ANALISIS JURNAL MUTU PELAYANAN KEPERAWATAN

JURNAL KEPUASAN PASIEN TERHADAP ASUHAN KEPERAWATAN UNTUK

MENINGKATLAN MUTU PELAYANAN KEPERAWATAN

Disusun oleh:

NI LUH NONI ANDAYANI

P1337420617071

3A3-REGULER KEPERAWATAN SEMARANG

JURUSAN KEPERAWATAN

PROGRAM STUDI SARJANA TERAPAN KEPERAWATAN SEMARANG

POLITEKNIK KESEHATAN KEMENTRIAN KESEHATAN SEMARANG

TAHUN AJARAN 2020

 JURNAL KEPUASAN PASIEN TERHADAP ASUHAN KEPERAWATAN UNTUK
MENINGKATLAN MUTU PELAYANAN KEPERAWATAN

JURNAL 1 JURNAL 2 JURNAL 3

JUDUL A Study to Assess the Patient satisfaction Patient Satisfaction with

Level of Patient with the quality of Services Provided at
Satisfaction on Quality of nursing care patient
Night and the
Nursing Care Among
satisfaction with Assessment of the
Patients in SRM General
nursing care Quality of Care
Hospital, Kattankulathur
in the Hospital

PENELITI Akilandeswari konduru, Anita Karaca and Anna Fafara, Malgorzata

DAN TAHUN T.Sujatha, Judie. A Zehra Durna, Florence Marc, Krzysztof Fudali,
Nightingale Hospital Małgorzata Gajdek and
SRM College of Nursing,
Pawel Januszewicz
SRM University, School of Nursing,
Kattankulathur, Istanbul Bilim Institute of Nursing and
Kancheepuram District- University, Istanbul, Health Sciences, Faculty
603203, Tamil Nadu, Turkey of Medicine, University
India of Rzeszow, Poland
Tanggal 3 December
Tanggal 31st October, 2018 Tahun 2018
2015

TUJUAN The main aim of the To evaluate patients’ Untuk menentukan

study was to assess the satisfaction with the kepuasan pelayanan
level of patient quality of nursing care keperawatan yang
satisfaction on quality of and examine diberikan pada malam
nursing care among hari.
associated factors.
patients in SRM general
hospital,Kattankulathur. Data were collected
using “Patient
 1. Untuk menilai Satisfaction with
tingkat kepuasan Nursing Care Quality
perawatan di
Questionnaire” with a
antara pasien
total of 19 items, and
2. Untuk
a questionnaire
mengasosiasikan
designed to record
tingkat kepuasan
sociodemographic
perawatan di
antara pasien characteristics and

dengan yang medical histories

dipilih variabel between January 1–

demografis. May 31, 2015.

DESAIN Descriptive study was A cross‐sectional, Penelitian ini dilakukan

used. The study was descriptive survey di dua Rumah Sakit
conducted with 100 study. The sample was Klinik umum kota
samples using non composed of 635 Rzeszów (Rumah Sakit
probability - Consecutive patients discharged Regional Klinis No.1
sampling techniques. from a private dinamai setelah Fryderyk
Data collection was done hospital. Chopin di Rzeszów and
for a period of 15 days. the Clinical Rumah Sakit
The study was conducted No. 2 dinamai Ratu Saint
at SRM general hospital Jadwiga di Rzeszów) di
in kattankulathur. klinik yang dipilih secara
acak dengan konservatif
dan karakteristik bedah
dari 1 Januari 2016
hingga 31 tahun 2016.
Partisipasi di dalamnya
bersifat sukarela dan
anonim. Pembelajaran
Populasi terdiri dari
pasien yang usia legal,
setuju untuk diperiksa,
menghabiskan
setidaknya dua malam di
klinik dan membutuhkan
bantuan dalam
perawatan diri selama
tugas malam (keparahan
penyakit dan sejauh
mana perawatan yang
diperlukan tidak
ditentukan). Kriteria
pengecualian berarti
bahwa pasien tidak
diizinkan untuk
berpartisipasi dalam
penelitian ini dan
kesadaran pasien
terganggu. Perawat di
awal shift malam mereka
memilih pasien untuk
berpartisipasi dalam
sebuah penelitian. Pada
gilirannya, lembaga
survei (tidak terkait
secara profesional
dengan klinik yang
dipilih secara acak serta
mereka yang bukan
karyawan dari rumah
sakit tertentu) melakukan
 penelitian di pagi hari.
Itu proyek penelitian
menerima pendapat
positif tentang Bioetika
Komite di Universitas
Rzeszow 2 Desember
2015. Resolusi No.
4/12/2015. Dalam survei
pendapat pasien,
metode survei diagnostik
digunakan dua standar
kuesioner dan survei
kuesioner asli

HASIL Penelitian ini telah Kepuasan Studi, 92% pasien

KEKUATAN dilakukan dengan pasien adalah kriteria menyatakan puas dengan
pandangan konkret untuk evaluasi perawatan di malam hari,
mengidentifikasi tingkat kualitas asuhan dan aspek terpenting
deskriptif kepuasan keperawatan dalam pendapat mereka
pasien terhadap asuhan (Alhusban & adalah ketersediaan
keperawatan yang Abualrub, 2009; perawat pada tugas
diberikan oleh tenaga Shinde & Kapurkar, malam. Meningkatkan
kesehatan di rumah sakit 2014). Ini kualitas layanan
umum SRM. hasil memberikan informasi keperawatan adalah hal
menunjukkan bahwa penting untuk manajer yang berkelanjutan
66% dari mengatakan layanan kesehatan tantangan dan masalah
puas terhadap asuhan dengan menyediakan yang berkelanjutan yang
keperawatan yang sumber daya penting harus diselesaikan.
diberikan oleh tenaga untuk proses asuhan Perawatan ditandai tidak
keperawatan di rumah keperawatan agar hanya dengan
sakit SRM. Mayoritas asuhan yang diberikan mengambil tindakan
dari mereka 66 (66,0%) berkualitas, yang diarahkan pada
memiliki kepuasan yang meningkatkan kualitas kesehatan, otonomi dan
baik, 34 (34,0%) di layanan keperawatan penilaian diri kegiatan
antaranya memiliki melalui identifikasi profesional, tetapi juga
kepuasan sedang dan bidang perencanaan dengan berusaha untuk
tidak ada yang tidak dan implementasi memastikan kualitas
puas. Temuan penelitian dengan pelatihan yang pelayanan yang baik.
ini konsisten dengan dilakukan. Evaluasi Perawat sebagai
penelitian yang perawatan melibatkan profesional yang
dilakukan oleh Lindgren pendefinisian tujuan menyediakan layanan
et al (2011) melakukan perawatan, medis harus tetap
studi prospektif pada pemantauan input menjaga kualitas
instrumen pelayanan kesehatan, mengukur pelayanan yang
keperawatan untuk sejauh mana hasil diberikan walaupun pada
mengukur kualitas yang diharapkan telah malam hari agar pasien
asuhan keperawatan di dicapai dan menilai memiliki kepuasan yang
bidang medis dan bedah sejauh mana baik atas asuhan
bangsal di rumah sakit di konsekuensi bahaya keperawatan malam
Swedia. Tujuan kedua dari intervensi yang yang diberikan.
dari penelitian ini adalah diberikan Kepuasan
untuk mengasosiasikan pasien dengan asuhan
level kepuasan perawatan keperawatan telah
di antara pasien dengan menjadi prediktor
mereka variabel paling penting dari
demografis yang dipilih. kepuasan keseluruhan
Karena itu hipotesis RH1 perawatan rumah sakit
menyatakan bahwa ada dan tujuan penting
yang signifikan organisasi kesehatan.
hubungan antara tingkat Mengukur kepuasan
kepuasan asuhan pasien dengan asuhan
keperawatan antara keperawatan bisa
pasien dan variabel efektif dalam
demografis yang mereka meningkatkan layanan
pilih. Temuan penelitian keperawatan yang
ini konsisten dengan berkualitas dengan
penelitian yang memfasilitasi
dilakukan oleh Mrayyan penciptaan standar
et al (2006) melakukan perawatan sementara
deskriptif crosssectional untuk memantau hasil.
desain komparatif. Perawat memiliki
Hasilnya menunjukkan peran sentral dalam
pelayanan keperawatan menawarkan
yang diberikan perawat dukungan emosional
baik dan tidak puas dan psikologis untuk
dalam pekerjaan mereka, pasien dan keluarga
melaporkan kepuasan mereka di semua
mereka terhadap perawat pengaturan, seperti
yang bekerja di bangsal mendukung pasien
yaitu sedikit lebih baik melalui diagnosis dan
dibandingkan perawat memastikan
yang bekerja di unit perawatan yang
perawatan kritis. Pasien optimal diberikan
melaporkan bahwa kepada mereka. Selain
mereka cukup puas, dan pemberian perawatan
kepala perawat teknis, perawat harus
melaporkan bahwa memiliki pengetahuan
perawat biasanya profesional yang
(praktis) memberikan berkualitas, sikap dan
asuhan keperawatan yang keterampilan,
berkualitas tinggi. menyediakan
dukungan informasi,
emosional dan praktis.
Itu sebabnya kepuasan
pasien harus diukur
terus menggunakan
instrumen penilaian
yang valid dan andal
untuk menilai kualitas
perawatan,
mengidentifikasi
variabel yang
memengaruhi
perawatan dan
menentukan item
mana yang harus
diprioritaskan dan
yang membutuhkan
perubahan dalam
layanan berdasarkan
respons pasien.
Pengukuran instrumen
penilaian yang baik
faktor-faktor yang
menentukan kepuasan
pasien harus
dikembangkan untuk
meningkatkan kualitas
layanan keperawatan.
Karena itu, temuan
manajemen
keperawatan
penelitian harus
 digunakan sebagai
indikator kontribusi
dibuat dengan
menyusui untuk
proses perawatan
pasien dan ini bisa
membantu kemajuan
profesi dalam hal
ilmiah

IMPLIKASI Kesimpulan dari Hasil penelitian 1. Kualitas layanan

penelitian ini adalah menunjukkan bahwa yang diberikan oleh
pandangan pasien telah perawat harus perawat di malam
menjadi elemen penting memberi tahu pasien hari mempengaruhi
dalam evaluasi mutu tentang masing- penilaian
pelayanan perawatan. masing aplikasi dan keseluruhan kualitas
Perawat harus tahu apa prosedur dan layanan medis,
faktor yang memberikan seperti dibuktikan
mempengaruhi kepuasan penjelasan yang dengan hubungan
pasien, salah satunya diperlukan tentang antara kepuasan
adalah meningkatkan penyakit, diagnosis pasien dengan
kualitas pelayanan dan perawatan untuk layanan yang
kesehatan. Berikut ini memastikan kepuasan diberikan pada
adalah direkomendasikan dan pasien penyediaan malam hari dan
untuk meningkatkan asuhan keperawatan penilaian kualitas
kualitas kinerja berkualitas tinggi. perawatan di rumah
keperawatan antara Hasilnya juga sakit.
Perbaikan lingkungan menunjukkan bahwa
2. Kepuasan pasien
kerja rumah sakit dan perawat harus
adalah ukuran
mungkin strategi biaya memberikan
terpenting tindakan
yang relatif rendah untuk perawatan dalam
entitas perawatan
meningkatkan kualitas kerangka rasa hormat, kesehatan yang
dalam perawatan rumah bantuan dan berkualitas.
sakit dan untuk kesopanan terhadap
3. Analisis penilaian
meningkatkan kepuasan pasien dengan
yang sangat baik
pasien agar mencapai menekankan
dari pengalaman
mutu pelayanan pentingnya
pasien dan kepuasan
keperawatan baik. komunikasi. Selain
dengan asuhan
itu, pasien sangat puas
keperawatan
dengan kualitas
menunjukkan
keseluruhan
kebutuhan untuk
perawatan di rumah
menekankan
sakit, perawatan dan
pentingnya layanan
melaporkan hal itu
yang diberikan oleh
mereka akan
perawat di malam
merekomendasikan
hari dari perspektif
rumah sakit ini kepada
pasien (perasaan
keluarga dan teman-
subyektif,
teman mereka.
kebutuhan, harapan)
Manajer perawat
dalam kegiatan pro-
dapat berkontribusi
kualitasnya.
pada penyediaan
layanan berkualitas 4. Asuhan keperawatan

dengan mengevaluasi dalam hal fungsi

kepuasan pasien perawatan dan

dengan perawatan terapeutik di malam

untuk pengembangan hari adalah yang

dan peningkatan paling dihargai oleh

asuhan keperawatan pasien, terutama

berdasarkan pada dalam hal itu

pasien harapan. Data harapan terhadap

yang diperoleh dari perawat sebagai:

evaluasi ini harus kemampuan untuk
dipertimbangkan mengamati,
dalam menentukan kemampuan untuk
persyaratan pelatihan berbicara dan
untuk perawat dan memenuhi
dalam layanan keinginan mengenai
program pelatihan istirahat malam dan
harus diselenggarakan ketekunan dalam
untuk melakukan
mengembangkan perawatan.
pengetahuan perawat
5. Semua kegiatan
dan keterampilan
yang terkait dengan
dalam perencanaan
penerimaan dan
perawatan. PSNCQQ
menginap pasien
dianggap berguna
dalam entitas medis
untuk administrator
mereka
perawat dalam
mempengaruhi
meningkatkan asuhan
penilaian kualitas
keperawatan.
layanan yang
diberikan, dan
survei kepuasan
pasien dapat
digunakan sebagai
metode untuk
menilai efektivitas
keperawatan
manajemen staf
(dalam lingkup
pengenalan
modifikasi).
 6. Harapan pasien
relatif terhadap staf
perawat terus-
menerus tumbuh dan
mereka jelas
diartikulasikan di
bidang layanan
disediakan di malam
hari.

ANALISI JURNAL

Pada jurnal 1 dikatakan tingkat kepuasan pasien dengan asuhan keperawatan adalah
indikator penting dari kualitas asuhan yang diberikan di rumah sakit. Putaran klinis keperawatan
memungkinkan perawat untuk berinteraksi dengan pasien, merespons kekhawatiran mereka, dan
memodifikasi kondisi yang tidak memuaskan. Lebih tepatnya, ronde keperawatan reguler
memberikan kesempatan untuk mengidentifikasi dan memenuhi kebutuhan pasien melalui
prosedur keperawatan aktif. Meningkatnya komunikasi perawat-pasien dapat meningkatkan
kepuasan mereka dengan perawatan. Penelitian dari jurnal 1 bertujuan untuk menentukan
dampak putaran keperawatan klinis reguler pada tingkat kepuasan pasien. Organisasi Kesehatan
Dunia (WHO) (2009) dan Dewan Perawat Internasional (ICN) (2006) menyatakan bahwa tujuan
keseluruhan adalah kesehatan yang setinggi mungkin untuk semua orang, dan memberikan
perawatan berkualitas tinggi adalah satu pendekatan untuk mencapai tujuan ini. Pernyataan
masalah Sebuah Studi untuk menilai tingkat kepuasan pasien pada kualitas perawatan di antara
pasien di Rumah Sakit Umum SRM, Kattankulathur. Untuk menilai tingkat kepuasan perawatan
di antara pasien dan Untuk mengasosiasikan tingkat kepuasan perawatan di antara pasien dengan
yang dipilih. Terlihat akan ada hubungan yang signifikan antara tingkat kepuasan perawatan di
antara pasien dan variabel demografis yang mereka pilih.

Adapun hasil dari penelitian ini adalah pandangan pasien telah menjadi elemen penting
dalam evaluasi mutu pelayanan perawatan. Perawat harus tahu apa faktor yang mempengaruhi
kepuasan pasien, salah satunya adalah meningkatkan kualitas pelayanan kesehatan. Berikut ini
adalah direkomendasikan untuk meningkatkan kualitas kinerja keperawatan antara Perbaikan
lingkungan kerja rumah sakit dan mungkin strategi biaya yang relatif rendah untuk
meningkatkan kualitas dalam perawatan rumah sakit dan untuk meningkatkan kepuasan pasien
agar mencapai mutu pelayanan keperawatan baik.

Hasil dari jurnal 2 mengatakan bahwa perawat harus memberi tahu pasien tentang
masing-masing aplikasi dan prosedur dan memberikan penjelasan yang diperlukan tentang
penyakit, diagnosis dan perawatan untuk memastikan kepuasan dan pasien penyediaan asuhan
keperawatan berkualitas tinggi. Hasilnya juga menunjukkan bahwa perawat harus memberikan
perawatan dalam kerangka rasa hormat, bantuan dan kesopanan terhadap pasien dengan
menekankan pentingnya komunikasi. Selain itu, pasien sangat puas dengan kualitas keseluruhan
perawatan di rumah sakit, perawatan dan melaporkan hal itu mereka akan merekomendasikan
rumah sakit ini kepada keluarga dan teman-teman mereka. Manajer perawat dapat berkontribusi
pada penyediaan layanan berkualitas dengan mengevaluasi kepuasan pasien dengan perawatan
untuk pengembangan dan peningkatan asuhan keperawatan berdasarkan pada pasien harapan.
Data yang diperoleh dari evaluasi ini harus dipertimbangkan dalam menentukan persyaratan
pelatihan untuk perawat dan dalam layanan program pelatihan harus diselenggarakan untuk
mengembangkan pengetahuan perawat dan keterampilan dalam perencanaan perawatan.
PSNCQQ dianggap berguna untuk administrator perawat dalam meningkatkan asuhan
keperawatan.

Sedangkan berdasarkan jurnal 3 dikatakan ada banyak penelitian yang menghubungkan

sistem kerja shift (awal) pagi dan malam) dengan kualitas asuhan keperawatan yang diberikan.
Hasil penelitian sendiri termasuk aspek asuhan keperawatan di malam hari. Studi ini menilai
kepuasan pasien dengan layanan keperawatan. Berikut ini diambil diperhitungkan: kebaikan
perawat, ketekunan dalam melakukan perawatan, ketersediaan di malam hari, kecepatan reaksi
terhadap panggilan, menghormati dan menghormati martabat. Bagaimana kepuasan pasien
didasarkan pada implementasi terpilih dari layanan keperawatan di malam. Mendefinisikan
konsep kualitas layanan medis di malam bukanlah tugas yang mudah. Menganalisis sastra dunia,
bisa jadi memperhatikan bahwa dengan menggunakan alat penelitian baru, tidak hanya itu
tingkat kepuasan dengan asuhan keperawatan dinilai, tetapi juga penilaian perawatan
keseluruhan yang disediakan di lembaga tertutup. Masalah ini tidak hanya menyangkut penilaian
umum layanan yang diberikan oleh rumah sakit, tetapi juga kondisi dan pengobatan serta
kepuasan dengan kontak dengan perawat dan staf rumah sakit lainnya. Pasien-klien menilai tidak
hanya layanan medis, tetapi juga tingkat budaya pribadi, kecepatan respons terhadap panggilan,
keandalan, kejujuran, dan ketersediaan. Model keperawatan tradisional tidak masalah, yang
dianggap bahwa pasien tidak kompeten untuk memberikan pendapat tentang kualitas layanan
medis. Kesimpulan dari penelitian ini adalah :

1. Kualitas layanan yang diberikan oleh perawat di malam hari mempengaruhi penilaian
keseluruhan kualitas layanan medis, seperti dibuktikan dengan hubungan antara kepuasan
pasien dengan layanan yang diberikan pada malam hari dan penilaian kualitas perawatan di
rumah sakit.

2. Kepuasan pasien adalah ukuran terpenting tindakan entitas perawatan kesehatan yang
berkualitas.

3. Analisis penilaian yang sangat baik dari pengalaman pasien dan kepuasan dengan asuhan
keperawatan menunjukkan kebutuhan untuk menekankan pentingnya layanan yang
diberikan oleh perawat di malam hari dari perspektif pasien (perasaan subyektif, kebutuhan,
harapan) dalam kegiatan pro-kualitasnya.

4. Asuhan keperawatan dalam hal fungsi perawatan dan terapeutik di malam hari adalah yang
paling dihargai oleh pasien, terutama dalam hal itu harapan terhadap perawat sebagai:
kemampuan untuk mengamati, kemampuan untuk berbicara dan memenuhi keinginan
mengenai istirahat malam dan ketekunan dalam melakukan perawatan.

5. Semua kegiatan yang terkait dengan penerimaan dan menginap pasien dalam entitas medis
mereka mempengaruhi penilaian kualitas layanan yang diberikan, dan survei kepuasan
pasien dapat digunakan sebagai metode untuk menilai efektivitas keperawatan manajemen
staf (dalam lingkup pengenalan modifikasi).

6. Harapan pasien relatif terhadap staf perawat terus-menerus tumbuh dan mereka jelas
diartikulasikan di bidang layanan disediakan di malam hari.

Dari ketiga jurnal tersebut dapat disimpulkan bahwa kepuasan pelayanan keperawatan yang
diberikan oleh perawat berperan penting untuk meningkatkan mutu pelayanan asuhan
keperawatan. Tingkat kepuasan pasien dengan asuhan keperawatan adalah indikator penting dari
kualitas asuhan yang diberikan di rumah sakit. Pandangan pasien telah menjadi elemen penting
dalam evaluasi mutu pelayanan perawatan. Perawat harus tahu apa faktor yang mempengaruhi
kepuasan pasien, salah satunya adalah meningkatkan kualitas pelayanan kesehatan. Kepuasan
pasien terhadap pelayanan kesehatan yang diberikan tidak hanya pada pelayanan dipagi hari
melainkan juga pelayanna dimalam hari. Bagaimana kepuasan pasien didasarkan pada
implementasi terpilih dari layanan keperawatan di malam. Asuhan keperawatan yang diberikan
merupakan hal yang penting untuk meningkatkan mutu pelayanan dikarenakan keperawatan
merupakan profei yang senantiasa selalu bersama dengan pasien dan dekat dengan keluarga
pasien sehingga perlu peningkatan pemberian pelayanan keperawatan agar meningkatkan mutu
pelayanan rumah sakit.
 Available online at www.ijpcr.com
International Journal of Pharmaceutical and Clinical Research 2015; 7(6): 458-461

ISSN- 0975 1556

Research Article

A Study to Assess the Level of Patient Satisfaction on Quality of

Nursing Care Among Patients in SRM General Hospital,
Kattankulathur.
Akilandeswari konduru, T.Sujatha*, Judie. A
SRM College of Nursing, SRM University, Kattankulathur, Kancheepuram District- 603203, Tamil Nadu, India

Available Online:31st October, 2015

ABSTRACT
Background: Patient satisfaction has become increasingly popular, as a critical component in the measurement of quality
of care. The main aim of the study was to assess the level of patient satisfaction on quality of nursing care among patients
in SRM general hospital,Kattankulathur.
Method: Descriptive study was used. The study was conducted with 100 samples using non probability - Consecutive
sampling techniques. Data collection was done for a period of 15 days. The study was conducted at SRM general hospital
in kattankulathur.
Results: The result shows that 66% of good satisfaction on level of nursing care. The study concludes that improvement of
hospital work environments might be a relatively low cost strategy to improve and quality in hospital care and to increase
patient satisfaction.

Key words: patient satisfaction, quality care, nursing care

INTRODUCTION for reaching this goal. The Norwegian national action

Patient satisfaction has become increasingly popular, as
a critical component in the measurement of quality of
care. Satisfaction is one of she cares outcome for
healthcare. Satisfaction with health care is measure with
a long history in the social science. Nursing service is
one of the most important components of hospital
service. Understanding how things are looking through
the patient’s eye should be central part of quality
improvement. The level of patient satisfaction with
nursing care is an important indicator of quality of care
provided in hospitals1.
Nursing clinical rounds allow nurses to interact with
patients, respond to their concerns, and modify the
unsatisfying conditions. More precisely, regular nursing
rounds provide an opportunity to identify and fulfill
patient needs via active nursing procedures. Although
hospitals employ various methods of rounds for
hospitalized patients, the main components of all rounds
are pain management, toileting, changing position, and
environmental management–comfort. It seems that
improving nurse-patient communication can improve
patients' outcome including their satisfaction with
nursing care. Therefore, this study aimed to determine
the impact of regular clinical nursing rounds on patient
satisfaction rate2.
The World Health Organization (WHO) (2009) and The
International Council of Nurses (ICN) (2006) state that
the overall goal is the highest possible health for all
people, and providing high quality care is one approach
plan on health and social care (Ministry of Health and
Care Services, 2011) emphasises the importance of high-
quality care through patient-centred care and the
importance of building systems for patients’ to take part
in the evaluation of quality of care on a regular basis3.
The investigator was happened to see many patients
unsatisfactory level of nursing care at various hospitals
while she was undergoing training . At the same time, the
researcher also came across many difficulty during her
admission for fracture leg . So, this motivated the
researcher to take up this study on level of patient
satisfaction with quality of nursing care among patients.
Statement of the problem
A Study to assess the level of patient satisfaction on
quality of nursing care among the patients in SRM
General Hospital, Kattankulathur.
Objectives
 To assess the level of nursing care satisfaction among
patients
 To associate the level of nursing care satisfaction
among patients with their selected
demographic variables.
Hypothesis
There will be significant association between the level of
nursing care satisfaction among patients and their
selected demographic variables.
Methodology and Materials

*Author for Correspondence

 Akilandeswari et al. / A Study to Assess…

Table 1: Frequency and Percentage distribution of level of nursing care satisfaction and their demograpic variables
N=100
Demographic variables Level of satisfaction
Moderate Good
n % n % Total Chi square test
Age 21 -30 yrs 5 62.5% 3 37.5% 8
31 -40 yrs 14 50.0% 14 50.0% 28
2=10.04p=0.03*
41 -50 yrs 7 24.1% 22 75.9% 29
DF=4 significant
51 -60 yrs 6 28.5% 15 71.5% 21
> 60 yrs 2 14.2% 12 85.8% 14
Sex Male 21 46.7% 24 53.3% 45 2=5.82 p=0.02 *
Female 13 23.6% 42 76.4% 55 DF=1 significant
Marital status Single 2 16.7% 10 83.3% 12 2=1.82 p=0.17
Married 32 36.4% 56 63.6% 88 DF=1 not significant
Religion Hindu 21 29.6% 50 70.4% 71
2=2.39 p=0.30
Muslim 10 47.6% 11 52.4% 21
DF=2 not significant
Christian 3 37.5% 5 62.5% 8
Education No formal education 8 50.0% 8 50.0% 16
Primary school 12 28.6% 30 71.4% 42
Middle school 9 27.3% 24 72.7% 33 2=5.01 p=0.41
High school 3 60.0% 2 40.0% 5 DF=5 not significant
post high school diploma 1 50.0% 1 50.0% 2
Profession/house 1 50.0% 1 50.0% 2
Occupation Un employed 5 16.1% 26 83.9% 31
Unskilled 9 42.9% 12 57.1% 21
Business and others 14 42.4% 19 57.6% 33 2=9.97 p=0.08
Skilled work 3 75.0% 1 25.0% 4 DF=5 not significant
Semi profession 2 22.2% 7 77.8% 9
Profession 1 50.0% 1 50.0% 2
Income Rs.1520 4 21.1% 15 78.9% 19
Rs.1521 – 4555 12 44.4% 15 55.6% 27
Rs.4556 – 7593 12 36.4% 21 63.6% 33 2=4.36 p=0.49
Rs.7594 – 11361 4 25.0% 12 75.0% 16 DF=5 not significant
Rs.11362 – 15187 2 50.0% 2 50.0% 4
Rs. 30375 1 100.0% 1
Medical condition No 15 33.3% 30 66.7% 45 2=0.02 p=0.89
Yes 19 34.5% 36 65.5% 55 DF=1 not significant
Surgical condition No 19 34.5% 36 65.5% 55 2=0.02 p=0.89
Yes 15 33.3% 30 66.7% 45 DF=1 not significant
No. of times Only once 13 25.0% 39 75.0% 52
Hospitalized Twice 16 43.2% 21 56.8% 37
2=7.27p=0.10
3 times 5 62.5% 3 37.5% 8
DF=4 not significant
4 times 2 100.0% 2
> 4 times 1 100.0% 1
No. of days 1 - 7 days 12 23.5% 39 76.5% 51
2=7.08p=0.03*
Hospitalized 8 - 14 days 11 32.4% 23 67.6% 34
DF=2 significant
>15 days 9 60.0% 6 40.0% 15
Rating of Excellent 0 0.0% 02 100.0% 2
Hospitalization Very good 12 34.3% 23 65.7% 35 2=1.05 p=0.78
Good 15 34.9% 28 65.1% 43 DF=3not significant
Fair 7 35.0% 13 65.0% 20
*significant at P≤0.05

Research design was adopted for the study. 100 patients Description of the tool
selected in medical and surgical ward. Permission was The structured questionnaire consist of two sections
obtained from, the Chief Medical Officer, SRM general Section A
hospital at kattankulathur. Informed consent was Section A consists of demographic data which includes
obtained from the study participants, after explaining the age, sex, marital status, religion, education, occupation
nature and duration of the study. The ethical guidelines and income.
were followed throughout the study. Section B

IJPCR, November 2015 - December 2015, Volume 7, Issue 6 Page 459

 Akilandeswari et al. / A Study to Assess…

Table 2: Frequency and percentage distribution of level of satisfaction among patients N=100
Level of satisfaction Frequency Percentage
Poor 0 0.0%
Moderate 34 34.0%
Good 66 66.0%

Table 3: Association Between Patients level of nursing care satisfaction and their demographic variables
Demographic variables Level of satisfaction Chi square test
Moderate Good
n % n % Total
Age 21 -30 yrs 5 62.5% 3 37.5% 8
31 -40 yrs 14 50.0% 14 50.0% 28
2=10.04p=0.03*
41 -50 yrs 7 24.1% 22 75.9% 29
DF=4 significant
51 -60 yrs 6 28.5% 15 71.5% 21
> 60 yrs 2 14.2% 12 85.8% 14
Sex Male 21 46.7% 24 53.3% 45 2=5.82 p=0.02 *
Female 13 23.6% 42 76.4% 55 DF=1 significant
Marital status Single 2 16.7% 10 83.3% 12 2=1.82 p=0.17
Married 32 36.4% 56 63.6% 88 DF=1 not significant
Religion Hindu 21 29.6% 50 70.4% 71
2=2.39 p=0.30
Muslim 10 47.6% 11 52.4% 21
DF=2 not significant
Christian 3 37.5% 5 62.5% 8
Education No formal education 8 50.0% 8 50.0% 16
Primary school 12 28.6% 30 71.4% 42
Middle school 9 27.3% 24 72.7% 33 2=5.01 p=0.41
High school 3 60.0% 2 40.0% 5 DF=5 not significant
post high school diploma 1 50.0% 1 50.0% 2
Profession/house 1 50.0% 1 50.0% 2
Occupation Un employed 5 16.1% 26 83.9% 31
Unskilled 9 42.9% 12 57.1% 21
Business and others 14 42.4% 19 57.6% 33 2=9.97 p=0.08
Skilled work 3 75.0% 1 25.0% 4 DF=5 not significant
Semi profession 2 22.2% 7 77.8% 9
Profession 1 50.0% 1 50.0% 2
Income Rs.1520 4 21.1% 15 78.9% 19
Rs.1521 – 4555 12 44.4% 15 55.6% 27
Rs.4556 – 7593 12 36.4% 21 63.6% 33 2=4.36 p=0.49
Rs.7594 – 11361 4 25.0% 12 75.0% 16 DF=5 not significant
Rs.11362 – 15187 2 50.0% 2 50.0% 4
Rs. 30375 1 100.0% 1
Medical condition No 15 33.3% 30 66.7% 45 2=0.02 p=0.89
Yes 19 34.5% 36 65.5% 55 DF=1 not significant
Surgical condition No 19 34.5% 36 65.5% 55 2=0.02 p=0.89
Yes 15 33.3% 30 66.7% 45 DF=1 not significant
No. of times Only once 13 25.0% 39 75.0% 52
Hospitalized Twice 16 43.2% 21 56.8% 37
2=7.27p=0.10
3 times 5 62.5% 3 37.5% 8
DF=4 not significant
4 times 2 100.0% 2
> 4 times 1 100.0% 1
No. of days 1 - 7 days 12 23.5% 39 76.5% 51
2=7.08p=0.03*
Hospitalized 8 - 14 days 11 32.4% 23 67.6% 34
DF=2 significant
>15 days 9 60.0% 6 40.0% 15
Rating of Excellent 0 0.0% 02 100.0% 2
hospitalization Very good 12 34.3% 23 65.7% 35 2=1.05 p=0.78
Good 15 34.9% 28 65.1% 43 DF=3not significant
Fair 7 35.0% 13 65.0% 20
*significant at P≤0.05

IJPCR, November 2015 - December 2015, Volume 7, Issue 6 Page 460

 Akilandeswari et al. / A Study to Assess…
A Standardized Tool done byDr.Laschinger’s-Patient
satisfaction on quality nursing care
questionnaire”[PSNCQQ]. It consists of a total 19
questions regarding patient satisfaction with nursing
care.
The scoring is given for our study such as Excellent,
Very Good, Good, Fair and Poor.
RESULT AND DISCUSSIONS
The present study has been undertaken with the view of
identify the descriptive level about the satisfaction
problem among nursing care, SRM general hospital. The
result shows that 66% of good satisfaction on level of
nursing care.
Data pertaining to demographic variables are
Table.1:In accordance with demographic variables,
Regarding Age, Majority 29% of the patient were
between 41-50 years, 55% were female, eighty eight
(88%) were married, 71 (71%) of the religion of Hindu,
42 (42%) of the primary school education, 31(31%)
were in business, 33(33%) had a family income between
Rs. 4556 – 7593 per month, 52 (52%) had experience in
visit to hospital and 51 (51%) of the clients had been
hospitalized for 1 – 7 days.
Table.2 shows the frequency and percentage distribution
of level of satisfaction among patients. Majority of them
66(66.0%) have good satisfaction, 34(34.0%) of them
have moderate satisfaction and none of them have poor
satisfaction. This study findings were consistent with the
studies done by Lindgren et al., [2011] conducted a
prospective study on the Karen instruments for
measuring quality of nursing care in medical and surgical
wards at a hospital in Sweden. A total of 95 patients and
120 personnel were included,95 patients of whom 47
were women. The mean age was 64.4 ±15.8 years, with
a range of 22–86. The mean length of hospitalization was
9.1 ±13.4 days, with a range of 3–105. Forty of the
patients had previously been treated in the same ward.
There were 120 participants in the personnel group, of
whom 111 were women and 9 were men. The personnel
group consisted of 61 registered nurses and 59 nursing
aids. The mean age was 43.6 ±8.3 with a range between
27 and 60 years. This indicates that the instruments may
be suitable to use in clinical practice for measuring the
quality of nursing care4.
The second objective of the study is to associate the level
of nursing care satisfaction among patients with their
selected demographic variables
Table 3 reveals the study findings shows that Elders,
females and less number of days hospitalized patients are
benefitted more than other variables. Hence the
IJPCR, November 2015 - December 2015, Volume 7, Issue 6
hypotheses RH1 stated that there is a significant
association between the level of nursing care satisfaction
among patients and their selected demographic variables
was accepted at p≤ 0.05 .
This study findings were consistent with the studies done
by Mrayyan et al., [2006] conducted a descriptive cross-
sectional comparative design. The result shows that
Nurses were either satisfied nor dissatisfied in their jobs,
nurses who work in wards reported a slightly better job
satisfaction than nurses who work in critical care units.
Patients reported that they were moderately satisfied, and
head nurses reported that nurses usually (practically)
provide a high quality of nursing care5. Hence the
hypotheses RH1 stated that there is a significant
association between the level of nursing care satisfaction
among patients and their selected demographic variables
was accepted at p≤ 0.05.
CONCLUSIONS
Patients views have become an important element in the
evaluation of health care. The nurses need to know what
factors influence patient satisfaction, if we have to
improve the quality of health care. Followings are
recommended to improve nursing performance quality.
Deficits in hospital care quality were common in all
countries. Improvement of hospital work environments
might be a relatively low cost strategy to improve and
quality in hospital care and to increase patient
satisfaction.
REFERENCES
1. Laschinger et al., A psychometric analysis of patient
satisfaction with nursing care quality questionnaire:
an actionable approach to measuring patient
satisfaction.Journal of nursing care quality 2005, Vol
20 [3], Pp :220-30.
2. Meade, Bursell & Ketelsen, Effects of nursing
rounds: on patients call light use satisfaction and
safety American Journal of Nursing,2006, Vol
106(9) , pp. 58-70.
3. Donabedian A. Evaluating the quality of medical
care. Milbank Memorial Fund Quarterly 1966; Vol
44(3), Pp 166-206.
4. Lindgren M, Andersson I S. „The Karen instrument
for measuring quality of nursing care: construct
validity and internal consistency. International
journal for quality in health care 2011; 17:115-20.
5. Mrayyan,(2006), Jordanian nurses job satisfaction,
patients satisfaction and quality of nursing care, Int
Nurs Revn 2006; 53[3]: 224-30.
Page 461
 | |
Received: 27 October 2017    Revised: 3 November 2018    Accepted: 3 December 2018

DOI: 10.1002/nop2.237

RESEARCH ARTICLE

Patient satisfaction with the quality of nursing care patient

satisfaction with nursing care

Anita Karaca  | Zehra Durna

Florence Nightingale Hospital School of

Nursing, Istanbul Bilim University, Istanbul,
Turkey
Correspondence
Anita Karaca, Florence Nightingale Hospital
School of Nursing, Istanbul Bilim University,
Istanbul, Turkey.
Email: anitakaraca@hotmail.com
Abstract
Aim: To evaluate patients’ satisfaction with the quality of nursing care and examine
associated factors.
Design: A cross‐sectional, descriptive survey study.
Methods: The sample was composed of 635 patients discharged from a private hos‐
pital. Data were collected using “Patient Satisfaction with Nursing Care Quality
Questionnaire” with a total of 19 items, and a questionnaire designed to record socio‐
demographic characteristics and medical histories between January 1–May 31, 2015.
Results: Patients were more satisfied with the “Concern and Caring by Nurses” and
less satisfied with the “Information You Were Given.” Patients (63.9%) described
nursing care offered during hospitalization as excellent. Patients who were
18–35 years old, married, college or university graduates, treated at the surgery and
obstetrics–gynaecology units, and patients who stated their health as excellent and
hospitalized once or at least five times were more satisfied with the nursing care.
According to this study, the nurses needed to show greater amount of interest to the
information‐giving process.

KEYWORDS
nursing care, patient satisfaction, patients’ expectations, quality of care

1 |  I NTRO D U C TI O N indicator of quality of care and it considered an outcome of health‐

Increasing competition in every field today also affects the health‐
care industry. The most important competitive advantage of health
service providers is to provide quality health services (Alsaqri, 2016;
Reck, 2013; Şişe, 2013). The need for increased quality of healthcare
services has been identified via health‐related information and ad‐
vances in technology, changes in expectations and opinions about
health care, an increase in individuals’ involvement in their health
care and increased cost and competitiveness in the health sector
(Freitas, Silva, Minamisava, Bezerra, & Sousa, 2014).
The quality and adequacy of healthcare services can be mea‐
sured based on views and satisfaction of patients and their relatives
(Merkouris et al., 2013). Patient satisfaction is the most important
care services (Abdel Maqsood, Oweis, & Hansa, 2012; Akhtari‐
Zavare, Abdullah, Syed Hassan, Binti Said, & Kamali, 2010; Mohanan,
Kaur, Das, & Bhalla, 2010). Patient satisfaction measurement pro‐
vided crucial information on performance thus contributing to total
quality management (Goh, Ang, Chan, He, & Vehvilainen Julkunen,
2016; Shinde & Kapurkar, 2014). Total quality management includes
professional knowledge, competence and application of appropriate
technology, the patients’ perception about the type and level of the
care they have received (Özsoy et al., 2007; You et al., 2013). In today’s
consumer‐oriented healthcare markets, a patient‐centred measure of
satisfaction with the quality of nursing care received is a major com‐
ponent of hospital quality management systems (Laschinger, Hall,
Pedersen, & Almost, 2005). Patients need their problems diagnosed

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Nursing Open. 2019;1–11. wileyonlinelibrary.com/journal/nop2 |  1

  
 |
2       KARACA and DURNA
and treated properly, their function restored and/or symptoms re‐
lieved. If the results are unsatisfactory, consumers will change the
healthcare facility they applied for treatment and care (Ksykiewicz‐
Dorota, Sierpińska, Gorczyca, & Rogala‐Pawelczyk, 2011; Shinde &
Kapurkar, 2014). Patients who are more satisfied with their care are
more likely to follow medically prescribed regimens and thus con‐
tributing to the positive influence on health (Buchanan, Dawkins,
& Lindo, 2015; Dzomeku, Atinga, Tulukuu, & Mantey, 2013; Fröjd,
Swenne, Rubertsson, Gunningberg, & Wadensten, 2011). More sat‐
isfied patients are more liable to recommend the hospital to family
and friends (Buchanan et al., 2015; Mohanan et al., 2010). Patients’
opinions are the best source that can tell the providers of what is
important, that is why this information can be used in healthcare
planning and evaluation (Abdel Maqsood et al., 2012; Alsaqri, 2016;
Merkouris et al., 2013; Villarruz‐Sulit, Dans, & Javelosa, 2009). All
these changes and developments in the healthcare field require
restructuring of all healthcare services, including nursing, through
questioning the quality of treatment services (Şişe, 2013).
1.1 | Background
Patient satisfaction is a concrete criterion for evaluation of health
care and therefore quality of nursing care (Alhusban & Abualrub,
2009; Shinde & Kapurkar, 2014). It provides crucial information for
healthcare managers by providing important resources for processes
such as those involved in measuring patients’ expectations and sat‐
isfaction with nursing care quality, improving nursing service quality
through identification of areas of failure and planning and imple‐
menting necessary training (Abdel Maqsood et al., 2012; Gadalean &
Cheptea, 2011; Geçkil, Dündar, & Şahin, 2008). Evaluation of health
care involves defining the objectives of care, monitoring healthcare
inputs, measuring the extent to which the expected outcomes have
been achieved and assessing the extent of any unintended or harm‐
ful consequences of the intervention (Alsaqri, 2016; Sitzia & Wood,
1997; Tang, Soong, & Lim, 2013).
Nursing care is one of the major components of healthcare ser‐
vices (Buchanan et al., 2015; Merkouris et al, 2013; Mohanan et al.,
2010; Sitzia & Wood, 1997). Patients’ satisfaction with nursing care
has become an established as the most important predictor of the
overall satisfaction with hospital care and an important goal of any
healthcare organization (Goh et al., 2016; Laschinger et al., 2005;
Mohanan et al., 2010; Reck, 2013). Measuring patients’ satisfac‐
tion with nursing care could be effective in improving nursing ser‐
vice quality by facilitating the creation of standards for care while
monitoring both results and patients’ perceptions of quality (Akın &
Erdoğan, 2007; Senarath & Gunawardena, 2011; Tang et al., 2013).
The nurses have a central role in offering emotional and psycho‐
logical support to patients and their families in all settings, such as
supporting the patient through diagnosis and ensuring optimum care
given to them. Besides the provision of technical care, nurses must
have the qualified professional knowledge, attitudes and skills, pro‐
viding the informational, emotional and practical supports (Akhtari‐
Zavare et al., 2010; Buchanan et al., 2015; Goh et al., 2016).
If healthcare organization managers are able to identify patient
expectations, they could accordingly adjust the performance of
services that they offer to meet these expectations (Freitas et al,
2014; Fröjd et al., 2011; Milutinovic, Simin, Brkic, & Brkic, 2012).
The surveys in health services concerning health satisfaction are
carried out to evaluate the patient satisfaction, to learn patient’s
expectations, their suggestions and feedbacks, make the qual‐
ity improvement constantly in all service periods, to search the
effects of socio‐demographic and treatment periods on patient
satisfaction (Buchanan et al., 2015; Özer & Çakıl, 2007; Sitzia &
Wood, 1997). That is why patient satisfaction should be measured
constantly using valid, reliable assessment instruments to assess
care quality, identify variables that affect care and determine
which items should be prioritized and which require alteration in
the service based on patients’ responses (Buchanan et al., 2015;
Merkouris et al., 2013). A good assessment instrument measur‐
ing the factors that determine patient satisfaction should be de‐
veloped to improve nursing service quality (Freitas et al., 2014;
Laschinger et al., 2005). Therefore, the findings of nursing man‐
agement research should be used as an indicator of the contribu‐
tion made by nursing to the patient care process and this could
aid the advancement of the profession in terms of scientification
(Alsaqri, 2016; Freitas et al., 2014; Goh et al., 2016).
1.2 | Research questions
• What is the satisfaction level of patients about the quality of nurs‐
ing care?
• Is there any relationship between patients’ satisfaction with the
quality of nursing care according to their socio‐demographic char‐
acteristics and medical history?
2 | M E TH O DS
2.1 | Design
The study used a descriptive, cross‐sectional research design.
2.2 | Setting and samples
Participants included 635 hospitalized patients receiving internal
medicine, surgery and obstetrics and gynaecology services at a pri‐
vate hospital between January 1–May 1, 2015. The sampling criteria
were as follows: patients aged 18 years or older, patients who were
discharged, hospitalized for at least 2 nights at the time of data col‐
lection, able to speak and understand Turkish, not too confused or
ill to complete the questionnaires and agreeing to participate in the
study.
The response rate of this study is 92.8%. The survey was not ad‐
ministered to all patients who had not planned their discharge (those
were decided or wished to be discharged suddenly) or were trans‐
ferred to another hospital. Incompletely filled out surveys were not
included in the study.
KARACA and DURNA
2.3 | Ethical considerations
Prior to data collection, the research protocol was reviewed
and approved by the relevant scientific ethics committee (IBU
Clinical Research Ethical Committee, Ethical Approval Number:
01.11.2014/25‐168). Permission to conduct the research was also
obtained from hospital administrators. Written approval to use
the Patient Satisfaction with Nursing Care Quality Questionnaire
(PSNCQQ) and translate it into Turkish was obtained from
Laschinger, who developed the scale. All patients provided written
informed consent.
2.4 | Measurement
2.4.1 | Patient Satisfaction with Nursing Care
Quality Questionnaire
The PSNCQQ was designed to measure the extent of anticipated
need, assess patient satisfaction following short‐stay hospitaliza‐
tion and determine the influence of socio‐demographic, personal
and other factors at a minimum level. The scale was developed
using the Patient Judgements of Hospital Quality Questionnaire,
which was developed by a multidisciplinary research team at the
Hospital Corporation of America (Laschinger et al., 2005; Reck,
2013).
The scale consists of 19 items pertaining to features of a wide
range of nursing activities including nurses’ attention, kindness, re‐
spect, courtesy, skills, competence and fulfilment of patient needs.
As it is short and it can be completed easily, it has very good psycho‐
metric properties that can be used by managers in quality improve‐
ment activities (Fröjd et al., 2011; Laschinger et al., 2005). Each item
consists of a “signpost,” which is a phrase designating its content and
a “descriptor,” which is a detailed question. The scale also includes a
general perceptions section consisting of four additional questions
designed to measure satisfaction with the overall quality of care
and treatment received during hospitalization, the overall quality
of nursing care, thoughts on overall health and the likelihood that
the patient would recommend the hospital to relatives and friends
(Laschinger et al., 2005; Milutinovic et al., 2012).
The scale was designed for application by administrators in areas
requiring improvement, to provide patient‐oriented outcomes and
for the identification of strong and weak aspects of the nursing care
process. Items were based on factors identified as important ele‐
ments of patient satisfaction with nursing care. The PSNCQQ can
be incorporated into existing hospital quality monitoring systems to
monitor patient satisfaction. In addition, the PSNCQQ can be used
as an evidence‐based indicator given its contribution to the patient
care process as a result variable, to evaluate changes in depart‐
mental and institutional processes. This feedback provides useful
information to nurse administrators (Abdel Maqsood et al., 2012;
Laschinger et al., 2005).
Participants’ responses are provided using a 5‐point Likert‐type
scale. Total possible scores range from 19–95. Lower total scores
|
      3
indicate greater satisfaction with nursing care. The scoring of the
scale was: 1 = excellent, 2 = very good, 3 = good, 4 = fair, 5 = poor.
2.5 | Data collection
Data were collected using the PSNCQQ, which measures health‐
related properties considered to affect patient satisfaction and a
questionnaire, designed in the light of related literature, to record
socio‐demographic characteristics and medical history. A question‐
naire consisting of 16 items pertaining to variables affecting pa‐
tient satisfaction was developed according to these characteristics.
Income levels were measured by the patients’ self‐perception of
their economic status and lifestyle. It was presented in four options:
low, moderate, high and very high. Perceived health was measured
by a self‐reported question was graded by six variables prior to their
admission as excellent, good, fair, poor, very poor and unsure.
The data were collected by the researcher. The patients com‐
pleted the questionnaires prior to their discharge from the hospital.
The patients who agreed to participate in the study were provided
with an explanation about the purpose of the study and they signed
informed consent forms. Those who refused to participate reported
that they did not have the time or were just not interested in partici‐
pating. Data were collected by face to face interviews from illiterate
patients.
2.6 | Data analysis
Data were analysed using SPSS software (IBM Corp. Released
2012. IBM SPSS Statistics for Windows, Version 21.0; IBM Corp,
Armonk, NY, USA). The analysis included descriptive statistics
such as frequencies, means, standard deviations and percentages.
The distribution of the data was assessed using the Single Sample
Kolmogorov–Smirnov test and as the significance values exceeded
0.05, parametric tests were used in the advanced‐level analysis.
About the parametric tests, t tests were performed to analyse in‐
dependent variables with two categories, one‐way ANOVAs were
performed to analyse independent variables with more than two
categories and Pearson’s correlation coefficients were used to ana‐
lyse relationships.
2.7 | Validity and reliability analysis
The PSNCQQ was translated into Turkish and the linguistic, and
conceptual equivalence of the items was established. Back trans‐
lation was performed to ensure language equivalence between
the English and Turkish versions of the scale. The original scale
was translated into Turkish linguists who were highly competent
in both languages. Five bilingual experts consisted of a doctor,
two nursing faculty members, a nurse manager and a linguist.
Expressions used in the scale were analysed individually and in
combination and optimal expressions were selected by forming a
pool of 19 items. Back translation from Turkish to English was per‐
formed by two trained linguists (English teachers) with knowledge
 |
4       KARACA and DURNA

and experience in both languages. The back‐translated and original TA B L E 1   Patient characteristics (N = 635)
versions of the PSNCQQ were compared and found to be highly
Variables N %
similar in meaning and reorganized based on the characteristics
Age (years)
of the country. After then, the expert met and reviewed to deter‐
mine the scope of the validity of the scale. Eight experts (nurs‐ 18–35 239 37.6

ing academicians specialized in medical nursing, surgical nursing 36–55 180 28.3

and nursing administration) provided opinions about meaning and 56 and more 216 34.0
content sufficiency. A pilot study was then conducted from 1–31 Gender
December 2014 to determine whether there were any unclear Female 491 77.3
questions in the scale. The data from the pilot study were then Male 144 22.7
excluded from the final data analysis. According to the results of Marital status
the pilot study, small changes were then made to the expressions
Married 473 74.5
in some scale items to increase their understandability.
Single 65 10.2
In this study, the coefficients for correlations between average
Divorced 22 3.5
PSNCQQ item scores ranged from 0.80–0.89, which demonstrated
Widowed 75 11.8
an appropriate level of reliability. Cronbach’s α for the PSNCQQ, cal‐
Education
culated to determine internal consistency and uniformity, was 0.98,
which was very high. In Laschinger et al.’s (2005) study, the coef‐ Illiterate 14 2.2

ficients for the correlations between PSNCQQ items ranged from Literate 16 2.5

0.61–0.89 and were described as high and Cronbach α was 0.97, Primary school 114 18.0
which was described as excellent. Therefore, the results obtained Secondary school 54 8.5
in the current study were similar to those reported by Laschinger et High school 200 31.5
al. (2005). In view of this, the Turkish version of the PSNCQQ could College or University 211 33.2
be considered to possess excellent psychometric properties, which Postgraduate 26 4.1
were similar to those reported for the original scale. Perceived income level
Very high 19 3.0
3 |   R E S U LT S High 268 42.2
Moderate 331 52.1
3.1 | Socio‐demographic characteristics and medical Low 17 2.7
history Occupation

The mean age of the sample age was 47.94 (SD 19.66) years and Worker (blue collars) 47 7.4

37.6% were aged between 18–35 years. The most of participants Civil servant 47 7.4

were women (77.3%), married (74.5%) and college or university Retired 109 17.2
graduates (33.2%), at moderate‐income level (52.1%) and house‐ Self‐employment 73 11.5
wives (31.3%). Of the patients, 2.2% were illiterate. More than half Housewife 199 31.3
of the sample (61.6%) were admitted to the service directly from the Student 17 2.7
patient admission department and had been hospitalized once in the Others 143 22.5
preceding 2 years (66.6%). The average duration of the current hos‐
pitalization was (4.38 SD 5.75) days (Table 1).
Analysis of PSNCQQ scores for perception‐related items
showed that 61.4% and 63.9% of participants’ responses for the
3.2 | PSNCQQ scores “Quality of the care and service provided during your stay at the
Analysis of PSNCQQ scores revealed that the item for which sat‐ hospital” and “Quality of the nursing care provided during your
isfaction levels were highest (1.38 SD 0.66) was the “Concern and stay at the hospital” items, respectively, were “excellent.” In ad‐
Caring by Nurses: Courtesy and respect you were given; friend‐ dition, 87.9% of patients stated that they would recommend the
liness and kindness” item. The item for which satisfaction levels hospital to their family and friends.
were lowest (1.74 SD 0.86) was the “Information You Were Given:
How clear and complete the nurses’ explanations were about tests,
3.3 | Comparison of PSNCQQ scores according to
treatments and what to expect” item. Overall, patients’ PSNCQQ
patients’ socio‐demographic characteristics
scores ranged between 1–4.05, with an average score of 1.61 (SD
0.65). This indicated that the level of satisfaction with nursing care The mean PSNCQQ score of patients at the age of 56 years or older
was high (Table 2). was significantly higher (1.75 SD 0.68) in relation to those observed for
KARACA and DURNA |
      5

TA B L E 2   Distribution of Patient
Items M SD Min Max
Satisfaction with Nursing Care Quality
Questionnaire (PSNCQQ) Scores (N = 635) 1. Information You Were Given: How clear and 1.74 0.86 1 5
complete the nurses’ explanations were about
tests, treatments and what to expect
2. Instructions: How well nurses explained how to 1.72 0.84 1 5
prepare for tests and operations
3. Ease of Getting Information: Willingness of 1.57 0.76 1 5
nurses to answer your questions
4. Information Given by Nurses: How well nurses 1.59 0.74 1 5
communicated with patients, families, and
doctors
5. Informing Family or Friends: How well the 1.72 0.82 1 5
nurses kept them informed about your condition
and needs
6. Involving Family or Friends in Your Care: How 1.71 0.77 1 5
much they were allowed to help in your care
7. Concern and Caring by Nurses: Courtesy and 1.38 0.66 1 5
respect you were given; friendliness and kindness
8. Attention of Nurses to Your Condition: How 1.51 0.72 1 4
often nurses checked on you and how well they
kept track of how you were doing
9. Recognition of Your Opinions: How much nurses 1.74 0.85 1 5
ask you what you think is important and give you
choices
10. Consideration of Your Needs: Willingness of 1.57 0.74 1 5
the nurses to be flexible in meeting your needs
11. The Daily Routine of the Nurses: How well 1.65 0.77 1 4
they adjusted their schedules to your needs
12. Helpfulness: Ability of the nurses to make you 1.49 0.70 1 4
comfortable and reassure you
13. Nursing Staff Response to Your Calls: How 1.48 0.68 1 4
quick they were to help
14. Skill and Competence of Nurses: How well 1.58 0.79 1 5
things were done, like giving medicine and
handling IVs
15. Coordination of Care: The teamwork between 1.58 0.72 1 5
nurses and other hospital staff who took care of
you
16. Restful Atmosphere Provided by Nurses: 1.60 0.81 1 5
Amount of peace and quiet
17. Privacy: Provisions for your privacy by nurses 1.53 0.73 1 5
18. Discharge Instructions: How clearly and 1.63 0.77 1 5
completely the nurses told you what to do and
what to expect when you left the hospital
19. Coordination of Care After Discharge: Nurses’ 1.7 0.81 1 5
efforts to provide for your needs after you left
the hospital.
Average PSNCQQ Score 1.61 0.65 1 4.05

patients aged 18–35 years (1.50 SD 0.61) and aged 36–55 years (1.56
SD 0.62; p < 0.001). No statistically significant differences were found
in the PSNCQQ scores of patients by gender or occupation (p > 0.05).
The widowed patients’ mean PSNCQQ score was found to be
statistically higher (1.81 SD 0.75) than that of the married patients’
(1.57 SD 0.62), and the difference was significant (p < 0.05). The
patients’ PSNCQQ scores varied significantly by education level and
income (p < 0.001). The literate patients and patients with moderate
incomes scores were higher (2.02 SD 0.65, 1.71 SD 0.68, respec‐
tively) than those of the patients who had completed college or uni‐
versity and patients with high incomes (1.52 SD 0.60, 1.48 SD 0.56,
respectively; Table 3).
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6       KARACA and DURNA

TA B L E 3   Comparison of Patient Satisfaction with Nursing Care Quality Questionnaire scores based on patients’ socio‐demographic
characteristics (N = 635)

Statistical evaluation

N M ± SD t/F p

Age (years)
18–35 239 1.50 ± 0.61 F: 9.506*** <0.001
36–55 180 1.56 ± 0.62
56 and more 216 1.75 ± 0.68
Gender
Female 491 1.59 ± 0.65 t: 0.102 0.317
Male 144 1.65 ± 0.63
Marital status
Married 473 1.57 ± 0.62 F: 3.234* 0.022
Single 65 1.64 ± 0.73
Divorced 22 1.57 ± 0.55
Widowed 75 1.81 ± 0.75
Educational background
Illiterate 14 2.00 ± 0.77 F: 3.042*** 0.006
Literate 16 2.02 ± 0.65
Primary school 114 1.65 ± 0.65
Secondary school 54 1.71 ± 0.77
High school 200 1.57 ± 0.61
College or University 211 1.52 ± 0.60
Postgraduate 26 1.64 ± 0.75
Income level
Very high 19 1.38 ± 0.67 F: 7.198*** <0.001
High 268 1.48 ± 0.56
Moderate 331 1.71 ± 0.68
Low 17 1.66 ± 0.72
Occupation
Worker (blue collars) 47 1.48 ± 0.49 F: 1.813 0.094
Civil servant 47 1.41 ± 0.54
Retired 109 1.70 ± 0.68
Self‐employed 73 1.61 ± 0.62
Housewife 199 1.64 ± 0.66
Student 17 1.75 ± 0.79
Others 143 1.56 ± 0.65

Notes. F: one‐way ANOVA; t: t test.

*
p < 0.05 **p < 0.01 ***p < 0.001

relation to those observed for patients admitted from the patient

3.4 | Comparison of PSNCQQ scores according to
patients’ medical histories
The mean PSNCQQ score of the patients hospitalized in the inter‐
nal medicine unit was higher (1.95 SD 0.75) than those of the pa‐
tients in the surgery and the obstetrics and gynaecology units (1.51
SD 0.57, 1.46 SD 0.55, respectively), and the differences were sig‐
nificant (p < 0.001). Score for patients admitted to the service from
the emergency department was significantly higher (1.90 SD 0.69)
admission department and through other means (1.54 SD 0.62, 1.58
SD 0.66, respectively; p < 0.001).
The mean score of the patients who had been hospitalized
twice in the preceding 2 years was higher (1.70 SD 0.71) than
those of the patients who had only been hospitalized once and
more than five times (1.55 SD 0.61, 1.35 SD 0.57, respectively),
and the differences were significant (p < 0.001). The mean scores
of the patients who perceived their health status very poor, poor,
KARACA and DURNA |
      7

TA B L E 4   Comparison of Patient
Statistical evaluation
Satisfaction with Nursing Care Quality
Questionnaire scores according to N M ± SD t/F p
patients’ medical histories (N = 635)
Unit in which the patient is hospitalized
Surgery 212 1.51 ± 0.57 F: 36.35*** <0.001
Obstetrics and gynaecology 261 1.46 ± 0.55
Internal medicine 162 1.95 ± 0.75
Manner of admission to ward
From emergency department 70 1.90 ± 0.70 F: 4.80*** 0.001
Directly from patient 391 1.54 ± 0.62
admissions department
After daily operations and 52 1.67 ± 0.68
tests
Transfer from another 28 1.69 ± 0.56
healthcare facility
Other 94 1.58 ± 0.66
Status of hospitalization in the last 2 years
Once 423 1.55 ± 0.61 F: 3.90*** 0.004
Twice 143 1.70 ± 0.71
Three times 42 1.81 ± 0.66
Four times 9 1.94 ± 0.67
Five times or more 18 1.35 ± 0.57
Perceived health
Excellent 68 1.31 ± 0.55 F: 4.91*** <0.001
Good 314 1.60 ± 0.64
Fair 160 1.65 ± 0.66
Poor 63 1.67 ± 0.64
Very poor 22 1.99 ± 0.69
Unsure 8 1.59 ± 0.71

Note. F: one‐way ANOVA; t: t test.

*
p < 0.05 **p < 0.01 ***p < 0.001

fair and good were higher (1.99 SD 0.69, 1.67 SD 0.64, 1.65 SD
0.66 and 1.60 SD 0.64, respectively) than in excellent health (1.31
SD 0.55), and the differences were significant (p < 0.001). Also,
the results showed that the duration of hospitalization was signifi‐
cantly associated with PSNCQQ scores; however, the correlation
was weak (rp: 0.195, p < 0.01; Table 4).
4 | D I S CU S S I O N
The results of this study revealed similarities and differences with
the existing national and international literatures. This issue has
been discussed as follow.
4.1 | Discussion of finding about the
PSNCQQ scores
Measures of patient satisfaction can assess communication in the
consultation such as information transfer, patient involvement in
decisions and reassurance (Goh et al., 2016; Shinde & Kapurkar,
2014). Effective and continuous interaction and communication
are critical determinants in patients' satisfaction, hospital stay
and recovery (Koç, Sağlam, & Şenol, 2011; Mohanan et al., 2010;
Negarandeh, Bahabadi, & Mamaghani, 2014; Villarruz‐Sulit et al.,
2009). Health professionals’ communication skills play a pivotal
role in ensuring that patients feel valued and cared for. The alloca‐
tion of sufficient time for talking and listening to patients and pro‐
viding information is a prerequisite for patient satisfaction, as it
ensures that patients are less stressed and more engaged and well
adjusted (Koç et al., 2011). There is evidence that the health pro‐
fessionals are perceived as communicating well when the patient
feels he/she shows individualized interest, understanding and
reassurance (Sitzia & Wood, 1997). A study (Abdel Maqsood et
al., 2012) indicated that patients were more satisfied with having
respectful communication whereas they were less satisfied with
the professional information provided by the nurses about their
disease, health status, investigations and prognosis of their condi‐
tion. In a meta‐analysis conducted by Özsoy et al. (2007), patients
 |
8       KARACA and DURNA
expected favour, attention, understanding, kindness and helpful‐
ness from individuals providing care services. In our study, the
highest level of satisfaction, represented by PSNCQQ scores, was
reported for the “Concern and Caring by Nurses” item. The results
indicate that the nurses’ communication style is to treat patients
respectfully and be friendly towards them. However, the nurses
were less interested in explanations about their interventions and
communication with patients that did not meet their expectations.
Information provision and education are important factors affect‐
ing patient satisfaction (Abdel Maqsood et al., 2012; Koç et al., 2011;
Villarruz‐Sulit et al., 2009). Nurses and other healthcare profession‐
als play a key role in providing support and information. Nurses care
for the patients on a 24‐hr basis and should be empowered to pro‐
vide requisite information and instructions to the patients (Alhusban
& Abualrub, 2009; Shinde & Kapurkar, 2014). Patient education has
been linked with positive clinical outcomes such as improved adher‐
ence to a therapeutic regime, reduced anxiety and enhanced ability
to cope with symptoms (Sitzia & Wood, 1997). It is known that re‐
ceipt of adequate information affects patients’ confidence and satis‐
faction and this is the most important factor in encouraging patients
to participate in their own health care. In addition, providing patients
and their families with information about patients’ conditions is im‐
portant in helping them overcome fear of the unknown (Dzomeku et
al., 2013; Koç et al., 2011; Milutinovic et al., 2012). Several studies
have reported inadequacies in information provision. For example,
Dzomeku et al. (2013) found that the type and amount of information
provided by nurses about patients’ conditions constituted one of the
main causes of dissatisfaction. In a meta‐analysis conducted by Özsoy
et al. (2007), the patients’ most important expectation concerning
care quality was that they should be informed about medication and
treatment. Patients reported that information played an important
role in their satisfaction and they emphasized that information pro‐
vided by nurses should be clear and concise. Therefore, it is crucial for
nurses to realize that information provision and education are nursing
responsibilities and that they should collaborate with other health‐
care staff to provide complete and relevant information to patients.
Abdel Maqsood et al. (2012) indicated that the patients had low levels
of satisfaction with information and instructions given by nurses and
nurses had the perception that “information giving” was the role of
the physicians and the nurses may be fearful to provide information
because of the power hierarchy between the nurses and the physi‐
cians. In this study, the lowest level of satisfaction, represented by
PSNCQQ scores, was reported for the “Information You Were Given”
explanations were about tests, treatments and what to expect” item.
This result indicates that the explanations and information provided
by nurses at the hospital were unsatisfactory in the nursing care.
4.2 | Discussion of finding about to the PSNCQQ
scores according to patients’ socio‐demographic
characteristics
Different studies indicated that older patients are generally more satis‐
fied (Dzomeku et al., 2013; Fröjd et al., 2011; Milutinovic et al., 2012).
Sitzia and Wood (1997) stated in their review study that older people
tend to be more satisfied with health care than younger people are.
Similarly, according to Shinde and Kapurkar (2014) older respondents
were more satisfied, probably because they were more social and ac‐
cepting than younger or they had more respect and care for providers.
On the contrary, we found that patients aged 56 years or older were
less satisfied than other age groups. This can be related to the fact that
the nurses did not pay more attention to elderly patients. Another pos‐
sible reasons can be that levels of satisfaction could differ according to
cultural values or the patients did not held positive attitudes towards
events, based on age‐related increases in tolerance and maturity levels.
Similarly, in our study, Sitzia and Wood (1997) found that patient
gender did not affect satisfaction values and a conclusion reached
also in the reports that significantly more men than women. In other
studies (Alsaqri, 2016; Arslan & Kelleci, 2011), no relationships were
found between gender and patient satisfaction levels. However,
while some of these studies (Akın & Erdoğan, 2007; Alhusban &
Abualrub, 2009) reported that women’s levels of satisfaction with
care were higher relative to those observed in men, others (Koç et
al., 2011; Milutinovic et al., 2012; Shinde & Kapurkar, 2014) showed
higher satisfaction levels in men relative to those observed in
women. In addition, in a study conducted by Dzomeku et al. (2013),
38% and 30% of hospitalized men and women, respectively, were
completely satisfied with their nursing care. While the reason for
these differences can involve cultural characteristics, they can also
occur because, relative to men, women pay more attention to hy‐
giene and care and are more anxious.
In this study, college or university graduates were more satisfied
relative to those who were literate patients. However, in some other
studies (Dzomeku et al., 2013; Geçkil et al., 2008; Milutinovic et al.,
2012; Özsoy et al., 2007), literate individuals and primary school
graduates reported greater satisfaction with nursing services rela‐
tive to that reported by college or university graduates. In addition,
Sitzia and Wood (1997) indicated that greater satisfaction was asso‐
ciated with lower levels of education. Patients with lower levels of
education being most satisfied, similarly, showed that higher educa‐
tional attainment was strongly associated with dissatisfaction. Some
studies (Akın & Erdoğan, 2007; Shinde & Kapurkar, 2014) revealed
that the level of education was not associated with patient satisfac‐
tion. These study findings indicated that patients expect more from
nursing and care as their education levels increase. This can occur
because patients with high educational levels possess more informa‐
tion about treatment alternatives and expect higher care standards
and therefore are more critical in this regard.
Patients with high incomes tend to anticipate an improvement
in their symptoms and expect to receive care from highly qualified
staff and they become dissatisfied if they receive care that does not
meet their expectations. Patients with low incomes had low health,
get lower health care, had less continuous relation with doctors and
have difficulties in getting appointments (Shinde & Kapurkar, 2014).
Some studies (Akhtari‐Zavare et al., 2010; Arslan & Kelleci, 2011;
Özsoy et al., 2007) reported that satisfaction with nursing care did
not differ significantly according to income. In our study, patients
KARACA and DURNA
with high incomes were more satisfied relative to those with mod‐
erate incomes. We can say that these patients received care in the
direction of their expectations.
4.3 | Discussion of finding about to the PSNCQQ
scores according to patients’ medical histories
Patients who were hospitalized in surgery and obstetrics and gy‐
naecology units were more satisfied relative to those hospitalized
in the internal medicine unit. Shinde and Kapurkar (2014) found that
the gynaecological ward had a significantly higher percentage of
patients’ satisfaction with nursing care than the surgical wards. In
a study conducted by Alhusban and Abualrub (2009), the patients
hospitalized in an obstetrics and gynaecology unit reported higher
satisfaction levels relative to those hospitalized in internal medicine
and surgical units, while in a study conducted by Geçkil et al. (2008),
patients hospitalized in surgical units reported higher satisfaction
levels relative to those hospitalized in obstetrics and internal medi‐
cine units. In the other studies (Akın & Erdoğan, 2007; Koç et al.,
2011; Tang et al., 2013), satisfaction scores for patients treated in in‐
ternal medicine units were higher relative to those treated in surgery
units. The difference in dissatisfaction between the types of units
occurred because of problems experienced during surgical proce‐
dures in conjunction with medical diagnoses and socio‐demographic
characteristics. All of these differences can be the levels of physical
and psychological dependency on the hospital.
The results of the present study revealed that the patients who
hospitalized once or at least five times in the preceding 2 years
were more satisfied relative to those hospitalized twice in the pre‐
ceding 2 years. Alsaqri (2016) showed that there was a statistically
significant difference between previous admissions and patient
satisfaction levels. The same study demonstrated patients with
a history of admission to hospital during the last 2 years found
nurses more caring. It seems that more lengths of stay in hospital
increase patients’ opportunities for receiving more nurses’ care
and observing their caring behaviours. Similarly, in these studies
(Koç et al., 2011; Milutinovic et al., 2012) satisfaction levels re‐
ported by patients who had been hospitalized previously were
higher relative to those who had not. In contrast, in a study con‐
ducted by Arslan and Kelleci (2011) satisfaction levels reported by
patients with previous hospital experience were lower relative to
those without previous hospital experience. The result of another
study (Akın & Erdoğan, 2007) found no statistical relationship
between satisfaction with nursing care and the numbers of hos‐
pitalization. According to these results, we can say that patients’
expectations can vary according to previous experience in simi‐
lar situations and as the number of admissions increase, they can
compare their care with that received previously. Also, the positiv‐
ity or negativity of patients’ previous experience can be reflected
in their approach to current care.
A study (Alsaqri, 2016) indicated that people who perceived
themselves as being healthy were more likely to be satisfied with
access to care. According to Alsaqri (2016), patients who perceived
|
      9
themselves to be in excellent or good health are more likely to be
satisfied with their health care. Also, it is indicated in the same study
that, a person’s health prior to arrival at hospital, whether through
accident, a chronic condition or a voluntary procedure may affect
the patients’ expectations about the care. In addition, Laschinger et
al. (2005) reported that patients with good health status postdis‐
charge report greater satisfaction than those with poor health sta‐
tus. Similarly, in our study, patients with very poor, poor, fair or good
health were less satisfied relative to those of patients with excellent
health. This may be due to the fact that healthier people do not need
as much medical care and they interact with healthcare providers
less frequently. They have less opportunity to experience problems
with access to health care and therefore may express more satisfac‐
tion with access.
4.4 | Study limitations
The sample was restricted to patients from the general surgery, ob‐
stetrics and internal medical units. In addition, the study was con‐
ducted in a single private hospital in Turkey. Therefore, the results
cannot be generalized to all hospitals. Future studies should include
more than one hospital in both the private and public sectors and
the nursing care provided in private and public hospitals should be
compared.
Test–retest reliability analysis should have been performed to
strengthen the results of the study. Therefore, patients should be
surveyed for a second time in 2 weeks of discharge and the results
should be tracked and addressed in future studies. Although meth‐
odological problems, such as poor return rates and an inability to
collect tracking data for all participants occurred in the study, the
results could be considered useful because of the stability criterion
for patient satisfaction surveys.
5 | CO N C LU S I O N
The results revealed that nurses should inform patients about each
application and procedure and provide necessary explanations about
illness, diagnosis and treatment to ensure patient satisfaction and
the provision of high‐quality nursing care. The results also showed
that nurses should provide care in a framework of respect, favour
and courtesy towards patients by emphasizing the importance of
communication. Besides these, the patients were highly satisfied
with overall quality of hospital care, nursing care and reported that
they would recommend this hospital to their families and friends.
Nurse managers could contribute to the quality service provi‐
sion by evaluating the patient satisfaction with nursing care for the
development and improvement of nursing care based on patients’
expectations. Data obtained from this evaluation should be consid‐
ered in determining training requirements for nurses and in‐service
training programs should be organized to develop nurses’ knowl‐
edge and skills in care planning. The PSNCQQ is considered useful
for nurse administrators in improving nursing care. The scale could
 |
10       KARACA and DURNA

allow managers to determine the attitudes of individuals with whom Fröjd, C., Swenne, C. L., Rubertsson, C., Gunningberg, L., & Wadensten,
they work and those whom they manage and exert some degree of B. (2011). Patient information and participation still in need of
improvement: Evaluation of patients’ perceptions of quality of
control over employees’ behaviour.
care. Journal of Nursing Management, 19, 226–236. https://doi.
org/10.1111/j.1365-2834.2010.01197.x
Gadalean, I., Cheptea, M., & Constantin, I. (2011). Evaluation of patient
AC K N OW L E D G E M E N T S
satisfaction. Applied Medical Informatics, 29(4), 41–47.
Geçkil, E., Dündar, Ö., & Şahin, T. (2008). Adıyaman il merkezindeki
The authors thank the patients who participated into the study.
hastaların hemşirelik bakımından memnuniyet düzeylerinin değer‐
lendirilmesi [Evaluation of patients’ satisfaction levels from nursing
care at the centre of the city Adiyaman]. Sağlık Bilimleri Fakültesi
C O N FL I C T O F I N T E R E S T
Hemşirelik Dergisi, 15(2), 41–51.
Goh, M. I., Ang, E. N. K., Chan, Y. H., He, H. G., & Vehvilainen Julkunen,
The authors declare that there was no conflict of interests.
K. (2016). A descriptive quantitative study on multi‐ethnic patient
satisfaction with nursing care measured by the revised humane
caring scale. Applied Nursing Researc, 31, 126–131. https://doi.
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Anita Karaca  https://orcid.org/0000-0001-6552-4399
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Diversity and Equality in Health and Care (2018) 15(4): 151-157 2018 Insight Medical Publishing Group

Research Article
Patient Satisfaction with Services Provided at
Night and the Assessment of the Quality of Care
in the Hospital
Anna Fafara*, Malgorzata Marc, Krzysztof Fudali, Małgorzata Gajdek and Pawel Januszewicz
Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow, Poland

ABSTRACT
Night nursing care has different priorities from the care in
the morning and afternoon hours. The patient as the subject
of nursing activities may assess the quality of this care in a
more or less objective way, thus giving the opportunity to
improve or improve these services. The study was conducted
to assess the quality of care and general nursing care. The
studied population constituted 585 patients hospitalized in
the Clinical Hospitals of the city of Rzeszów. The research
was carried out from 1 January 2016 to 31 May 2016. In the
patients opinion survey, the method of the diagnostic survey
was used, using two standardized NSNS questionnaires, the
PASAT HOSPIT1 package and the original questionnaire. The
assessment of services provided by nurses at night that was
made with the use of the Newcastle scale was high (experience
- 63.7 points, satisfaction - 60.3 points), and the assessment
based on the Author's Questionnaire. The correlation between
the assessment of night-time care and the overall assessment
of nursing care indicates statistically significant (R=0.51 and
R=0.47) and significantly influenced assessment of the overall
nursing care. The quality of the night tasks resulting from the
therapeutic function and caring were considerably related to
the overall assessment of the nursing care. The relationship
between the assessment according to the PASAT HOSPIT 1
questionnaire and the assessment of nursing care on the basis
of the Newcastle scale is most correlated with the nurse's
availability (satisfaction -p=0.0000***), the speed of response
to the call (satisfaction -p=0.0000***) and the satisfaction
from nursing care.
Keywords: Quality of care; Patient; Nurse; Night shift;
Nursing

Introduction self-esteem, importance and importance throughout the entire

healthcare system. Expectations towards medical staff focus
Health care constitute activities that meet the needs of society
on appropriate and professional treatment that is in line with
in the field of health promotion, prevention, treatment,
global standards. The patient/client has the right to choose, ask
diagnosis and rehabilitation. One of the determinants of the
questions, obtain optimal knowledge about the health condition,
effectiveness of a health care provider in terms of healthcare
the proposed treatment methods, nursing. In addition, in medical
is the quality factor [1]. In addition, it should give a sense of
entities covered by the accreditation system the staff expects the
efficiency, effectiveness and security. The high quality of care
patient to assess the level of the care provided which is equally
should not only be organized in the best possible way, but have
satisfactory from nurses health services and their own feelings.
maximum human resources, medical and financial resources
There are many factors hindering the work of nurses at night.
and infrastructure. The most import and the most commonly
Every effort should be made to make one of the components
used measure of the quality of nursing care is the measurement
such as night nursing services a strong pillar of the health care
of the level of patient satisfaction, i.e. its subjective assessment
system [5]. A patient's care satisfaction survey strengthens
understood in terms of a sense of satisfaction with the received
his self-esteem, importance and importance throughout the
care or lack thereof. Analyzing available literature, you can find
entire healthcare system. The patient has become an entity
many publications on the evaluation and feelings of patients
in the market of medical services. Patients expect a sense of
during hospitalization [2-4]. A good indicator of the quality of
security and want to trust the staff who will look after them. The
nursing care is the examination of the level of satisfaction. Due
healthcare system must therefore be based on integrity, respect
to the fact that each person has a specific ceiling and the scale
and interest in the problems of the sick [6]. Kelly emphasizes
of requirements and expectations, satisfaction is subjective
that "night nursing" is traditionally marginalized and treated
individual impression. In their research, Otani and Kurz showed
as "Cinderella" services. Quite wrongly, due to, for example,
that nursing care had the greatest impact on the assessment
professional liability issues [7].
of the patient's total satisfaction with the hospital stay [5].
The quality of nursing care has a huge impact on the patient's For example, a professional offense can occur both at night and
opinion. A patient's care satisfaction survey strengthens his in the morning, in the afternoon or in the evening. The primary
 152 Anna Fafara
goal of changes in nursing is to optimize the quality of care,
leading to maximum patient satisfaction [8].
Methods
The research was carried out in two public Clinical Hospitals
of the city of Rzeszów (Clinical Regional Hospital No.1
named after Fryderyk Chopin in Rzeszów and the Clinical
Hospital No. 2 named after Saint Jadwiga Queen in Rzeszów)
in randomly selected clinics with comparable conservative and
surgical characteristics from January 1, 2016 until 31st of 2016.
Participation in them was voluntary and anonymous. The study
population consisted of patients who were of legal age, agreed to
be examined, spent at least two nights in the clinic and needed help
in self-care during night duty (the severity of the disease and the
extent of the care required are not specified). Exclusion criteria
mean that the patient is not allowed to participate in the study
and the patient's consciousness is disturbed. The nurses at the
beginning of their night shift selected patients for participation in
a research. In turn, pollsters (unrelated professionally with the
randomly selected clinic as well as those who are not employees
of a given hospital) carried out the research in the morning. The
research project received a positive opinion of the Bioethics
Committee at the University of Rzeszów of December 2, 2015
- Resolution No. 4/12/2015. In the patient opinion survey,
the method of a diagnostic survey was used two standardized
questionnaires and an original questionnaire survey:
The Newcastle satisfaction with nursing scale (NSNS)
Scale developed at the Health Care Research Center at Newcastle
University in England [9]. The Polish cultural adaptation of
NSNS was done by Gutysz-Wojnicka and Dyk, respecting
the criteria of equivalence [10]. Reliability of the scale was
analyzed separately "for experience" and "satisfaction" using the
reliability coefficient of Alfa Cronbach.
The scale consists of three parts:
• part one-examines the experience of nursing care (26 claims
including: 11 negative, 15 positive),
• part two-examines the level of self-satisfaction (19 aspects of
nursing care),
• the third part-examines the patient's feelings related to the
hospital stay and contains questions about the demographic
characteristics of the patient [10].
PASAT questionnaire - PASAT HOSPIT1 package
A nationwide tool for conducting patient opinion surveys. It is
a unified model of patient satisfaction survey, repeatedly tested
using statistical techniques. It was developed at the Center for
Quality Monitoring in Health Care in Krakow. The tests should
be carried out with patients staying in the hospital wards for not
less than 48 hours. For a one-off satisfaction study, it is proposed
to include approximately 400 hospital patients. The questionnaire
consists of 16 questions (groups of questions) regarding patient
satisfaction from the stay in the hospital ward and the patient's
report. The subject was subject to aspects of hospital care such
as: admission to the hospital, stay in a hospital ward, medical
care, other staff (nurses' friendliness, availability during the day
and at night, diligence of treatments, speed of response to the
call, provision of nursing services in the atmosphere of respect
and respect for the dignity of courtesy), care for the bedridden
patients and other aspects of the stay in the hospital (providing
during the hospital stay the comprehensive information about
the state of health and methods of treatment, about the risk
connected with the treatment and about the side effects of
medications, the course of surgery and about the possibility of
contact with competent people in difficult times).
The questionnaire of the self-made survey
Contains a set of 11 questions with the possibility of answering
in a 5-point Likert scale and a short report. Among the evaluated
dimensions of night-time nursing services are tasks resulting
mainly from the caring and therapeutic function. Questions are
closed. The criteria for including the patient in the study were:
18 years of age and more, minimum 2 nights spent in the ward,
reading and writing skills, while staying in the hospital only
in one ward no impairment of consciousness and being asked
for a consent to participate in the study. A test sample of 600
people were selected. 592 were obtained successfully, of which
585 questionnaires were correctly filled and completed, which
constituted 97.5% of the assumed test sample. The minimum
test sample was 383. The confidence level was 95%, the size
of the fractions: 0.5, maximum error: 4%. In the statistical
analysis of the obtained research results, statistical tests were
used: Mann-Whitney, Kruskal-Wallis and Spearman's rank
correlation coefficient. The calculations were performed using
the IBM SPSS Statistics 20 program. The work assumed the
significance level p<0.05.
Results
331 women and 254 men participated in the study. Among the
585-person study group, 150(25.6%) of the respondents were
aged 60 and over. The secondary education was 216(36.9%).
314 patients (53.7%) were professionally active and working.
The highest number of hospitalized people were at least 6 days
- 222(37.9%), 198(33.8 %) of the respondents spent 4-5 nights
in the hospital. 168(31%) reported difficulties in falling asleep
during normal functioning in home life. 248(42.4%) of patients
stated that there were no problems falling asleep. Gender, age
and marital status did not differentiate in a statistically significant
way of assessing the quality of nursing care. Residents of rural
areas estimate the satisfaction of care much better (difference by
12 points, p <0.001). The highest experience in nursing care was
rated by people with higher education (p=0.0204*). Nurses are
better assessed by unemployed people (=67.4), and pensioners
(=69.1). The more nights spent in the hospital, the lower ratings
issued by respondents for nursing care (Table 1).
Assessment of nursing care provided at night, and
overall nursing care based on the Newcastle scale
The assessment of the services provided by nurses at night by
 Patient Satisfaction with Services Provided at Night and the Assessment of the Quality of Care in the Hospital 153

the numerical scale of Newcastle was high. For the experience
of nursing care it was 63.7 points, and for the satisfaction of
nursing care 60.3 points. The assessment of nursing night care
was high-about 75 points. The results obtained between the
assessment of night care and the overall assessment of nursing
care indicate a statistically significant correlation of moderate
strength (R= 0.51 and R=0.47). Assessment of night care
significantly influenced the assessment of overall nursing care.
The assessment of the quality of nocturnal tasks resulting from
the nurse's therapeutic function was related to the general
assessment of nursing care.
The assessment of individual care tasks was significantly
related to the overall assessment of nursing care. The strongest
assessment of the nurse's work was correlated with satisfying
the wishes regarding night rest and: experience from nursing
care (p=0.0000***), satisfaction with nursing care (p=0.0000***).
An important care task was also the possibility of talking with
the nurse and: experience from nursing care (p=0.0000***),
satisfaction with nursing care (p=0.0000***). The obtained
dependencies significantly differentiated the assessment of
nurses' work (Table 2).
Assessment of night care (PASSAT HOSPIT1)
Using the Spearman's rank correlation coefficient, the
relationship between the opinion on nursing care expressed
in the PASAT HOSPIT 1 questionnaires was examined (in
question 11), and the evaluation of night care during the last
night before the questionnaire was completed (Table 3).
In the same way, answers to questions have been summarized.
11 A-F from the PASAT HOSPIT 1 questionnaire with a
nursing assessment done on the Newcastle scale. Correlations
are statistically significant. A stronger relationship with the
assessments included in PASAT HOSPIT 1 shows the satisfaction
assessment of nursing care. The strongest correlations concern
the nurse's availability and speed of reaction to the call and
satisfaction with nursing care (Table 4).
Discussion
There are many studies linking the shift work system (early
morning and night) with the quality of nursing care [11-14].
The results of own research included aspects of, above all,
nursing care at night. The study assessed the satisfaction of
patients with nursing services. The following were taken
into account: the kindness of nurses, diligence in performing
treatments, availability at night, speed of reaction to the call,
respect and respect for dignity. How the patient's satisfaction
is based on the selected implementation of nursing services at
night. Defining the concept of quality of medical services at
night is not an easy task. Analyzing world literature, it can be
noticed that with the use of new research tools, not only the
level of satisfaction with nursing care is assessed, but also the
assessment of the overall care provided in closed institutions
[15,16].
This problem concerns not only the general assessment of
services provided by the hospital, but also the conditions and
course of treatment as well as satisfaction with the contact with
the nurse and other hospital staff. Patient-the client assesses not
only the medical service, but also the level of personal culture,
speed of response to the call, reliability, honesty and availability
[17].
The traditional nursing model does not matter, which assumed
that the patient is not competent to give opinion on the quality
of medical services. On the other hand, there are no definitions
of the terms: satisfaction [18].

Table 1: Socio-demographic factors, time of hospitalization and the nature/specialty of the ward and the level of satisfaction
and with night time benefits (according to Newcastle).
Socio-demographic factors Newcastle SCALE
and others (time of hospitalization, Experience from Satisfaction with
nature / specialty of the ward / clinic) nursing care nursing care
Sex p=0,1442 p=0,1615
Age p=0,1878 p=0,1028
Marital status p=0,1634 p=0,1784
Professional status p=0,1223 p=0,0021**
Education p=0,0204* p=0,2874
Place of residence p=0,8436 p=0,0007***
The number of nights spent in the hospital p=0,0002*** p=0,0001***
Clinic / branch p=0,4944 p=0,7134

Table 2: Tasks resulting from the caring function and the general assessment of nursing care.

Therapeutic services Newcastle SCALE

Experience from nursing care Satisfaction from nursing care
Satisfying the patient's wishes regarding the night rest by the nurse p=0,0000*** p=0,0000***
Getting the necessary nursing help p=0,0000*** p=0,0000***
Satisfying your food and drink needs p=0,0000*** p=0,0000***
154 Anna Fafara

Table 3: List of correlations between assessments of various aspects of nursing care and the assessment of nursing services
performed at night.
PASAT HOSPIT 2 Evaluation of night care
(quest. 11A-F)
kindness of nurses 0,16
(p=0,0001***)
diligence of performing treatments 0,16
(p=0,0002***)
availability during the day 0,14
(p=0,0009***)
availability at night 0,15
(p=0,0003***)
response speed 0,15
(p=0,0004***)
respect and respect for dignity 0,16
(p=0,0002***)

Table 4: List of correlations between assessments of various aspects of nursing care.

PASAT HOSPIT 2 Newcastle SCALE
(quest. 11A-F) experience from nursing care satisfaction from nursing care
kindness of nurses 0,07 0,12
(p=0,0747) (p=0,0047**)
diligence of performing treatments 0,08 0,12
(p=0,0524) (p=0,0026**)
availability during the day 0,14 0,20
(p=0,0005***) (p=0,0000***)
availability at night 0,17 0,23
(p=0,0000***) (p=0,0000***)
response speed 0,18 0,25
(p=0,0000***) (p=0,0000***)
respect for dignity 0,16 0,21
(p=0,0001***) (p=0,0000***)

Nursing care usually takes place in direct contact with the
patient. Nursing is a kind of subsystem that determines the
level of medical services. High quality nursing practice should
have a rational basis in the form of high qualifications and
continuous professional development of nurses. Increasingly,
in clinical nursing, the method of individual cases is used
not only in theory but also in practice [19]. The role of a
nurse changed from a person dealing only with a patient per
person with logistic management skills, supervising control
and measurement devices, human resource management, and
material flows. The assessment of the nurse's work does not
therefore cover the whole process of providing services. These
skills are directly related with quality management [20]. The
tasks of the nurse working on the night shift include observing
whether patients have symptoms of sleep disorders, which
should inform the doctor and provide the patients with optimal
conditions to meet the need for night rest. If possible, the nurse
should respect the patient's habits, including bedtime, number
of hours of sleep, favorite sleeping position or drinking a
warm drink at bedtime. The nurse is obliged to ensure that the
top light is off and if needed, this should provide night-time
lighting, it must be remembered that the rooms should have an
appropriate microclimate. You should not be hungry or fed up.
Activities performed during night duty should be limited only
to necessary and performed with calmness, because the noise
wakes up patients. The assessment of individual care tasks was
significantly related to the overall assessment of nursing care.
The strongest assessment of nurse work was correlated with the
wishes for night rest: experience in nursing care (p=0.0000***),
and satisfaction with nursing care (p=0.0000***). An important
care task was also the possibility of talking with a nurse:
experiences from nursing care (p=0.0000***) and satisfaction
with nursing care (p=0.0000***). The obtained dependencies
significantly influenced the assessment of nurses' work.
Respondents expressed a similar opinion in the studies of
Larrabee et al. The patients indicated tasks resulting from the care
function as the most important and characteristic in the work of
nurses (79.1% - caring for, 54.6% - patience, 34.2% - showing
care and interest, 32.1% - knowledge, skills, attitude) [21]. To
filuk in their research confirmed that 63% of respondents could
always count on talking to their nurse about their problems [22].
Research of Gawel and co-workers confirmed that nurses spend
enough time for interviews with patients (87.8% of nurses talk
with patients). However, the respondents stressed the need for
even longer communication (45.6% of patients) [23]. Koracka
and Łukaszuk in the conducted studies they confirmed that the
availability of staff at night in the opinion of the respondents,
it was at a very high level (82.18% very good) and was not
dependent on the number of the respondents' stays in the hospital
(p =0.673) [24]. Interesting research results were obtained by
 Patient Satisfaction with Services Provided at Night and the Assessment of the Quality of Care in the Hospital 155
Sierpińska, in which the low assessment of nurses' work during
the night time according to the respondents (0.4%) resulted
mainly from non-observance of quiet hours, loud behavior of
patients and too little interest in the patient [25]. Six hundred
randomly selected patients in the studies of Moczydłowska and
colleagues emphasized that the nurse respected the patient's
dignity (90,7%) [26].
In the studies of Aiken et al. confirm that patients experience
a high level of trust in the nurse at night, and their satisfaction
decreases with the limited availability of nurses [27]. The
assessment of services provided by nurses at night significantly
influenced on the assessment of overall nursing care. On a
regular basis, according to the medical order, the drugs are
administered at certain times, also at night. Thus, the nurse is
obliged to monitor the patient's condition and observe the patient
for, among others, onset of side effects. After administering
analgesics, the patient should be under constant supervision
and the response to treatment should be evaluated regularly. In
carrying out the tasks resulting from the therapeutic function,
the nurses spend the most time suffering with the patient, which
in effect guarantees a professional and comprehensive care
[28]. Analyzing the assessment of the quality of nocturnal tasks
resulting from the therapeutic function, it can be stated that the
opinion of the respondents was related to the general assessment
of nursing care.
Correlations were of average strength, with the exception of
slightly different planning categories of delays: experience
from nursing care (p=0.0000***) and satisfaction with nursing
care (p=0.0000***). Comparison of the results of own research
with the results obtained by other researchers is not easy,
because various research tools and different criteria were used
to select the study group, which made comparison difficult. Kerr
and colleagues nursing staff must have different experience
understanding the patient during the day [29]. The studies by
Przychodzka. Show that nurses do not give them enough time
for interviews (Chi2=14.83, p=0.0001(57.00%-patients from
the provincial hospital, 30.00%, p=0), 0001 patients from a
clinical hospital) [30]. According to Bikkeri Thomson, patients
assess interpersonal care above that of manual activities. The
most important factor confirming the patient's satisfaction
with the stay in the hospital there were experiences related to
nursing services (β=0.27, p<0.001), and then meeting patients'
expectations (β=0.21, p<0.001) [31]. One of the aspects
examined by Furtak-Niczyporuk. Was the punctuality of
nurses when administering medication to patients. It has been
shown that for 63% of respondents, the precise adherence to
the administration time of medicines by nursing staff is a very
important element. Analysis of these tests also allowed to assess
the response rate of nurses to reported pain by the patient. 58%
of the respondents rated the nursing staff very well. In the same
studies, 92% of patients declared satisfaction with nursing care
at night, and the most important aspect in their opinion was the
availability of nurses on night duty [32].
Using standardized tools, reliable, specific and sensitive
analysis of the patient's opinion on the quality of services
provided at night was carried out. The advantage of the NSNS
scale is the fact that it is only adapted to measuring the patient's
satisfaction and experience from nursing care. Certainly, the
extension in the analysis of the factors assigned to particular
aspects of nursing care would allow to create specific scopes of
tasks resulting from the professional functions of nurses. Pasat
Hospit1 assesses the overall hospital care. Benchmarking of
medical entities using PASAT is a guarantee of high quality
of medical services. However, this tool allows you to analyze
nursing care as one of the areas of overall care, and thus does
not recognize the weaknesses of nursing.
Increasing the quality of nursing services is a continuous
challenge and the continuing problem solved does not end
cyclical activities. Nursing is characterized not only by taking
actions directed to health, autonomy and self-assessment of
professional activity, but also by striving to ensure the highest
quality. Nurses as professionals providing medical services are
people referring to patients in a personal and professional way
[33].
Conclusion
1. The quality of services provided by nurses at night influences
the overall assessment of the quality of medical services, as
evidenced by the relationship between the patient's satisfaction
with the services provided at night and the assessment of the
quality of care in the hospital.
2. The patient's satisfaction is the most important measure of the
actions of pro-quality healthcare entities.
3. The analysis of very good assessments of patients' experiences
and satisfaction with nursing care indicates the need to emphasize
the importance of services provided by nurses at night time
from the patient's perspective (his subjective feelings, needs,
expectations) in his pro-quality activities.
4. Nursing care in terms of care and therapeutic function at night
was the most valued by patients, especially in terms of such
expectations towards nurses as: the ability to observe, the ability
to talk and fulfill wishes regarding night rest and diligence in
performing treatments.
5. All activities related to both the admission and the stay of the
patient in medical entities they influence the assessment of the
quality of services provided, and patient satisfaction surveys can
be used as a method of assessing the effectiveness of nursing
staff management (in the scope of introducing modifications).
6. Expectations of patients relative to nursing staff are constantly
growing and they are clearly articulated in the area of ​​services
provided at night.
Demands
Improvement of working conditions and activities for broadly
understood care of patients at night should be a priority objective
156 Anna Fafara
of the pro-quality direction of development of every medical
institution, especially clinical.
Ethical Approval
The research was carried out in accordance with the Resolution
of the Bioethical Commission at the University of Rzeszów of
December 2, 2015 - Resolution No. 4/12/2015
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ADDRESS OF CORRESPONDENCE: Dr. Anna Fafara,
Institute of Nursing and Health Sciences, Faculty of Medicine,
University of Rzeszów, Poland, Tel: +48 17 872 09 11; E-mail:
anna.fafara238@wp.pl
Submitted: July 05, 2018; Accepted: July 17, 2018; Published:
July 24, 2018