quantity of information provided to patients. The

potential benefits of assessing patients' satisfaction with nursing care make

further studies a major priority in order to monitor care over time and

evaluate nursing innovations.

Lui et al; (2007) examined in-patient satisfaction with nursing care in a

teaching hospital in China. Patient satisfaction with nursing care was

assessed by a self-designed questionnaire administered to 320 in-patients

selected by a convenience sampling method. The patients had a relatively

high level of satisfaction with nursing care. Patients' age, educational

background, occupation, methods of payment, and hospital wards were main

23

factors influencing their satisfaction with nursing care. The study provided a

new tool for measuring patient satisfaction with nursing care in China.

Life in Epilepsy--10 inventory (QOLIE-10) results. Target variables were

the subscales of the Short Form Patient] Satisfaction Questionnaire (PSQ-

18). The investigators used Univariate ·analysis to identify those

variables significantly associated with subscales and multi linear regression

to determine those independently significant. The study population

comprised 193 patients. The researcher concluded lower educational level

and better quality of life are the main variables associated with higher

general satisfaction with care among patients with epilepsy.

2.2 Studies on quality nursing care.

Ruth et al, (1993) conducted a quality nursing care survey in Israel, during

1988-1990, the four nursing process components were examined. The survey

covered 13 hospitals with 119 medical and surgical wards, in which the

nursing care quality for a sample of 2065 patients was assessed. Instruments

used were (a) the Patient Classification Form, to assess patient dependency

level, and (b) Monitor--an index of the quality of nursing care for acute

medical and surgical wards. The survey process involved orientation of the

24

hospitals' senior staff, and training of participants in the administration of

patient classification and of Monitor. Factors chosen for possible influence

on quality of nursing care were: patient dependency category, type of ward

(medical, surgical), ward size and hospital size. According to the study the

highest quality nursing care was found in "Meeting the patient's physical

needs"; the lowest in "Assessment and planning of patient care". The most

influential factor was found to be the patient dependency category.

Ritz et al;(2000) conducted a study to evaluate quality of life (QOL) and cost

outcomes of advanced practice nurses' (APNs') interventions with women

diagnosed with breast cancer in a Midwestern suburban community of 210

women with newly diagnosed breast cancer with an age range of 30-85

years. The control group (n = 104) received standard medical care. The

intervention group (n = 1 06) received standard care plus APN interventions

based on Brooten's cost-quality model and the Oncology Nursing Society's

standards of advanced practice in oncology nursing. QOL was measured

using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in

Illness Scale and Profile of Mood States at seven intervals over two years.

Information about costs (charges and reimbursement) was collected through

billing systemscharges. According to the study unmarried women and

25

women with no family history of breast cancer benefited from nurse

interventions in mood states and wellbeing. No significant cost differences

were found. The investigators concluded that APN interventions improved

some QOL indicators but did not raise or lower costs, the first six months

after breast cancer diagnosis is a critical time during which APN

interventions can improve QOL outcomes and more research is necessary to

define cost-effective interventions.

Hogston (1995) conducted a study to examine the everyday methods by

which nurses evaluate quality care. The method was qualitative; specifically,

a grounded theory approach was used. The sample comprised 18 registered

nurses from a large hospital in the south of England. Data was collected

through tape-recorded interviews and the constant comparative method used

to analyze the data. The findings revealed that although nurses used

objective methods such as evaluating planned care as part of the nursing

process, the investigator used more subjective methods such as peer review

and intuition. The study seeks to explain the value of these less formal

methods of evaluation and recognizes how difficult they may be to

substantiate in light of the recent health care reforms. It is suggested that the

use of a more formalized process of peer review using reflection as its

26

foundation would enable nurses to satisfy managerial concerns for a

measurable outcome to quality.

Kane (2007) conducted a study on Nurse staffing and quality of patient care.

This study reveals that Increased-nursing staffing in hospitals was associated

with lower hospital-related mortality, failure to rescue, and other patient

outcomes, but the association is not necessarily causal. The effect size varied

with the nurse staffmg measure, the reduction in relative risk was greater and

more consistent across the studies, corresponding to an increased registered

nurse to patient ratio but not hours and skill mix. Estimates of the size of the

nursing effect must be tempered by provider characteristics including

hospital commitment to high quality care not considered in most of the

studies. Greater nurse staffing was associated with better outcomes in

intensive care units and in surgical patients.

Needleman (2002) conducted a study on Nurse-staffing levels and the

quality of care in hospitals. This study reveals that a higher proportion of

hours of nursing care provided by registered nurses and a greater number of

hours of care by registered nurses per day are associated with better care for

hospitalized patients.

27

Chang et al;(2002) conducted a study to determine whether nursing practice,

as judged by nurse peer reviewers, varies by type or location of hospital and

to assess which aspects of practice tend to be most at variance with nursing

theory. The article provides a framework of continued quality assessment

and improvement that is based on prior research. Trained nurse peer

reviewers carried out structured implicit review, which utilized their

professional judgment to evaluate the process of nursing care for patients

admitted to acute hospitals with heart failure or cerebrovascular accident.

According to the investigators the study show significant variations in the

quality of nursing care and support the continued development of nursing

quality assessment and improvement initiatives directed at reducing the gap

between nursing theory and practice.

2.3 Summary

Review of literature enabled the investigator to have a deep knowledge

and insight in to the problem. This chapter - covered, review of literature

related to factors influencing patient satisfaction with nursing care and

quality nursing care.

3.1 Introduction

28

CHAPTER-3

METHODOLOGY

Research methodology is the systemic way to solve the research problem. It

includes the step that researcher adopts to study his problem with the logic

behind. It indicates the general pattern of organizing the procedure of

gathering valid and reliable data for an investigation.

This chapter provides a brief description of the method adopted by the

investigator to conduct this study. This chapter includes the research

approach, research design, setting of the study and sampling technique. It

further deals with the development of the tool, procedure for the data

collection and plan for data analysis.

3.2 Research approach

The survey approach was selected as the objectives of the study were (1) to

assess the patient satisfaction with quality nursing care and (2) to identify

the relationship between level of patient satisfaction and selected

29

variables. More over survey approach is suitable for educational fact finding

in a relatively small sample.

3.3 Research design

To accomplish the objectives of the study a survey design is used for data

collection and analysis of the data. In order to assess the various aspects

such as nursing care, interpersonal relationship, satisfaction of the patient

with quality nursing care data were collected from patients by a modified Dr

Laschinger's Patient Satisfaction with Nursing Care Quality Questionnaire

Malayalam Version, including 23 question based on nursing responsibilities,

follow up care etc

3.4 Settings of the study

This study was conducted in neuro medical units of Sree Chitra Tirunal

Institute for Medical science and technology, is an institution of national

importance where there is a separate department for neurology, which

includes neurology medical wards, neuro medical intensive care unit and

comprehensive epilepsy ward.

30

3.5 Study population

The target population of the study was both male and female patient

admitted in the neurology medical units.

3.6 Criteria for sample selection

The samples selected were based on the following criteria.

Inclusion criteria

+ Patient who can understand and read Malayalam I English

+ Patient who are willing to participate.

+ Patient who have age above 15years.

+ Patient who are fully awake.

Exclusion criteria

+ Patient on ventilator and who cannot respond are excluded from the

study.

3. 7 Sampling Technique

31

The patients who are admitted in the neurology medical units and general

medical units during the data collection period and who fulfilled the

inclusion criteria was selected as samples by purposive sampling technique.

Out of this investigator look 25 samples for study from four weeks duration.

The duration of study period included from September 2010 to December.

3.8 Data Collection Tool

Data collection tool refers to the instrument, which was used by the

investigator to obtain relevant data. A modified questionnaire was prepared

by the investigator from Dr. Laschingers. The tool was examined by experts

of Sree Chitra Tirunal Institute For Medical science And Technology for

content validity. The research tool was finalized according to expert's

optmon.

3.9 Development of the tool

The structured questionnaire consist of two sections

Section-1: General information or Demographic data.

32

Section-2: It consists of a total 23 questions regarding patient satisfaction

with nursing care in the form of five point one rating scale. The total

obtainable patient satisfaction score ranged from 0 to 92.

3.10 Pilot study

A pilot study was conducted from 15/10/2010 to 17/12/2010. The aim of the

pilot· study was to find out the practicability and feasibility of the tool the

study was conducted among 10 samples the sampling technique used was

convenient sampling informed consent was taking from the samples. The

finalized tool was used to assess patient satisfaction with quality nursing

care. The pilot study findings reveled that the study was feasible and

practicable.

3.11 Data collection procedure

Since there was no problem faced during pilot study, the same method data

collection was used for the final study.

3.12 Plan of analysis

33

The investigator developed a plan for data analysis after the data collection.

The data obtained from satisfaction questionnaire would be analyzed by

descriptive statistics. Percentages would be used for describing the sample.

3.13 Summary

This chapter presented the research approach used for the study, research

design of the study, setting of the study, sample and sampling techniques,

development of description of tool, pilot study, data collection procedure and plan

for analysis.

34

CHAPTER-4

ANALYSIS AND INTERPRETATION

4.1 Introduction

Analysis is the categorizing, ordering, manipulating and summarizing the

data to an intelligible and interpretable form so that the research problem can

be studied and tested including relationship between variables.

Interpretation refers to the process of making sense of the results and

examining the implications of the findings with in a broad context.

4.2 Distribution of samples according to demographic data.

4.3 Satisfaction of patient with nursing care.

4.2 Distribution of samples according to age.

35

The age of patients ranged from 15 to 73 years with a mean of 41.1, median

43 and mode 48. The age distribution is given in table 4.1

Table No. 4.1 Distribution of samples according to age.

Age Group Frequency Percentage

15-49 10 25%

>SO 15 75%

TOTAL 25 100%

The data given in table 4.1 shows distribution of samples according to age

group. Majority (75%) of the patients belonged to age group of>SO years.

The same data is shown as bar diagram in the figure 4.1

36 /»/.s I KIM lb)S OF SAMPLES AO 'OHDI.SG I" A'.i:

Figure 4.1 Bar diagram showing distribution of sample according to age category

Table No 4.2

Distribution of samples according to sex Sex Frequency Percentage

MALE 1 4 5 6 %

FEMALE 1 1 4 4 %

37

Table 4.2 shows that more patients were male (male 56%). Same data shown as in pie diagram in the figure.

• Malf • I-'ti/iittlf

44

Figure 4.2

Pie diagram showing distribution of sample according to sex

Table 4.3 Distribution of samples according to the economic category

38

Category Frequency Percentage A < 4 0 0 7 2 8 %

B , B 1 - 7 0 0 - 1 3 0 0 ,

4 0 0 - 7 0 0

1 2 4 8 %

C , D - 1 3 0 0 - 2 0 0 0 ,

> 2 0 0 0

6 2 4 %

TOTAL 2 5 1 0 0 %

The data given in the table 4 .3 shows the distribution of samples according to economic category. Majority ( 4 8 % ) of patients were coming under B & B 1 category. The same data shown as cylindrical diagram in Figure 4 . 3 .

39

Figure 4.3

Bar diagram showing distribution of samples according to economic

category.

Table 4.4.Distribution of samples according to the educational status

Educational Status Frequency Percentage

Below 9th standard 10 40%

10th-12th 8 32%

Degree 7 28%

Total 25 100%

The data given in the table 4.4 shows distribution of samples according to

educational status. Majority ( 40%) of patients were not passed 9TH

standard. The same data shown as bar diagram in figure 4.4;

40 IHMHIPt IV>\ SAMPLES A< < OKIM.XG I" FIX < All"\

Figure 4.4 Bar diagram showing distribution of sample according to educational level.

4.3. Satisfaction of patient with nursing care. The total satisfaction ranged from 55 to 75 the mean satisfaction of the 25 sample was 62.32.

Mean, standard deviation and p value of patient satisfaction with nursing care by age.

AGE IN YEARS

15-49

>50

41

Table 4.5

MEAN(S.D)

62.5 (5.15)

61.86 (2.19)

PVALUE

0.75

The data shows the p value of patient satisfaction according to age group is

0.75, there is no statistically significant relationship between the age and

patient satisfaction.

Mean, standard deviation and p value of patient satisfaction nursing care

by sex.

TABLE4.6

SEX MEAN(S.D) PVALUE

MALE 64.34 (4.34)

FEMALE 59.72 (3.27) 0.0072

42

The data shows that the mean satisfaction of the female (59.72) is lesser than

the mean satisfaction of the male (64.34). p value of patient satisfaction

according to sex is 0.0072.

Mean, standard deviation and p value of patient satisfaction with quality

nursing care by economical category according to hospital protocol.

Table 4.7

Economic category Mean (S.D) P value

AANDBl 62.27 (5.74)

B,CANDD 62.47 (1.51) 0.94

The data shows the p value of patient satisfaction according to economic

category is 0.94; there is no statistically significant relationship between the

economic category and patient satisfaction.

43

4.4 Summary

This chapter deals with analyses and interpretation of data collected from

twenty-five patients of SCTIMST, Trivandrum. Descriptive statistics were

used for analysis. Bar and pie diagram were used to illustrate the findings of

the study. As a conclusion in this study most of the samples taken in this

study are male >50 years of age, having education level of 9 th standard

and category belongs to B and Bl category. This study shows significant

relationship between sex and patient satisfaction.

44

CHAPTER-5

SUMMARY, CONCLUSION, LIMITATION RECOMMENDATION AND DISCUSSION

5.1 Introduction

A brief account of study is given in this chapter, which covers objectives,

findings of the study and possible application of the result. Recommendation

for future research and suggestions for improving the study are also

presented.

5.2 Summary

This study was conducted to assess the satisfaction of the patient with

nursing care and selected variables. A review of related research literature

helped the investigator for get a clear concept about the research topic

undertaken as well as to develop tools, methodology of the study and for

analysis. The prepared tool was given to experts for content validity. The

pilot study fmdings revealed that the study was feasible and practicable. This

45

I study was conducted in neurology medical unit of SCTIMST. Convenient

sampling teclmique was used for study. A modified satisfaction I

questionnaire was used for collecting data from 25 samples. Questionnaire

contains23 questions regarding quality of nursing care and patient's

demographic data's were also collected. The data collection done in the

month of September 2010 to December 2010 analyzed and interpreted by

using descriptive statistics.

5.3. Objectives of the study

1. To assess the patient satisfaction with nursing care.

2. To identify the relationship of satisfaction with selected variables.

5.4 Limitation

Patient on ventilator and who cannot respond are excluded from the

study.

> Patient who are not willing are excluded from the study.

> Patient who are not fully conscious are excluded from the study.

> Patient who are less than 15 years of age.

46

5.5 Major findings of the study

The study revealed the percentage of males was greater than females. And

the major age group was above the age of 50, the educational status was less

than 9 years of schooling and the economic category of B and B I. The study

shows that patient satisfaction with nursing care is average and there is

significant relationship between sex and patient satisfaction but there is no

significant relationship between age and economic category and patient

satisfaction.

5. 6 Recommendations for future study

Keeping in mind the findings and limitations of the study, the following

·'

recommendation were made for future research.

Similar study can be reported by increasing the size of the sample.

Similar study would be repeated in out patient department of this institute.

5. 7. Discussion

I 47

Patient satisfaction is a popular way of evaluating nursing practice in most

developing countries. Satisfaction studies can function to give care providers

some idea of how they would have to modify their provision of services in

order to make their patients more satisfied. Satisfied patients usually trust

their health care providers, and as a return they comply with medical and

nursing orders. There are many studies related to the different aspects of

patient satisfaction. This present study emphasized to assess satisfaction of

patients with quality of nursing care in neuromedical unit using a modified

Dr Laschinger' s Patient satisfaction with Nursing Quality Questionnaire.

The aim of the study is to assess the patient satisfaction with nursing care

quality and to identify the relationship of satisfaction with selected variables.

Khan et al;(2007) conducted a study on patient satisfaction with nursing care

with Henderson's basic nursing care model. The study revealed that 45%

patients were satisfied with care provided, while 55% were partially

dissatisfied and 90% patients were not feeling comfortable to talk to nurses.

Lumby (2005) and Gonzalex-Valentin et al; (2005) conducted studies on

patient satisfaction with nursing care through a validated questionnaire, the

Service Quality Scale (SERVQUAL), followed by interviews with a

percentage of the study population. The result of the studies revealed age,

···--·-----------~--------~-

48

sex and education levels of the patients were maJor influences on

individual perceptions of nursing care.

This study shows there is significant relationship between sex and patient

satisfaction but there is no significant relationship between age and

economic category and patient satisfaction.

5. 8 Conclusion

Based on the fmdings of the study, the following conclusions were drawn.

With the limited number of sample, the study findings lack generalization.

Therefore studies using more number of samples might may be useful to

validate the findings.

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APPENDIX

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an'ltru<m6>Wc86>l o1~l 12ll~ m!9cru16>oR o11Ul>s'lce,m6mo. (a) n(Bgrulo m1ce,rulg m'lan1w1am D (b) OJ@6>«> m~ m'lan1<Dflam D (c) m~m'lan1<Dflam D (d) anmac86>s1~o<mm m'lan1<Dflam D (e) amoUl>mow m'lan1<Dflm8 D

2. n.Ja>1aUl>owmce,u6c86>l aru6TE1Wl o 630~aon!l:fml aru6TE1W! o an~oooc86>! cman1ml~

m!9cru16>oR o11Ul>l3,cfb<t>6mo.

(a) n(Bgrulo m1ce,ru!g m'lan1<Dflam D (b) OJ@6>«> m~ m'lan1<Dflam D (c) m~m'lan1<Dflam D (d) anmac86>s1~o<mm m'lan1<Dflm8 D (e) amoUl>mow m'lan1<Dflam D

l 1

I a. m16m'3@!6>S cruo(fl)<D>6m'3u8cB6) @arn»<Oo mm8cfblm>an1ml~ ml9cru16>oR mc:mocgoruo.

(a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ · co,an1<D>1m8 D (c) m~co,an1<D>1m8 D (d) ancoc:t86>s1~oarnn co,an1<D>1m8 D (e) c:mo(fl)l2lO<D> co,an1<D>1m8 D

4. m16m'3C:@OS!O cfb!Slo611JOo(J')6m'3C:@OS!I2ll~ m\Pm>16>oR 6>n.J<O!I2lOgo (a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ co,an1<D>1m8 D (c) m~co,an1<D>1m8 D (d) ancoc:t86>s1~oarnn co,an1<D>1m8 D (e) C:l2lO(fl)l2lO<D> co,an1<D>1m8 D

s. m16m3@l6>S c:coowo.flru<06m'3@l o ~OJ(fl) ..\6m3@! o 611JCTLOl f86>6>@ «JT()01<D>'lce6>l cman1 e.Jl~ ml9cru16>oR @arn»<OOJOC31<mJo. (a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ · co,an1<D>1m8 D (c) m~co,an1<D>1m8 D (d) ancoc:ce6>s1~oarnn co,an1<D>1am D (e) c:mo(fl)l2lO<D> co,an1coflm8 D

6. m16m36>@ n.J<01.o.J<01ce6>!m><m1m8 cfb!Slo611JOo6m36>@ niDl<lnl2lOt<mo «JT()ffilOJC31.~l·

(a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ co,an1<D>1m8 D (c) m~co,an1<D>1m8 D (d) ancoc:ce6>s1~oarnn co,an1<D>1m8 D .(e) c:mo(fl)l2lO<D> co,an1<D>1m8 D

7. m\Pcru1m m16m3C:@OS!~ C3<D><D>!O CN'Dn!'>~C30J!O 611Jn!'>ll2l0ffi0J!O niD6m36>ffi<D>l~

ano<D>'l«>lm>l. (a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ co,an1<D>1am D (c) m~co,an1<D>1m8 D (d) ancoc:t86>s1~oarnn co,an1<D>1m8 D (e) c:mo(fl)l2lO<D> co,an1<D>1m8 D

8. m16m3@!6>S ~C:<OOW.,\ffi1e.J n.J<01C:(fl)OW1ce6>!CTT><m1m m\Pcru niDl<lnl2lOt<mo <mOeJn.J<O.,\o cfb06T01~l·

(a) nmgrulo m1cfbrulg co,an1<D>1am D (b) OJ@Ei><O m~ co,an1<D>1m8 D (c) m~co,an1coflm8 D (d) ancoc:ce6>s1~oarnn co,an1<D>1m8 D (e) c:mo(fl)mo<D> co,an1<D>1am 0

I mamosoruo (a) ~grulo m1dbrulg co"'an1<n>1am (b) OJ@6>CO m~ co"'an1<n>1am (c) m~co"'an1<n>1am

(d) ancoacB6>s1~oanm co"'an1<n>1am (e) amoUt>moeo> co"'an1<n>1am

10. m16tm@l6>S ~OJUt>.,\6tmu6 m1oarug1anmcman1e.Jl~ m~cru16>~ db!91ru

0 0 0 0 0

(a) ~grulo m1dbrulg co"'an1<n>1am 0 (b) OJ@6>CO m~ co"'an1<n>1am 0 (c) m~co"'an1<n>1am 0 (d) ancoacB6>s1~oanm co"'an1<DJlam 0 (e) amoUt>moeo> co"'an1<n>1am 0

11. m16tm@l6>S ~OJUt>.,\6tmu6 ~a» «m)OJcruco<mm1e.Jlo cruow1~ ancolcman1ml~

m~cru16>~ db!91ru. (a) ~grulo m1dbrulg co"'an1<DJlam D (b) OJ@6>CO m~ co"'an1<n>1am 0 (c) m~co"'an1<DJlam D (d) ancoacB6>s1~oanm co"'an1<DJlam 0 (e) amoUt>moeo> co"'an1<DJlam 0

12. m16tm6>@ CTUnOO<DJlcB6>!CTT><l»1e.J!o 6>6>WC0.,\6>'MS!CTT><m1e.J!o m~m)' db06m1~ nl.,\lW<l» (a) ~grulo m1dbrulg co"'an1<DJlam 0 (b) OJ@6>CO m~ co"'an1<n>1am 0 (c) m~co"'an1<n>1am 0 (d) ancoacB6>s1~oanm co"'an1<DJlam 0 (e) amoUt>moeo> co"'an1<n>1am 0

13. m16tmu6 ~6>an&1e.Jlo ~OJUt>.,\<mm1ml oll@1cB6>lacruou6 m~cru16>~ ~s6>m

<m6>CTT>CO>l~ ln.J<m1dbC06mo. (a) ~grulo m1dbrulg co"'an1<n>1am 0 (b) OJ@6>CO m~ co"'an1<n>1am 0 (c) m~co"'an1<n>1am D (d) ancoacB6>s1~oanm co"'an1<DJlam 0 (e) amoUt>moeo> co"'an1<n>1am 0

14. mcolcml db§l1~cB6>lcman1e.Jlo ~6mi~CT8 ancolcman1e.Jlf2ll~ m~cru16>~ db!91ru (a) ~grulo m1dbrulg co"'an1<DJlam 0 (b) OJ@6>CO m~ co"'an1<n>1am 0 (c) m~co"'an1<n>1am D (d) ancoac:86>s1~oanm co"'an1<n>1am D (e) amoUt>moeo> co"'an1<n>1am D

15. m16GT36>~ nJ<t>1.a.Jm1c96>!m>cm1am m!Pcru!o ~OOlnJtcm1<D>16>eJ mg c;u?OnDldb~lo

cmam1eJ!~ 6>n(J)dbc:\ o oman <t>,cm1<DfleJl~®O<Dflml <TT>l. (a) nmgrulo m1dbrulg m,cm1<D>1am D (b) ru~6>m m~ m,®1<D>1am D (c) m~m,®1<D>1am D (d) ®mac96>s1~omrn> m,cm1<D>1am D (e) amooomo<D> m,cm1<D>1am D

16. ooornnrulo crumowomnJ<t>ClJlfZlO<D> 63ml «m~rnnm,~o cru~~s1c96>lm>cm1ml~

m!Pcru16>~ db!91ru (a) omgrulo m1dbrulg m,®1<D>1am D (b) ru~6>a> m~ m,cm1<D>1am D (c) m~m,®1<D>1am D (d) cmmcc96>s1~omrn> m,®1<D>1am 0 (e) amooomo<D> m,cm1<D>1am D

11. cmollb~l6>S m>JdbOmc:\cm cruomdM:flc96>lm>cm1ml~ m!Pcru16>~ db!91ru (a) omgrulo m1dbrulg m,cm1<D>1am D (b) ru~6>m m~ m,cm1<D>1am D (c) m~m,cm1CD>'lam D (d) cmmac96>s1~omrn> m,cm1<D>1am D (e) amooomo<D> m,cm1<D>1am D

18. ~31am 6>.a.Jm>cm1ml aoon!l:fo 6>.a.J<J<!Y6m nJ<t>1.a.Jm6TT> m,cm1db6>~c96>l o1-9dl~

@6mO<J<D>c96>0ClJ!<TT> 6Tl.J!cw'lf1l!§ldb6>~db!01~l~ m!Pcru16>~ ~nJaaooo. (a) omgrulo m1dbrulg m,cm1<D>1am. D . (b) ru~6>m m~ m,cm1<D>1am D (c) m~m,cm1<D>1am D (d) cmmac96>s1~omrn> m,cm1<D>1am D (e) amooomo<D> m,cm1<D>1am D

19. ruc:\cB<mfZlO<D>lo nJl06pJf1lO<D>!o ~~ cw1cru.a.Jo0ea ~nJaaooo cmrmcm1eJ!~ m!Pcru16>~ db\Piru (a) (b) (c) (d) (e)

nmgrulo m1dbrulg m,cm1<D>1am ru~6>m m~ m,cm1<D>1am m~m,cm1<D>1am

cmmac96>s1~omrn> m,cm1<D>1am amooomo<D> m,cm1<D>1am

D D D D D

20. ~Ul>lnJl«»1<D>1am m1cmlo a»o&CJ6cS6) e.J@1~ Ul>llUl>ln!:ICD>lo acrurumrulo 6>moarnnarnn1am n(BciD ro,«»1<D>1e.Jl~«»o<D>1rol cml. (a) n(Jlgrulo m1c:Ebrulg ro,a»1<D>1am 0 (b) ru~6>ro m~ ro,«»1<D>1am D (c) m~ro,«»1<D>1am 0 (d) a»roacS6>s1~oarnn ro,«»1<m'lam 0 (e) amoUl>mocm ro,«»1<m'lam 0

21. m!Pcrulmoro1am m1cmlo a»o&CJ6cS6) e.J@'l~ acrurumo 6>moarnnarnn1am n(BciD ro,a»1<m'le.Jl~«»o<m'lrol cml. (a) n(Bgrulo m1c:Ebrulg «>,«»1<D>1am 0 (b) ru@6>«> m~ ro,«»1<D>1am 0 (c) m~ro,«»1<m'lam 0 (d) a»roacS6>s1~oarnn ro,a»1<D>1am D (e) amoUl>mocm ro,a»1<m'lam D

22. m16m@l6>5 ~aa>OU>.,\6><trnl>cS6>l01~l m16mu6!86>l~ «31?)@1lnJOCD>o (a) n(Jlgrulo m1c:Ebrulg ro,a»1<m'lam 0 (b) ru~6>ro m~ ro,«»1<m'lam 0 (c) m~ro,«»1<D>1am D (d) a»roacS6>s1~oarnn ro,«»1<m'lam 0 (e) amoUl>moa» ro,«»1<D>1am 0

23. m16m3CJ6cS6) ~'D ~Ul>lnJl«»1<D>1am e.J@1~ m!Pcru1ow nJa>1.a.Ja>6mo ru~l amocS6>1cmoam m16mu6, m16m@l6>s crul nn ~ arnnl cS6>CI6cS6>l o 6Tl.J(YU) l cS6>CI6cS6>l o ~'D ~Ul>l nJl«»1<m'lam n(j)l<l»1210l«»o Ul> l nJ00Ul> 6>.a.JgJ l o. (a) n(Jlgrulo m1c:Ebrulg ro,a»1<D>1am 0 (b) OJ@6>«> m~ ro,«»1<D>1am · 0 (c) m~ro,«»1<m'lam 0 (d) <mroac66>s1~oarnn ro,a»1<D>1am 0 (e) c:moUl>mocm ro,«»1<D>1am 0

PATIENT SATISFACTION WITH NURSING CARE QUESTIONNAIRE

(Laschinger, McGillis Hall, Pedersen & Almost, 2005)

Please rate some things about the nursing care during your hospital stay in terms of whether they were Excellent, Very Good, Good, Fair or Poor. Please check only one rating for each statement.

Excellent Very Good Fair Poor Good

l.INFORMATION YOU 0 0 0 0 0 WERE GIVEN: How clear and complete the nurses' explanations were about tests, treatments, and what to expect.

2. INSTRUCTIONS: How 0 0 0 0 0 well nurses explained how to prepare for tests and operations. 3. EASE OF GETTING 0 0 0 0 0 INFORMATION: Willingness of nurses to answer your questions.

4. INFORMATION 0 0 0 0 0 GIVEN BY NURSES: How well nurses communicated with patients, families, and doctors. 5. INFORMING FAMILY 0 0 0 0 0 OR FRIENDS: How well the nurses kept them informed about your condition and needs.

6. INVOLVING FAMILY 0 0 0 0 0 OR FRIENDS IN YOUR CARE: How much they were allowed to help in

f l I I your care. J

7. CONCERN AND 0 0 0 0 0 CARING BY NURSES: Courtesy and respect you were given; friendliness and kindness.

8. 15. ATIENTION OF 0 0 0 0 0 NURSES TO YOUR CONDITION: How often nurses checked on you and how well they kept track of how you were doing.

9. RECOGNITION OF 0 0 0 0 0 YOUR OPINIONS: How much nurses ask you what you think is important and give you choices. ·

10. CONSIDERATION OF 0 0 0 0 0 YOUR NEEDS: Willingness of the nurses to be flexible in meeting your needs.

11. THE DAILY 0 0 0 0 0 ROUTINE OF THE NURSES: How well they adjusted their schedules to your needs.

12. HELPFULNESS: 0 0 0 0 0 Ability of the nurses to make you comfortable and reassure you.

13. NURSING STAFF 0 0 0 0 0 RESPONSE TO YOUR CALLS: How quick they were to help.

14. SKILL AND 0 0 0 0 0 COMPETENCE OF

,

NURSES: How well things were done, like giving medicine and handling IV s.

15. COORDINATION OF D D D D D CARE: The teamwork between nurses and other hospital staff who took care of you.

16. RESTFUL D D D D D ATMOSPHERE PROVIDED BY NURSES: Amount of peace and quiet.

17. PRIVACY: Provisions D D D D D for your privacy by nurses.

18. DISCHARGE D D D D D INSTRUCTIONS: how clearly and completely the nurses told you what to do and what to expect when you left the hospital.

19. COORDINATION OF D D D 0 0 CARE AFTER DISCHARGE: Nurses' efforts to provide for your needs after you left the hospital.

20. Overall quality of care 0 0 0 0 0 and services you received during your hospital stay

21. Overall quality of 0 D 0 0 0 nursing care you received during your hospital stay.

22. In general, would you 0 0 0 D 0 say your health is:

23. Based on the nursing Strongly Somewhat Agre Somew Strong care I received, I would agree agree e hat ly recommend this hospital to disagree disagre my family and friends e