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Puch-Ku GF, Uicab-Pool GA, Ruiz-Rodríguez M, Castañeda-Hidalgo H. Dimensiones del cuidado de enfermería y la satisfacción del paciente adulto hospitalizado. Rev Enferm Inst Mex Seguro Soc. 2016;24(2):123-8.

Dimensions of nursing care and adult inpatient satisfaction

Gladis Faustina Puch-Ku,¹ Gloria de los Ángeles Uicab-Pool,² Myriam Ruiz-Rodríguez,³ Hortensia Castañeda-Hidalgo⁴

¹Escuela de Enfermería del Instituto Mexicano del Seguro Social, Mérida, Yucatán, México; ²Facultad de Enfermería, Universidad Autónoma de Yucatán, Mérida, Yucatán, México; ³Departamento de Salud Pública, Universidad Industrial de Santander, Santander, Colombia; ⁴Facultad de Enfermería, Universidad Autónoma de Tamaulipas, Tampico/Ciudad Madero, Tamaulipas, México

Correspondence: Gladis Faustina Puch-Ku

Email: gladis.puch@imss.gob.mx

Received: July 31^st 2015

Judged: January 27^th 2016

Accepted: March 8^th 2016

Abstract

Introduction: Measuring patient satisfaction with nursing care, according to Donabedian, is an indicator of quality, is a set of concepts and attitudes that builds on their expectations and satisfaction of their needs.

Objective: To determine the relationship between sociodemographic characteristics and type of disease of adults hospitalized with the satisfaction level of nursing care in internal medicine Regional General Hospital No. 12 Lic Benito Juárez García.

Methodology: Quantitative, observational, correlational and cross-sectional study used the “Patient satisfaction with nursing care” instrument in a sample of 296 patients of an institution of secondary care in the city of Mérida, Yucatán.

Results: The overall level of patient satisfaction compared with nursing is 70.1; the dimension of care was assessed more negatively averaging 59.6 and dimension of education was evaluated more positively with an average of 90.3.

Conclusions: We observed no association between sociodemographic characteristics of age, sex, marital status, education, hospitalization area and type of diagnostic nursing care of hospitalized patients in the areas of medicine men, women and mixed in a second unit level Mexican Social Security Institute. But if there was a relation with socioeconomic status and employment status regarding patient satisfaction with nursing care.

Keywords: Patient satisfaction; Nursing care; Quality of health care

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Introduction

In recent years, there has been a growing interest in the nurse, patient, and family relationship as central to the perception of care.¹

The quality of nursing care is evaluated from the patient's perspective. This provides information that benefits the service provider organization, the direct providers, and the patients themselves.²

According to Avedis Donabedian, measuring patient satisfaction with nursing care is an indicator of quality. User perception and attitudes are concepts that build their expectations and the satisfaction of their needs.³

The quality of nursing care is a term known since the time of Florence Nightingale, who postulated that "the laws of the disease may be modified by comparing treatments with results" and if tools are used to measure care systems and the effectiveness of care in hospitals.⁴

To achieve quality of services in Mexico, the Sistema Integral de Calidad en Salud (SICALIDAD) was established (within the Programa Nacional de Salud), whose components were granting effective and safe services that meet user expectations, and regularly measuring patient satisfaction.⁵

At the international level studies in Venezuela, Jordan, and Finland showed hospitalized user satisfaction and thus the optimum quality of care provided by nursing staff.^6-8 In this same area, Mrayyan conducted a study that included three aspects: 1) job satisfaction of nurses, 2) patient satisfaction, and 3) the quality of nursing care. The studies concluded that there is an interrelationship between the three aspects mentioned above and therefore in the quality of attention.⁹

According to Donabedian, cited by Hernández, health care quality can be measured in three dimensions: structure, process, and results.10 The author argues that the care process is essential for quality and this must be explicit; therefore, it is essential to measure to compare, to learn, and to improve. Donabedian establishes the need to provide quantity with quality and quality with efficiency, these two concepts being inseparable.¹¹

It is worth mentioning that the Nursing Care Quality Questionnaire was applied in a study on the perception of the quality of nursing care in inpatients, and that they have a positive perception of this care. The study concludes that there is a relationship between the perception of nursing care and the patients’ educational level.¹² 

Similarly, Akin used the evaluation of the quality of nursing care in the so-called Newcastle Satisfaction with Nursing Scales (NSNS), and found that there is a relationship between the perception of nursing care and that women were more satisfied with the care received, compared with men.¹³

In Mexico, Castañeda (cited by Contreras) found that male users had a higher level of satisfaction with nursing care.⁹

In a study by Balseiro et al., the authors concluded that users rated the quality of care given by nurses good to excellent.¹⁴

One study used the Patient Satisfaction with Nursing Care Instrument designed by Hinshaw and Atwood in 1982, called PSI (Patient Satisfaction Instrument), which was translated, adapted, and validated by Acevedo et al. This study concluded that the higher the patient's age, the greater their satisfaction with nursing care. And the best way to evaluate nursing care is the satisfaction that patients receive during their hospital stay.

Castaneda et al. conducted a study on the relationship of sociodemographic characteristics of users and their level of satisfaction with nursing care. They observed a relationship between the variables studied in three secondary public institutions. The users most satisfied with nursing care were male and those with more schooling. No correlation was found between age and level of satisfaction. The trust inspired by the nursing staff showed greater influence for the user to perceive themselves as satisfied.¹⁵  

There are also studies with negative results, like that done by Ponce et al., cited by Contreras. The authors found that half of patients assessed the quality of nursing care as insufficient.

Similarly, Gutierrez et al. found that nurses did not respect patient privacy (51%), that patients were not addressed by name or surname (32%), and that patients also did not know the name of the nurse who took care of them (49%).¹⁶

Nursing should be concerned about researching the quality of care it provides, through the perception of patients, and generating changes in care practice.¹²
Nurses’ theoretical knowledge, practical experience, and sensitivity are the basis for identifying the needs of hospitalized patients and thus providing comprehensive and quality care.

Thus, knowing patient satisfaction with nursing care during their hospital stay, and if the result is positive, would support quality care, at least of the hospital nursing services studied; it also strengthens patient trust in the care nurses provide in the health-disease process for their early recovery and reintegration into the family.

The elderly population is increasing and they are the ones who suffer the most chronic illnesses and their hospitalizations are more recurrent.

Among the main problems facing the elderly is the loss of functional, emotional, and cognitive abilities, in addition to chronic degenerative diseases.¹⁷

Today’s society is increasingly demanding regarding the quality of care received in health services, so the Comisión Nacional de Arbitraje Médico gives the user the opportunity to freely express their dissatisfaction and disagreement with the attention received.¹⁸

The 2012 Encuesta Nacional de Salud y Nutrición examined the social response to the population’s health problems; it obtained as a result at the national level that 80.6% of users of all hospital services perceived service quality as very good or good. This ratio was 80.3 and 84.2% for 2006 and 2000, respectively. By contrast, 6% of users perceived the quality of care as poor or very poor, similar to that reported in 2006 at 6.4%, but higher than that reported in 2000 with 4.2%. In 2012, 13.4% of users of hospital services said they would not return to the same institution that they attended; this proportion was 12.7% in 2006 and 15.7% in 2000.¹⁹

The Comisión Interinstitucional de Enfermería established the Sistema de Evaluación de la Calidad de los Servicios de Enfermería, managed using indicators, which made it possible to control the risk of unnecessary harm to the patient and identify its perception in terms of the treatment received. The indicator of decent treatment by nursing is one of the first three positioned for the evaluation of professional nursing work in their technical and interpersonal dimension. It is defined as "the patient or relative’s perception of treatment and care provided by nurses during their hospital stay".²⁰

The quality of nursing services is seen as timely, personalized, humanized, continuous, and efficient care provided by nurses, according to standards defined for a competent and responsible professional practice, in order to achieve customer and service provider satisfaction.²¹

For its part, the Instituto Mexicano del Seguro Social (IMSS) evaluates the quality of nursing care through the indicator of decent treatment, which is rated by patients satisfactorily; however, the result is not reliable, because the patient does not respond freely, as they are still hospitalized and the people providing the questionnaires are the same nurses who work at the hospital. Therefore, to avoid retaliation in care, there is an assumption of not responding truthfully. There are also comments from patients who report that the nursing staff does not give continuity to the care provided in the three shifts during their hospital stay.

This study aims to determine the relationship between the dimensions of nursing care with the satisfaction level of hospitalized adult patients.

Methodology

This correlational descriptive study was conducted in a secondary care hospital in Merida, Yucatan. The study population was all patients discharged from Internal Medicine (approximately 300 patients per month are discharged). The sample was determined by random unrestricted sampling taking as the frame of reference the list of all patients discharged from the Internal Medicine service that met the inclusion criteria; the approximate sample size was 277 patients.

The Patient Satisfaction with Nursing Care Instrument was used (PSI: Patient Satisfaction Instrument, Hinshaw and Atwood [1982], translated into Spanish by Hortensia Castañeda Hidalgo with permission from Dr. Hinshaw). This is a self-administered instrument; it consists of an identification form that includes sociodemographic characteristics: age, gender, education, marital status, whether the patient works or not, the days hospitalized, their monthly household income, if they have dependents, as well as the items and services that they have in their home.

This instrument consists of 23 items that measure three dimensions: professional technical care (7 questions), trust (11 questions), and patient education (5 questions). The PSI was applied to the patient at the time of hospital discharge, but informed consent was requested previously. This study was done in the Internal Medicine service of said hospital.

It included patients over 18 with more than three days of hospitalization and who do not have altered consciousness.

The exclusion criteria considered under-age patients, those under sedation, with language disorders, those whose health prevented them from concentrating, and those diagnosed with any psychiatric illness.

This research protocol was submitted for evaluation by the Committee for Research and Bioethics at the Facultad de Enfermería at the Universidad Autónoma de Yucatán and the Research Committee of the Instituto Mexicano del Seguro Social. The study met the requirements of both institutions to begin data collection.

The data analysis was based on descriptive statistics; frequency distribution tables, percentages, and graphs were used. Comparative processes were conducted by t-test for independent samples for the variables of sex and employment status; analysis of variance was used for the variables of marital status, education, and socioeconomic level; and, finally, the relationship was explored between the variables of age, length of stay, discharge diagnosis, and satisfaction with nursing care. Pearson’s correlation coefficient or Chi-squared test of independence were used according to the nature of the variables. All this was done with the help of SPSS, version 15, and a significance level alpha of 0.05 was applied.

Results

Sociodemographic characteristics

Of 296 patients enrolled in the study, 144 (48.6%) were male, while 152 (51.4%) were female; the average age was 59 years six months and the maximum and minimum age values were 93 and 19, respectively.

It was found that 79.4% of patients had at least one of the levels of basic education (elementary, middle, or high school, these levels being sequential). Moreover, 93 participants worked (31.4%). As for marital status, it was observed that 66.2% were married.

Regarding patients’ discharge diagnosis, it was determined that 23.3% (69) had an acute condition and 76.7% (227) had a chronic condition. The average length of patients’ hospital stay was 10 days.

In order to determine the participants’ socioeconomic status, a cluster analysis was performed (based on active services, such as home appliances that the patient had), which classified patients into three integrated groups. It was revealed that the group of 13 patients corresponded to lower-middle socioeconomic status, the group of 88 patients had upper-middle socioeconomic status, and that 195 patients had low status. 

Satisfaction with nursing care

It is worth mentioning that the Satisfaction with Nursing Care Instrument measures three dimensions: 1) technical and professional care, 2) trust, 3) patient education.

Table I presents the indicator value in a scale from 0 to 100; calculated for each dimension and the instrument in general, the level of overall patient satisfaction regarding nursing care was 70.1; the dimension of care was evaluated the most negatively for the other two dimensions, averaging 59.6. It could also be observed that the dimension of education was assessed more positively with an average of 90.3.

In addition, patients were classified by their level of satisfaction with nursing care, thus obtaining the distribution of frequencies and percentages: dissatisfied 46.3% (137), satisfied 44.6% (132), and very dissatisfied 9.1% (27). We note that the percentage of patients who were dissatisfied and very dissatisfied is slightly less than 50%.

In the first dimension, professional technical care, we note most issues were assessed positively by the patient, except for the fact of providing good advice (Table II). In the second dimension, trust, which refers to the interpersonal relationship between nurse and patient, most aspects of trust in nurses were evaluated well, except with regard to care and kindness, the confidence to talk to them about problems, and excessive paperwork (Table III).

Patient education: the third dimension was presented similarly. In this we see that the only aspect which was poorly rated by patients was the explanation that the nurse provides about tests to be made on the patient. In the Medicine service, men had the highest averages in the dimension of patient education, with 91 points, and patient satisfaction with nursing care with 70.7 points (Table IV). There was no significant difference when comparing the level of patient satisfaction based on acute and chronic conditions (Table V).

Moreover, the relationship between schooling and the level of patient satisfaction with nursing care was explored through the Chi-squared test for independence. We found no relationship between these variables (Chi-squared = 2.62, p > 0.05). Similarly the relationship between marital status and satisfaction was explored, showing independence between these variables (Chi-squared = 4.31, p > 0.05). We also found no relationship between sex and patient satisfaction with nursing care (Chi-squared = 1.28, p > 0.05). By performing the same procedure to explore the relationship with employment status, meaning whether or not the patient works and satisfaction with nursing care, we find that there is a relation between these variables (Chi-squared = 31.63, p < 0.05).

Through this same test we studied the relationship between socioeconomic status and satisfaction. We found that there is a relation between these variables (Chi-squared = 13.08, p < 0.05). Similarly, studying the relationship between the number of days of hospitalization and satisfaction through Pearson’s correlation coefficient, we found no relationship between these variables (r = 0.003, p > 0.05).

Finally, with a similar purpose but through Pearson’s correlation coefficient, we determined that there is no relationship between patient age and satisfaction with nursing service (r = 0.007, p > 0.05).

Discussion

As for the central results of this study, it is noteworthy that overall patient satisfaction with nursing care was 70.1. Of the 296 patients studied, 53.6% were satisfied with nursing care. Furthermore, the best qualified dimension was education (90.3%), followed by trust (67.7%) and, finally, care (59.6%).

The level of satisfaction in this study is lower than other studies.^15,22 In the study on the quality of care in inpatient and its influence on user satisfaction, it was reported that 81.3% of patients are very satisfied. Meanwhile, in a study in three hospitals, Acevedo15 found that patients were satisfied with nursing care.

In this study we note that of the five sociodemographic variables related to satisfaction with nursing care, only employment status and socioeconomic status were statistically significant (p < 0.05); the other three variables (education, sex, and age) were not significant. These data were related to the results obtained by Blanco et al.; their study found no relationship with satisfaction and sociodemographic characteristics such as age, sex, and schooling.²³

The result of the education dimension in this study had an average of 91%, so it was rated best by men. Similarly, men had a better overall average satisfaction with nursing care. Similarly, studies referenced, like that of González, reported that sex, educational background, and knowledge by the nursing staff are linked to patient satisfaction, and that women with higher academic levels were more dissatisfied with care.²⁴

On the other hand, in this study, no significant differences were found regarding patient satisfaction between the hospitalization area and the type of condition. In the latter aspect, patients with chronic disease were expected to have a significant level of satisfaction with nursing care, given that these patients have had hospital readmissions for their chronic condition.

Similarly, there was no relationship between schooling and the level of patient satisfaction with nursing care. It is worth mentioning that the result is similar to Ortega’s study, which reported that educational level had no effect on patients’ perception of the quality of nursing care.²⁴ This author’s results differ with Acevedo and Castañeda, whose findings noted that the more schooling the user has, the greater satisfaction with nursing care.¹⁵

Conclusions

We note that there is no relationship between the sociodemographic characteristics of age, sex, marital status, education, hospitalization area, and type of diagnosis with the nursing care of hospitalized patients in the areas of women’s medicine, men’s medicine, and mixed medicine in a secondary care unit of the Instituto Mexicano del Seguro Social. Instead, there was a relationship between socioeconomic status and employment status and patient satisfaction with nursing care.

This study showed that the dimensions of care and trust were rated worse. These are the pillars of the work of professional nurses, and patients express that they expect a lot of these personnel in these dimensions. This is worrying, since they are two dimensions that characterize nursing staff and that distinguish the profession. It is essential to intervene in a positive way to strengthen the holistic sense that characterizes this profession with improvement strategies for the benefit of the profession and the patients themselves who are most in need at this stage of vulnerability from disease.

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