A Cross Sectional Study to Measure Patients' Perception of Quality of Nursing Care at Medical Wards in selected hospitals, Puducherry

 

Dr. V. Indra

Adjunct Faculty CUM SME, Texila American University, Coimbatore, India

 

 

ABSTRACT:

A very important aspect on which patient satisfaction depends is ‘nursing care’ because nurses are involved in almost every aspect of client’s care in hospital. In this article, a cross sectional study to measure the patients' perception of quality of nursing care in medical wards in selected hospitals, Puducherry is done.

 

 

 

INTRODUCTION:

Healthcare as an industry has changed and grown with quality care being recognized as a right rather than a privilege. According to the Institute of Medicine (IOM) “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” [1].

 

An outcome measure, which is being increasingly used in health care quality management, is “Patient Satisfaction”. Department of Health and Children’s Strategy Document (Ireland) emphasized the need for a quality health service that puts the patient first. More and more patients are demanding to be informed partners in decisions regarding their health and their concerns are now directed at the whole spectrum of their healthcare whilst in a healthcare institution.

 

 

It has been suggested that to understand patient satisfaction, “patient’s perception” of the care received must first be understood, as to rate a service on a satisfaction scale the patient has first to perceive the service [2].

 

A very important aspect on which patient satisfaction depends is ‘nursing care’ because nurses are involved in almost every aspect of client’s care in hospital. The Picker commonwealth program for patient centered care has identified seven dimensions of client-centered care almost all of which cover the scope of nursing practice. Nurses interact with patients more often than any other health care personnel in a hospital. Nurse is the one who translates information imparted by physicians technically and professionally with a humane touch. Patient’s perception of nursing care can be influenced by their pre-service expectations of the service provider that are in turn influenced by number of factors such as, cultural background, socioeconomic status etc [3]. After receiving a service the patient compares the perceived service with the expected one. If the perceived service matches or exceeds their expectations they opt to come to the hospital again and recommend it to the needy persons. The hospital administrators as well as all health care workers have to be clever enough to know what the patient actually wants. By getting to know the patient a little more and to get their views on the care one ought to come closer to what the patient considers as good care. Several attempts have been made to measure patient satisfaction with nursing care [4]. Many hospitals use a form letter to find out how patients feel about their nursing care. Research in nursing and patient satisfaction/ perception studies while routinely conducted in the developed world to monitor and improve the quality of care lags behind in the developing world especially in the Indian subcontinent. Thus need was felt to delve into a nursing study to know the patients perception’s of quality of nursing care provided in a tertiary care hospital [5].

 

Quality care is difficult to define Patients' perceptions of their care, especially in the hospital setting, are not well known. Donabedian in 1980 developed the elements of quality which include the following: structure, process and outcome. Structure is the physical, organizational and system culture which supports the delivery of quality. Process is what is done in caring for the patients which includes the steps taken to deliver care. Outcome is the end result of the care given, usually the improvement in health[6].

 

STATEMENT OF THE PROBLEM:

A cross sectional study to measure the patients' perception of quality of nursing care in medical wards in selected hospitals, Puducherry.

 

OBJECTIVES:

1.    Measure the patients' perception of quality of nursing care in various dimensions

2.    Identify the overall patients' perception of quality of nursing care in medical wards

3.    Association between patients' length of stay and their perception of quality of nursing care

 

MATERIALS AND METHODS:

A cross sectional descriptive study design was used to measure patients' perception of quality of nursing care in medical wards in selected hospitals, Puducherry. Total of 50 patients recruited for the study by using purposive sampling technique, based on inclusion criteria such as adult medical patients aged 18 years or older, who have spent at least 3 days or more in the ward, able to understand Tamil or English and agreed to participate in this study and signed informed consent, and selected patients were interviewed.

 

Patients' satisfaction with nursing care quality (PSNCQQ) questionnaire, standardized instrument, was used to measure the patients' perception of quality of nursing care. Section I consisted of demographic data and section II consisted of patients' perception of quality of nursing care which has 22 items on five point likert scale. The scoring level was interpreted as low quality nursing care (<50%), adequate or good quality nursing care (50-75%) and high quality nursing care (>75%).

 

The original instrument in English was translated into Tamil and the reliability was obtained by using Spearman- Brown formula with value of .92. The data was analyzed using descriptive and inferential statistics.

 

RESULTS AND DISCUSSION:

The results showed that the mean age of samples were 40.4 with standard deviation of (+) or (-) 20.49. Half of them (50%) were males. Thirty four percent of patients were between the age group of 21-40 years (12 males and 5 females) and only 18% of them were adolescence (<20 years) (4 males and 5 females). Sixteen patients (32%) were illiterate and 17 patients (34%) were coolie. More than half of them (54%) were stayed in the ward for 3-4 days and only 8 (16%) were stayed for more than 5 days. Majority of the patients (80%) had no history of previous hospitalization. Most of the patients (88%) rated quality of nursing care as positive and no one rated as negative.

 

Table 1. Mean, standard deviation, frequency and percentage of overall patients' perception of quality of nursing care

Quality of nursing care	% of score	Frequency	% of patients	Mean	Standard deviation
Low	< 50%	6	12	64.8	13.2
Moderate/good	50 – 75%	40	80
High	>75%	4	8

 

Table 1 shows that the total mean score of patients' perception of quality of nursing care was 64.8 with standard deviation of (+) or (-) 13.2. This indicates that patients’ perception of quality of nursing care is adequate or good quality nursing care (80%). This was supported by the study results showed that overall mean score of 5,6 patients' perception of quality of nursing care was high.

 

Table2. Frequency and percentage distribution of patients' perception of quality of nursing care in various dimensions among medical patients

S. No	Dimensions of quality of nursing care	Low quality		Good quality		High quality
		NO	%	NO	%	NO	%
1	Provision of information	19	38	28	56	3	6
2	Concern and Caring	11	22	35	70	4	8
3	Skill and Competency	19	38	23	46	8	16
4	Management of patient	2	4	30	60	18	36

 

Table 2 reveals four dimensions of quality of nursing care such as providing information, concern and caring, skill and competency and management of patient. Eighteen patients (36%) had perceived high quality in management of patient dimension and 35 (70%) patients perceived good quality in concern and caring dimension. This was then contradicted by the results of the study showed that 1/10^th (11.5%) had poor perception on caring aspect. There were

 

19 (38%) perceived low quality in the dimensions of providing information and skill and competency. This was supported by the results of the study revealed that almost 1/3 patients (31.6%) perceived that nurses did not offer adequate “explanation and information” about their 1 treatment in hospital and home care and follow up advice.

 

Table 3. Association between patients' length of stay and their perception of quality of nursing care

Length of stay	Low quality	Moderate/ good quality	High quality	Chi – square value
< 5 days	4	35	3	X2 - 4.27 DF – 2 (NS) P value – 5.99
> 5 days	2	5	1

 

Table 3 reveals that association between patients' length of stay and perception of quality of nursing care and there were not statistically significant. But another study found a significant association with length of stay.

 

CONCLUSION:

This study gives valuable insight into patients' perception of overall aspect and various dimensions of quality of nursing care. The patients' perception of overall aspects of quality was good quality nursing care. Patients perceived high quality nursing care in the dimension of management of patient but they perceived low quality in the dimensions of providing information and skill and competency. Thus, nurses need to improve their skill and competency and update their knowledge by attending continuing nursing education programme and skill training workshops and provide information to the patients in order to improve patients' perception of quality of nursing care.

 

REFERENCES:

1.       Mufti Samina, Qadri GJ, Tabish SA, Mufti Samiya, Riyaz R. Patient's perception of Nursing care at a large scale teaching hospital in India. International Journal of Health Sciences. 2008 Jul; 12(2):92-100.

2.       Grandahl VA. Patient's perception of actual care conditions and patient th satisfaction with care quality in hospital. Retrieved on 12^th oct 2013. Available from: www.diva-portal.org /smash/ get/diva 2:471271 /FULLTEXT01.

3.       Bilkish NP, Sangita CS, Prakash A, Manjunath SK. A Cross sectional study of patient's satisfaction towards services received at tertiary care hospital on OPD basis. National journal of community medicine. 2012 Jun; 3(2): 232-237.

4.       Redfern S, Norman I. Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique-part I. J ClinNurs. 1999 Jul; 8(4):407-421.

5.       Zhao SH, Akkadechanunt T, and Xue XL. Quality nursing care as perceived by nurses and patients in a Chinese hospital, Journal of Clinical Nursing 2009 Jun; 18(12):1722-8.

6.       Lee MA &Yom YH. A comparative study of patients' and nurses' perceptions of the quality of nursing services, satisfaction and intent to revisit the hospital: a questionnaire survey, International journal of Nursing Studies 2007 May; 44(4): 545-55.

 

 

 

Received on 06.03.2018        Modified on 19.04.2018

Accepted on 22.05.2018       ©A&V Publications All right reserved