International Journal of Nursing Practice 2012; 18: 140–146

RESEARCH PAPER

Differences between patients’ expectations and

satisfaction with nursing care in a private
hospital in Jordan ijn_2008 140..146

Amal Samir Abdel Maqsood PhD

Lecturer, Medical Surgical Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt

Arwa I Oweis RN DSNc

Dean of Nursing and Associate Professor, Department of Maternal and Child Health Nursing, Jordan University of Science and Technology,
Irbid, Jordan

Fadia Shawqi Hasna PhD

Dean of Nursing and Associate Professor, Faculty of Nursing, Philadelphia University, Jerash, Jordan

Accepted for publication July 2011

Abdel Maqsood AS, Oweis AI, Hasna FS. International Journal of Nursing Practice 2012; 18: 140–146
Differences between patients’ expectations and satisfaction with nursing care in a private hospital
in Jordan

A descriptive correlation study was conducted to describe the differences between patient expectations and satisfaction with
nursing care, and to determine the relationships among patient’s satisfaction with nursing care and selected sociodemo-
graphic variables. A convenience sample of 250 patients with different medical, surgical and gynaecologic diagnoses was
recruited to participate in the study, which was carried out at a private hospital in Amman. Two research instruments and
a sociodemographic data form were used for data collection: The Patient Expectations Questionnaire and Patient Satisfaction
with Nursing Care Quality Questionnaire. The results indicated that patients were more satisfied with technical and ethical
aspects of nursing care whereas they were less satisfied with nursing care during the night shift as well as with professional
information provided by the nurses. The difference between patients’ expectations and satisfaction was statistically
significant. Patients’ opinions regarding their expectations and their satisfaction with nursing care can be considered as an
important opportunity for nurses to plan and implement appropriate strategies that improve the quality of nursing care.
Key words: nursing care, patients’ expectations, patients’ satisfaction, quality of nursing care.

BACKGROUND care became a pivotal indicator of the quality of care

Since patient-centred care has become a major concern of provided in hospitals.1,2 O’Connell et al.,3 highlighted dif-
health-care providers, patient satisfaction with nursing ficulties in dissociating patient’s satisfaction with nursing
care from their overall satisfaction with their hospital
Correspondence: Amal Samir Abdel Maqsood, Medical Surgical Nursing
experience. Given the fact that nurses provide the
Department; Faculty of Nursing, Alexandria University, Edmon Fermon primary service to patients, therefore they influence the
Street, Smoha, Alexandria 21527, Egypt. Email: overall level of patients’ satisfaction. Moreover, previous
amal_abdmaqsoud@yahoo.com research showed that patients’ satisfaction with nursing

© 2012 Blackwell Publishing Asia Pty Ltd doi:10.1111/j.1440-172X.2012.02008.x

Patients’ expectations and satisfaction
care reflect the increasing hospital accountability to the
public4–6 and to outcomes of their health-care experi-
ence.7 Oleni et al.8 explored the elements of patients’
satisfaction with nursing care using literature from
Sweden, UK and the USA, and although no consensus
regarding the factors that constitute patients’ satisfaction
with nursing care could be reached in the literature, many
sources relate patients’ satisfaction directly to quality of
care. Satisfaction is widely recognized as a patient
legitimate measure of health care, particularly managed
care.9–11
Eriksen12 defined patients’ satisfaction as the patients’
subjective evaluation of the cognitive-emotional response
resulting from the interaction between the expectations
of nursing care and the perception of actual nurse
behaviours/characteristic. In addition, patients’ opinions
are important because they are the best source that can tell
the providers of what is important, that is why this infor-
mation can be used in health-care planning and evalua-
tion.2,13 On the other hand, patient’s satisfaction has been
associated with improved patient compliance with therapy
that presumably leads to better health outcomes. Nurses
and other health-care professionals play a key role in pro-
viding support and information.5 Patients’ satisfaction is
viewed as a mediator between patients’ perceptions of
quality and their future intentions to reuse the service or
recommend the hospital to family and friends.1
In order to achieve patients’ satisfaction consistently,
data about what the patient prefers should be obtained
before care is delivered not at the end of a care episode in
an attempt to bridge the gap between patients’ percep-
tions of quality of care and those of the nurses. Assessing
patients’ preferences should be a major component of the
nursing assessment.14,15
The aims of this study were to explore the relationship
between patients’ expectations and satisfaction with
nursing care received during hospitalization. Also to
determine the relationship between patients’ sociodemo-
graphic variables and their expectations and satisfaction
levels.
Findings of this study could be transferable to other
private hospital settings and might have similar implica-
tions for nursing care improvements. These findings can
inform the planning and implementation of continuing
education programs for nursing staff. Nursing manage-
ment can also use these findings as one evidence-based
indicator of nursing contribution to the patient care
process.
141
METHODOLOGY
A convenience sample of 250 patients with different
medical, surgical and gynaecologic diagnoses were
recruited to participate in this descriptive correlation
study, carried out at a private hospital in Amman. This
hospital was selected because it has been accredited by the
Joint Commission International in 2008; it was estab-
lished in 2001, with a capacity of 100 beds and 24 com-
prehensive outpatient clinics including most of the
medical specialties. The total number of hospital nurses at
the time of data collection was 245 (120 registered nurses
and 125 practical nurses). Registered nurses are usually
holders of a Bachelor’s degree in nursing (4-year univer-
sity programs) or graduates from a 3-year diploma
program whereas practical nurses are usually graduates
from a 2-year diploma program or have a high school
certificate from a nursing stream. Patients were selected
from three departments of the hospital, the female
medical surgical department which has 21 beds serviced
by 13 nurses (7 registered nurses and 6 practical nurses).
The male medical surgical department has 23 beds and 21
nurses (11 registered nurses and 10 practical nurses) and
the obstetrics and gynaecology department which has 21
beds and 13 nurses (7 registered nurses and 6 practical
nurses).
The inclusion criteria for patients to be selected were
being Jordanian, over 18 years of age, hospitalized for at
least 2 nights at the time of data collection, able to com-
municate and agreeing to participate in the study, and
being psychologically and physically willing to participate.
INSTRUMENTS
The Patient Satisfaction with Nursing Care Quality Ques-
tionnaire (PSNCQQ) developed by Laschinger and Hall16
was mainly used for the purpose of this study; the ques-
tionnaire was modified after obtaining permission to use
and modify it. The variables of this research instrument
(PSNCQQ) were used to devise the Patient Expectation
Questionnaire, which was given to patients upon admis-
sion to the hospital purely documenting their expectations
of nursing care. Then just before discharge, these same
patients were given the PSNCQQ that included the very
same variables. In addition, a demographic data form was
used in this study. The PSNCQQ was used after an exten-
sive review of the literature since patient satisfaction with
nursing care is a major indicator of the quality of hospi-
talization experience; although most instruments used in
the literature did not have a framework and variables were
© 2012 Blackwell Publishing Asia Pty Ltd
142
not measured in a tangible way that can be transferable to
quality managers and be used by them; this instrument is
largely based on the Patient Judgment of Hospital Quality
used by Meterko et al.17 in 1990. It included measurable
standards of patient satisfaction. The researchers decided
to use it upon admission and pre-discharge. Both ques-
tionnaires consist of 16 items scored on a Likert-type scale
from 1 to 4 (1 being ‘strongly disagree’ whereas 4 being
‘strongly agree’). Each participant received a total score
on the questionnaire ranging from 16 to 64; high scores
indicated high expectations of nursing care.
The PSNCQQ given pre-discharge had three additional
questions that were excluded from the comparisons with
the Patient Expectation Questionnaires; these additional
questions tapped satisfaction with the overall quality of
care received during the hospital stay, overall quality of
nursing care, and intention to recommend the hospital to
family and friends and these questions can only be
answered after the hospitalization experience that is why
they are not included in the expectations questionnaire.
The 4-point Likert scale ranged from 4 ‘very good’ to 1
‘poor’ was used for each item of the PSNCQQ. Each
participant received a total score on the questionnaire
ranging from 16 to 64. High scores on the PSNCQQ
indicated high levels of patient satisfaction with nursing
care.
In addition, the sociodemographic data form was
revised to include a 15-item self-reported scale developed
by the researchers after a review of the literature.4,18
Sociodemographic variables included age, education and
social status as well as hospital variables such as type of
lodging, duration of stay in days and types of treatment
received in the hospital that are proposed to influence the
patient expectations and satisfaction. The patient was
asked to respond to all questions included in the socio-
demographic data form. Translation of the instruments
was done using the back translation method for each
instrument.
INSTRUMENTS VALIDITY
AND RELIABILITY
Laschinger and Hall16 reports that PSNCQQ instrument
reliability for item correlations ranges from 0.61 to 0.89;
the reported Cronbach’s alpha coefficient is 0.97. In the
current study, the Cronbach’s alpha coefficient was 0.81
for PSNCQQ and 0.82 for Patient Expectation Question-
naire indicating that the questionnaires were reliable.
© 2012 Blackwell Publishing Asia Pty Ltd
AS Abdel Maqsood et al.
Laschinger and Hall16 states that the predictive validity
of this instrument for expected outcomes has been estab-
lished as valid for the purposes of health services research.
Content validity of these instruments was assessed by a
panel of three experts specialized in adult health nursing
for clarity, validity and comprehensiveness of the ques-
tionnaire items. A pilot study with 15 participants, who
were then excluded from the study, was conducted to
determine the clarity of the instrument and the time
required from each participant to complete the question-
naire; based on the pilot study the length of patient’s stay
was decreased from at least 5 days of hospitalization to at
least 2 nights.
DATA COLLECTION PROCEDURE
The research protocol was reviewed and approved by the
scientific research committee at Philadelphia University.
Permission to conduct the study was obtained from the
director of the hospital; following that, the researcher
scheduled a meeting with the head nurse and nursing staff
of each unit to discuss the nature of the study and the data
collection process. Data were collected by one of the
researchers from December 2009 to February 2010. The
researcher explained the nature and the purpose of
the study to eligible participants who were reassured that
their participation is voluntary, that they can withdraw
from the study at any time, and that their names will not
be identified; hence, their privacy, anonymity as well as
confidentiality was protected. Furthermore, they were
assured that their participation will not affect the quality
of care they would be receiving. Written consent forms
were signed by the participants before data collection.
The patients were given their copy of the Patient Expec-
tation Questionnaire and were asked to complete it on
admission. On the other hand, the PSNCQQ question-
naire was completed just before they were discharged.
DATA ANALYSIS
Data were analyzed using the Statistical Package for the
Social Sciences version 10 (SPSS) computer program
(SPSS Inc, Chicago, IL, USA). Descriptive and inferential
statistics were performed on the expectation and satisfac-
tion questionnaires as well as the demographic data
section. Frequencies, means and standard deviations were
used to describe the characteristics of participants; t-test
was used to examine the differences between patients’
expectations and satisfaction. Finally, correlations were
Patients’ expectations and satisfaction 143

used to determine associations between patient’s satisfac- with overall quality of hospital care, nursing care and
tion and demographic variables; values of P < 0.05 were reported that they would recommend this hospital to their
considered significant. families and friends.
Furthermore, a paired sample t-test was conducted to
evaluate the impact of patient’s expectations and satisfac-
RESULTS
tion. The results revealed a significant increase from
Table 1 shows the sociodemographic characteristics of
expectations to satisfaction (M = 54.48 ⫾ 8.6 to
the patients where the mean age was (43.7 years and
M = 58.19 ⫾ 9.0) with a P-value less than 0.05
SD ⫾ 19.4) with male patients representing 54% of the
(t = -6.814, d.f. = 245). The mean decrease was 2.14
sample; the majority of participants were married (60%)
with 95% CI ranging from 4.77 to 2.63.
whereas the highest portions for education were holders
Table 2 illustrates only the items with significant dif-
of a secondary school certificate and higher education
ference between patients’ expectations and satisfaction
(34%, 38.4%, respectively; the findings also revealed that
for the highest scoring items whereby nurses’ skills and
more than half of the patients (50.8%) were admitted to
competence had the highest score in terms of satisfaction
the medical department. The largest portion of the
(3.71); and the second high scoring item in terms of
patients was hospitalized for 5 days or less (67.6%).
satisfaction was for maintaining privacy (3.71). In all
The findings of this study indicated that the mean
items in Table 2, patients’ satisfaction was significantly
expectation score was 54.5 ⫾ 8.67, whereas mean satis-
higher than patients’ expectations.
faction score was 58.2 ⫾ 9.03. Findings of this study
Table 3 illustrates the items only with significant dif-
showed that in general the patients were highly satisfied
ference between patients’ expectations and satisfaction
for the least scoring items whereby information provided
Table 1 Sociodemographic characteristics of the patients
to patients was the least scoring item for both patients’
n = (250)
expectation (3.31) and satisfaction of patients (3.55); this
relationship was statistically significant for all items
Variables N %
included in this table.
The results also indicated that there were no significant
Age (years)
relationships between patients’ sociodemographic charac-
Mean = 43.7 (SD) 19.4 teristics and satisfaction with nursing care.
Gender
Male 135 54 DISCUSSION
Female 115 46 Findings of this study indicated that the patients were
Marital status satisfied with the overall nursing care and their satisfaction
Single 69 27.6 level exceeded their expectations. The results also indi-
Married 150 60 cated that patients were more satisfied with technical and
Educational level ethical aspects of nursing care including nurses’ skills and
Secondary school 85 34 competencies, maintaining privacy, being sympathetic
Higher education (diploma and bachelor) 96 38.4 and having respectful communication whereas they were
Department
less satisfied with the professional information provided
Medical 127 50.8
by the nurses about their disease, health status, investiga-
Surgical 105 42.0
Type of lodging
tions and prognosis of their condition. This finding reflects
Private 102 40.8 some idea about the status of the nurses in private hospi-
Semi = private 61 24.4 tals in the sense that they shied away from providing
Length of hospitalization information to the patients as this was mostly viewed as
Less than 5 days 102 40.8 the doctors’ responsibility. This role of information giver
5 days 67 26.8 expected by the public from the nurses is instrumental to
More than 5 days 81 32.4 the empowerment of nurses by playing the roles of advo-
cates to their patients. Indeed, Taylor and Ferszt19 stressed
SD, standard deviation. the importance of nurses releasing information to the

© 2012 Blackwell Publishing Asia Pty Ltd

144 AS Abdel Maqsood et al.

Table 2 Difference between patient expectations and satisfaction on items where patients were mostly satisfied

Patient mostly satisfied with Mean Mean P t d.f.

Expectation Satisfaction

Nurses maintained my privacy. 3.48 3.71 0.000 5.308 249

Nurses provide skilled and competent care. 3.51 3.71 0.000 4.594 248
Nurses were sympathetic with me. 3.46 3.69 0.000 5.362 249
Nurses responded to my call promptly. 3.42 3.68 0.000 3.827 249
Nurses communicated respectfully. 3.53 3.68 0.002 3.166 248

d.f., degrees of freedom.

Table 3 Difference between patient expectations and satisfaction on items where patients were least satisfied

Patient least satisfied with Mean Mean P t d.f.

Expectation Satisfaction

Nurses gave information about my health status and progress. 3.31 3.55 0.000 4.864 248
Nurses gave clear and complete explanation about the investigations and treatments. 3.35 3.57 0.000 4.560 249
Nurses provided care for me at night. 3.32 3.56 0.000 4.395 249

d.f., degrees of freedom.

patients re their condition, treatment protocols and even
prognosis as part of the advocacy for human rights and
informed decisions regarding their care; whereas Martin20
explained all the barriers nurses faced in assuming their
roles as advocates because of the ‘ritualized nurse-doctor
relationship’ (p. 191) of power hierarchy with the
doctors. He used his analysis to discuss how nurses were
pressured to accept the ‘status quo’ (p. 192); this situation
results in a serious dilemma for the nurses whereby they
are expected to have empathy but at the same time must
comply with doctors’ regimen of disclosure of informa-
tion as well as distancing themselves from the patient. In
this context, Schmalenberg and Kramer21 mentioned that
good relationships between nurses and physicians are
important to high-quality patient care. By allowing the
nurses to assume their roles as ‘information givers’, since
they spend most of the time with the patients in the
hospital, a culture of inter-professionalism between
doctors and nurses would be encouraged; staying away
from authority struggles and territorialism and looking at
the larger picture that is the benefit of the patient and
quality of care of the hospital would be strongly recom-
mended. The findings of this study also indicated that the
patients were less satisfied with nursing care during the
night shift; this might be explained by the under-
resourcing hence heavier nursing workload during the
night shift in comparison with the day shift. Similar find-
ings were reported in the literature.22,23 Moreover,
Abdalkader and Hayajneh24 in a study about staffing of
nurses in Jordanian hospitals reported that there were
fewer nurses working at night; in addition, 73% of the
nurses stated that the ratios of the nurses to patients
during night shift were not appropriate. This study also
showed that 67% of the nurses did not feel energetic when
working on night shift: ‘Tiredness may be due to insom-
nia, change in sleeping patterns, and circadian rhythms’
(p. 80).
On the other hand the above-mentioned findings
showed that patients were satisfied with the ethical aspects
of nursing care; this is in harmony with the strong cultural
values of the nursing profession in Jordan. The fact of not
releasing information might be explained by the fear of
releasing bad news especially in patients with terminal
conditions which is a trend highly affected by the Jorda-
nian cultural context and the fatalism that results in the
belief that patients’ prognosis is in God’s hands; a similar
situation is related in the literature by Martin;20 further-
more, these findings are contextualized and validated by

© 2012 Blackwell Publishing Asia Pty Ltd

Patients’ expectations and satisfaction
Mrayyan,25 where she reported that nurses in the private
sector of Jordan suffer many stressors such as nursing
shortage, burnout and high turnover rates; this in her view
is related to acute job dissatisfaction intensified by the
hierarchy with the doctors and fear of confrontation with
them because of this hierarchy; this might be an underly-
ing reason for the lack of disclosure of information to
patients that is considered a medical responsibility. This
gamut of stressors seems global as pointed out by
Scott et al.,26 Al-Ma’aitah et al.,27 Lee et al.28 cited in
Mrayyan.25 Moreover, Mrayyan25 stressed the poor com-
munication as well as lack of support from nurse managers
in the role overlap with doctors leading to low autonomy
levels in the profession. Finally, it seems important to
note that the correlations between patients’ sociodemo-
graphic characteristics and satisfaction with nursing care
were not significant although some studies in the litera-
ture found a significant association with race, gender, age
and satisfaction with nursing care.29
LIMITATIONS OF THE STUDY
Since patients had a number of different nurses caring for
them, they were hesitant in answering questions that
referred to all nurses. In addition, nursing occurs within a
multidisciplinary context; patients had difficulties to
isolate the nursing care from the whole health-care expe-
rience. Finally, the investigation was conducted in only
one private hospital in Jordan. Therefore, the results
cannot be generalized to all private hospitals but might
provide a flavour of the level of patient satisfaction in
private settings; in the future, it would be interesting to
compare private with public setting including more than
one hospital in both sectors.
CONCLUSIONS
This study found that patients were satisfied with the
overall nursing care and their satisfaction level exceeded
their expectations. The results also indicated that patients
were more satisfied with technical and ethical aspects of
nursing care including nurses’ skills, competencies, main-
taining privacy, being sympathetic and respectful commu-
nication. However, patients were less satisfied with
nursing care during the night shift as well as with infor-
mation provided by the nurses regarding their disease,
health status, investigation and prognosis of their condi-
tion. Nurses should be aware of these comments and take
them into account when providing care. Furthermore, as
the nurse was regarded as the central figure in the
145
patients’ health-care experience, it is particularly impor-
tant that nurses are able to acknowledge and take into
account patients’ expectations when they provide patient-
centred care.
IMPLICATIONS AND
RECOMMENDATIONS
The PSNCQQ can be incorporated into an existing hos-
pital quality monitoring system focusing on patient
satisfaction. The questionnaire could also be used as an
outcome variable to evaluate the impact of unit or orga-
nizational change on patient satisfaction. Moreover,
nurses can use the satisfaction with quality of nursing care
in evaluating and improving the nursing care in clinical
practice. This research study contributed knowledge to
what makes the patient happy and satisfied from several
aspects of nursing care that is why care should be tailored
for the individual patient; and tailoring requires knowing
what the patient prefers before care is given; hence assess-
ing patients’ preferences should be a major component of
the nursing assessment. The nursing assessment should
also focus on identifying the needs for nursing care during
the hospitalization and after discharge; this will be done by
clinical nurse specialists; therefore advocating and legis-
lating for clinical nurse specialist titles and posts to be
initiated in all hospitals in Jordan in tune with the efforts
of the Jordanian Nursing Council will presumably
improve patient satisfaction and the image of the nursing
profession at the national level. Finally, a follow-up moni-
toring of the results by filling the questionnaires by the
patients a fortnight after their discharge is highly recom-
mended as it might remedy any ‘halo-effect’ bias from this
study.
REFERENCES
1 Peterson W, Charles C, DiCenso A, Sword W. The New-
castle satisfaction with nursing scales: A valid measure of
maternal satisfaction with inpatient postpartum nursing
care. Journal of Advanced Nursing 2005; 52: 672–681.
2 Wagner D, Bear M. Patient satisfaction with nursing care: A
concept analysis within a nursing framework. Journal of
Advanced Nursing 2009; 65: 692–701.
3 O’Connell B, Young J, Twigg D. Patient satisfaction with
nursing care: A measurement conundrum. International
Journal of Nursing Practice 1999; 5: 72–77.
4 Larrabee JH, Ostrow CL, Withrow ML, Janney MA,
Hobbs GR, Burant C. Predictors of a patient satisfaction
with inpatient hospital nursing care. Research in Nursing &
Health 2004; 27: 254–268.
© 2012 Blackwell Publishing Asia Pty Ltd
146
5 Valentin G, Lopez P, Garrido R. Patient satisfaction with
nursing care in a regional university hospital in southern
Spain. Journal of Nursing Care Quality 2005; 1: 63–72.
6 Kutney-Lee A, McHugh MD, Sloane DM et al. Nursing:
A key to patient satisfaction. Health Affairs 2009; July/
August; 28(4): 669–677. Available from URL: http://
www.nursing.upenn.edu/chopr/Documents/Kutney-L
ee%20(2009)%20Nursing%20Key%20to%20Pub%20
Satisfaction.%20Health%20Affairs.pdf. Accessed 15 April
2010.
7 Arthur V, Clifford C. Rheumatology: The expectations and
preferences of patients for their follow-up monitoring care:
A qualitative study to determine the dimensions of patient
satisfaction. Journal of Clinical Nursing 2004; 13: 234–242.
8 Oleni M, Johansson P, Fridlund B. Nursing care at night:
An evaluation using the night nursing care instrument.
Journal of Advanced Nursing 2004; 47: 25–32.
9 La Ferriere R. Client satisfaction with home health care
nursing. Journal of Community Health Nursing 1993; 10:
67–76.
10 Wolf ZR, Colahan M, Costello A, Warwick F, Ambrose
MS, Giardino ER. Relationship between nurse caring and
patient satisfaction. Medsurg Nursing 1998; 7: 99–105.
11 Milutinovic D, Brestovacki B, Martinov M. Patients’ satis-
faction with nursing care as an indicator of quality of
hospital service. Health & Medicine 2009; 3: 412–419.
12 Eriksen LR. Patient satisfaction with nursing care: Concept
clarification. Journal of Nursing Management 1995; 3: 59–76.
13 Johansson P, Oleni M, Fridlund B. Patient satisfaction with
nursing care in the context of health care: A literature study.
Scandinavian Journal of Caring Sciences 2002; 16: 337–344.
14 Walsh M, Walsh A. Measuring patient satisfaction with
nursing care: Experience of using the Newcastle Satisfaction
with Nursing Scale. Journal of Advanced Nursing 1999; 29:
307–315.
15 Thiedke CC. What do we really know about patient satis-
faction? Family Practice Management 2007; 1: 1–5.
16 Laschinger HS, Hall L. A psychometric analysis of the
patient satisfaction with nursing care quality questionnaire.
Journal of Nursing Care Quality 2005; 3: 220–230.
© 2012 Blackwell Publishing Asia Pty Ltd
AS Abdel Maqsood et al.
17 Meterko M, Nelson EC, Rubin HR et al. ‘Patients’ judg-
ment of hospital quality: A report on a pilot study. Medical
Care 1990; 28 (Suppl.): S1–S56.
18 Al-Ma’aitah R, Cameron S, Armstrong-Strassen M, Hors-
burgh ME. Predictors of job satisfaction, turnover, and
burnout in female and male Jordanian nurses. The Canadian
Journal of Nursing Research 1999; 31: 15–30.
19 Taylor P, Ferszt G. The nurse as patient advocate. Nursing
1998; August; 28(8): 70–71. Available from URL: http://
www.springnet.com. Accessed 1 August 2009.
20 Martin G. Ritual action and its effect on the role of the
nurse as advocate. Journal of Advanced Nursing 1998; 27:
189–194.
21 Schmalenberg C, Kramer M. Nurse-physician relationships
in hospitals: 20 000 nurse tell their story. Critical Care Nurse
2009; 29: 74–83.
22 Staniszewska S, Ahmed L. Patient expectations and satisfac-
tion with health care. Nursing Standard 1998; 18: 34–38.
23 Whale Z. Shift work and quality of care. Journal of Clinical
Nursing 2007; 2: 269–272.
24 Abdalkader R, Hayajneh F. Effect of night shift on nurses
working in intensive care units at Jordan University
Hospital. European Journal of Scientific Research 2008; 23:
70–86.
25 Mrayyan M. Nursing practice problems in private hospitals
in Jordan: students’ perspectives. Nurse Education in Practice
2007; 7: 82–87.
26 Scott JG, Sochalski J, Aiken L. Review of magnet hospital
research. The Journal of Nursing Administration 1999; 29:
9–19.
27 Al-Ma’aitah R, Cameron SJ, Armstrong-Stassen M, Hors-
burgh M. Effect of gender and education on the quality of
nursing work life of Jordanian nurses. Nursing and Health
Care Perspectives 1999; 20: 88–94.
28 Lee H, Song R, Cho YS, Lee GZ, Daly B. A comprehensive
model for predicting burnout in Korean nurses. Journal of
Advanced Nursing 2003; 44: 534–545.
29 Findik U, Unsar S, Sut N. Patient satisfaction with nursing
care and its relationship with patient characteristics. Nursing
& Health Sciences 2010; 12: 52–63.