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A Cross Sectional Study To Measure Patients' Perception Of Quality Of Nursing Care At Medical Wards
Correspondence: A. Tamilselvi HOD, Department of Medical Surgical Nursing, P.S.G. College of Nursing Coimbatore. E-mail: selvitamil2k4@yahoo.co.uk
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Traditionally quality of care has been measured against expectations of health professionals and standards rather than being grounded in the perspectives of patients. The most important aspect on which patients' perspective on quality of care depends is “nursing care” because nurses are involved in every aspect of patients' care in hospital. Thus, it is important to measure patients' perception of quality of nursing care in medical wards. A cross sectional descriptive study design was used and total of 50 patients recruited for the study by using purposive sampling technique. Patients' satisfaction with nursing care quality (PSNCQQ) questionnaire was used to measure the patients' perception of quality of nursing care after obtaining reliability. The results revealed that 34% of patients were between the age group of 21-40 years and half of them were males. The total mean score of patients' perception of quality of nursing care was 64.8 with standard deviation of (+) or (-) 13.2 and 40 patients' (80%) perceived overall aspect of quality of nursing care. 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 treatment in hospital and home care and follow up advice. Thus, it was concluded that nurses need to improve their skill and competency and update their knowledge by attending continuing nursing education program and skill training workshops
Keywords
patients' perception
quality of nursing care
medical wards
Introduction:
Globally, health care industry has changed and grown and quality of health care is being recognized as a right rather than privilege.1 The overall goal stated by the World Health Organization (WHO) and the international council of nurses (ICN) is the highest possible level of health for all people,2 and providing high quality care is one approach for reaching this goal. Measuring quality of care in the health care organization has become very important aspect in evaluating health care services.3
Traditionally, quality of care has been measured against expectations of health professionals and standards rather than being grounded in the views of patients.
4Recently, the criteria for evaluating the performance of the health care system was developed by the U.S. National Centre for health services research and department (NCHSRD, 1970) includedthree categories such as mortality, morbidity and patients' perspective. Among these three, patients' perspective is probably the most difficult aspect to measure, but it is very important in determining quality of care3 and cannot be set aside.
The most important aspect on which patients' perspective on quality of care depends is “nursing care” because nurses are involved in every aspect of patients' care in hospital.1 Nowadays health care organizations are more concerned about quality of nursing care and each health care industry is accountable to its patients. Consumers expect value for their money and count on the quality of services when needed. As valiant effort and marsh emphasize, patients now complain, demand, report and sue and have realized that quality of nursing care is an important factor in patient outcome.1
Thus, it is important to measure patients' perception of quality of nursing care in medical wards of a selected hospital.
Statement of the Problem:
A cross sectional study to measure the patients' perception of quality of nursing care in medical wards at a selected hospital.
Objectives:
Measure the patients' perception of quality of nursing care in various dimensions
Identify the overall patients' perception of quality of nursing care in medical wards.
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 of a selected hospital. 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 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 patients' perception of quality of nursing care was high.5,6
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 contradicted by the results of the study showed that 1/10th (11.5%) had poor perception on caring aspect.1 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 treatment in hospital and home care and follow up advice.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 anotherstudy found a significant association with length of stay.1
Quality of nursing care |
Percentage of score |
Frequency |
Percentage of patients |
Mean |
Standard deviation |
|---|---|---|---|---|---|
Low |
< 50% |
6 |
12 |
64.8 |
13.2 |
Moderate / good |
50-75% |
40 |
80 |
||
high |
>75% |
4 |
8 |
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 |
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 |
>5days |
2 |
5 |
1 |
- Frequency and percentage distribution of patients' perception of quality of nursing care in various dimensions among medical patients
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.
Acknowledgments:
We thank the management, principal, nursing superintendent, and staff of the concerned hospital for their cooperation and support.
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