PATIENT’S PERCEPTION AND SATISFACTION LEVEL ON NURSING CARE SERVICES

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PATIENT’S PERCEPTION AND SATISFACTION LEVEL WITH NURSING CARE SERVICES

 

CHAPTER ONE:

 INTRODUCTION

 1.1 BACKGROUND INFORMATION

Nursing care is a major component of health care services that helps alleviate anxiety in surgical patients. Negativepatients’perceptionsaboutnursingcareaddtothestressthattheyalreadyhave due to surgery. This may also be influenced by what they expect nurses to be doing for them and nurses’ behavior towards the patients.

It was noted that in highly industrialized countries, some 5000-9000 major operations are performed per 100,000 people per year, and the rates in East Africa in the early 1990s were in the range of 70-500/100,000 (Nordberg, et.al, 2001). These rates do not reflect the current prevalence of surgical cases admitted in hospitals, it is expected that the updated prevalence could be higher. Among the patients admitted to hospitals, it was observed that hospitalization for surgery is associated with increased anxiety. It was also shown that post-operative and anxiety continue to be problematic for patients after the surgery (Allen, et.al, 2002). Therefore, it is expected that nursing care needs to be engaged and should provide individualized care that acknowledges the emotional, physical, spiritual, and environmental dimensions of patients. A study conducted in Uganda found that patients’ perceptions of quality nursing care include; human rights, receiving information, access to services as well as safety, privacy, respect, politeness, kindness, and continuity of care(Nankhumbi,2005). According to the Nigeria Institute of Public Policy Research and Analysis (KIPPRA) report (1994) facets of patient satisfaction range from the politeness of providers to waiting for services (Ojwang, et.al, 2010). The report pointed out complaints that nurses in Nigerian public hospitals were rude, impolite, and offered cold reception.

In the general surgical wards, patients undergo two phases of nursing care i.e.; preoperative and postoperative nursing care. Nurseshavethedutytomeetpatients’needsandexpectationsspecific to each phase of surgical care. The preoperative phase is the time during the surgical experience that begins with the client having surgery and ends with the transferofpatienttooperatingunit(White,2007). In this phase, patients are expected to be assessed by nurses during the planning of their care, to be taught about their condition, treatment options, and surgical procedure, and to be evaluated in anticipation of surgery. The purpose of preoperative care is to evaluate the patient’s readiness for surgery, identify potential risks and hazards of surgery, advise the patient about the surgical procedure, prepare the patient for postoperative experiences, plan for home care, and provide emotional support (Pearson & Osborn, 2010). Postoperative nursing care involves maintaining the airway, monitoring vital signs, assessing the effects of anesthetic agents, assessing patients for complications, and providing comfort and pain relief (Smeltzer&Bare,2004). This is immediate postoperative care which is usually provided in a Postanaesthetic Care Unit (PACU), which is before the patient is taken back to the surgical ward. In addition to the immediate postoperative nursing care, the general postoperative care provided in the surgical ward focuses on promoting the patients’ recovery and initiating the teaching, follows up care, and referrals essential for recovery and rehabilitation after discharge.

Therefore, the study explored patients’ perceptions regarding nursing care provided in surgical wards focusing on the preoperative and postoperative phases. Understandingthepatients’perceptions of nursing care provided in surgical wards is very important because it would assist in identifying strengths and weaknesses of the type of care provided from patients’ perspective. This eventually could help in improving nursing care to meet the satisfaction of the consumers.

1-2 PROBLEM STATEMENT

In the KIPPRA report (1994), the public complained that nurses were rude and offered cold reception in public hospitals. Another study conducted in Tanzania at Abuja National Hospital (ANH) revealed that patients were dissatisfied with the attitude of health professionals (Muhondwa, et.al, 2008). The study further revealed that nurses treated patients and relatives of hospitalized patients as inferior. Though some studies conducted in Jordan found that the majority of participants had positive experiences regarding the time nurses spent with patients as well as respect for patients, there were still reports of patient’s dissatisfaction with the information provided because they felt the information given was inadequate (Ahmad&Alasad,2004). Hence, it is not only the time nurses spent with patients and respect for patients that would determine patients’ perceptions of nursing care but also other factors such as adequate information about their condition and treatment, kindness, cheerfulness, and among others. This could be supported by a study which was conducted in Ethiopia that found that patients had the lowest satisfaction with nursing care in the amount and type of information nurses gave them (Chaka,2005).

Nurses’ attitudes toward patients have a great influence on patients’ perceptions of nursing care. Mostsurgicalpatientsareanxiousandstressedabouttheirsurgery.They have a lot of expectations from nurses about their care. Hence, they require a lot of information about their conditions, procedures, treatment options, and expectations after surgery. Some unpublished routine surveys have been done at Nigerian National Hospital (NNH) regarding customer care satisfaction in various departments however; some themes were not adequately addressed. This study, therefore, intended to explore some thematic areas that have not been addressed such as perceptions and experiences regarding nursing care.

1.3   STUDY JUSTIFICATION

According to JCAHO, 2011, and the Patients’ Bill of Rights, patients have a right to quality care and information regarding their care. Many health organizations and health institutions are striving to achieve high-quality services to attract more consumers. Patients would like to go to institutions that provide nursing care that is holistic and patient-centered. Since surgical patients have high levels of anxiety that would also affect the overall outcome of their health, nurses need tohavetheskillsofprovidingcarethatwouldalleviatetheiranxiety. Nursingcaremakesabigger portionofallhealthservicesinhealthorganizations; therefore,exploringpatients’perceptionsand experiences are crucial in identifying areas of patients’ satisfaction and dissatisfaction. The study wouldaddtothebodyofknowledgeofnursingdisciplineinareaofpatients’satisfaction.It could also allow nurses to understand what patients expect from them and also clarify any misinformation patients may have regarding nursing care. This would enhance the image of nursing through behavior modification. It could also assist nurses to develop nursing care plans that are patient-centered because patients’ expectations and experiences would be considered. Hence, providing quality nursing care that is consistent with patient’s expectations while maintaining standards of nursing in surgical wards. The results may be used in quality assurance programs.

 

1.4   RESEARCH OBJECTIVES

 

1.4.1    Broad Objective

The broad objective was to explore patients’ perceptions and experiences regarding nursing care in surgical wards at Nigerian National Hospital.

1.4.2    Specific Objectives

  1. To determine patients’ expectations from nurses about their care.

 

  1. To determine patients’ experiences encountered while receiving nursing care.

 

  1. To assess patients’ satisfaction with nursing care in surgical wards.

 

1.5   RESEARCH QUESTION

Why are patients having negative perceptions of nursing care?

 

1.6   RESEARCH HYPOTHESIS

Patients’ perceptions regarding nursing care are not influenced by nurses’ attitudes toward their care.

1.7   EXPECTED BENEFITS

  • It would add to the body of knowledge of nursing discipline.

 

  • Feedback from the patients would be the basis for the improvement of nursing practice.

 

  • The study tested King’s Theory of Goal Attainment in a clinical setup.

 

1.8   THEORETICAL FRAMEWORK

The study was based on Imogine King’s Theory of Goal attainment. The major elements of King’s middle-range Theory of Goal of Attainment are seen in the interpersonal system. Two people, who are usually strangers,cometogetherinahealthcareorganizationtohelpandbehelped to maintain a state of health that permits function in roles (George,2002).

King’s theory of nurse-patient interaction states that nursing is viewed as an “interpersonal process of action, reaction, interaction, and transaction,wherebynurseandpatientshareinformationabout their perceptions in the nursing situation” and as “a process of human interaction, between nurse andpatientwherebyeachperceivestheotherandthesituation, and through communications, they set goals, explore means and agree on means to achieve goals”(Basavanthappa,2007). According to King’s theory, perception had been described as a process in which data obtained through the senses and from memory are organized, interpreted, and transformed. This process of human interaction with the environment influences behavior, provides meaning to experience, and represents the individual’s image of reality and learning. Communication represents and is part of, the information aspect of interaction and may occur within a person as well as between people. The transaction represents the aspect of human interaction in which values are apparent and involve compromising, conferring, and social exchange. When transactions occur between nurses and clients, the goals are attained.

The theory had been chosen because it identified how patients’ characteristics and nurses’ attributes affected the patients’ perceptions regarding nursing care. The nurse-patient relationship is mutual whereby both interact to understand one another. This can be demonstrated by a study conducted by Lemoniadou, et.al, (2003), in Greece whereby the researchers were comparing surgical patients’ autonomy, privacy, and informed consent with nursing interventions. It was found that nurse responsibilities in supporting patient autonomy, informed consent, and privacy were perceived as the best by nurses. Patients, on the other hand, perceived this support as occasional. Then it was concluded that the discrepancies in perception were because patients’ perceptions were based on their personal experiences, whereas nurses responded based on their general view of the specific situation. Another scenario that demonstrates the concept of interaction, communication, and perception is a study conducted in South Australia which viewed surgical nursing care as engaged (involving patients in their care) or detached (not involving patients in their care) by women (Koch, et.al, 1997). According to the study, the engaged nurse was the one who is actively involved in the care of the patient and was perceived to be a positive experience. The engaged nurse acknowledged the physical, emotional, spiritualandenvironmentalaspectsofthepatientandprovidedcarethatassistedtherecoveryfrom surgery. While the detached nurse was perceived as negative experience because was using a procedural approach to care and avoided personal contact with the patient. This led to feelings of vulnerability and insecurity for the patients (Koch, 1997). Here the detached nurse ignored King’s Lawofnurse-patientinteractionwhichsays‘nursesandpatientsinmutualpresence, interacting purposefully, making transactions in nursing situations based on each perception, purposeful communication, and valued goal’.

PATIENT’S PERCEPTION AND SATISFACTION LEVEL ON NURSING CARE SERVICES. GET MORE MEDICINE AND SURGERY PROJECT TOPICS AND MATERIALS BSC

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