A STUDY TO ASSESS THE SATISFACTION OF …dspace.sctimst.ac.in/jspui/bitstream/123456789/1546/1/148.pdf · Chapter No TITLE Page No ... 1.7 Limitations 18 1.8 Summary 19 II REVIEW

A STUDY TO ASSESS THE SATISFACTION OF PATIENTS WITH

THE QUALITY OF NURSING CARE IN NEURO SURGICAL UNITS

AT SCTIMST, TRIV ANDRUM

PROJECT REPORT

Su6mitted in partia{ ju[fiffment of tlie requirements for tlie

CJJipfoma in :Neuro :Nursing

l31~11r~.~.l3 CODE NO: 5894

SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY TRIVANDRUM

2009

CERTIFICATE FROM SUPERVISORY GUIDE

This is to certify that Miss.Bijitha.L.B has completed the project work on 'A

study to assess the satisfaction of inpatients with quality of nursing care in neuro

surgical units at SCTIMST, Trivandrum ', under my direct supervision for the partial

fulfillment for the Diploma in Neuro Nursing in the University of Sree Chitra Tirunal

Institute for Medical Science and Technology. It also certified that no part of this report

has been included in any other thesis for processing any other degree by the candidate.

Trivandrum November 2009

Dr. Saramma.P.P, M.N, PhD

Senior Lecturer in nursing SCTIMST -

CERTIFICATE FROM THE CANDIDATE

This is to certify that the project on 'A study to assess the satisfaction of the

patients with quality of nursing care in neuro surgical units of Sree Chitra Tirunal

. Institute for Medical Sciences and Technology, Trivandrum ', is a genuine work by me,

under the guidance of Dr. Saramma.P.P, Lecturer in nursing, SCTIMST, Trivandrum .It

also certified that this work has not been presented previously to any other University for

award of degree, diploma or other recognition.

Trivandrum November 2009

Miss._BIJITHA .L.B CODE NO: 5894

SCTIMST

APPROVAL SHEET

This is to certify that Miss.Bijitha.L.B, bearing code no: 5894 has been admitted

to the Diploma in Neuro Nursing in January 2009, and she has undertaken the project

entitled, 'A study to assess the satisfaction of the patients with quality of nursing care in

the neurosurgical units of SCTIMST, Trivandrum', which is approved for the Diploma in

Neuro Nursing, awarded by the Sree Chitra Tirunal Institute for Medical Science and

Technology, Trivandrum, and it is found satisfactory.

EXAMINERS

(1) .................... .

GUIDE

(1) .................. . .

Trivandrum, November 2009

(2) .................... .

(2) •••.•••••.•..•.•.•

jlc~nowCetfgement

First of all let me thank GOD, All Mighty for the unending love, care and blessing

especially during the tenure of this study.

I take this opportunity to express my smcere gratitude to Dr.Saramma.P.P,

Lecturer in Nursing, SCTIMST, Trivandrum, for the guidance. Her contributions and

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

With profound sentiments and gratitude, I acknowledge the encouragement and

help received from the following persons for the successful completion of the study.

I express my special thanks to the Doctors, Ward ln:-charges and Nursing staff of

neurosurgery units, who gave their vulnerable suggestions and guidance for conducting

this study.

I express my smcere tha.oks to Dr. Sankara Sarma, Additional professor,

SCTIMST, for his help in statistical analysis.

I am grateful to the library staff of SCTIMST for their co-operation and help.

I am thankful to all the patients who co-operated and participated in the study

during the time of data collection.

I express my thanks to all the staff, colleagues and friends who directly and

indirectly helped for completion of the study.

I am grateful to my parents and Binu, Saran and all my well wishers for their

prayer and support.

ABSTRACT

A study to assess the satisfaction of patients with quality of nursing care in

the Neuro surgical units of Sree Chitra Tirunal Institute For Medical Science and

Technology, Trivandrum.

Background: Patient satisfaction with nursing care has been constantly been found to be

correlated with overall satisfaction with care. Objectives: (1) To assess the patient's level

of satisfaction with quality of nursing care (2) To assess the relationship between

inpatient satisfaction level and selected variables. Method: The study was conducted in

Sree Chitra Tirunal Institute of Medical science and Technology, Trivandrum, a tertiary

referral hospital. A satisfaction survey was conducted in 50 post neuro surgery patients

with a modified patient satisfaction with nursing care quality questionnaire, which had 18

questions regarding three aspects of nursing care. (i) Information and education. (ii)

Identification of patient needs and individualized care. (iii) Attitude and behavior of staff.

Result: 28 males and 22 females participated in the study. In overall patient satisfaction

with nursing care, 36% of the samples had 100% satisfaction and 58% of the samples had

a satisfaction score of above 90%. Overall majority of the samples had higher level of

satisfaction with nursing care provided. While assessing the patient satisfaction with three

aspects of nursing care, majority of the samples had higher level of satisfaction.

Conclusion: The study showed that majority of the participants was highly satisfied with

the quality of nursing care provided. The results also showed that there was no significant

statistical relationship between the overall satisfaction with nursing care and selected

variables

CONTENTS

Chapter No TITLE Page No

I INTRODUCTION 1

1.1 Introduction 1

1.2 Background ofthe study 2

1.3 Need and significance of the study 16

1.4 Statement of the problem 17

1.5 Objectives ofthe study 17

1.6 Definition of terms 17 -

1.7 Limitations 18

1.8 Summary 19

II REVIEW OF LITERATURE 20

2.1 Introduction 20

2.2 Studies on patient satisfaction with nursing care 20

2.3 Studies on determinants of patient satisfaction 25

III METHODOLOGY 28

3.1 Introduction 28

3.2 Research approach 28

3.3 Research design 28

3.4 Setting of the study 29

3.5 Study population 29

3.6 Sample 29

3.7 Criteria for sample selection 29

3.8 Sampling technique 30

3.9 Data collection tool 30

3.10 Description of the tool 30

3.11 Pilot study 32

3.12 Data collection procedure 33

3.13- Plan for analysis 33

3.14 Protection of human subjects 33

3.15 Summary 34 <0'~-

IV ANALYSIS AND INTERPRETATION OF 35

DATA

v SUMMARY, CONCLUSION, DISCUSSION 47

AND RECOMMENDATIONS

REFERENCES 51

APPENDICES 58

LIST OF TABLES

Table TITLE

Page No No

1 Distribution of samples according to demographic 36

variables

2 Distribution of samples according to satisfaction with 40

information and explanation

3 Distribution of samples according to satisfaction with 40

identification of patients need and nursing care

4 Distribution of samples according to the satisfaction with 41 attitudes and behavior of staff

5 Distribution of samples according to their overall

satisfaction scores. 44

6 Mean, standard deviation and p value for overall 44 satisfaction level and age group

7 Mean, standard deviation and p value for overall 45

satisfaction level and sex

8 Mean, standard deviation and p value for overall 45

satisfaction level and educational status

9 Mean, standard deviation and p value for overall 46

satisfaction level and category

Mean, standard deviation and p value for overall 46 10 satisfaction level and length of hospital stay

LIST OF FIGURES

Fig No TITLE Page No .

1 Distribution of samples according to age 38

2 Distribution of samples according to sex 38

3 Distribution of samples according to educational status 38

4 Distribution of samples according to category 39

5 Distribution of samples according to the length of

hospital stay 39

6 Distribution of samples according to their satisfaction 42

with information and explanations

7 Distribution of samples according to their satisfaction 42 with identification of patient's need and nursing care

8 Distribution of samples according to their satisfaction 43 with attitudes and behavior of staff

9 Distribution of samples according to their overall

43 satisfaction with nursing care

------c -~-----cc- ------------------~---~------~------ ------~----------------------------:----------------- -----------------------

ABBREVIATIONS

SCTIMST - Sree Chitra Tirunal Institute for Medical sciences and Technology

NS -Neurosurgery

ICU ·- Intensive care unit

NSNS -New castle satisfaction with nursing scale

. PSQ - Patient satisfaction questionnaire

PSNCQQ - Patient satisfaction with nursing care quality questionnaire

IVDP - Inter vertebral disc prolapse

STNS - Sub thalamic nerve stimulation

ETV - Endoscopic third ventriculostomy.

CHAPTER I

INTRODUCTION

"The perfect health care delivery is a perfect outcome and a perfectly happy patient"

1.1 Introduction

Satisfaction can be defined as, the extend of an individual's experience compared

with his or her expectations (Pascoe, 1983). Patient satisfaction is related to the extent to

which general health care needs and condition specific needs are met. Evaluating to what

extent patients are satisfied with health service is clinically relevant, as satisfied patients

are more likely to comply with treatment take an active role in their own care, to continue

using medical care services and stay- with in a health provider and maintain with in a

specific system. Satisfaction is one of the core outcome measures for health care .It is

intuiJ:ively 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. Most current research is less interested in correlations

between patient characteristics and satisfaction and more focused on improving the

quality of care and service delivered to patients and health plan members. (Pitaloka &

Rizal, 2005)

The focus on total quality management and value of the care provided to the

patient has increased considerably in the past decade. Patient satisfaction has become

increasingly popular, as a critical component in the measurement of quality of care .The

last decades has witnessed fast economic growth and rapid urbanization in developing

1

countries. This along with the technological advances leads to increased demands and

new expectations of patients. People acquire knowledge from the information, from the

medias as well as guidelines planned by the health planners. By reducing the gap between

what patient wants and what he gets will reduce the dissatisfaction. Understanding how

things are looking through the patient eye should be central part of quality improvement.

Patient satisfaction is sometime treated as an outcome measure of health care provided.

(Sing, 2004).

Nursing service is one of the most important components of hospital services.

Nurses are the largest technical group of personal engaged in hospital care next to doctors

and have the greatest contact with patients. If nursing care is not of high quality, hospital

will fail in its responsibility of providing care. (Abranowitz, 1987).

L2 Background of the study

1.2.1 Patient Satisfaction:

Patient satisfaction is an important patient-centered outcome to measure, is

accepted as a standard measure of quality of care, and is steadily gaining in popularity.

Consumer Satisfaction studies can be used for three related but distinct purposes: as

evaluations of the quality of care, as outcome variables, and as indicators of which

aspects of a service need to be changed to improve patient response.

Donabedian (1988) theorized that quality of medical could be evaluated from

three perspectives (1) Process -How and what things are done, (2) structure -setting in

which care is administered, (3) outcome - the effects of health status and patient

satisfaction.

2

In general, most quality measures can be placed into 2 general subject groupings.

This includes process measures and outcome measures. Process measure reflects the

quality of activities (preparations, interactions, and interventions) that occur prior to and

during care. The process of care thus includes the infrastructure as well as the direct

delivery of care to patients. Outcome measures reflect the result of care (whether

intended or unintended). This result could manifest at any time during or after the

patient's stay.

Patient satisfaction with nursing care has consistently been found to be correlated

with overall satisfaction with care and has been defined as the patient subjective

evaluation of the cognitive and emotional response that result from interaction of the

patients expectation of nursing care and their perception of actual nurse behavior and

characteristics. (Erickson, 1995). Measuring patient satisfaction with care is instrumental

to the success 'of providing patient centered care and allows consumers to participate in

the evaluation process. Majority of the studies in patient satisfaction has been cross

sectional and . descriptive in nature, characteristics of providers and organizations that

. result in more personal care has been associated with higher level of satisfaction. (Cleary

& Neil, 1983).

Patients should be allowed to define their own priorities and evaluate their care

accordingly, rather than having those criteria selected by professionals. Satisfaction

studies can function to give providers of care some idea of how they would have to

modify their provision of services in order to make their patients more satisfied. The

extent to which consumer opinion can influence policy makers and health care personnel

3

"not only dependent upon collecting the right kind of data, it also requires that policy

wakers and health personnel accept the value of the consumer's point of view.

The main indication for measuring patient satisfaction with nursing care is to

identify areas for improvement. However, few studies have examined the effects of

interventions, recognizing the contributions of nursing to improved patient outcome and

quality of care will lead to the provision of "safe patient centered care". Designing

studies to evaluate intervention to take into consideration increasing patient acuity,

shortened length of stay and cultural diversity of patient will provide for enduring

changes resulting in high quality situation. (Toole & wett, 1989) The nurse work

environment has been found to be both directly and indirectly related to patient

satisfaction (Vahey, 2004). Patient cared for one unit, which nurses characterized as

having adequate staff, good administrative support of nursing care and good relation

between doctors and nurses were more than twice as likely as other patient to report high

satisfaction with their care, additionally their nurses reported significantly lower burnout.

Patient satisfaction has also been found to associate with patient adherence to care

provider recommendations and intent to return for or referrer service (Hill, 2002).

Patient satisfaction has been interpreted as the art of care, technical quality of

care, accessibility, convenience, efficacy of outcomes of care, cost of care, physical

environment, availability and continuity of care.

4

1.2.2 Quality of Nursing Care:

"Nursing is a process of recognizing, understanding and meeting the health needs

of any person or society and is based on constantly changing the body of scientific

know ledge."

Nursing is a major component of health care delivery system, and nurse make up

the largest employment group within the system, having the greatest contact with the

patient. Nursing services are necessary for every patients seeking care of various types

including primary, secondary, tertiary and restorative care. Abramowitz et al {1987),

noted that, the nurse acts as a goodwill ambassadors and frontline representatives of the

hospitals. Nurses, rather than physicians, are the person responsible for the day-to-day

activities on the unit. The nurse provides main connection with the patients, act as a

patient advocate with other care providers, give physical care to the patients and offer

both emotional support to both patients and families .In their teaching capacity, they also

play a key role in post hospital adjustment.

The four essential realms of contemporary nursing practice are

• Attention to the full range of human experiences and response to health and

illness.

• Integration of objective data with knowledge gained from an understanding of

client's or group's subjective experience.

• Application of scientific knowledge to the process of diagnosis and treatment.

• Provision of caring relationship that facilitates health and healing.

5

Nursing practice requrres a combination of intellectual achievement, ethical

standards, scientific knowledge, technological skill and personal compassion. In these

recent years, nurse's role consists of caregivers, advocate, critical thinker, teacher,

communicator, manager, resercher and rehabilitator.

Quality of the health activities is the complete satisfaction of the needs of those who

are in most need of health services, for the lowest organizational cost, within the given

limits and guidelines ofhigher administrative bodies and those paying (Ritonja1985).

The history of quality assurance activities in nursing can be traced backed to Florence

Nightingale's attempt to improve the condition of care to the soldiers of the Crimean war.

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

efforts of quality improvement work, since then, assurance of quality nursing care has

remained a priority for nurses through out the world. (Kahn1987). Subsequently nursing

has developed into profession with an emergency unique body of knowledge and thus has

resulted in a growing interest in the improvement of quality nursing care.

The goal of quality assurance in nursing

• Improve and maintain the patient state of health

• Improve and maintain the patient functional abilities

• Develop patient's psychological condition or well-being.

• Gain the patient satisfaction

Nurse caring was defined as an interactive and intersubjective process that occurs

during moments of shared vulnerability between nurse and patient, and that is both self

(nurse) and other (patient) directed. Caring is directed toward the welfare of the patient

6

and takes place when nurses respond to patients in a caring situation (Gaut &et al1983 )

According to Watson (1988), caring preserves human dignity in cure-dominated health

care systems and becomes a standard by which cure is measured. Thus, caring may be

associated with patient outcomes, including speed of patient recovery and discharge.

Wolf et al (1994).

Patient satisfaction is defmed as the patient's opinion of the care received from

nursing staff who work in hospitals and an outcome criterion of nursing care services

(Hinshaw & Atwood, 1981 ).

The fmdings from recent researches identified the following as most significant to

female patients: listening; responding to the patient's uniqueness; being perceptive and

supportive of the patient's concerns; being physically present; having attitudes and

displaying behaviors that made the patient feel valued as a human being not as an

inanimate object or a thing on display; returning to the patient voluntarily without being

asked; showing concern that is comforting and relaxing; using a soft gentle voice arid

mannerisms; inv()king feelings of security; and evoking patient feelings of wanting to

reciprocate.

In male patients, the following behaviors were important: being physically present

so the patient felt concern as a valued person; returning voluntarily without solicitation;

making the patient feel comfortable, relaxed, and secure; attending to the comfort and

needs of the patient before doing tasks; and, using a kind, soft, pleasant, gentle voice and

attitude.

Riemen (1986) described, what patients described as noncaring actions.

Noncaring interactions included, being in a hurry and efficient, doing a job, being rough

7

not responding, and treating patients as objects. Patients felt

ashamed, frightened, and out of contrel in such situations. Wolf (1989) speculated that

patients and families have noted the absence of caring when such behaviors and attitudes

are not evident in the repertoire criterion of nursing care services. . .

Greeneich & et al (1994) suggested that, nurses make a unique contribution to the

satisfaction of patients and family members. Nursing care, which is the chief service '

provided to the hospitalized patient, most likely has a greater influence on patients'

satisfaction with health care services, as compared to other providers (Oberst, 1984).

Nursing ser¥itces are characterized by their around-the-clock presence at the point of

service. (Curtin, 1995). According to Guzman et al (1988), patient satisfaction with

nursing care predicts other aspects of care as well, since nurses' role is said to affect all

aspects of the hospitalization experience. The relationship between patient and nurse is an

important influence for patients' perceptions of satisfaction with nursing care.

"CliTJ.ical quality + Service quality= Patient Satisfaction"

1.2.3 Person centered nursing:

The concept of person centeredness has become established in approaches to the

delivery of health care and particularly within nursing. (Binnie & Higginson, 2001).

Being person centered requires the formation of therapeutic relationship between

professionals, patient and the significant others and these relationships are build on

mutual trust, understanding and sharing collective know ledge.

8

The person centered nursing framework comprises of four constructs:

• Pre requisites

• Care environment (Context in which care is delivered)

• Person centered process (Delivering care)

• Expected outcome (Results and effectiveness)

(i) Prerequisites:

The prerequisites focus on the attributes of the nurse and include being

professionally competent, having developed interpersonal skills, being committed to the

job, being able to demonstrate clarity of beliefs and values, and knowing self.

Professional competence focuses on the knowledge and skills of the nurse to make

decisions and prioritize care, and includes competence in physical or technical aspects of

care. Having developed interpersonal skills reflects the ability to communicate at a

variety of levels. Commitment to the job is indicative of dedication and a sense that the

nurse wants to provide care that is best for the patient. Clarity of beliefs and values

highlights the importance of the nurse knowing their own views and being aware of how

these can have an impact on decisions made by the patient. (War field & Manley, 1990).

This is closely linked to knowing self and the assumption that before we can help others

we need to have insight into how we function as a person. The competence of nurses,

particularly in relation to interpersonal and communication skills, has been described in a

recent qualitative study by McCabe (2004), who concluded that nurses can communicate

well with patients when they use a person-centered approach, but that the ability to do so

9

heavily influenced by the work and culture of the organization, 1.e. the care

environment.

(ii) The care environment:

The care environment construct focuses on the context in which care is delivered

and includes an appropriate skill mix; systems that facilitate shared decision-making;

effective staff relationships; supportive organizational systems, the sharing of power, and

the potential for innovation and risk-taking. These characteristics of context are

consistent with the conceptual development of the concept undertaken by McCormack et

al. (2002) and Rycroft-Maione et al. (2002). Key characteristics of context arising from

these studies include the culture of the workplace, the quality of nursing leadership and

the commitment of the organization to the use of multiple sources of evidence to evaluate

the quality of care delivery. It is acknowledged, however, that the care environment has a

major impact on the operationalization of _person-centered nursing, and has the greatest

potential to limit or enhance the facilitation of person-centered processes (McCormack

2004).

(iii) Person-centered processes:

Person-centered processes focus on delivering care through a range of activities

that operationalize person-centered nursing and include working with patient's beliefs

and values, engagement, having sympathetic presence, sharing decision-making and

providing for physical needs. This is the component of the framework that specifically

focuses on the patient, describing person-centered nursing in the context of care delivery.

Working with patients' beliefs and values reinforces one of the fundamental principles of

10

person-centered nursing, which places importance on developing a clear picture of what

the patient values about their life and how they make sense of what is happening. This is

closely linked to shared decision making i.e. nurses facilitating patient participation

through giving information and integrating newly formed perspectives into established

practices. This must involve a process of negotiation that takes account of individual

values to form a legitimate basis for decision-making, the success of which rests on good

processes of colnmunication. McCormack (2004) illustrates the links between these

processes stating that, 'knowing what is important forms a foundation for decision­

making that adopts a 'negotiated' approach between practitioner and patient'.

Furthermore, Hedberg and Larsson (2004) evidence the link between environmental

elements (the care environment) and decision-making processes, concluding that

interruptions and work procedures are two of the enviroruitental elements that nurses face

in their daily work and that contribute to the complexity of decision-making.

(iv) Outcomes:

Outcomes are the results expected from effective person centered nursing and

include satisfaction with care, involvement in care, feeling of well-being, and creating a

therapeutic environment described as one in which decision-making is shared,· staff

relationships are collaborative, leadership is transformational and innovative practices are

supported. Patient satisfaction reflects the evaluation a patient places on their care

experience and is well documented in the literature as an indicator of quality care.

(Edwards & Staniszewska 2000; Edwards et al, 2004). Furthermore, outcome also has

relationship with other elements of the person-centered nursing framework. Wanzer et al.

11

(2004) explored the relationship between patient centered communication and

satisfaction. He concluded that, communicative behaviours, such as listening and

immediacy, are strongly related to satisfaction with the healthcare experience. The other

outcome indicators identified within the framework are less evident in the literature,

although a feeling of well being engendered by a positive care experience was clearly

highlighted by McCance (2003) and is indicative of the patient feeling valued.

1.2.4 Patient satisfaction and its dimensions

Cure is a fundamental health service expectation (Conway1997). Specifically,

patient satisfaction is defined as, an evaluation of distinct healthcare dimensions (Linder

1982). It may be considered as one of the desired outcomes of care, and so patient

satisfaction information should be indispensable to quality assessments for designing and

managing healthcare. (Turner et al, 1995). Patient satisfaction enhances hospital image,

which_ in tum translates into increased service use and market share (Andaleeb, 1988).

Satisfied customers are likely to exhibit favorable behavioral intentions, which are

beneficial to the healthcare provider's long-term success.

Components of satisfaction consist of:

• Structural

• Technical

• Interpersonal aspects of care.

The structural aspects include: access, physical setting, costs, convenience, and treatment

by non-clinical staff/insurers.

12

The technical aspects include knowledge, competence/quality of care, interventions, and

outcomes.

The interpersonal aspects include: communication, empathy, and education.

Patients' satisfaction has been advocated as an outcome measure of quality nursing

care (Comley and DeMeyer, 2001; Donabedian, 1980). There are seven main dimensions

that have been addressed in the literature as crucial in the measurement of patients'

satisfaction. The dimensions are:

• Respect for patients' values, preference and expressed needs

• Coordination, integration and information flow

• Information and education

• Physical comfort

• Emotional support and alleviation of fear and anxiety

• Involvement of family and friends

• Transition and continuity. (Ryden et al., 2000).

13

NEUROSURGERY ~ I Cranial surgery

I I Spinal surgery I I -

I Tumors I I Movement disorders I Cerebro vascular I Hydrocephalus I . surgenes

.

I Epilepsy surgery I lioma--G

Pi tuitary enoma . ad

-A coustic ne uroma -M edullo bl astoma . _",;_

ramo -C pharyngoma - Meningioma

- Cerebral aneurisms -Shunt - Arteriovenous - Endoscopic third -Parkinson's disease .malformation ventriculostomy -Rigidity

(Sub thalamic nerve stimulation)

Spinal surgery

,-------,.4-"'"~.....,___-----, l Spinal anomalies I Spinal tumors

Astrocytoma Schwannoma Ependymoma

14

+ Inter vertebral disc prolapse (Laminectomy)

Chiari malformation (Foramen magnum nP.rnmnrP.~~inn)

Syringomylia (Foramen magnum decompression)

Atlanto axial dislocation (Trasoral odenctectomy

Mylomeningocele (Repair)

Framework for Patient satisfaction with nursing care

Demographic characteristics of patients; Age, sex, education, income, marital status, social class.

Hospital conditions

Department of admission, Facilities available Cleanliness

Patient satisfaction with nursing care

Nursing care given

- Patient nurse interaction - Nurse's competence - Amount of information provided to the patient - Care quality - Behavior of staff

I?

Patient conditions

- Past experiences - Other diseases -Nature of disease - Length of stay

1.3 Need and significance of the study

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

patient healing process. Even though there are competent physicians present in a given

health institution, it not be adequate without appropriate nursing care. Nurses have 24hrs

contact with patients as well as being near to them, thus they are the frontline the patient

expect more from them, and nurses should also fulfill patients need with competent and

· compassionate approach .The patient perception of quality nursing care includes caring

compassion, competence, confidence and commitment in the delivery of care. (Gunther et

al, 2002).

The Sree Chitra Tirunal Institute for Medical Sciences and Technology

(SCTIMST) is an institute of national importance, established by an act of Indian

Parliament. It is an autonomous institute under the administrative control of the

Department of Science and Technology, Government of India, and is situated at

Trivandrum, capital city of state of Kerala. It is a tertiary referral hospital with major

specialties Neurology, Neurosurgery, Cardiology, Cardiac surgery. The hospital is 239

bedded, having three operation theatre complexes and five ICU complexes. About 12,000

patients are registered here per month. Approximately 120 neurosurgeries are performed

per month. Neurovascular surgeries (aneurysms), Craniotomy for tumor excision, spinal

surgeries, shunt endoscopic procedures and investigative procedures are the main

neurosurgical procedures performed here.

Post neurosurgery patients require constant and vigilant nursmg care, as their

condition can be life threatening. Post surgery patient's satisfaction is pivotal to the

achievement of the optimum clinical outcome, speedy recovery, reduced length of stay

16

and avoidance of recurrent admission. (Larrabee et al, 2001). Achieving optimum patient

satisfaction with quality nursing care ha·s been the primary focus of nurses.-It was with

this intent, that the researcher conducted a study on patient satisfaction with quality of

nursing care in neurosurgical units of SCTIMST, with the objective to assess the patient

satisfaction with the quality of nursing care, and to assess the relationship between patient

satisfaction level and selected variables like age, sex, educational status, and length of

stay in the hospital.

1.4 Statement of the problem

A study to assess the satisfaction of patients with the quality of nursing care in the

neurosurgical units at Sree Chitra Tirunal Institute for Medical sciences and Technology,

Trivandrum.

1.5 Objectives of the study

• . To .assess patient's level of satisfaction with quality of nursing care.

• To assess the relationship between patient satisfaction level and selected variables

1.6 Operational definitions

Satisfaction:

A feeling of happiness or pleasure because one have achieved something or got

what one wanted.

17

Patient satisfaction.

The degree to which tlie individual regards the health care services or products or manner

in which it is delivered by the provider as useful effective, or beneficial.

Patients:

Patients, in this study refer to the persons, who are admitted in the neurosurgical

units (wards and ICU), and underwent Neurosurgical procedures.

Neurosurgical units:

In this study neuro surgical units refers to the. neuro surgical wards and the neuro

surgical -ICU, of the Sree Chitra Tirunal Institute of Medical sciences and Technology,

Thiruvananthapuram.

Patient satisfaction with nursing care:

Patient satisfaction with nursing care is defined as the patients' opinion of the care

received from nursing staff and is acknowledged as an outcome indicator of the quality of

nursmg care.

1.7 Limitations

This study is limited to

• Patient's who can read and understand Malayalam.

• Patient's who are willing to participate in this study.

• Patient's who are underwent neurosurgical procedures or surgery .

. • Patients who are above 18 years of age.

18

1.8 Summary

This report organized with introduction, background of the study, need and

significance of the study, statement of the problem, objectives of the study, operational

definitions and limitations.

19

2.1 Introduction

CHAPTER II

REVIEW OF LITERATURE

Review of literature is the key step in research process, which helps to

lay a foundation for the study and gain better understanding and insight necessary to

build upon existing know ledge.

The review ofliterature relevant to this study is presented in following sections:

• Studies on patient satisfaction with nursing care

• Studies on determinants of patient satisfaction

2.1 Studies on patient satisfaction with nursing care

Liu et al, (2007), conducted a study in the Union hospital of Tongji Medical

college, China, to examine the inpatient satisfaction with nursing care .The study was

conducted with a self designe~ questionnaire administered to 320 patients. The outcome

of the study was, the patients had a relatively high level of satisfaction with nursing care.

Patient's age, sex, educational status, occupation, methods of payment and hospital wards

were the main factors influencing satisfaction with nursing care.

Almailam et al, (2005), evaluated the patient satisfaction with nursing care

provided in a 11 0-bedded private hospital in Kuwait. Data was collected from 420

inpatients by random sampling with a structured questionnaire from January to March.

The authors found that the overall patient satisfaction with nursing care, provided in the

hospital was very high.

20

Khan. H et al (2007) conducted a study at District Headquarter 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. A cross-sectional study was

conducted from July 1, 2006 to August 31, 2006 with a questionnaire regarding

satisfaction, which was administered by the investigator in line with Henderson's basic

nursing care model. Six dimensions of care were selected for examination. Total 153

eligible patients were identified and invited for interview through questionnaire. 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 behavior, 90 %

patients were not feeling comfortable talking to nurses. Only 10 % felts nurses were

excellent. 84 % patients had negative experiences as they observed nurses were not

attentive to their needs, particularly at nig!lt. The same percentage also had negative

perception with respect to physical care: Overall, the data showed that patients'

expectations were not s~fficiently met. The researcher concluded that, the nurses need to

know the factors that influence patient satisfaction, and must improve the quality of

health care.

Chau J et al (2005), examined the relationship between patient satisfaction and

triage of nursing care in Queen Elizabeth hospital, Hong Kong. A descriptive co

relational study was conducted with Consumer emergency care satisfaction scale. Final

sample consisted of 156 urgent, semi urgent non-urgent patients. The result of the study

21

showed majority of the participants was satisfied with the triage of nursing care and

teaching.

Eng et al (2006) identified the factors that determine post-cardiac patient

satisfaction with quality of nursing care in the Institute of Jantung Negara. A single cross­

sectional descriptive study was conducted using 'NURSQUAL' instrument consisting of

four elements; technical competence, information giving, assurance and empathy. It

consisted of four research questions with 33 items. The study was conducted from

January to March 2005, in 52 post cardiac surgery patients. The findings showed that

there was a significant difference between technical competence, information giving,

assurance and empathy with patient satisfaction (p value < 0.05). The element of

assurance made the strongest statistically significant unique contribution to the prediction

of patient satisfaction with a p value< 0.05.

Vahey, et al (2004), examined the effects of nurse work environment and nurse

burnout and the effects of nurse work environment and patient satisfaction with nursing

care. The survey was conducted in 40 units of 20 urban hospitals across the United

States: A cross sectional survey was conducted 820 nurses and 621 patients. The nurse's

outcome was measured by Maslach burnout inventory. Patients were interviewed about

their satisfaction with nursing care, using the La Monica Oberst patient satisfaction scale

(LOPSS). The outcome of the study was, patient cared for one unit that nurses

characterized as having adequate staff, good administrative support for nursing care,

good relation between doctors and nurses were more than twice likely as other patients to

report high satisfaction with their care, and nurses reported significantly lower burnout.

The overall level of nurse burnout in hospital units also altered patient satisfaction.

22

Hogan (2009), aimed to evaluate surgical patient satisfaction with nursing care. A

convenient sample of 618 general surgical patient participated in structured interview.

Data analysis revealed patient satisfaction with personal and professional nature of

nurses. Result of the study was, participants understood information from the nurses and

were satisfied with nursing ability. Participants were dissatisfied with minimal nurse

contact, lack of personalized care and lack of information about the operation,

recuperation and minimal treatment option.

Chaka (2005) assessed the quality of nursmg care as indicated by patient

satisfaction. The study was conducted in 631 adult patients who were admitted in

mJdical, surgical and gynecological wards from 2004 - 2005. New castle satisfaction

with nursing scale (NSNS) was used as tool .The outcome of the study was, the

participants who were females age group 41 to 50 yrs of age, having low education, less

income, patient who were admitted in third class and no history of previous admission

were m_ore satisfied. The overall rating of satisfaction was 67%. The top aspects that

patient scored highest for their satisfaction with nursing care was at the amount of

freedom given, nurses capability in their work and nurses treatment as an individual. The

aspect with which the patient is least satisfied was the amount and type of information

they received regarding their condition and treatment and also the amount nurses know

about patient care. Age was the significant predictor of patient satisfaction with nursing

care. The researcher recommended the need of improving interpersonal relationship of

nurses with their patients.

Qureshi et al (2005) elicited the patient opinion about the quality of services and

analyzed the various factors that influence the patient satisfaction at SMHS hospital,

23

Srinagar. The investigator interviewed 100 inpatients both male and female age between

15 to 70 yrs in medical, surgical, ENT, ophthalmology, dermatology and burns ward with

a questionnaire. The outcome of the study was, from the aggregate the scores of 21

questions of patient satisfaction questionnaire, it was found that 14.3 % of the patients

considered the service of SMHS hospital as excellent. 69.9% considered as good and

9.1% of patients considered as average. 6.7% was poorly satisfied with the services.

Highest score for patient satisfaction was regarding attending doctors and second was for

nursing care .95% of the patient preferred to suggest this hospital for relatives and friends

for future consultation.

} Alhusban et al (2009) assessed the level of patient satisfaction with nursing care

and identified the important aspects that enhance satisfaction in Al-Mafraq hospital,

Jordan. A cross sectional descriptive study was conducted in a convenient sample of 100

patients with Newcastle satisfaction with nursing care scale. The findings of the study

indicated that level of satisfaction of patients with nursing care was moderate and

experience of nursing care was positive. Female patients were more satisfied than males.

Gynecological patients were more satisfied than other surgical patients.

Uzun (2001) assessed the patient satisfaction with nursing care m 422 adult

discharged patients in the University hospital, Turkey. SERVQUAL scale was used for

determining patient satisfaction with nursing care. Socio demographic characteristics

such as patient's age, gender, and educational level with regard to patient satisfaction

were determined. The researcher found that reliability, responsiveness, assurance and

empathy are the areas need to be improved for patient satisfaction.

24

Moreen et al (2008) explored the positive relationship between nurse's perception

of empowerment and patient satisfaction using Kantar' s theory as adapted by Laschinger

and others. The instrument used was, the conditions of work effectiveness questionnaire

II, which measures nurse empowerment, and Press Ganey Associates patient satisfaction

survey which measures patient satisfaction. A convenient sample of 259 nurses, 622

inpatients and 679 ambulatory surgery patients and 305 emergency department admitted

patients were assessed. The result of the study was, a significant relationship was found

between nurse's perceptions of empowerment and access to information, opportunity,

support and resources. A significant positive correlation was found between nurse's

J perception of empowerment and patient satisfaction.

2.2 Studies on determinants of patient satisfaction

Yildirim et al (2005) identified the factors associated with patient satisfaction and

dissatisfaction and described the demographic characteristics. The study was carried out

from January 1 to June 31, 2001. The adult patients who consecutively presented to the

emergency department between 8am to 5pm and stayed more than 24 hrs were included

in the study. Patients were asked to complete a questionnaire prior to discharge. The

questionnaire was about the attitude, politeness, and efficiency of medical and ancillary

staff. 249 patients were included in the study. Researcher concluded that, 45% of the

patients preferred emergency department because of the previous perception of higher

quality care. The main cause of dissatisfaction was lengthy waiting time (27% ). High

quality care was the main preference of care.

25

Bautista et al (2007) determined the variables associated with satisfaction with

care among epilepsy patients in USA. The researcher interviewed 193 patients in the

epilepsy center. Predictor variables included age, gender, race, education, income,

insurance, seizure frequency and quality of life. Target variables were the subscales of

the short form patient satisfaction questionnaire (PSQ-18). The researcher concluded that

lower educational level and better quality of life are the main variables associated with

general satisfaction with care among patients with epilepsy.

Hebber et al (2008) identified the predictors of quality improvement and patient

satisfaction in University hospital, Florida. 4380 patients were surveyed over a period of

~years. The sample included patients over a wide range of age from 1 to 100 yrs

within an average age of 56 years. A closed ended questionnaire with 71 questions was

used. A scale of 5 was interpreted as very good and scale of 1 was very poor. The finding

of the study was high percent of the people are likely to recommend the hospital. 53% of

the people recommended as very good and 30% said it was good, 3%is poor and 5%is

very poor. Overall rating of care provided was very good. The predictor variables which

affected the patient satisfaction was (1) Staff working well together, (2) Overall

cheerfulness of the hospital, (3) Response to concerns and complaints, (4) Staff effort to

include patient in decisions regarding treatment, (5) Staff sensitivity to inconvenience

that health problems and hospitalization can cause, (6) Nurse keeping the patients

informed. Overall rating of the care also affected by the attention paid by the nurse to

special or personal need of patients.

Nguyen et al (2002) identified the factors affecting satisfaction among primary

patients receiving medical and surgical care. 533 discharged patients completed a Patient

26

judgment hospital quality questionnaire covering seven dimensions of satisfaction which

includes admission, nursing and daily care, medical care, information, hospital

environment, ancillary staff, overall quality of care and services recommendations and

intentions. The two strongest predictors of satisfaction were older age and better self

perceived health status of admission. Gender, room environment and length of stay were

the factors, which also affected patient satisfaction.

Key words for related search and number of articles

Keywords Free articles Total articles

Pat~nt satisfaction with nursing care 465 7918 I

Patient satisfaction survey 3582 22747

Measuring patient satisfaction 229 1317

Nursing care quality 1948 39416

27

3.1 Introduction

CHAPTER III

RESERCH METHODOLOGY

Research methodology is the systematic way to solve the research· problem. It

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

(Kothari, 1990). 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 method adopted by the investigator to

conduct this study. This chapter includes the research approach, research design, setting

of t~ study, sample and sampling technique. It further deals with the development of

tool, procedure for data collection, and for data analysis.

3.2 Research approach

Survey approach is used for the present study. Survey approach is more useful in

educational fact finding, in relatively small samples.

3.4 Research design

The descriptive survey design was used to fulfill the objectives of the study. The

framework of the study is given below.

Attribute variable Study population Tool Outcome

Age, sex, Patients Standard Satisfaction education, admitted in questionnaire of patients financial Neuro on Patient with category, surgical unit. satisfaction Quality of length of Sample= 50 with nursing nursing hospital patients . care care stay

28

3.5 Setting of the study

This study was· conducted in neurosurgery units of-Sree Chitra Tirunal Institute

for Medical Sciences and Technology, Trivandrum. The rationale for selecting this

institute for the study was that the investigator was more familiar with the institution.

SCTIMST is an institute of national importance where there is a separate wing for

neurosurgery, which includes neurosurgery OPD, ward and ICU

3.6 Study population

The target population of the study was both male and female patients admitted in

the neurosurgical units ofSCTIMST.

~

3.7 Sample size

The sample size consists of 50 patients. 10 samples were selected for pilot study.

3.8 Criteria for sample selection

Inclusion criteria:

• Patient who can read and understand Malayalam

• Patient who are willing to participate.

• Patients who are for discharge on the day of data collection.

Exclusion criteria:

• Patient who cannot respond and patient on ventilator are excluded from

the study.

29

3.9 Sampling technique

Patients who are in the neurosurgery units during the data collection period and

who fulfilled the inclusion criteria were selected as samples by consecutive sampling

technique.

3.10 Data collection tool

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

obtain relevant data. A modified Patient Satisfaction with Nursing Care Quality

Questionnaire (PSNCQQ) prepared by Laschinger et al (2005) was used. The

questionnaire was translated to regional language Malayalam with some modifications by

th~ researcher. The tool was then examined and validated by the experts of SCTIMST.

The research tool was fmalized according to the expert's opinion.

3.11 Description of the tool

Laschinger et al (2005) prepared patient Satisfaction with Nursing Care Quality

Questionnaire (PSNCQQ). The questionnaire was five point. rating scale consisting of

items about nursing care during hospital stay.

The ratings were

• Excellent

• Very good

• Good

• Fair

• Poor

30

· The questionnaire was translated to regional language Malayalam with some

modifications by the researcher. The Malayalam questionnaire consists of two sections.

Section I:

General information and demographic data. It includes name, age, sex, hospital

number, procedure done, and educational status. Educational status was placed under four

sub headings.

• Uneducated - No basic education

• Primary -Up to lOth Std

• Secondary -lOth to 12th)

• Degree

~ Financial category (according to the hospital records).

• A - Patient's monthly income below Rs 400

• Bl-

• B - Monthly income between 701 to1300

• c - Monthly income between 1301 to 2000.

• D - Monthly income above 2000

Length of stay

• Up to 10 days

• 11-20 days

• Above 21 days

31

Section II:

It consists of a total of 18 questions regarding patient satisfaction. The options given

for rating were

• Always

• Occasionally

• Never

The questions were regarding mainly 3 aspects of nursing care.

1. Information and explanation

Proper information to the patients and relatives about procedures, surgery, patient

condition and care

2. Identification of patient's ~eeds and nursing care.

Consideration of patient needs and individual care.

3. Attitude and behavior of staff

Staffs behavior and attitudes towardsJhe patients.

3.12 Pilot study

Pilot study was conducted from September 20th- 25th, 2009. The aim of the pilot

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

conducted among 1 0 samples. The sampling technique used was consecutive sampling.

Informed consent was taken from the samples before data collection. The finalized tool

was used to assess the patient's satisfaction with nursing care. The pilot study findings

revealed that the study was practicable and feasible.

32

3.13 Data collection procedure

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

collection was used in final study. The final study was during the month of October 2009.

The researcher first introduced herself to the patient and explained the need and

purpose of the study. Informed consent was taken from the patient before data collection.

Then the research tool was given to the patients. 20 minutes was given for answering the

questionnaire. The total time taken was a maximum of30 minutes per sample

3.14 Plan for analysis

After data collection, data's were organized, tabulated, summarized and

~alyzed. Descriptive statistics like frequency, mean, inferential statistics and chi-square,

test of significance was used.

For measuring the satisfaction level of patients, the satisfaction ratings by the

patients were taken as sa!isfaction scores and were converted in to percentage. The

overall patient satisfaction and satisfaction with different aspects of nursing care was

calcula~ed as percentage of satisfaction.

3.15 Protection of human subjects

The proposed study was conducted after the approval of the guide. Permission

was obtained from the Head of the Neurosurgical department, and the Sister- in- Charge.

Informed consent was taken from each subject before the data collection. Assurance was

given to the study participants regarding the confidentiality of data collected.

33

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

3.16 Summary

This chapter includes the research approach, research design, setting of the study,

study population, sample, sample size, sampling technique, selection criteria, description

of the tool, pilot study, data gathering process, plan for data analysis, and protection of

human subjects.

34

CHAPTER IV

ANALYSIS AND INTERPRETATION OF DATA

4.1 Introduction

Analysis is categorizing, ordering, manipulating and summarizing the data to an

intelligible and interpretable form, so that research problem can be studied and tested

including relationship between variables. (Kerlinger, 1986).

Interpretation is the process of making a sense of the result and examining the

implicatiQp of finding with in broader context.

The data's in this study"was arranged and analyzed under the following sections:

(1) Distribution of samples according to demographic variables

(2) Distribution of samples according to satisfaction scores

(3) Relationship between satisfaction scores and selected variables.

35

Table 1: Distribution of samples according to demographic variables

Demographic data Frequency Percentage

Age:

18-40 yrs 19 . 38%

41-60 yrs 21 42%

Above 60 yrs 10 20%

Sex:

Male 28 56%

~ Female 22 44%

-Educational status:

Up to 9th standard 11 22%

1 oth - 12th standard 26 52%

Above 12th standard 13 26%

Category:

A 5 10%

B&Bl 28 56%

c 3 6%

D 14 28%

36

Length of hospital stay=

Up to 10 days 21 42%

10-20 days 26 52%

Above 20 days 3 6%

Table 1 represents the distribution of samples according to demographic

variables. 38% ofthe samples were in the age group of 18-40 years. 42% of the samples

were between 41-60 years. 20% ofthe samples were above 60 years (Fig 1).

56% of the samples were males and 44% were females. (Fig 2).

) 52% of the samples were educated between lOth -12th std and 26% were educated

above 12th std. (Fig 3).

56% of the samples were in the B&B 1 financial category. 10% and 6% were in

the A and C category respectively. 28% were in D category. (Fig 4).

In the length of hospital stay, 52% of the samples were between 10-20 days and

42% were there up to 10 days. Only 6% of the samples had above 20 days of hospital

stay (Fig 5).

37

Fig 1: Distribution of samples according to age group

Fig 4: Distribution of samples according to category

39

Table 2: Distribution of samples according to their satisfaction with information and explanations

Satisfaction level Frequency Percentage

75% 3 6

87.5% 3 6

100% 44 88

Table 3: pistribution of samples according to their satisfaction with identification of patient's need and nursing care

Satisfaction level Frequency Percentage

87.5% 3 6

93.75% 7 14

100% 40 80

40

-Table 4: Distribution of samples according to their satisfaction with attitudes and

behaviours of staff

. Satisfaction level Frequency Percentage

65%-75% 2 .

4

83.3% 12 24

91.6% 15 30

100% 21 42

TJ,le 2 shows the distribution of samples according to their satisfaction with the

information and explanations given by the staff. 88% of the samples were 100% satisfied

with the information and explanations given by the staff. 6% of the samples had a

satisfaction score of 87.5% and another 6% of the samples had a satisfaction score of

75%. (Fig 6)

Table 3 shows that 80% of the samples were 100% satisfied with the

identification of patient's need and nursing care. 14% and 6% of the samples had a

satisfaction score of93.75% and 87.5% respectively. (Fig 7)

Table 4 shows that 42% of the samples were 100% satisfied with the attitude and

behavior of the staff. 30% and 24% of the samples had a satisfaction score of91.6% and

83.3% respectively. 4% of the samples had a satisfaction score between 65%- 75%. (Fig

8)

41

Fig 6: Distribution of samples according to their satisfaction with information and explanations

90 80 -j

CO 70

60 60 CO

50 4 C3) 40 J 40 J s 30 4 I

20 J 10-1

Fig 7: Distribution of samples according to their satisfaction with identification of patient's need and nursing care

42

Fig 8: Distribution of samples according to their satisfaction with attitudes and behavior of staff

Table 5: Distribution of samples according to their overall satisfaction scores.

Satisfaction Score Frequency Percentage

75%-90% 3 6

91%-95% 17 34

96%-99% ·12 24

100% 18 36

Table 5 shows the distribution of samples according to their overall satisfaction

scores.36% of the samples were 100% satisfied with the overall nursing care. 24% and

34% of the samples had a satisfaction score between 96%-99% and 91%-95%

respecti~ely. 6% of the samples had a satisfaction score between 75%-90%. (Fig 9).

Relationship between satisfaction scores and selected variables

Table 6: Mean, standard deviation and p value for overall satisfaction level and age group

Age group Frequency Mean SD P value

18-40 yrs 19 1.87 0.103

41-60 yrs 22 1.88 0.122 0.75

Above 60 yrs 9 1.91 0.090

Table 6 shows that there is no significant statistical relationship between age

group and overall satisfaction level of patients at 0.05 level. (p = 0.75)

44

Table 7: Mean, standard deviation and p value for overall satisfaction level and sex

Sex Frequency Mean SD P value

Male 28 1.90 0.105 0.12

Female 22 1.85 0.109

Table 7, an unpaired t test showed that there is no significant statistical

relationship between sex and overall satisfaction level of patients. (p = 0.12)

Table ¥Mean, standard deviation and p value for overall satisfaction level and

educational status

Educational status Frequency Mean SD P value

Up to 9th std 11 1.87 0:090

10-12th std 26 1.89 0.126 0.89

Above 12th std 13 1.88 0.089

Table 8 shows that there is no significant statistical relationship between

educational status and overall satisfaction level of patients. (p = 0.89)

45

Table 9: Mean, standard deviation and p value for overall satisfaction level and

category

Category Frequency Mean SD P value

A 5 1.94 0.089 .

B 28 1.88 0.100 0.44

c 3 1.93 0.115

D 14 1.85 0.128

Table 9 shows that there is no significant statistical relationship between category

and ovekll satisfaction level of patients. (p = 0.44)

Table 10: Mean, standard deviation and p value for overall satisfaction level and length

ofhospital stay

Length of stay Frequency Mean SD P value

Up to 10 days 21 1.89 0.124

11-20 days 26 1.88 0.102 0.86

Above 21 days 3 1.86 0.057

Table 9 shows that there is no significant statistical relationship between length of

hospital stay and overall satisfaction level of patients. (p = 0.86)

46

CHAPTER V

SUMMARY, CONCLUSION, DISCUSSION AND RECOMMENDATION

This chapter gives a brief account of the present study including the conclusions

drawn from the findings of the study.

5.1 Summary

A study was conducted to assess the satisfaction level of patients with quality of

~

nursing care at Sree Chitra Institute for Medical Sciences and Technology, Trivandrum.

50 samples were selected by consecutive sampling. Satisfaction was assessed with a

modifie{patient Satisfaction with Nursing Care Quality Questionnaire.

Significant findings of the study were,

+ Majority of the patients had higher level of satisfaction with overall nursing care.

36% ofthe samples were 100% satisfied with the overall nursing care. 58% of the

samples had a satisfaction score of above 91% and 6% of the samples had a

satisfaction score ranging from 75%-90%. None of the samples had a satisfaction

score less than 75%.

+ In the aspect of information and explanations, 88% ofthe samples were 100% and

6% of the samples had a satisfaction score of 87.5%. Another 6% of the samples

were75% satisfied with the information and explanations given by the staff.

47

+ 80% of the samples were 1 00% satisfied with the identification of patients need

and nursing care.14% and 6% of the samples had a satisfaction score of 93.7 5 %

and 87.5% respectively.

+ With the attitude and behavior of the staff, 42% of the samples were 100%

satisfied. 30% and 24% of the samples had a satisfaction score of 91.6% and

83.3% respectively. 4% of the samples had a satisfaction score ranging from 65%-

75%.

+ There was no significant statistical relationship found between the overall

satisfaction of patients and selected variables (Age, sex, educational status,

( . category, and length ofhosp1tal stay)

5.2 Conclusion

Patient satisfaction and their expectations of care are valid indicators of quality of

nursing· care. Nursing care involves many aspects of care. The findings of this study

showed that, overall, majority of the patients had a higher level of satisfaction with the

quality and nature of the care they receive. Majority of the samples showed that they had

a higher level of satisfaction with all 3 aspects of nursing care. The results also showed

that there was no significant statistical relationship between the overall satisfaction with

nursing care and selected variables

48

5.3 Discussion

Patient satisfaction is an important indicator in evaluating quality of

patient care. Nurses have seen their role at the bedside, dealing with the needs of the

individual patient, and were unlikely to consider whether their nursing care was delivered

in the most effective and efficient way with the maximum utilization of scarce resources.

The study was conducted in the post neuro surgical units of the SCTIMST with

the purpose of identifying the patient satisfaction with nursing care in 50 post neuro

surgical patients. Patient satisfaction was assessed in 3 aspects of nursing care,

(i) Information and explanation, (ii) Identification of patients needs and nursing care, (iii) ,..

Attitur and behavior of staff. Study find~ngs revealed that majority of the patients had

higher level of satisfaction with information and explanation, and identification of

patient's needs and nursing care and attitude and behavior of staff. A study by Hogan

(2009) found that patients were satisfied with the information from nurses and were

satisfied with nursing ability. This supports the present findings in this study.

In overall patient satisfaction, majority of the patients were found to have higher

level of satisfaction with the nursing care provided. 36% of the samples were found to

have 1 00% satisfaction with the care provided by the nursing staff. Liu et al (2007) and

Almailam et al (2005) found that patients had high level of satisfaction with nursing care,

which supports the presents study findings.

49

Some comments given by the samples are

"Staffs are very kind and friendly to me"

"Nurses don't think that I am just a 'case' to them. They care me like their own

relatives"

"I am very satisfied with the care provided by the nurses"

Some general complaints were regarding the difficulties faced by the patients in

the Out Patient Department, like prolonged waiting time, getting dates for the surgery.

5.4 Recommendations:

• iame study can be conducted with large sample in the future with the same tool

• The study can be conducted in OPD and others areas .

• The same study can be conducted in a group of hospitals and find the areas of

dissatisfaction.

"Dissatisfied Members Have Feet

They Will WalkAway From You"- Leonard Abramson

50

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Journal ofNursing Care Quality, 6(2), 63-76.

• Nguyen, (2007) Factors associated with satisfaction with care among patients

with epilepsy and behavior, 2007 Dec; 11(4): 518-24. Epub 2007 Oct 23

• Oberst, M.T. (1984). Patients' perceptions of care: Measurement of quality and

satisfaction. Imprint, 53(10), 2366-2373.

• Pascoe,G .C, Patient satisfaction in primary health care: a literature review and

( analysis. Eval Programme Plan 6, 185-210 (1983)

• Qureshi, A case study on patient satisfaction in SMHS hospital, Srinagar, JK-

Practitioner 2005;12(3): 154-155

• Riemen, D.J. (1986). Noncaring and caring in the clinical setting: Patients'

descriptions. Topics in Clinical Nursing, 8(2), 30-36.

• Ritonja S, Permanent Quality Assurance- the Basic Principles of Total Quality

Management in Healthcare Organization 1998; 31:214-9.

55

"""---~--"-~--"-"-· ~~-

+ Nielsen, P.A. (1992). Quality of care: Discovering a medified practice theory.

Journal of Nursing Care Quality, 6(2), 63-76.

+ Nguyen, (2007) Factors associated with satisfaction with care among patients

with epilepsy and behavior, 2007 Dec; 11(4): 518-24. Epub 2007 Oct 23

+ Oberst, M.T. (1984). Patients' perceptions of care: Measurement of quality and

satisfaction. Imprint, 53(10), 2366-2373.

+ P~e,G .C, Patient satisfaction in primary health care: a literature review and

analysis. Eval Programme Plan 6, 185-210 (1983)

+ Qureshi, A case study on patient satisfaction in SMHS hospital, Srinagar, JK­

Practitioner 2005;12(3): 154-155

+ Riemen, D.J. (1986). Noncaring and caring in the clinical setting: Patients'

descriptions. Topics in Clinical Nursing, 8(2), 30-36.

+ Ritonja S, Permanent Quality Assurance- the Basic Principles ofTotal Quality

Management in Healthcare Organization 1998; 31: 214-9.

55

+ Rycroft M et al (2002) Ingredients for change: revisiting a conceptual framework.

,Quality and Safety in Health Care 1 1-, 174-180

http:/ /www.qhc. bmjjoumals.com

+ Sing S (2004 ). Holistic approach for patient satisfaction -an innovative

experiment at AIMS Health Administrator Vol: XVII, Number 1: 98-101

+ Uzun.O, Patient satisfactions with nursing care at a university hospital in Turkey.

Nursing Care Quality Joumal2001; 16 (1): 24- 33.

+ Vahey DC, Nurse burnout and patient satisfaction; medical care2004 Feb; 42(2

Suppl):II57-66 (Electronic version)

(

+ Warfield C. & Manley K. (1990), Developing a new philosophy in lhe NDU

Nursing Standard 4(41), 27-30.

+ Watson J. (1985) Nursing: Human Science and Human Care- A

Theory ofNursing, National League ofNursing Press, New York.

+ Wolf, Z.R. (1989). Uncovering the hidden work of nursing. Nursing and Health

Care, 1 0(8), 462-467.

56

+ Wolf et al (1994). Dimensions of nurse caring. Image: Journal ofNursing

Scholarship, 26(2), and 107-111.

• Watson, J. (1988b ). Introduction: An ethic of caring/curing/nursing qua nursing.

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• Yilridium et al, patient satisfaction in a university hospital emergency department

. in Turkey, ACTA MEDICA (Hradec Knilove) 2005; 48(1): 59-62

(

57

APPENDIX: 1

n Patient Satisfaction With Nursing Care Quality Questionnaire (PSNCQQ)

Request Form

I request permission to copy the Patient Satisfaction With Nursing Care Quality Questionnaire as developed by Dr. Heather K. Spence Laschinger et al (2005). Upon completion ofthe research, I will provide Dr. Laschinger with a brief summary ofthe results, including information related to the use of the PSNCQQ used in my study.

Please complete the following information: Date 29-06-2009 Name Title_ ( hosp1tal University/Organization Address

Phone E-mail

Description of Study

Bijitha.L.B. Patient satisfaction with nursing care in selected

S_CTIMST, Trivandrum Medical College Trivandrum, Kerala **********

[email protected]

Sample size 50. Survey approach is used.

Permission is hereby granted to copy and use the Patient Satisfaction With Nursing Care Quality Questionnaire (PSNCQQ). Date: June 30, 2009 Signature:

Dr. Heather K. Spence Laschinger, Professor School ofNursing, University of Western Ontario London, Ontario, Canada N6A 5C1 Tel: 519-661-4065 Fax: 519-661-3410 E-mail: [email protected]

58

APPENDIX: 2

PATIENT SATISFACTION WITH NURSING CARE QUALITY QUESTIONNAIRE (Laschinger, McGillis Hall, Pedersen & Almost, 2005)

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

Excellent Very

Good Fair Poor Good

INFORMATION YOU WERE GIVEN: How clear and complete 0 0 0 0 0 the nurses' explanations were about tests, treatments, and what to ex ect. INSTRUCTIONS: How well nurses explained how to prepare 0 0 0 0 0 for tests and operations. EASE OF GETTING INFO MATION: Willingness of 0 0 0 0 0 nurse to answer our uestions.

INFORMATION GIVEN BY NURSES: How well nurses - 0 0 0 0 0 communicated with patients, families, and doctors.

INFORMING FAMILY OR FRIENDS: How well the nurses 0 0 0 0 0 kept them informed about your condition and needs.

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

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

59

ATTENTION OF NURSES TO YOUR CONDITION: How often nurses checked on you and how D D D D D well they kept track of how you were doing.

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

CONSIDERATION OF YOUR NEEDS: Willingness of the nurses D D D D D to be flexible in meeting your needs. THE DAILY ROUTINE OF THE NURSES: How well they D D D D D adjusted their schedules to your needs. HELPFULNESS: Ability of the nurses to make you comfortable D D D D D and reassure you. NURSING STAFF RESPONSE TO YOUR CALLS: How quick D D D D D they were to help.

SKILL A~D COMPETENCE OF NURSES: How well things D D D D D

- were done, like giving medicine and handling N s.

COORDINATION OF CARE: The teamwork between nurses and D D D D D other hospital staff who took care of ou. RESTFUL ATMOSPHERE PROVIDED BY NURSES: D D D D D Amount of peace and quiet.

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

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

COORDINATION OF CARE D 0 D 0 0 AFTER DISCHARGE: Nurses'

60

efforts to provide for your needs after you left the hospital.

OVERALL PERCEPTIONS

Overall quality of care and services you received during your hospital sta

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

In general, would you say your health is:

Based on the nursing care I received, I would recommend this hospital to my family and friends

GENERAL

Gender: D Male D Female

Excellent

D

D

D

Strongly agree

D

Very Good Fair Poor

Good

D D D D

D D D D

D D D 0

Somewhat Somewhat Strongly agree Agree disagree disagree

D D D D

Age in years: ___ years

Marital Status: Single q Married/Cohabiting D Separated/Divorced D Widowed

~cljing this most recent hospital stay, how many times were you (the patient) hospitalized

in the past 2 years? D Only once D .. Twice D 3 Times D 4 Times D Over 4

Times

Overall, how would you rate your (the patient's) health before this most recent hospital stay?

D Excellent D Good D Fair D Poor D Very Poor D Unsure

Were you:

D Admitted through the Emergency Department

D Admitted through patient registration/to the unit directly

0 Admitted after day procedure or test

D Transferred from another facility

D Other

For most of your hospital stay, were you in a room:

D By yourself D With 1 other person D With more than 1 other person

D Please check here if someone other than the patient completed this survey.

THANK YOU FOR TAKING THE TIME TO FILL OUT THIS SURVEY.

61

APPENDIX: 3

INFORMED CONSENT

I, .............................. , hereby agree to participate in the research

study to assess patient satisfaction with nursing care, conducted. by Miss.BIJITHA.L.B,

1 'st yr Diploma in Neuro Nursing, of SCTIMST, Trivandrum. I understand that there

will not be any change in the nature of care I receive and the data given by me will be

kept confidential, will be used only for research purpose.

( Signature of the participant

Date: ............... .

62

APPENDIX: 5

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