The degree of satisfaction of in‐hospital medical patients with nursing care and predictors of dissatisfaction: findings from a secondary analysis

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Over the last two decades, there has been increasing interest in the patient experience with healthcare, and patient satisfaction has become an outcome measure of the quality of health services 1. According to the Cox Interaction Model of Client Health Behavior, defined in 2003, among the five independent outcomes of patient care, satisfaction with care received is considered a key element 1.
Patient satisfaction has also been defined as a nurse‐sensitive outcome 2 being the patient's subjective evaluation of the cognitive and emotional reaction to the interaction between expectations of nursing care (NC) and perceptions of NC received 3. Satisfaction with NC has become more important as it predicts overall satisfaction with the hospital experience 4. Moreover, patient satisfaction influences the degree of adherence to prescribed medications and recommendations, which may reduce the clinical severity of the disease 6.
It has been amply documented that patient satisfaction is influenced by several factors clustered into three main categories: background, physical environment factors and those related to the organisational models of care delivery 7. Background factors include demographic characteristics, social influences, previous healthcare experience, intrinsic motivation, cognitive appraisal and affective responses 1; males, older patients and those with lower levels of education and expectations usually report higher levels of satisfaction 7.
Environmental resources refer to cleanliness, food, sound level and fellow patients 1, whereas organisation‐related factors concern staff resources, staff mix, caseloads and NC hours 9. In the current literature, interpersonal aspects of care and nurse–patient interactions have for the most part been documented as attributes of patient satisfaction with NC. Patients are satisfied with NC when it is perceived as individualised and when nurses are caring, supportive, responsive, encouraging and empathetic, interventions are tailor‐made to the unique needs of the patient 7. This kind of relationship requires continuing and prolonged nurse–patient interaction, with a consistent amount of time dedicated to exploring patient perspectives and personal needs.
Unfortunately, austerity measures aimed at dealing with the current economic crisis have increased patient‐to‐nurse ratios in many hospitals. In addition, in some contexts, overtime working hours have been adopted to mitigate staffing shortages; this strategy may lead to poor quality of care, an increase in the quantity of NC left undone 11. Aiken et al. 11, in their cross‐sectional survey in 12 European countries and the United States, documented an 11% increase in the odds of nurses reporting poor or fair quality for each additional patient per nurse . In contrast, nurses spending adequate amounts of time with patients have been reported as among the most important predictors of patient satisfaction 13. Well‐organised hospitals with an adequate patient‐to‐nurse ratio have reported higher levels of patient satisfaction and quality of care 11.
In general, available studies have reported high levels of overall satisfaction during in‐hospital stays 5. However, concerns have been expressed regarding patient satisfaction concept validity that may be affected by methodological and theoretical issues 14. Patients who are asked to report their experience with the NC received when they are still hospitalised may give higher scores out of fear that a negative feedback might have consequences on their care. The tendency of patients towards social conformity may also affect the reliability of the data collected. Different data collection procedures and tools have also been adopted to measure patient satisfaction, rendering comparison of the findings difficult 7. Moreover, despite the fact that satisfaction is a complex and multidimensional phenomenon, some single‐item scales are still being adopted 16.
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