Contributing Factors for Perceived Satisfaction with Nursing Care among Inpatients in General Wards

—–————————————————————————————————————————————— ABSTRACT: Introduction: Patients' perceived satisfaction with quality of care may affects health outcomes. Patients who are satisfied with their nursing care are more likely to follow treatment and consequently to have better health outcomes. It encourages them to behave in a healthy way after discharge, and positive rating of service quality seems to be correlated with no hesitation about revisiting the same hospital ward in time of need. This study was done to identify the contributing factors for perceived satisfaction with nursing care among inpatients in general wards in Lumbini Medical College. Methods: A descriptive cross sectional study was conducted in Lumbini Medical College Teaching Hospital throughout the month of August, 2015. A total of 60 heterogeneous study population from three different wards (Medical, Surgical, and Orthopedics), who gave consent for participation, were included using non-probability convenient sampling technique. Nepalese version of Newcastle Satisfaction with Nursing Scale (NSNS) was used to measure the satisfaction score. Results: There were a total of 60 respondents with mean age of 30.08 years (SD= 9.72). Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually. However, the relationship was not significant when adjusted for other variables by linear regression. Conclusion: Majority of respondents were satisfied with the quality of nursing care. Male, duration of hospital stay, and number of hospital admission had a significant relation with the satisfaction score when calculated individually. The nurses should know the factors influencing patients' satisfaction and work on those to improve the quality of nursing care.


INTRODUCTION:
There has been increasing interest in patients' satisfaction with nursing care in the past few decades.Patient satisfaction with nursing care is considered an important factor in explaining patients' perceptions of service quality. 1 Patient satisfaction has been used as an indicator of quality services provided by health care personnel.The most important predictor of patients' overall satisfaction with hospital care is particularly related to their satisfaction with nursing care.Patient satisfaction is defined as the extent of the resemblance between the expected quality of care and the actual received care. 2,3Patient satisfaction is defined as the extent of the resemblance between the expected quality of care and the actual received care.5][6][7] Patients' satisfaction is now a critical variable in any calculation of quality or value and therefore in the assessment of corporate/individual accountability.It is a legitimate and important measure of quality of care. 6,8,9ealth care providers in developing countries seem to be ignoring the importance of patients' perceptions of health services. 10Thus, a scarcity of literature made it difficult to find studies examining patients' satisfaction with nursing care in developing countries.Quality of health care in developing countries usually is defined by health care providers from technical perspective.Recent literature however, emphasizes the importance of patients' perspective in assessing quality of health care. 10It's the patient's perspective that increasingly is being viewed as a meaningful indicator of health services quality and may, in fact, represent the most important perspective. 11his study was done to identify the contributing factors for perceived satisfaction with nursing care among inpatients in general wards of Lumbini Medical College Teaching Hospital, a 700 bedded referral centre in a developing country.

METHODS:
A descriptive cross sectional study was conducted in Lumbini Medical College Teaching Hospital throughout the month of August, 2015.A total of 60 inpatients from three different departments (Medical, Surgical, and Orthopedics), who gave consent for participation and spent over night or more in the hospital wards were included using non-probability convenient sampling technique.
Newcastle Satisfaction with Nursing Scale (NSNS) was translated into its Nepalese version by repeated forward and backward translation till a panel of expert in Medical College was satisfied by the results. 5,12Pretesting was done by another panel of expert from the Nursing Department.This scale consists of 19 items and each item was to be scored on a five point Likert scale ranging from "very unsatisfied" carrying a value of one to "very satisfied" carrying a value of five.
All the respondents were detailed about the nature and objective of the study and they were insured confidentiality of the information and also were allowed to leave any questions unanswered, if they had any doubts or were uncomfortable.Then, they were asked to rate their degree of satisfaction on the scale.Demographic data were collected in the same setting.Data were entered into Microsoft Excel 2013 and then analyzed with SPSS 21. Results was presented as mean, standard deviation, frequency and percentage.Mean between variables was analyzed with t-test and correlation with Karl Pearson correlation coefficient.Linear regression was applied to evaluate relationship between variables adjusted for other variables.

RESULTS:
There were a total of 60 respondents with a mean age of 30.08 yr (SD=9.72).Mean age of male was 31.06 yr (SD=10.35)and female was 28.89 yr (SD=8.93)and the difference was not significant (t=0.86,df=58, p=0.4).Majority of them (n=24, 40%) were of age group of 30 to 40 years.A Pearson correlation coefficient was calculated for the relationship between participants age and satisfaction score.A weak negative correlation was found (r = -0.27,p=0.04) indicating a significant linear relationship between the two variables.Younger patients tend to be more satisfied with the nursing care.
There were 44 (73.3%) literate participants and the remaining 16 (26.7%)were illiterate.The mean score of satisfaction in literate was 3.14 (SD=0.11)and in illiterate was 3.19 (SD=0.13).This difference was not significant (t=1.48,df=58, p=0.15)  Mean hospital stay of the patients was 2.07 days (SD=3.1)with range of one to nine days.Correlation between days of hospital stay and satisfaction score showed a negative significant linear relationship (r = -0.32,p=0.01).Patients who stayed longer in hospital tend to be less satisfied with the nursing care.Other results are shown in Table 1.
Multi-linear regression was applied to estimate the relationship between several

DISCUSSION :
Patients' satisfaction is an important quality outcome indicator of health care in the hospital setting.The measurement of patients' satisfaction with nursing is particularly important since nursing service is often a primary determinant of overall satisfaction during a hospital stay. 13Moreover, satisfied patients usually trust their health care providers, and as a return they comply with medical and nursing orders.Eventually the patients' healing process is enhanced and at the same time, they disseminate their experiences to others which increase the number of patients who uses the services.If not satisfied, the opposite may happen. 14e finding of our study is in consistent with study done by Jafar A. et al. in Jordan and almost identical to another study done by Amerbyoun A. et al. in Iranian Military Hospitals. 15,166][17][18] While there was no significant correlation between gender and patient satisfaction in a study by Wallin et al., 18 similar to our finding, another study by Ottosson et al. reported higher satisfaction among male than female. 19Moreover, these findings were also similar to that of Mustard et al. who worked for improving patients' satisfaction through the consistent use of scripting by the nursing staff and pointed out that demographic characteristics such as sex and race seem to be unimportant. 20resent study reveals that there is no significant relation between the education status of patients and their satisfaction score in contrast to that by Wallin et al. who reported that less educated patients had higher satisfaction. 18In that study, 87% of respondents, who were illiterate, were fully satisfied compared to 56% who had diploma and above.This finding is also similar to the study by Quinn et al. in which less educated patients tended to have higher satisfaction than the patients with higher education. 21n a study by Wallin et al., 18 majority (66.7%) of respondents who had not had a history of previous hospital admission were fully satisfied compared to 10% of those who were admitted previously at least once to hospital.In our study, we found comparable satisfaction score in these two group of patients.

CONCLUSION:
This study highlights the contributing factors that influence the patient's satisfaction with nursing care among inpatients.Male, duration of hospital stay, and number of hospital stay had a significant relation with the satisfaction score when calculated individually.The nurses should know the factors influencing patients' satisfaction and work on those to improve the quality of nursing care.

Table 1 :
Some variables of the respondents.Koirala M. et al.Contributing factors for perceived satisfaction with nursing care.independentvariables with satisfaction score.Relationship between none of the variables was statistically significant with the satisfaction score when adjusted for other variables.The result is shown in Table2. jlmc.edu.np

Table 2 :
Adjusted coefficient of regression analysis