Assessment of patients’ satisfaction level with nursing care in the department of neurology

Introduction

Assessment of satisfaction with nursing care is determined by the manner of nursing, performance of instrumental activities, environmental quality [1] and kindness, politeness, concern and caring [1, 2], as well as professionalism, support provided during education, and communication skills [1]. Additional importance is played by the hospital environment, i.e. sanitary conditions in the ward, frequency and quality of meals, number of staff, access to media, and respect for patients’ rights [3]. The patients’ satisfaction and subjective feeling about medical care is closely related to the quality of care [4]. Assessment of nursing care is related to the improvement of service quality and mobilizes professional care and professional development [5]. The aim of this study was to assess the satisfaction level with nursing care among patients staying in the neurology department.

Material and methods

The study was conducted in 2021 in the Department of Neurology at the 5th Military Clinical Hospital with Polyclinic in Cracow. After receiving the necessary information on the purpose and course of this study, 81 patients who gave their free and informed consent were selected to participate in the study. The study involved 59% of women and 41% of men. Among the respondents, 46% were between 41 and 65 years of age, also 46% of the respondents had higher education. Most patients, 60%, were in a relationship. Individuals who were professionally active accounted for 58% of the total respondents. The duration of stay in the ward ranged from 2 days to a month, and the average number of nights spent by patients in the ward during this stay was 7.8.
A diagnostic survey method was used to conduct the study. The author’s survey questionnaire and the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL) were used as tools. The scale allows the patient to assess nursing care and satisfaction with care on a Likert scale (up to 7 and 5 points, respectively), and includes questions regarding demographics and duration of hospital stay. The scale also has 2 questions relating to the overall assessment of patient satisfaction with nursing care, as well as the overall stay on the ward [6]. The author’s survey questionnaire allowed us to collect sociodemographic data and answers to questions related to the stay in the ward. Statistical analysis was carried out in Statistica 10 software using the Kruskal-Wallis, Mann-Whitney U, c2 tests. The statistical significance level was set at p < 0.05.

Results

The mean nursing care experience score was 77.69 (SD = 13.48) (Table 1). The mean score of satisfaction with nursing care was 83.674 (SD = 16.84) (Table 2). Table 3 shows the relationships between higher values of the assessment of patients’ experience with nursing care and the assessment of selected variables characterizing the nurses’ work on the ward and the conditions of stay. Table 4 shows the correlations between higher values of patients’ satisfaction with nursing care and patients’ assessment of selected variables related to the stay in the ward in terms of nurses’ intervention and hospital environment. The respondents assessed the nursing care received in the ward very highly – 37% of the respondents assessed it as excellent, and 49% as very good. Only 14% of respondents stated that the received care was good or sufficient.
The overall assessment of the stay in the ward was equally high – 56% of respondents assessed the stay as very good, and 26% as excellent, 16% of the respondents rated the stay as good and sufficiently good, and 2% of the respondents assessed the stay as bad. Assessment of nursing care was not statistically significantly dependent on the number of nurses to provide high-quality care (p = 0.07). The analysis did not confirm a statistically significant difference in the assessment of nursing care experience according to gender, age, marital status of the respondents, and number of nurses on duty, but only according to education (p = 0.03). Assessment of nursing care experience had higher values among working professionals and students (p = 0.00). The analysis did not confirm the relationship between the assessment of satisfaction with nursing care and gender, age, education, and professional activity of the respondents, and the number of nurses on duty. Nursing care satisfaction scores had lower values in the non-union group (p = 0.02).

Discussion

The patient’s satisfaction results from the fulfilment of his/her expectations [7], and as a subjective evaluation of the quality of medical services refers to various aspects of hospitalization that constitute its overall image [8], including sanitary conditions in the ward, frequency and quality of meals, number of staff, access to utilities, and respect for patients’ rights [3].
The study using the NSNS-PL tool showed that the mean score for experience of nursing care was 77.69 and the mean score for satisfaction with care was 83.67. Analysis of relationships between variables did not confirm significant correlations between the assessment of nursing care experience and sociodemographic variables such as gender of the respondents, their age, and marital status. Education, occupational activity, and studying were found to differentiate the evaluation of experience in the study group. This means that higher score values of experience evaluation were obtained by the respondents with secondary or higher education as well as those studying and working professionally. Satisfaction with care was not significantly dependent on gender, age of the respondents, education, or professional activity, but it was dependent on marital status. Higher scores of satisfaction with care were achieved by those who were in a relationship and widowers. Care experience scores and satisfaction scores were not dependent on the number of nurses on duty but on their behaviour and conditions on the ward.
In comparison, Marć’s study in a group of patients hospitalized in a neurology department showed that the mean nursing care experience score was 67 points, while the mean satisfaction score was 73.2 points [9]. The results of the study conducted by Zarzycka et al. among patients in the neurosurgery department did not show a statistically significant relationship between satisfaction with care and the patients’ age and education, duration of hospital stay, or number of hospitalizations. However, the evaluation of experience in providing care was dependent on education – the patients with primary or vocational education obtained higher scores in this category [10]. Kozimala et al. also addressed patient satisfaction using the NSNS tool among patients treated in non-surgical wards. The mean score of experience in providing care reached 76.8 points, and satisfaction reached 87.3 points. Statistical analysis did not confirm a significant relationship between gender, age, and education of patients and the above scores [11]. The results of the mean scores of nursing care experience and satisfaction in the study of Daszuta et al. among patients undergoing subarachnoid anaesthesia were 74.98 points vs. 64.80, respectively. Variables such as age, gender, education, and place of residence of the respondents showed no significant relationship with experience and satisfaction with care [12]. The results of a study conducted among epilepsy patients by Manzanares et al. to evaluate the research tool, confirmed a good level of patient satisfaction with care [13].
The expertise of nurses is highly desirable in treatment teams, as emphasized by Higgins et al. Participants in the study, patients diagnosed with epilepsy, revealed greater satisfaction with the support provided by specialist nurses in this area and highlighted their greater involvement, in contrast to patients who were not under the care of specialist nurses [14]. A study that Bužgová et al. showed that patients with progressive neurological diseases who received specialist palliative care were more satisfied with the care provided [15]. Studies under the direction of the same author in a group of patients with multiple sclerosis also investigated differences between specialist palliative care and standard care. The results confirmed that patients who received specialist care expressed higher satisfaction compared to the group of patients under the care of another team [16].
The patients’ health status and emerging deficits as a result of illness may also be related to the level of perceived satisfaction with care. A study conducted by Huang et al. investigated such a relationship and found that cognitive impairment (memory impairment) was associated with lower satisfaction with nursing care. The study additionally emphasized the need to identify cognitively impaired patients with communication difficulties in order to better adapt care to their needs [17]. In comparison, in a study by Szőcs et al., patients in severe condition as a result of stroke experienced lower satisfaction with care [18]. In addition to health status, the satisfaction level may also be influenced by therapeutic management. The study of Szőcs et al. cited above found that the therapeutic management such as thrombolysis had a positive effect on patient satisfaction [18]. The results of another study assessing patient satisfaction with treatment methods were presented by Hoffman et al. Participants in this study, multiple sclerosis patients who had their medication administered with a new auto-injector, reported a significant improvement in overall satisfaction due to the effectiveness and convenience of their treatment [19].
Interesting results regarding satisfaction with the management of migraine headaches were presented by Rua et al. Patients who were referred to the neurology department reported higher levels of satisfaction with their care due to, among others, contact with the medical staff, the way they were informed about their condition, and treatment methods, compared to patients referred directly for MRI [20]. Nurse education interventions may also determine patient satisfaction with care. This was shown in a study conducted by Byers et al. among post-stroke patients to evaluate the effectiveness of stroke education. Those who participated in individualized education provided by nurses were more satisfied [21]. In contrast, a study by Hong et al. involving patients with intracerebral haemorrhage found that comprehensive nursing interventions are important for both nullifying negative emotions, minimizing the risk of complications, and satisfaction with nursing care [22].
An example of a study that showed other factors determining satisfaction with care is one conducted by Borghans et al. They found that the duration of hospital stay was not related to patients’ satisfaction with care. The results of higher satisfaction scores referred to such issues as the provision of information by nurses, the way information was provided, or respect for privacy [23]. Other studies have noted that providing an environment for eating and not performing other activities during that time may also be important in assessing the quality of care [24]. Karaca, in his study, assessed the response time of the nursing team, and similarly to our study, his results indicated that patients evaluated this aspect of care very highly. In addition, the results of this study emphasized the need for nurses to be sensitive to the emotions expressed by the patient, to ensure the right to information and autonomy, and stressed the importance of nurses’ competence for the quality of care [25]. Satisfaction with care may also be determined by the number of nurses providing health care services. A study by Edmealem et al. showed that patients who were provided care by one nurse reported higher satisfaction compared to other patients who did not have one specific nurse. Furthermore, patient satisfaction with care is related to targeted attention to comorbidities [26].
Assessment of satisfaction with care is conducted not only in relation to direct contact with medical staff in the provision of health services, but also based on telemedicine. A study conducted by Lacritz et al. addressed satisfaction with a neuropsychological assessment conducted by telephone. The vast majority expressed satisfaction in the assessment, while age, gender, education, and ethnicity were not related to satisfaction. This type of professional-patient contact may be considered when face-to-face neuropsychological assessment is not possible, but it requires appropriate preparation that takes into account the timing and flexibility of the examination, the presence of distractions in the patient’s environment, and possible communication difficulties [27]. In another study on e-visits among adults after stroke, Appireddy et al. showed positive patient feedback on this type of visit and at the same time highlighted the need to involve different professional groups involved in patient health services, both medical staff and health system managers to shape evidence-based e-visit guidelines [28].

Summary

Satisfaction with care is considered at multiple levels of health care provision. Persons from the therapeutic team should pay attention to the procedures performed, communication with patients, possibilities of patients’ perception, and their active participation in the treatment process, as well as receiving information on the state of health and therapeutic procedures and respecting their rights. These factors may determine the satisfaction level with care and thus the quality of care. In addition, it is worth paying attention to the opinions of patients regarding the conditions in which hospitalization takes place. The patients’ satisfaction with care should be the goal of therapeutic interventions undertaken to improve the health of patients.

Conclusions

The patient’s satisfaction with care in a neurology department is high and depends on demographic factors, the conditions of the hospital environment, and the interventions taken by nurses. Research on patients’ satisfaction with care should be continued due to its importance in creating quality of care.

Disclosure

The authors declare no conflict of interest.

References