Adult Patient Satisfaction with In-patient Nursing Care in a Referral and Teaching Hospital Southern Nations Nationalities and Peoples’ Region (SNNPR), Ethiopia

Back ground: Knowing patients’ satisfaction with nursing care is important for any healthcare agency as nurses and nursing care comprise the majority of the healthcare provision in hospitals throughout a 24 hour day. Objectives: This study was aimed to assess adult inpatient satisfaction with nursing care and its determinant factors in the study area. Methods: A cross-Sectional Survey was conducted at Hawassa University specialized and teaching hospitals (HUSTH) in Ethiopia from April 1-30, 2014. The study population consisted of patients who were admitted to the study wards at the time of data collection. Patients aged >18, admitted at least for two days and able to communicate. Data was collected using a modified ‘Newcastle Satisfaction with Nursing Scale’ (NSNS). EPI –data version 3.1 and SPSS version 16 were used for data entry and analysis respectively. Bivariate and multivariate linear regression analysis was conducted for identifying the predictors of satisfaction. Summary tables were used for presenting the result. Ethical approval was obtained from Jimma University Results: A total of 406 patients participated in the study. The study showed that the mean satisfaction score of the patients was 47%. Multivariate linear regression indicated that perceived need and expectation of care were independent predictors of the patients’ satisfaction. Conclusions: This study revealed that the satisfaction level of patients with the inpatient nursing care they received was low. It was influenced by their perceived need and expectation of care from their providers. Thus, we recommend that the hospitals managers should frequently assess its patients’ satisfaction status and provide tailored on-job training to its nurses in order to improve their skill for enhancing patients’ satisfaction. *Corresponding author: Waju Beyene Salgedo, Assistant Professor, Jimma University, Health Economics Management and Policy Kochi Jimma, Oromia, Ethiopia, Tel: +251911808400; E-mail: dagimwaju@yahoo.com Received October 29, 2015; Accepted February 25, 2016; Published February 29, 2016 Citation: Legesse MT, Salgedo WB, Walle AA (2016) Adult Patient Satisfaction with In-patient Nursing Care in a Referral and Teaching Hospital in Southern Nations Nationalities and Peoples’ Region (SNNPR), Ethiopia. J Nurs Care 5: 334. doi:10.4172/2167-1168.1000334 Copyright: © 2016 Legesse MT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
The on-going improvement in the quality of healthcare has become a daily objective for healthcare professionals and healthcare systems as a whole. Patient satisfaction that constitutes an important dimension of quality care and patients' outcomes, complementing measures of institutional performance and clinical outcome have proven to be a valuable, relatively cheap and conventional way to assess the provision of quality care to patients. Patient satisfaction has been used in various situations for assessing the superiority of one treatment, pattern of care and one healthcare system over another [1].
Satisfied patients are more likely than unsatisfied ones to continue using the health care services, maintaining their relationships with specific health care providers and complying with the care regimens [2].
The way patients perceive nursing care largely depends on their social status, age, educational level, cultural background and previous hospital experiences. Support and respect from nurses, constant availability of nurses and appropriately given responses are the main indicators of satisfaction [3].
A critical challenge for health service providers in developing countries is to find ways to make them more client-oriented. Improving service in the health care require hospitals to measure their own performance in order to improve upon current system of service delivery. Well designed health care delivery system can reduce rehospitalization, improve quality of life and the health care provided [4].
The health care providers in developing countries seem to be ignoring the importance of patients' perceptions regarding health services [5].
Assessing patient satisfaction with nursing care is important in evaluating whether patients' needs are fulfilled and subsequently facilitating in the planning as well as implementing appropriate nursing interventions for patients. Determining those factors that contribute most to patient satisfaction can further assist nurses in improving the quality of nursing care [6].
In Ethiopia, the federal Minister of health is making different efforts that are still on process to fulfil the hospitals with the right manpower, medical equipment and other facilities to meet the needs of the patient. However although these efforts are undergoing to improve the service delivery, the needs of the people have not yet been adequately met [7].

Methods
A cross-Sectional Survey was conducted at Hawassa specialized and teaching hospital in Ethiopia from April 1-30, 2014. The study participants were adult patients aged 18 years and above, who were admitted to the medical, surgical, gynecology and ophthalmological wards. The Sample size was determined by single population proportion formula with assumption of p = 50%, 95% confidence interval, 5% marginal error and 10% of non-response rate making the total calculated size 423. The sample size was proportionally allocated to each ward based on the total number of patient admitted and all adult inpatient wards were included in the study.
The dependent variable of measurement was patients' satisfaction while the independent variables were: socio demographic factors (age, sex, religion, occupation, marital status, ethnicity, education, and income), hospital conditions (admission ward, duration of admission, particular nurse giving care), patients' conditions (disease, history of previous admission) and nursing care provided (perceived need and expectation of care).
Data was collected using Inpatients Patients Satisfaction Questionnaire (IPSQ) adapted from Newcastle Satisfaction with Nursing Scale (NSNS) [8,9]. IPSQ included three parts: sociodemographic and personal characteristics that had 12 items, Perceived patient satisfaction with nursing care measured using a five level Likert scale that had 19 items and nurse patient interaction with 10 items in a five points Likert Scale (1 = strongly disagree, 5 = strongly agree). The items were internally consistent with Cronbach's alpha value of 0.80.
The questionnaire was translated into Amharic by two language experts to ease its administration. It was pretested in a nearby hospital (Adare hospital taking 5% of the sample and slight modification was made. The data was collected by six trained nurses and one supervisor. Data was checked for completeness and consistency, edited, entered into computer & analyzed using SPSS window version 16. Cross tabulation was made & presented using tables & graphs and narrative description. The relationship between Patient satisfaction status and independent variables was assessed using bivariate followed by multivariate linear regressions. The overall level of patients' satisfaction was measured by the mean of the percentage of maximum scale score (PMSS) as calculated by the following formula.

( )
Actual score potential minimum score PMSS x100 Potential Maximum score potential minimum score Ethical clearance was obtained from ethical Review committee of College of Public Health and Medical Sciences, Jimma University. The regional health bureau and other respective offices were informed by letters while verbal consent was obtained from respondents during data collection.

Socio-demographic characteristics
A total of 406 participants were included in the study giving a response rate of 96%. From the total patients, 213 (52.5%) were female. The mean age of respondents was 39.88 (± 15.850). A larger proportion of the respondents, 123 (30.3%), were in the age group > 44years followed by 115 (28.3%) from 25-34 years of age. More than half of the respondents, 237 (58.4%), were from urban area. Three hundred thirteen (77.1%) of study subjects were married. Concerning educational status, 102 (25.1%) of the respondents could not read and write, 157 (38%) of the participants were protestant in religion, and most of the respondents, 97 (32.9%) were Sidama by ethnicity ( Table 1).

The hospital's conditions
The duration of hospitalization varied from two nights to more than seven nights, with 55.9% being in hospital for more than two nights. With regards to previous hospitalization experience, 79

Patients need and expectation
Regarding patients perceived need and expectation, more than three fourth of the participants positively reported that the nurse checked their ID cards prior to administering medication. A significant proportion (42.9%) of the respondents agreed that the nurses maintain and respect their needs. Similarly 44.6% of the respondents responded that nurses provided them clean and quite environment. About half of the subjects said that the doctors and the nurses work in collaboration for giving services and a little less than half said that nurses perform their services without waiting for doctors. On the other hand 43.8% of the participants said that nurses were careless on their duty (Table 3).

Overall patients' satisfactions with nursing care
Overall level of patient satisfaction (percentage mean score) with nursing care was 47% with a maximum score of 90% and a minimum of 19%. Percentage mean satisfaction score was calculated based on percentage of maximum scale score (Table 4).

Factors associated with patient satisfaction
We assessed the association of dependent and independent variable by using bivariate regression model followed by multivariate regression    model. First we analyzed each independent variable and then we put all variables those showed p-value of < 0.5 into multiple logistic regression model to rule out confounder/s. The result of multivariate analysis showed that age, sex ,educational status, occupation, frequency of admission, duration of hospitalization, other disease, particular care giving nurse were not significantly associated. The results showed that significant predictors of patient satisfaction with nursing care were perceived need, expectation and duration of hospitalization.
A unit score increase in perceived need score will lead to 0.562 increments in patient satisfaction with nursing care (95% CI = 0.581, -0.758). A unit score increase in expectation score will lead to 0.345 increments in patient satisfaction with nursing care (95% CI = 0.334, -0.499) and a day increase in duration of hospital stay will lead to 0.193 decrease in patient satisfaction with nursing care (95%CI = -0.383-0.179) ( Table 5).

Discussion
Patient satisfaction is an important indicator of quality of healthcare in a hospital setting. The measurement of patients' satisfaction with nursing is particularly important since nursing care is often a primary determinant of overall satisfaction during a hospital stay [3].
This study revealed that the overall satisfaction level of the patients with nursing care was 47% (M = 3.01, SD = 0.986). This level of patients' satisfaction was low compared to other study. A study conducted in Kenyatta National Hospital Nairobi, on the level of patients' satisfaction with nursing care study revealed that 67.8% patients were satisfied [10]. The deference may be due to difference in setting and duration of stay, need and expectations in Nairobi hospitals. On the other hand, the level of satisfaction in this study was higher than study conducted in Ghana teaching hospital where about 33% of respondents were fully satisfied with their nursing care [4].
Concerning patients' socio-demographic characteristics, the results of this study showed no significant associations with patient satisfaction. These findings similar with the findings of Mustard, who studied improving patient satisfaction through the consistent use of scripting by the nursing staff and pointed out that demographic characteristics seem to be unimportant [11].
The results of this study also showed a significant positive association between perceived need and expectation of care with patient satisfaction score during hospital stay. Perceived need was one of the predictor in the final model. A unit score increase in Perceived need will lead to 0.562 increments in the patient satisfaction (95% CI = 0.581-0.758). If the perceived needs of the patient fulfilled they would have been more satisfied with nursing care they received. The other predictors were expectation of care score and duration of hospital stay.
A unit increase in expectation of care score will lead to 0.345 increases in the patient satisfaction score (95% CI = 0.334, 0.499). If they get what they expected nursing care service they will be more satisfied. This study also in line with finding in Iran, which showed that nearly all patients were satisfied by meeting their needs & expectations [3]. The study conducted in Ghana teaching hospital showed that patients' satisfaction is influenced by his/her expectation of care which revealed that majority (73%) were expecting to be treated with love and dignity [4].
Patients who stayed more than seven nights had 0.193 unit lower satisfaction score as compared to those who stayed for two nights (95% CI = -0.383,-0.179). This may be due to the nurse give more attention to new admitted and critical patients rather than those stayed for long time. Similarly, a study conducted in Kenya public hospital on evaluation of nursing care pointed out that Satisfaction was also related to duration of hospitalization, (81.8%) of the patients hospitalized between 2 to 5 days were more satisfied than those stayed more than two weeks [12].
Also this study found that 169 (41.6%) of the participants strongly disagree with that the nurse give health education and one hundred seventy eight (43.8%) of the participant strongly agree with that the nurse are careless on their duty. This lead to be patient not satisfied with nursing care.

Conclusions
The overall level of patient satisfaction as measured by the mean of percentage of maximum scale score was low. The need and expectation of a significant proportion of patients has been found to be met as perceived by the patients. In addition, the longer duration of hospitalization led to dissatisfaction with the nursing care. Perceived need, expectation and duration of hospitalization were found to be independent predictors of in-patients satisfaction with nursing care. Most of the participants strongly disagreed with that nurses were giving health education and majority of them strongly agreed with that the nurses are careless in their duty. Thus, we recommended that the managers of the hospital should devise a mechanism to improve the performance of nurse and monitor the implementation process in order to take appropriate improvement actions. Moreover the hospital should perform periodic surveys on patients need, expectations and hospital so as to design the nursing care accordingly.