Journal of Nursing Management, 2009, 17, 749–758

Patient satisfaction with nursing care in Jordan

1 2
MOHAMMAD ABEDRABO ALHUSBAN MSN, RN and RAEDA FAWZI ABUALRUB PhD, RN
1
Staff nurse, Al-Mafraq Governmental Hospital, Al-Mafraq and 2Assistant Professor, College of Nursing, Jordan
University of Science and Technology, Irbid, Jordan

Correspondence ALHUSBAN M.A. & ABUALRUB R.F.(2009) Journal of Nursing Management 17, 749–758
Raeda Fawzi AbuAlrub Patient satisfaction with nursing care in Jordan
PO Box 1894
Irbid Aims (i) To assess the level of patientsÕ experiences of nursing care and identify
Jordan important aspects that enhance such experiences; (ii) to assess the level of patientsÕ
E-mail: raeda71@yahoo.com satisfaction with nursing care and identify important aspects that enhance satis-
faction; and (iii) to compare the level of patientsÕ satisfaction and their experiences
according to demographic variables of patients, hospital wards and hospital set-
tings.
Design and method A cross-sectional descriptive study was used. The sample of the
study was a convenience one (n = 300). The Newcastle Satisfaction with Nursing
Scale and a demographic form were used to collect the data.
Results The findings of the study indicated that the level of satisfaction of
Jordanian patients with nursing care was moderate and their experiences of
nursing care were positive. Female patients were more satisfied with nursing
care than male patients. Gynaecological patients were more satisfied than
medical/surgical patients and patients in the semi-private hospitals were more
satisfied than those in public hospitals.
Implications for nursing management The findings of the study provided the basis
for developing strategies that may enhance the level of Jordanian patientsÕ satis-
faction.
Conclusion The findings of the study provide nurses with information about aspects
that enhance or hinder patient satisfaction.
Keywords: experience, Jordan, nursing care, patient, satisfaction

Accepted for publication: 23 May 2008

in a highly competitive environment has led to

Introduction
Consumers of health care services demand quality care.
Patient satisfaction has been used as an indicator of
quality services provided by health care personnel. The
most important predictor of patientsÕ overall satisfac-
tion with hospital care is particularly related to their
satisfaction with nursing care (Mahon 1997, OÕConnell
et al. 1999). In recent years, the focus on consumerism
DOI: 10.1111/j.1365-2834.2008.00927.x
ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd
increased interest in measuring patient satisfaction with
health care (Merkouris et al. 1999, Alasad & Ahmad
2003).
Pascoe (1983) defined patient satisfaction as Ôa health
care recipientÕs reaction to salient aspects of the context,
process, and result of their service experience (p. 189).
PascoeÕs definition of patient satisfaction encompasses
both cognitive and emotional evaluation of health care
749
M. A. Alhusban and R. F. Abualrub
services (Peterson et al. 2005). On the other hand,
Scarding (1994) defined patient satisfaction as the
extent of the resemblance between the expected quality
of care and the actual received care. Patient satisfaction
with nursing care is important for any health care
agency because nurses comprise the majority of health
care providers and they provide care for patients
24 hours a day (McDonnel & Nash 1990, Alasad &
Ahmad 2003).
Information about factors that can enhance patient
satisfaction is essential for marketing purposes (Phi
et al. 2002). Data about patient satisfaction equips
nurses with useful information about the structure,
process and outcome of nursing care such as adequacy
of staffing, therapeutic needs and patient behaviours
(Pascoe 1983, Phi et al. 2002). Patient satisfaction is
considered as a requirement for Ôtherapeutic treatmentÕ
and sometimes as an Ôequivalent to self therapyÕ. Satis-
fied patients help themselves healed faster because they
are more willing to comply with treatment and adhere
to instructions of health care providers, and thus have a
shorter recovery time (Pascoe 1983, Cleary & McNeil
1988, Merkouris et al. 1999).
Background
The health care system in Jordan consists of: (i) public
(governmental) hospitals which are mainly funded by
the government (Ministry of Health); (ii) private
hospitals which are funded by investors; (iii) and
semi-private hospitals (teaching) which are funded
mainly by universities and partly by the government
(Ministry of Health). The public hospitals are non-
profit organizations, while private and semi-private
hospitals are for-profit organizations. In Jordan, there
is no standardized process for granting the licensure
exam. Usually, having a degree in nursing is the only
requirement to practice nursing in any hospital; how-
ever, nursing leaders in Jordan are working on stan-
dardizing a licensure exam as a prerequisite for
practicing nursing.
Few studies in Jordan have focused on the quality of
nursing care from the patientsÕ perspective. More
studies are needed to investigate patient satisfaction
with nursing care because such studies present infor-
mation that is important for nurses to focus on while
providing care to their patients. In Jordan, this is only
the second study to investigate the level of satisfaction
of Jordanian patients and their experiences of nursing
care. It also identifies satisfying factors that are impor-
tant for them. While the first study was conducted in a
semi-private hospital, the present study was conducted
750 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758
in both semi-private and public hospitals. It provides
information about the difference in the level of patientsÕ
satisfaction between public and semi-private hospitals.
Such information has implications for nurse adminis-
trators in regard to the effect of the organizational
setting on the level of patientsÕ satisfaction. In addition,
the semi-private hospital accessed for the present study
was not included in the study of Alasad and Ahmad
(2003). The purpose of the present study was to: (i)
assess the level of patientsÕ experiences of nursing care
and identify important aspects that enhance such
experiences; (ii) assess the level of patientsÕ satisfaction
with nursing care and identify important aspects that
enhance patient satisfaction; and (iii) compare the level
of patientsÕ satisfaction and their experiences according
to demographic variables of patients, hospital wards
and hospital settings.
The following research questions were investigated:
(i) what is the level of patientsÕ experiences of various
aspects of nursing care? (ii) what is the level of patientsÕ
satisfaction with various aspects of nursing care? and
(iii) is there a difference in the level of patientsÕ
satisfaction and their experiences in relation to
demographic variables of patients, hospital wards and
hospital settings?
Literature review
PatientsÕ satisfaction and experiences of nursing care
Alasad and Ahmad (2003) conducted a survey using a
cross-sectional design to investigate patient satisfaction
with nursing care among 266 Jordanian patients. The
Newcastle Satisfaction with Nursing Scale (NSNS) was
used for data collection. The findings showed that: (i)
females were more satisfied with nursing care than
males; (ii) patients with a high level of education were
less satisfied than patients with a lower level of educa-
tion; (iii) patients in medical or gynaecological wards
had higher levels of satisfaction than patients in surgical
wards.
Moreover, Ahmad and Alasad (2004) reported on the
experiences of nursing care among 225 Jordanian
patients recruited from medical and surgical wards in a
semi-private (teaching) hospital. These results showed
that spending adequate time with patients and showing
respect to their family members were perceived by
participants as positive experiences. On the other hand,
the inadequacy of received information was perceived
by participants as a negative experience.
Vincent et al. (2004) conducted a cross-sectional
study to evaluate the association between Ôcontinuity of
careÕ and the level of patientsÕ satisfaction. The study

was carried out in seven Veterans primary care clinics
(n = 21 689). The results showed that as self-reported
continuity of care increased so did patient satisfaction.
In a descriptive cross-sectional study among 510
Jordanian patients, Mrayyan (2006) found that partic-
ipants were most satisfied with ÔnursesÕ availabilityÕ and
least satisfied with Ôcontinuity of careÕ.
On the other hand, a cross-sectional descriptive cor-
relational study was conducted in Finland to examine
the relationship between Ôindividualized careÕ and the
level of satisfaction with nursing care. The total study
sample was 279 surgical patients. The results showed
that: (i) patients were generally satisfied with the
individualized care they received from nurses; and
(ii) patients who perceived receiving higher individuality
of care reported experiencing higher levels of satisfac-
tion (Suhonen et al. 2005).
Akin and Erdogan (2007) examined the validity and
reliability of the Satisfaction with Nursing Care Scale
(SNCS) of the NSNS among 200 medical and surgical
Turkish patients. They found that the SNCS has content
validity and adequate reliability. CronbachÕs alpha was
0.96 and alpha coefficients for the items ranged from
0.43 to 0.89. The results also showed that the overall
satisfaction level of participants was reported to be
ÔgoodÕ.
In a Japanese hospital, a study was conducted by
Tokuanaga et al. (2002) to test if the level of satisfac-
tion differed among two groups of patients: those who
requested Ôtechnical elementsÕ of hospital care and those
who requested Ôinterpersonal elementsÕ. The total study
sample was 10 350 patients. The results showed that
patients who requested Ôinterpersonal elementsÕ con-
sidered kindness and warmth of nurses important for
their satisfaction. Whereas, patients who requested
Ôtechnical elementsÕ considered skills of nurses impor-
tant for their satisfaction.
Furthermore, Hancock et al. (2003) conducted a
study to: (i) identify important elements of nursing care
from the viewpoint of nurses, older patients and their
family members; and (ii) assess the level of satisfaction
of nurses, older patients and their family members. The
Caregiving Activities Survey was used to collect data
from 232 older patients, 99 family members and 90
nurses. In terms of importance, the results indicated
that: (i) Ôcarrying out doctorsÕ ordersÕ was rated highest
by all groups; and (ii) providing physical aspects of care
was rated as the second highest category then psycho-
social care and last of all discharge planning. In terms of
satisfaction, nurses, patients and their family members
were highly satisfied with the aspect of Ôcarrying out
doctorsÕ ordersÕ and moderately satisfied with the
ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758
Patient satisfaction
aspects of physical care, psychosocial care and dis-
charge planning.
Demographic variables and patient satisfaction with
nursing care
The literature revealed that: (i) older patients were more
satisfied than younger patients (Bodil 1999, OÕConnell
et al. 1999, Phi et al. 2002, Tokunaga et al. 2002,
Easter et al. 2003, Venn & Fone 2005, Akin & Erdogan
2007); (ii) men tended to be more satisfied than women
(Bodil 1999, Phi et al. 2002); (iii) highly educated
patients were less satisfied than patients with less
education (Bodil 1999, Alasad & Ahmad 2003, Stephen
et al. 2003), (iv) patients who stayed longer in the
hospital tended to be less satisfied than those who
stayed for a short time (Bodil 1999, Phi et al. 2002,
Tokunaga et al. 2002); (v) patients who stayed in
private rooms were more satisfied than others (Phi et al.
2002); and (vi) patients who stayed in medical or
gynaecological wards were more satisfied than others
(Phi et al. 2002, Alasad & Ahmad 2003, Akin &
Erdogan 2007).
On the other hand, other studies revealed that: (i) age
was not associated with satisfaction (Barbara et al.
1999, Wallin et al. 2000, Alasad & Ahmad 2003);
(ii) gender was not associated with satisfaction (Barbara
et al. 1999, Wallin et al. 2000, Stephen et al. 2003);
and (iii) women tended to be more satisfied than men
(OÕConnell et al. 1999, Tokunaga et al. 2002, Alasad
& Ahmad 2003, Chan & Chau 2005, Venn & Fone
2005, Akin & Erdogan 2007).
In summary, the literature revealed that continuity of
care and individualized care were associated with higher
patient satisfaction. NursesÕ kindness and warmth, their
skills and amount of information they provided to
patients, the time they spent with patients as well as the
respect they provided to their relatives and friends
enhanced the level of patientsÕ satisfaction and their
experiences of nursing care. Moreover, the literature
revealed the consistency for the associations between
patientsÕ satisfaction and their education level, length of
stay, and the stay in medical or gynaecological wards and
private rooms. On the other hand, the literature showed
inconsistent results in regard to the association between
patientsÕ satisfaction and their age or gender.
Improving the quality of care in health care organi-
zations is a major challenge that faces health care pro-
viders in Jordan (World Bank report 1999). This study
provides information about the aspects that enhance
satisfaction of Jordanian patients; and highlights the
differences in the level of patientsÕ satisfaction between
public and semi-private hospitals.
751
M. A. Alhusban and R. F. Abualrub
Methods
Sample and data collection
The sample was a convenience one that consisted of 300
medical, surgical and gynaecological patients from
three different settings. Patients from three hospitals
were included in the study: one semi-private hospital
(n = 150, medical, surgical and gynaecological wards);
one public hospital (n = 100, medical and surgical
wards) and a public gynaecological hospital (n = 50).
The purpose of using a combination of public and semi-
private hospitals was to facilitate the comparison of
data from both types of institutions.
The proposal for this study was approved by the
Institutional Review Board of Jordan University of
Science and Technology and the three cooperating
hospitals. The purpose and significance of the study
were explained to eligible patients. Participation was
voluntary and patients were informed that refusing to
participate in the study would not affect the care they
received in the hospital. Anonymity and confidentiality
were ensured; (i) no patient names or identifying
information was recorded, (ii) all findings are reported
in aggregate, and (iii) questionnaires were destroyed
after the data were compiled for statistical analysis.
Participants were recruited from medical, surgical and
gynaecological wards. The inclusion criteria were
patients who (i) were 18 years or older; (ii) could read
and write Arabic; (iii) were conscious and well oriented;
and (iv) had a length of stay more than 48 hours.
The average age of the participants was 37.5 years
and ranged from 18–81 years. The length of stay ranged
from 2–48 days. The majority of participants were
females (n = 219; 73%). The educational level of most
participants was high school (n = 165; 55%), followed
by bachelor degree level (n = 77; 25.7%).
Instruments
The NSNS was used for data collection. Permission to
use the questionnaire was granted by the director of the
Newcastle Clinical Trials Unit, Dr Elaine McCeoll. The
NSNS was selected for collecting data for the present
study because (i) it was found to be valid and reliable in
previous studies conducted in western and middle
eastern countries (Jordan) (Walsh & Walsh 1999,
Alasad & Ahmad 2003, Ahmad & Alasad 2004); (ii) it
can detect differences in the level of satisfaction be-
tween wards in the same hospital and different hospitals
(Thomas et al. 1996); and (iii) it addresses nursing care
rather than other dimensions of the hospital experience
(Peterson et al. 2005). The questionnaire consists of
three components:
752 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758
Experience of nursing care
PatientsÕ experience of nursing care is defined as the
cognitive judgment of several aspects of nursing (Pascoe
1983). Respondents rated their experience of nursing
care on 26 items, using a seven-point Likert scale
(1 = disagree completely, 7 = agree completely) (see
Table 1). They indicated how true each item is of their
own experience. Responses for each item were summed
and transformed to give an overall experience score,
with a potential range of 0–100, where 100 represents
the best possible experience (Thomas et al. 1996). The
alpha coefficient for the Ôexperience of nursing careÕ
scale was 0.91 (Walsh & Walsh 1999). In the present
study, the alpha coefficient for the Ôexperience of nurs-
ing careÕ scale was 0.84.
Opinions of nursing care (satisfaction with nursing
care)
Patient satisfaction with nursing care is defined as the
emotional reaction of the patient to several aspects of
nursing care (Pascoe 1983).. Respondents rated their
satisfaction with various aspects of nursing care, using
a five-point Likert scale (1 = not at all satisfied,
5 = completely satisfied). This section consisted of 19
items (see Table 2). Responses for each item were
summed and transformed to give an overall satisfaction
score of 0–100, where 100 denotes complete satisfac-
tion (Thomas et al. 1996). The alpha coefficient for the
Ôsatisfaction with nursing careÕ scale was 0.96
(Walsh & Walsh 1999). In the present study, the alpha
coefficient for the Ôsatisfaction with nursing careÕ scale
was 0.95.
The NSNS indicates a good conceptual match for the
definition of patient satisfaction by PascoeÕs (1983):
Ôthat is, patientsÕ evaluation of health care services is
based on both a cognitive judgment of the experience
(Experiences of Nursing Care Scale) and an emotional
reaction to that experience (Satisfaction with Nursing
Care Scale)Õ (Peterson et al. 2005, p. 674).
Demographic information
This section includes gender, age, level of education and
length of stay in the hospital (Thomas et al. 1996). The
instrument was translated from English to Arabic by an
individual who is proficient in both languages, and then
back translated from Arabic to English by another
individual who is also proficient in both languages.
The translated versions were reviewed and examined by
a committee comprised of four experts, who are
interested in the research topic and competent in both
Arabic and English. The committee considered the
equivalence of terms, clarity and cultural adaptation.
 Patient satisfaction

Table 1
Means (x) and standard deviations (SD) for PatientÕs Experience of Nursing Care (Total Study Sample n = 300; Mean out of 7)

Gynecological
(n = 100) Medical (n = 100) Surgical (n = 100) Total (n = 300)

Item x % SD x % SD x % SD x % SD

1. It was easy to have a laugh with the 5 71.4 1.66 5.16 73.7 1.5 4.77 68.1 1.74 4.97 71.0 1.64
nurses
*2. Nurses favoured some patients 5.42 77.4 1.88 5.54 79.1 1.36 5.18 74.0 1.82 5.38 76.9 1.7
over others
*3. Nurses did not tell me enough 5.07 72.4 1.9 4.94 70.6 1.8 5.07 72.4 1.69 5.03 71.9 1.8
about my treatment
*4. Nurses were too easy going and 5.72 81.7 1.54 5.1 72.9 1.69 5.21 74.4 1.66 5.34 76.3 1.65
laid back
*5. Nurses took a long time when the 4.85 69.3 2.1 4.16 59.4 1.88 5.05 72.1 1.7 4.69 67.0 1.93
they were called
6. Nurses gave me information just 5.42 77.4 1.47 5 71.4 1.73 5.09 72.7 1.71 5.17 73.9 1.64
when I needed it
*7. Nurses did not seem to know what 4.69 67.0 1.95 5.11 73.0 1.72 4.89 69.9 1.68 4.9 70.0 1.79
I was going through
*8. Nurses turned the lights off too 5.2 74.3 2.05 5.42 77.4 1.8 5.03 71.9 1.72 5.22 74.6 1.86
late at night
*9. Nurses made me do things before 5.67 81.0 1.9 5.79 82.7 1.65 5.1 72.9 1.83 5.52 78.9 1.81
I was ready
10. No matter how busy nurses were, 4.72 67.4 1.94 4.75 67.9 1.61 4.5 64.3 1.9 4.66 66.6 1.82
they made time for me
11. I saw the nurses as friends 5.31 75.9 1.66 5.07 72.4 1.46 4.86 69.4 1.69 5.08 72.6 1.61
12. Nurses spent time comforting 5.24 74.9 1.7 5.25 75.0 1.42 5.25 75.0 1.59 5.25 75.0 1.57
patients who were upset
13. Nurses checked regularly to make 5.67 81.0 1.6 5.3 75.7 1.4 5.14 73.4 1.54 5.37 76.7 1.53
sure I was okay
*14. Nurses let things get on top of 4.91 70.1 1.94 4.96 70.9 1.49 4.7 67.1 1.73 4.86 69.4 1.73
them
*15. Nurses took no interest in me as 5.41 77.3 1.84 5.33 76.1 1.53 5.35 76.4 1.55 5.36 76.6 1.64
a person
16. Nurses explained what was wrong 4.64 66.3 2.13 4.86 69.4 1.66 4.63 66.1 1.86 4.71 67.3 1.89
with me
17. Nurses explained what they were 4.78 68.3 2.04 2.89 41.3 1.64 4.42 63.1 2 4.7 67.1 1.91
going to do to me before they did it
18. Nurses told the next shift what 6.03 86.1 1.2 5.6 80.0 1.41 5.53 79.0 1.44 5.72 81.7 1.37
was happening with my care
19. Nurses knew what to do without 4.58 65.4 1.75 4.55 65.0 1.89 4.44 63.4 1.78 4.52 64.6 1.8
relying on doctors
*20. Nurses used to go away and 5.66 80.9 1.51 5.23 74.7 1.61 5.2 74.3 173 5.36 76.6 1.63
forget what patients had asked for
21. Nurses made sure that patients 5.52 78.9 1.63 5.51 78.7 1.3 5.12 73.1 1.6 5.38 76.9 1.52
had privacy when they needed it
22. Nurses had time to sit and talk 4 57.1 2 4.23 60.4 1.88 3.3 47.1 1.89 3.84 54.9 1.96
to me
23. Doctors and nurses worked well 5.86 83.7 1.45 5.74 82.0 1.41 5.51 78.7 1.45 5.7 81.4 1.44
together as a team
*24. Nurses did not seem to know 5.33 76.1 1.89 5.74 82.0 1.19 5.29 75.6 1.7 5.45 77.9 1.62
what each other was doing
25. Nurses knew what to do for the 5.55 79.3 1.37 5.49 78.4 1.37 5.43 77.6 1.46 5.49 78.4 1.39
best
26. There was a happy atmosphere in 5.43 77.6 1.72 5.34 76.3 1.55 4.97 71.0 1.7 5.25 75.0 1.67
the ward, thanks to the nurses
Average 5.22 74.6 0.95 5.16 73.7 0.86 4.96 70.9 0.92 5.1 73 0.91

*All these negative items were reversed during analysis to be positive items.

A modification was made according to the committee gynaecological wards before the study was conducted.
recommendations. Moreover, the instrument was pilot The findings of the pilot test indicated that the instru-
tested with 30 patients from medical, surgical and ment was clear, understandable and reliable.

ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758 753
M. A. Alhusban and R. F. Abualrub

Table 2
Means (x) and standard deviations (SD) for patient satisfaction with nursing care (total study sample (n = 300); mean out of 5)

Gynecological
(n = 100) Medical (n = 100) Surgical (n = 100) Total (n = 300)

Item x % SD x % SD x % SD x % SD

1. The amount of time nurses spent 3.25 65 1.2 3.15 63 1.06 3.2 64 1.08 3.2 64 1.1
with you
2. How capable nurses were at their 3.96 79.2 0.9 3.68 73.6 0.97 3.7 74 0.96 3.79 75.8 1.0
job
3. There always being a nurse around 3.65 73 1.2 3.5 70 1.03 3.5 70 1.02 3.54 70.8 1.1
if you needed one
4. The amount nurses knew about 3.87 77.4 0.9 3.71 74.2 1 3.6 72 0.93 3.72 74.4 1.0
your care
5. How quickly nurses came when 3.44 68.8 1.2 3.38 67.6 1.05 3.4 68 1.15 3.39 67.8 1.1
you called for them
6. The way the nurses made you feel 3.39 67.8 1.3 3.27 65.4 1.14 3.1 62 1.26 3.24 64.8 1.2
at home
7. The amount of information nurses 3.47 69.4 1.2 3.3 66 0.96 3.2 64 1.16 3.31 66.2 1.1
gave to you about your condition
and treatment
8. How often nurses checked to see 3.7 74 1.1 3.46 69.2 1.15 3.3 66 1.11 3.49 69.8 1.1
if you were okay
9. NursesÕ helpfulness 3.92 78.4 1.0 3.8 76 1.02 3.6 72 1.07 3.78 75.6 1.0
10. The way nurses explained things 3.73 74.6 0.9 3.44 68.8 0.99 3.3 66 1.17 3.5 70 1.0
to you
11. How nurses helped put your 3.51 70.2 1.2 3.27 65.4 1.13 2.9 58 1.17 3.24 64.8 1.2
relativesÕ or friendsÕ minds at rest
12. Nurses manner in going about 3.9 78 0.9 3.74 74.8 0.85 3.7 74 1.01 3.77 75.4 0.9
their work
13. The type of information nurses 3.34 66.8 1.2 3.35 67 0.96 3.3 66 1.15 3.33 66.6 1.1
gave to you about your condition
and treatment
14. NursesÕ treatment of you as an 3.43 68.6 1.1 3.23 64.6 0.98 3.0 60 1.18 3.2 64 1.1
individual
15. How nurses listened to your 4.43 88.6 1.3 3.24 64.8 1.16 2.9 58 1.3 3.18 63.6 1.3
worries and concerns
16. The amount of freedom you were 3.99 79.8 1.0 3.87 77.4 0.79 3.3 66 1.09 3.72 74.4 1.0
given on the ward
17. How willing nurses were to 3.71 74.2 1.1 3.43 68.6 1.06 3.4 68 1.15 3.51 70.2 1.1
respond to your request
18. The amount of privacy nurses 3.69 73.8 1.0 3.44 68.8 0.94 3.2 64 1.05 3.44 68.8 1.0
gave you
19. NursesÕ awareness of your needs 3.9 78 1.0 3.61 72.2 0.91 3.4 68.4 1.12 3.64 72.8 1.0
Average 3.65 73 0.8 3.47 69.4 0.78 3.3 66 0.84 3.47 69.4 0.8

and standard deviations for the items of patientsÕ

Results
Research Question 1, Ôwhat is the level of patientsÕ
experiences of various aspects of nursing care?Õ was
addressed by the use of descriptive statistics. The
maximum scores for patientsÕ experiences and satisfac-
tion were calculated out of 100. The scores were cate-
gorized into three levels: (i) a score less than 60%
indicated Ôbelow goodÕ level of experience or ÔlowÕ level
of satisfaction with nursing care; (ii) a score between
60–80% indicated ÔgoodÕ level of experience or Ômod-
erateÕ level of satisfaction with nursing care; and (iii) a
score of more than 80% indicated a Ôabove goodÕ level
of experience or ÔhighÕ level of satisfaction. The means
experiences with nursing care as well as item scores out
of 100 for the total sample across wards are presented
in Table 1.
The average mean of experience with nursing care
for the total sample was ÔgoodÕ (x = 5.1; SD = 0.91;
score = 72.9%). Participants in gynaecological wards
had a better experience with nursing care when com-
pared with participants in medical and surgical wards.
In gynaecological wards, participants indicated that
they had a Ôabove goodÕ level of experience with aspects
such as Ônurses told the next shift what was happening
with my careÕ. On the other hand, participants
indicated that they had a Ôbelow goodÕ level of

754 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758

experience with aspects such as Ônurses had time to sit
and talk to meÕ.
The average mean of experience with nursing care in
medical wards was also ÔgoodÕ (x = 5.16; SD = 0.86;
score = 73.7%). In medical wards, participants indi-
cated that they had a Ôabove goodÕ level of experience
with factors such as Ônurses made me do things when I
was readyÕ, and Ôdoctors and nurses worked well
together as a teamÕ. Conversely, participants indicated
that they had a Ôbelow goodÕ level of experience with
aspects such as Ônurses explained what they were going
to do for me before they did itÕ, and Ônurses took a long
time to respond when they were calledÕ.
The average mean of experience with nursing care in
surgical wards was ÔgoodÕ (x = 4.96; SD = 0.92; score
70.9%). In surgical wards, participants indicated that
they had a ÔgoodÕ level of experience with aspects such
as Ônurses told the next shift what was happening with
my careÕ and Ôdoctors and nurses worked well together
as a teamÕ. On the other hand, participants indicated
that they had a Ôbelow goodÕ level of experience with
aspects such as Ônurses had time to sit and talk to meÕ.
Research Question 2, what is the level of patientsÕ
satisfaction with various aspects of nursing care? was
also addressed by the use of descriptive statistics. The
average mean of satisfaction with nursing care for the
total sample was ÔmoderateÕ (x = 3.47; SD = 0.8;
score = 69.4%). Participants in gynaecological wards
were more satisfied than participants in medical and
surgical wards (x = 3.65; SD = 0.8; score = 73%). In
the gynaecological ward, participants indicated that
they had ÔhighÕ levels of satisfaction with aspects such as
Ôhow nurses listened to your worries and concernsÕ. On
the other hand, participants had a ÔmoderateÕ level of
satisfaction with aspects such as Ôthe amount of time
nurses spent with youÕ and Ôthe type of information
nurses gave to you about your condition and treatmentÕ.
The means and standard deviations for the items of
patient satisfaction as well as item scores out of 100 for
the total sample are presented in Table 2.
The average mean of satisfaction with nursing care in
medical wards was Ômoderate (x = 3.47; SD = 0.78;
score = 69.4%). Participants indicated that they had a
ÔmoderateÕ level of satisfaction with all items of the scale
such as Ôthe amount of freedom you are given on the
wardÕ and Ônurses helpfulnessÕ.
The average mean of satisfaction with nursing care in
surgical wards was also ÔmoderateÕ (x = 3.3; SD = 0.84;
score = 66.2%). Participants indicated that they had a
ÔmoderateÕ level of satisfaction with aspects such as
Ôhow capable nurses were at their jobsÕ. Conversely,
participants indicated that they had ÔlowÕ levels of
ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758
Patient satisfaction
satisfaction with aspects such as Ôhow nurses helped put
your relatives or friends minds at restÕ.
Research Question 3, Ôis there a difference in the level
of patientsÕ experiences of nursing care or their satis-
faction in relation to demographic factors of patients,
hospital wards, and hospital settings?Õ was addressed by
the use of t-test, analysis of variance (A N O V A ) and Pear-
sonÕs correlations. A N O V A and t-tests were used for the
categorical variables. PearsonÕ correlation was used for
the continuous variables (age and length of stay). Female
patients (x = 3.53) were more satisfied with nursing care
than male patients (x = 3.32) (t = )2.0, P = 0.04). They
also had better (x = 5.14) experience of nursing care
than male patients (x = 5.04), but the increase in the
mean score was insignificant (t = )0.86, P = 0.39).
Analysis of variance was performed to investigate if
there was a difference in the level of patientsÕ experi-
ences and satisfaction with the nursing care in regard to
education level, hospital wards and hospital settings.
There was no statistical difference between patientsÕ
education level and reported means of experience and
satisfaction. Participants in the gynaecological ward
had higher levels of satisfaction than participants in
medical and surgical wards (F = 4.39, P = 0.01). The
post Hoc Test (Tukey) showed that the significant dif-
ference was between the gynaecological ward and the
surgical ward at P = 0.009. There was no statistical
difference between selected wards and the reported
mean of patientsÕ experiences. The results of A N O V A also
showed that participants in the semi-private hospital
had higher levels of both experience and satisfaction
with nursing care than participants in public hospitals.
There were no significant correlations between patientsÕ
age or their length of stay and levels of experiences and
satisfaction. The results of A N O V A showing the rela-
tionships between selected wards and hospitals and the
reported means of patientsÕ experiences and satisfaction
are presented in Table 3.
Discussion and implications
Experiences and satisfaction with nursing care
PatientsÕ experiences of nursing care in the current study
were generally positive. Participants had the most
positive experiences in regard to aspects such as Ônurses
told the next shift what was happening with my careÕ
and Ôdoctors and nurses worked together as a teamÕ.
These findings are consistent with the findings of
Ahmad and Alasad (2004) and McColl et al. (1996).
Such results indicate the importance of collaboration
and continuity of nursing care.
755
M. A. Alhusban and R. F. Abualrub

Table 3
Analysis of variance showing the relationships between selected wards and hospitals and the reported means of patientsÕ experiences and
satisfaction with nursing care

Gynecological (n = 100) Medical (n = 100) Surgical (n = 100) F P

Experiences of nursing care 5.22 5.16 4.96 2.144 0.119

Satisfaction with nursing care 3.65* 3.47 3.31* 4.395 0.013
Semi-private hospital (n = 150) Public hospital (1) (n = 50) Public hospital (2) (n = 100)

Experiences of nursing care 5.31  5.00  4.87  7.517 0.001

Satisfaction with nursing care 3.64à 3.43 3.24à 7.707 0.001

*Post hoc test (Tukey) showed the difference between gynecological and surgical ward at P = 0.009.
 Post hoc test (Tukey) showed a significant difference between semi-private hospital and public hospital (2) regarding experience of nursing care
at P = 0.000, and between semi-private hospital and public hospital (1) at P = 0.049*.
àPost hoc test (Tukey) showed the difference between the semi-private hospital and public hospital (2) regarding satisfaction with nursing care at
P = 0.000.

ParticipantsÕ satisfaction with nursing care was
moderate. The participants were mostly satisfied with
aspects such as Ôthe nurses capability of their jobÕ,
Ônurses helpfulnessÕ, Ônurses manner in going about their
workÕ and Ôthe amount nurses knew about patient careÕ.
These factors reflect the nursesÕ competences and skills,
which mean that satisfaction of patients is mostly
affected by the skills and competences of nurses in
performing their work. Such results are congruent with
the findings of Alasad and Ahmad (2003).
Participants of the present study had the most nega-
tive experiences with aspects such as Ônurses had time to
sit and talk to meÕ, Ônurses knew what to do without
relying on doctorsÕ. Such findings are also consistent
with the findings of Ahmad and Alasad (2004), McColl
et al. (1996) and Walsh and Walsh (1999). The par-
ticipants were also least satisfied with aspects such as
Ôhow nurses listened to your worries and concernsÕ and
Ôthe amount of time nurses spent with youÕ. These
aspects indicate that the time that nurses spend with
patients is not adequate, which might be attributed to
heavy workload, inadequate staffing, performing non-
nursing activities and nursing shortage. Such results
inform nurses, nurse administrators and managers that
despite cultural differences, the issues of spending
inadequate time with patients and poor nursing auton-
omy seem to be common dissatisfiers among patients
with different cultures.
Demographic variables and patientsÕ experiences
and satisfaction with nursing care
Female patients were more satisfied with nursing care
than male patients. Such a result is consistent with the
findings of Alasad and Ahmad (2003), Easter et al.
(2003) and Venn and Fone (2005). On the other hand,
the results showed that female patients had better
experiences than male patients; but the difference was
insignificant. Such a result is inconsistent with the
findings of Ahmad and Alasad (2004) who found that
male patients had better experiences of nursing care
than female patients. It is worth mentioning here that
experience of nursing care and satisfaction with nursing
care have different operational definitions in the present
study. Experience of nursing care was measured by 26
items (cognitive judgment); whereas, satisfaction with
nursing care was measured by 19 different items
(emotional judgment).
The findings of the study also indicated that patientsÕ
education level had no effect on their experiences or
satisfaction with nursing care; such findings were con-
sistent with the results of Akin and Erdogan (2007) and
Chan and Chau (2005). On the other hand, such
findings were inconsistent with the findings of Alasad
and Ahmad (2003), Barbara et al. (1999) and Bodil
(1999). These studies found that patients with higher
levels of education had lower levels of satisfaction. The
results also showed that there were no significant
relationships between the patientÕs age or length of stay
and his level of experience or satisfaction, which is
inconsistent with the findings of Bodil (1999), Stephen
et al. (2003), Tokunaga et al. (2002) and Vincent et al.
(2004). However, no association between age and the
level of patientsÕ satisfaction was found by Alasad and
Ahmad (2003), Barbara et al. (1999) and Wallin et al.
(2000). Such inconsistent results in regard to the asso-
ciations between the demographic variables of patients
and the level of satisfaction call for further research
that control for other variables such as the demo-
graphic variables of nurses who provide care for those
patients and other organizational variables such as
nursesÕ satisfaction.

756 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758

Discussion
When comparing wards, the results showed that par-
ticipants in gynaecological wards had higher level of
satisfaction with nursing care than participants in sur-
gical wards; such a result is consistent with the findings
of Akin and Erdogan (2007), Alasad and Ahmad (2003)
and Phi et al. (2002). A possible explanation for this
result might be because of the fact that the health status
of gynaecological patients is better than those in surgi-
cal wards. Usually, patients who are admitted to sur-
gical wards are more sensitive to the quality of care they
receive because of their reduced health status. Vera
(1999) indicated that variation in patientsÕ satisfaction
and their feelings of vulnerability were related to the
levels of care they received. Another explanation might
be the gender of patients; all gynaecological patients are
females who have higher levels of satisfaction than
males as the findings of this study and other studies have
shown. Females were more satisfied than males because
they felt more comfortable discussing health issues with
their health care providers and thus received more
emotional support which may affect their level of sat-
isfaction positively.
When comparing between the hospitals, the results
showed that patients of the semi-private hospital had
better experiences of nursing care and higher levels of
satisfaction than patients in public hospitals. Vera
(1999) found that the level of quality of care relied on
several factors which were (i) environmental factors
such as staffing level and early discharge; (ii) organiza-
tional factors such as the type of the hospital; (iii) and
demographic factors of nurses and patients. Therefore,
a possible explanation for such results might be the fact
that the semi-private hospital is a teaching hospital. The
semi-private hospital included in this study is accredited
by local and national agencies; whereas the public
hospitals included in this study are not accredited.
Hospitals which seek accreditation are striving to
enhance their quality of care as well as patient outcomes.
Patient satisfaction data as a measure of care quality are
routinely collected and used for accreditation purposes
(JCAHO 1991).
Moreover, the workplace setting of semi-private
hospitals is different from that of public hospitals; for
example, there is more emphasis on training and
continuing education programmes in semi-private
hospitals. NursesÕ salaries in semi-private hospitals
are higher than those in public hospitals which
might motivate nurses to work in such hospitals.
Furthermore, nurses in semi-private hospitals might
have more opportunities to advance their careers
ª 2008 The Authors. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 17, 749–758
Patient satisfaction
through continuing their graduate education as the
semi-private hospital is a university (campus) hospital.
The factors that enhance the level of patientsÕ satis-
faction as indicated by the current study are continuity of
nursing care, nursesÕ competences and skills, nursesÕ
decision making skills and the adequacy of time provided
for direct nursing care. Such results provide significant
implications for nurse administrators. For example, they
should (i) develop a system for assessing patient satis-
faction regularly to identify weaknesses and areas for
improvement; (ii) implement standards for enhancing
nursing competencies and skills through continuing
education and training programmes; (iii) provide work-
shops for nurses in the field of communication and
decision making skills to enhance their capabilities to
effectively interact with patients and their families; and
(iv) provide support systems to minimize the non-nursing
activities and enhance the direct patientsÕ care.
Some of the limitations of the study were (i) the gen-
eralizability of findings is potentially limited as the
sample was a convenience one that was only derived
from three hospitals located in north of Jordan; (ii) the
majority of participants were females; and (iii) the level
of patientsÕ satisfaction was only measured subjectively
which might create a reporting bias. Despite these
limitations, the findings of the study provide the basis
for several recommendations to enhance patientsÕ
experiences and satisfaction with nursing care. Nurses
need to (i) increase the time they spend with patients;
(ii) provide more information to patients in regard to
their treatment and health status; and (iii) enhance
continuity of care and maintain patientsÕ individuality.
Moreover, nurse administrators and managers should
(i) capitalize on the importance of continuity of nursing
care, and nursesÕ competences and skills by providing
regular workshops and continuing education and
training classes; (ii) hold workshops to foster and
enhance the skills of decision making and effective time
management among nurses; (iii) benchmark practice
against hospitals where the level of patientsÕ satisfaction
is high; and (iv) strive to change the organizational
structure of public hospitals to be similar to those of
semi-private hospitals.
Conclusion
Identifying the level of patientsÕ satisfaction with nurs-
ing care is a good indicator for the quality of nursing
care services. The findings of the study provide nurses
with information about aspects that enhance or hinder
patient satisfaction. Nurses can enhance patientsÕ
experiences and satisfaction by spending more time
757
M. A. Alhusban and R. F. Abualrub
talking to them, explaining what they are going to do
for them, responding to their needs in a reasonable
time, supporting their relatives and friends, being more
helpful, and being more capable and competent at their
jobs.
Acknowledgements
The authors would like to thank the patients who provided
information necessary for the completion of the study, and the
NSNS team at the University of Newcastle for their permis-
sion to use the NSNS questionnaire in this study.
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