PATIENT’S PERCEPTION AND SATISFACTION LEVEL ON NURSING CARE SERVICES
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 behaviour towards thepatients.
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 early 1990s were in the range of 70-500/100,000 (Nordberg, et.al, 2001). These rates do not reflect current prevalence of surgical cases admitted in hospitals, it is expected that the updated prevalence could be higher. Among the patients admitted in hospitals, it was observed that hospitalization for surgery is associatedwithincreasedanxiety.It wasalsoshownthatpost-operativepainandanxietycontinue 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 continuityofcare(Nankhumbi,2005).AccordingtotheNigeriaInstituteofPublicPolicyResearch and Analysis (KIPPRA) report (1994) facets of patients satisfaction range from politeness of providers to waiting for services (Ojwang, et.al, 2010). The report pointed out complaints that nurses in Nigeria public hospitals were rude, impolite and offered coldreception.
In the general surgical wards, patients undergo two phases of nursing care i.e.; preoperative and postoperativenursingcare.Nurseshavethedutytomeetpatients’needsandexpectationsspecific
to each phase of surgical care. Preoperative phase is that time during the surgical experiencesthat beginswithclienttohavesurgeryandendswithtransferofpatienttooperatingunit(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, surgical procedure, and to be evaluated in anticipation of surgery. The purpose of preoperative care is to evaluate the patient’s readiness for surgery,identifypotentialrisksandhazardsofsurgery,advisepatientaboutthesurgicalprocedure, prepare 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 anaesthetic agents, assessing patients for complicationandprovidingcomfortandpainrelief(Smeltzer&Bare,2004).Thisisanimmediate 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 surgical ward focuses on promoting the patients’ recovery and initiating the teaching, follows up care and referrals essential for recovery and rehabilitation afterdischarge.
Therefore, the study explored patients perceptions regarding nursing care provided in surgical wardsfocusingonpreoperativeandpostoperativephases.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 the nursing care so as to meet the satisfaction of theconsumers.
1-2 PROBLEM STATEMENT
In the KIPPRA report (1994), the public complained that nurses were rude and offered cold receptioninpublichospitals.AnotherstudyconductedinTanzaniaatAbujaNationalHospital
(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 hospitalizedpatientsasinferior.Though,somestudiesconductedinJordanfoundoutthatmajority ofparticipantshadpositiveexperiencesregardingtimenursesspentwithpatientsaswellasrespect for patients, there were still reports of patients’ dissatisfaction with information provided because theyfelttheinformationgivenwasinadequate(Ahmad&Alasad,2004).Hence,itisnotonlytime 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 found that patients had lowest satisfaction with nursing care in the amount and type of information nurses gave them (Chaka,2005).
Nurses’ attitudes towards patients have great influence on patients’ perceptions of nursing care. Mostsurgicalpatientsareanxiousandstressedabouttheirsurgery.Theyhavealotofexpectations 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 customers 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 nursingcare.
1.3 STUDY JUSTIFICATION
According to JCAHO, 2011, and patients’ bill of Rights, patients have a right to quality care and information regarding their care. Many health organization and health institutions are striving to achieve high quality services so as to attract more consumers. Patientswould like to go to
institutions that provide nursing care that is holistic and patient centered. Since surgical patients have high level of anxiety that would also affect the overall outcome of their health, nurses need tohavetheskillsofprovidingcarethatwouldalleviatetheiranxiety.Nursingcaremakesabigger portionofallhealthservicesinhealthorganizations;therefore,exploringpatients’perceptionsand experiences is crucial in identifying areas of patients’ satisfaction and dissatisfaction. The study wouldaddtothebodyofknowledgeofnursingdisciplineinareaofpatients’satisfaction.Itcould also allow nurses to understand what patients expect from them and also clarifying 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 patients’ expectations while maintaining standards of nursing in surgical wards. The results may be used in quality assurance programmes.
The broad objective was to explore patients’ perceptions and experiences regarding nursing care in surgical wards at Nigerian National Hospital.
- To determine patients’ expectations from nurses about theircare.
- To determine patients’ experiences encountered while receiving nursingcare.
- To assess patients’ satisfaction of nursing care in surgicalwards.
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 towards their care.
1.7 EXPECTED BENEFITS
- It would add to the body of knowledge of nursingdiscipline.
- Feedback from the patients would be the basis for improvement of nursingpractice.
- The study tested the King’s Theory of Goal Attainment in clinical setup.
1.8 THEORETICAL FRAMEWORK
The study was based on the 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,whoareusuallystrangers,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 “interpersonal process ofaction,reaction,interactionandtransaction,wherebynurseandpatientshareinformationabout their perceptions in the nursing situation” and as “a process of human interaction, between nurse andpatientwherebyeachperceivestheotherandthesituation,andthroughcommunications,they setgoals,exploremeansandagreeonmeanstoachievegoals”(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 interactionwiththeenvironmentinfluencesbehaviour,providesmeaningtoexperience,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. Transactionrepresentstheaspectofhumaninteractioninwhichvaluesareapparentandinvolve
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. Nurse-patient relationship is a mutual relationship whereby both interact in order 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’s 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 was due to the fact that patients perceptions were based on their personal experiences, where as nurses responded on the basis of their general view of 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 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 Lawofnurse-patientinteractionwhichsays‘nursesandpatientsinmutualpresence,interacting
purposefully, make transaction in nursing situation based on each individual perceptions, purposeful communication and valued goal’.
1.9 CONCEPTUAL FRAMEWORK
FIGURE: 1.9.1 Conceptual Framework showing how patients’ perceptions regarding nursing care is influenced by patients’ characteristics