Patient Satisfaction as Nursing Care Patient satisfaction is a key metric in assessing the quality of healthcare services. As healthcare becomes more patient-centered, the importance of ensuring patients are satisfied with the care they receive cannot be understated. Nursing care plays a significant role in shaping patient satisfaction, as nurses are the primary caregivers and have the most direct and consistent interaction with patients. This article will explore patient satisfaction, dimensions of patient satisfaction, how it is measured, and its relationship to nursing care. Additionally, we will discuss the challenges of measuring patient satisfaction and identify strategies for improving satisfaction in healthcare settings.
Patient Satisfaction
Patient satisfaction refers to the degree to which patients are content with the healthcare services they receive, particularly in terms of meeting their expectations and addressing their health concerns. Satisfaction can be viewed as the outcome of the interaction between the patient’s expectations and their actual experiences of care. This concept has evolved from the early studies of healthcare quality in the 1970s, which viewed satisfaction as an afterthought, to its current status as a central component in assessing healthcare quality and outcomes.
In the late 1980s, Donabedian (1988) introduced a model that identified three main components for assessing healthcare quality: structure, process, and outcomes. Within this framework, patient satisfaction emerged as a key indicator of outcomes. Since then, patient satisfaction research has gained significant momentum, driven by the rise of Total Quality Management (TQM) principles and the increasing competitiveness of healthcare markets. Today, healthcare organizations use patient satisfaction surveys to evaluate the quality of care, identify areas for improvement, and benchmark their services against competitors.
Dimensions of Patient Satisfaction
Patient satisfaction is a multifaceted concept that encompasses several dimensions. Understanding these dimensions is crucial for healthcare organizations that aim to provide high-quality care and improve patient experiences. A comprehensive taxonomy of patient satisfaction was developed by Ware, Davies-Avery, and Stewart (1978), who reviewed studies over a 25-year period prior to 1975. Their initial classification included dimensions such as the art of care, technical quality, accessibility, finances, physical environment, availability, efficacy, and continuity.
Over the years, researchers refined this taxonomy, and the most widely recognized dimensions of patient satisfaction now include:
- Nursing and Daily Care: This dimension reflects the quality of care provided by nursing staff and encompasses aspects such as attentiveness, empathy, and communication with patients.
- Hospital Environment and Ancillary Staff: This dimension includes factors such as cleanliness, comfort, and the behavior of support staff such as janitors and food service workers.
- Medical Care: Patient satisfaction with physicians and other medical professionals, including their ability to explain procedures, answer questions, and involve patients in decision-making.
- Information: The extent to which patients feel informed about their care, treatment options, and post-discharge instructions.
- Admissions and Discharge Process: The ease and efficiency of the admissions and discharge processes, including wait times and the clarity of instructions given to patients.
- Billing: The transparency and clarity of billing processes, including insurance handling and the explanation of charges.
These six dimensions provide a broad view of the various factors that influence patient satisfaction, each of which can be measured and addressed independently to improve overall satisfaction.
Instrumental Measure of Patient Satisfaction
To accurately assess patient satisfaction, reliable and valid measurement tools are necessary. One of the most widely used instruments for measuring satisfaction with nursing care is the Risser Patient Satisfaction Scale (PSS), developed by Risser in 1975. The PSS includes 25 questions divided into three subscales:
- Technical/Professional Area: This measures the technical competence of nurses, including their ability to administer care safely and effectively.
- Educational Relationship Area: This assesses the educational interactions between nurses and patients, such as the provision of information and explanations about treatments.
- Trusting Relationship Area: This evaluates the emotional and relational aspects of care, such as trust, empathy, and emotional support provided by nurses.
The PSS was originally designed to assess the satisfaction of ambulatory patients but was later adapted for use in hospital settings. Subsequent research, including studies by Hinshaw and Atwood (1982), and La Monica, Oberst, Madea, and Wolf (1986), further refined the scale to reflect nursing behaviors in acute care environments. These studies established the reliability and validity of the PSS, making it a valuable tool for healthcare organizations seeking to assess patient satisfaction with nursing care.
Patient Satisfaction with Nursing Care
Nursing care is consistently found to be one of the most significant predictors of overall patient satisfaction. Erikson (1995) defined patient satisfaction with nursing care as the “patient’s subjective evaluation of the cognitive/emotional response that results from the interaction of the patient’s expectations of nursing care and their perception of the actual nurse behaviors/characteristics.” Essentially, this means that how patients perceive their interactions with nurses—and how those perceptions compare to their expectations—shapes their overall satisfaction with the care they receive.
Numerous studies have demonstrated that patient satisfaction with nursing care is correlated with better clinical outcomes, increased patient adherence to care plans, and a higher likelihood of patients recommending the facility to others or returning for future care. Satisfaction with nursing care is also linked to a reduction in hospital-acquired infections, lower readmission rates, and improved recovery times.
Nursing Research on Patient Satisfaction
Most studies on patient satisfaction have been cross-sectional and descriptive, focusing on identifying the factors that contribute to higher satisfaction levels. One of the most important findings in this area is that patients are more satisfied when they receive “personalized” care from nurses who demonstrate attentiveness, empathy, and communication skills (Cleary & McNeil, 1988).
Research has also shown that the work environment of nurses plays a significant role in shaping patient satisfaction. In a landmark study, Vahey, Aiken, Sloane, Clarke, and Vargas (2004) found that patients cared for in units with adequate staffing, strong administrative support for nursing care, and positive relationships between nurses and physicians were twice as likely to report high levels of satisfaction with their care. Additionally, nurses working in such environments were less likely to experience burnout, which further contributed to better patient outcomes.
The relationship between nursing work environments, nurse burnout, and patient satisfaction highlights the importance of investing in organizational structures that support nurses’ well-being. When nurses feel supported and valued, they are more likely to provide high-quality, patient-centered care, which in turn leads to higher levels of patient satisfaction.
Implementations for Improvement in Satisfaction
There are several strategies that healthcare organizations can implement to improve patient satisfaction, particularly with regard to nursing care. The American Nurses Association (ANA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) have identified patient satisfaction as a critical quality indicator, underscoring its importance in the delivery of safe and effective care.
Some key implementations for improving patient satisfaction include:
- Improving Nurse-Patient Communication: Ensuring that nurses have the time and resources to communicate effectively with patients is essential for improving satisfaction. Nurses should be trained in active listening, empathy, and providing clear explanations of care processes.
- Enhancing Work Environments for Nurses: Creating supportive work environments with adequate staffing levels, manageable workloads, and strong leadership can help reduce nurse burnout and improve the quality of care. This, in turn, leads to higher patient satisfaction.
- Addressing Patient Expectations: Healthcare organizations should focus on understanding patient expectations and working to meet or exceed them. This can be achieved through patient education, shared decision-making, and clear communication of treatment plans and care options.
- Using Technology to Streamline Care: Implementing electronic health records (EHRs) and other technologies can help streamline care processes, reduce errors, and improve communication between nurses and patients. Technology can also be used to gather real-time feedback from patients, allowing healthcare providers to make immediate improvements.
Challenges for Satisfaction Measurement
Despite the growing importance of patient satisfaction, there are several challenges associated with measuring and improving it. One of the main challenges is developing psychometrically sound, reliable, and valid measures of satisfaction. Patient satisfaction is a multidimensional concept, and no single item can adequately capture all aspects of it. Therefore, researchers must design surveys that are comprehensive enough to capture all relevant dimensions while also being concise to avoid overburdening patients.
Another challenge is the tendency for patients to provide socially desirable responses in satisfaction surveys, resulting in skewed data. To address this issue, some researchers suggest focusing on areas of dissatisfaction or patient complaints, as these may provide more accurate insights into areas for improvement.
Additionally, the timing of satisfaction surveys can influence results. Surveys administered too soon after discharge may not capture patients’ full experiences, while those administered too late may suffer from recall bias. Therefore, healthcare organizations must carefully consider the timing of their surveys to ensure accurate and meaningful data collection.
Conclusion
Patient satisfaction with nursing care is a critical component of healthcare quality. It encompasses multiple dimensions, including communication, empathy, technical competence, and the work environment of nurses. Research has shown that satisfied patients are more likely to adhere to care plans, experience better health outcomes, and recommend healthcare providers to others.
To improve patient satisfaction, healthcare organizations should invest in creating supportive work environments for nurses, enhancing communication, and addressing patient expectations. However, challenges remain in measuring satisfaction, and future research should focus on developing more accurate and reliable measurement tools. By prioritizing patient satisfaction, healthcare organizations can deliver patient-centered care that meets the needs and expectations of their patients.