Patient Satisfaction With Nursing Care

Author(s): Jafar Alasad, Nazih Abu Tabar and Mohannad Eid AbuRuz
Source: The Journal of Nursing Administration , November 2015, Vol. 45, No. 11
(November 2015), pp. 563-568
Published by: Lippincott Williams & Wilkins

Stable URL: https://www.jstor.org/stable/10.2307/26813344

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THE JOURNAL OF NURSING ADMINISTRATION
Patient Satisfaction With Nursing Care
Measuring Outcomes in an International Setting
Jafar Alasad, PhD
Nazih Abu Tabar, MSc, RN
Mohannad Eid AbuRuz, PhD
OBJECTIVE: The purpose of this study was to assess
patient satisfaction with nursing care.
BACKGROUND: Patients_ satisfaction with nursing
care is considered an important factor in explaining
patients_ perceptions of service quality.
METHODS: The study was conducted in a major
tertiary hospital in Riyadh, Saudi Arabia. An explor-
atory approach utilizing cross-sectional survey de-
sign was used. Data were collected from 424 patients
through patients_ interviews using the Arabic version
of the Newcastle Satisfaction With Nursing Scale.
RESULTS: The results showed a high level of satis-
faction among patients in all hospital areas. Female
patients were significantly more satisfied than males
with no differences among other groups.
CONCLUSION: Patient satisfaction with nursing
care remains an important factor in explaining pa-
tients_ perceptions of service quality. International
healthcare settings should systematically monitor the
relationship between nursing care and experience to
support quality care provision.
Satisfaction results from meeting expectations. The
higher one_s expectations, the less service average per-
formance can meet or exceed them, with the result
Author Affiliations: Associate Professor (Dr Alasad), Faculty of
Nursing, University of Jordan, Amman, Jordan; Lecturer (Mr Abu Tabar),
College of Nursing, King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia; and Assistant Professor (Dr AbuRuz),
Department of Clinical Nursing, Applied Science University, Amman,
Jordan.
The authors declare no conflicts of interest.
Correspondence: Dr Alasad, Faculty of Nursing, University of
Jordan, Amman, 11942, Jordan (jalasad@ju.edu.jo).
Supplemental digital content is available for this article. Direct
URL citations appear in the printed text and are provided in the
HTML and PDF versions of this article on the journal_s Web site
(www.jonajournal.com).
DOI: 10.1097/NNA.0000000000000264
JONA  Vol. 45, No. 11  November 2015
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JONA
Volume 45, Number 11, pp 563-568
Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.
often being reduced satisfaction or even dissatisfac-
tion.1 The higher the perceived level of performance,
the more likely that expectations will be exceeded,
resulting in satisfaction.1 Patient satisfaction is a term
that can be interpreted differently by patients; its
meaning can also differ for the same patient at dif-
ferent times.2,3 Patient satisfaction has been defined
Bas the patient_s perception of care received compared
with the care expected.[4(p15) Aiello et al5 concluded
that patients base their expectations on their encoun-
ters with behaviors of nurses. Bowling indicated that
there is prevalent recognition in health policy of the
significance of evaluating health services from pa-
tients_ perspectives and that patients_ evaluations of
their healthcare are now an established component
of quality assessment, mainly through surveys of
patient satisfaction.6
The Relevance of Patient Satisfaction
Patient_s satisfaction is an essential component in
assessing quality of healthcare.7,8 According to
O_Connor et al,9 BIt_s the patient_s perspective that
is increasingly being viewed as a meaningful indica-
tor of health services quality and may, in fact, repre-
sent the most important perspective.[9(p32) Satisfaction
and quality assessment are often used interchangeably,
and although they have some elements in common,
satisfaction is generally recognized as the broader
concept that can be viewed at the individual service
encounter (transaction) level or at a more global level,
encompassing all experiences with an organization.3
The quality of nursing care significantly influences
patient satisfaction. Quality nursing care can be defined
as care carried out by nurses meeting the patients_
expectations.10 Patient satisfaction with nursing care
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is considered an increasingly important factor in ex-
plaining patients_ perceptions of service quality.10,11,12
Perceptions about what is quality nursing care differ
between nurses and patients and across care settings.13
Zhang13 indicated that patients find satisfaction in
aspects other than the technical expertise of the hos-
pital staff, primarily the human aspect of caring.13
For hospitalized patients, satisfaction represents a
balance between the patient_s perception and expec-
tation of their nursing care.14 Patients_ satisfaction
has been widely advocated as an outcome measure
of quality nursing care.15,16 Measures of patient satis-
faction have been found to correlate directly with treat-
ment compliance, nursing quality, and outcome of care.10
Studies have demonstrated varying results con-
cerning the relationship between patient characteris-
tics and patient satisfaction with nursing care.16,17
The patients_ ability to evaluate their care is dimin-
ished when they do not have enough knowledge about
their condition.18 Research indicates that older people
tend to be more satisfied with most aspects of hospital
care than do younger people.10,19 In addition, patients
might be reluctant to be honest when assessed for
their satisfaction if they feel that they may be iden-
tified because of fears of retaliation by care providers.
Because patient satisfaction is a subjective evaluation
about the care received, it must be assessed from the
patients_ perspectives.16
Few studies report patient satisfaction with
health services in Saudi Arabia or other areas in the
Middle East.20-22 Data reporting satisfaction with
nursing care are limited in number and relatively re-
cent.8,15,23 Study findings are inconsistent and high-
light the need for further research. This study is 1 of
few studies to report Saudi patient satisfaction with
nursing care and contributes to the literature.
Purpose
The purpose of this study, a cross-sectional survey de-
sign, was to assess patient satisfaction with nursing care
at King Abdulaziz Medical City in Riyadh (KAMC-R),
which is 1 of the main tertiary hospitals in Saudi Arabia.
Participants and Setting
The study sample constituted all patients who were
admitted to medical, surgical, and obstetrics and gy-
necology wards at KAMC-R during the period of
data collection. Inclusion criteria for the participants
included the following: (1) be 18 years or older, (2)
have been in the ward for 2 nights or more, (3) alert
and oriented, and (4) agree to give informed consent
to participate in the study. Exclusion criteria included
the following: patients in critical care areas or other
specialized units, day-care patients, and patients
564
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younger than 18 years. Patients meeting the inclusion
criteria were invited to participate. To determine the
sample size, Cohen_s24 technique for power analysis
was used. The sample size was computed based on
the t test for independent means (2-tailed). The as-
sumption in using the t test is that the populations_
samples are normally distributed and that they are
homogeneous. The G*Power 3.0.10 software (Franz
Faul 2008; Kiel University, Germany) was used to
compute sample size.25 A total sample of 200 partic-
ipants was obtained for an ! of .05, a power of 0.80,
and medium effect size of 0.40. The actual sample
obtained in the study was 424 patients.
Data Collection and Instrument
Patients_ satisfaction with nursing care was assessed
using the Newcastle Satisfaction With Nursing Scale
(NSNS),26 Arabic version.10 The NSNS is considered
parsimonious and empirically supported. The scale
provides information about nursing quality from pa-
tients_ perspectives. In addition, specific items of the
scale can be used to monitor particular aspects of nurs-
ing practice. Scale scores could be monitored over
time to build up population norms. The NSNS in-
cludes demographic information, satisfaction with
nursing care scale, and 1 item scale (7-point response
scale) of overall patient satisfaction.26 The satisfac-
tion with nursing care part consists of 19 items. All
items are scored on a 5-point Likert scale (1 = not at
all satisfied, 2 = barely satisfied, 2 = quite satisfied,
4 = very satisfied, and 5 = completely satisfied). The
total score was computed and transformed to yield
an overall satisfaction score of 0 to 100, where 100
denote complete satisfaction. The 1-item scale on over-
all patient satisfaction serves as stand-alone scale and
used to check validity and reliability of participants_
response in the total score of the 19-item scale. The
NSNS was found to be valid and reliable in previous
studies.10,11,27 The Arabic version of the scale was
translated from English by Alasad and Ahmad.10
Translation and back-translation was conducted by
2 professionals and checked for face and content val-
idity by a panel of bilingual nursing experts. Beaton and
colleagues_28 guidelines for adaptation of self-reported
measures were used to guide the translation process.
Alasad and Ahmad10 reported Cronbach_s ! internal
consistency reliability of the Arabic version of the NSNS
to be .93. In the current study, Cronbach_s ! was .92.
A total of 446 patients admitted to KAMC-R
between October 2011 and December 2012 meeting
the inclusion criteria were invited to participate. Four
hundred twenty-four of the patients (95%) who were
invited agreed to participate. Data were collected through
standardized interview with patients by a single trained
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data collector. The data collector read the scale items,
and participants were asked to rate their satisfaction
with nursing care by selecting 1 number best describ-
ing their opinion in each item of the scale. Patients
were able to read through each item while listening to
it read by the data collector. Patients_ responses were
then filled in the questionnaire by the data collector.
Ethical Considerations
Participation on the study was voluntary and based
on informed consent. The study was reviewed and
approved by the institutional review board (IRB) at
KAMC-R. Ethical integrity was monitored by a re-
search coordinator reporting directly to the IRB. Pe-
riodic reports were submitted to the IRB on the process
of data collection, consenting of participants, and
protection of their rights.
Data Management and Analysis
All descriptive and inferential statistics were com-
puted using the Statistical Package for the Social
Sciences (SPSS) version 20 (New York). Preliminary
data analysis was conducted to describe the study
sample and report mean of satisfaction for the entire
sample and among groups. Satisfaction with differ-
ent aspects of care was presented based on the mean
score of individual items. Inferential statistics (t test
and analysis of variance [ANOVA]) were used to ex-
plore differences among groups of patients in relation
to satisfaction and selected aspects of care.
Results
A total of 424 patients participated in the study;
62.7% (n = 266) of them were female. Participants_
average age was 43.7 (SD, 17.4) years, and the ma-
jority (76.2%, n = 323) had less than high school
education, with 91 (21.5 %) reported as illiterate.
Median length of hospitalization was 6 nights with a
range of 2 to 70 for all patients. Most participants (n =
336) were residents of the central region of Saudi Arabia
and are described in the Table, Supplemental Digital
Content 1, http://links.lww.com/JONA/A425.
The mean satisfaction score for all participants
was 90.67%, which means that patients were highly
satisfied. Table 1 shows the mean (scale of 5) satis-
faction score for all items of the satisfaction scale for
all participants and for medical, surgical, and gyne-
cological patients. Items are sorted according to the
total mean. The highest (mean, 4.83) satisfaction was
with the item Bthe amount of privacy nurses gave
you,[ and the lowest (mean, 4.17) satisfaction was
for the item Bhow quickly nurses came when you called
for them[ for all patients.
The result of ANOVA revealed no significant dif-
ferences between medical, surgical, and gynecological
wards (P > .05) in the overall satisfaction scores and in
all individual items of the satisfaction scale. Table 2

Table 1. Mean Satisfaction Score for Items of the Satisfaction Scale for All Patients
Medical Surgical Obstetrics/Gynecology
Scale Item All (N = 424) (n = 141) (n = 124) (n = 159)

The amount of privacy nurses gave you 4.83 4.76 4.78 4.92
Nurses_ awareness of your needs 4.79 4.75 4.72 4.88
How willing nurses were to respond to your requests 4.78 4.74 4.72 4.86
Nurses_ treatment of you as an individual 4.69 4.75 4.68 4.65
How nurses listened to your worries and concerns 4.66 4.70 4.66 4.62
Nurses_ manner in going about their work 4.60 4.69 4.58 4.53
The type of information nurses gave to you about your 4.54 4.59 4.51 4.52
condition and treatment
The amount of time nurses spent with you 4.54 4.60 4.47 4.55
Nurses_ helpfulness 4.53 4.59 4.45 4.52
The amount of freedom you were given on the ward 4.53 4.60 4.46 4.51
How nurses helped put your relatives_ or friends_ minds at rest 4.53 4.63 4.43 4.52
How capable nurses were at the their job 4.51 4.49 4.42 4.61
The amount nurses knew about your care 4.49 4.56 4.37 4.49
The way nurses explained things to you 4.49 4.50 4.44 4.52
How often nurses checked to see if you were okay 4.45 4.39 4.40 4.54
The amount of information nurses gave you about your 4.41 4.46 4.33 4.43
condition and treatment
The way the nurses made you feel at home 4.33 4.39 4.29 4.31
They are always being a nurse around if you needed one 4.18 4.15 4.18 4.22
How quickly nurses came when you called for them 4.17 4.10 4.17 4.23
Overall, how would you rate the nursing care you received in 6.22 6.20 6.05 6.33
this ward (1-item scale) 4.44 4.45 4.32 4.52

P > .05 for all items among the groups.

JONA  Vol. 45, No. 11  November 2015 565

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reports the total satisfaction score for all patients and
total satisfaction for medical, surgical, and gyneco-
logical patients with the F statistics and P value.
Testing for differences in satisfaction between
age groups and educational level revealed no signif-
icant differences (P > .05) among these groups of
patients. However, female patients were more satis-
fied than males as the t test revealed significant dif-
ference (P < .05) between males and females in the
total satisfaction score and in the 1-item scale of
overall satisfaction. Furthermore, there was signifi-
cant correlation (0.54, P < .01) between total patients_
scores in the 19-item satisfaction scale and the 1-item
scale on overall patient satisfaction.
Discussion
The purpose of this study was to assess patient sat-
isfaction with nursing care at KAMC-R at 1 of the
main tertiary hospitals in the Kingdom of Saudi Arabia.
Most previous satisfaction studies collected data from
patients after discharge, relying on patients_ retro-
spective experience of the care they received.16 Data
in this study were collected from patients during
their stay in the hospital and therefore report cur-
rent patient satisfaction with nursing care. The issue
of low response rates related to postal questionnaires
was avoided in this study by having a research as-
sistant collect data concurrently during the inpa-
tient stay.
This study demonstrated a high level of satisfac-
tion by patients (mean, 90.67%). This is in contrast
with low satisfaction reported in other Saudi hospi-
tals.23 The high level of satisfaction could be due to
the quality of nursing services provided. KAMC-R
was opened in May 1983. The facility has been ap-
proved by The Joint Commission international stan-
dards with excellent performance. The nursing services
department incorporates an international workforce
of almost 4000 personnel comprised of professional
nurses, paranursing, auxiliary, and support staff.29
Organizational culture including recruitment stan-
dards, financial benefits, and the retention of a qual-
ified and committed nursing workforce at KAMC-R
Table 2. Total Satisfaction (%) and SD for All Patients According to Area of Admission and
F Statistics
Patient_s Category Mean %
Medical 91.08
Surgical 89.64
Obstetrics and gynecology 91.12
All patients (total) 90.67
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may have led to high patient satisfaction, which would
improve hospital care safety and quality.2
The high satisfaction in this study is consistent
with other studies that also reported high satisfaction
scores.10,19,30 Ervin3 pointed out that studies of pa-
tient satisfaction with nursing care have demonstrated
high levels of satisfaction in general but still need to
be linked to patient outcomes such as health status.
In this study, data about patient outcomes were not
collected and should be the focus of a future study to
explore the relationship of satisfaction and health
status of patients. High satisfaction with nursing care
may imply that the care has been individualized and
that the nursing assessment and care were effective
during hospitalization.3
Several studies found that patients treated on
surgical wards reported higher satisfaction than pa-
tients treated on medical wards.10,19,31 In the current
study, there was no significant difference in satisfac-
tion scores between patients treated on surgical wards
and those on medical wards. Medical patients usually
have several chronic health problems that negatively
affect their level of satisfaction, whereas most surgical
patients are treated for more acute health problems
that have tangible outcomes on their health status.32
This issue needs to be explored further as it is most
likely the health status and patient_s treatment out-
come that have the greater effect on their satisfaction
rather than the ward where they were treated.6
Patients_ gender and level of education have been
reported to affect level of patient satisfaction in pre-
vious studies.19,33,34 In this study, female patients were
significantly more satisfied with the nursing care than
males. This finding is inconsistent with previous re-
search where male patients tended to have a positive
experience of nursing care more often than did female
patients.8,35,36 The majority of nurses at KAMC-R
are females, and in medical-surgical wards, female
patients are usually cared for by female nurses, whereas
male patients are cared for by male and female nurses.
The gender of the individual nurse related to patient
satisfaction is not reported in this study.
The level of education in this study was not found
to have significant effect on patient satisfaction as
n SD F Statistics P
141 9.41 0.890 .411
124 11.27
159 10.11
424 10.24
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there was no significant difference among patients
with different levels of education. In other studies,
patients with higher levels of education were signif-
icantly less satisfied with nursing care than patients
with lower educational level.37<39 It has been sug-
gested that patients with high level of education have
higher expectations of the standard of care and therefore
demand greater individual alignment of their care.10,11
The significant correlation between total pa-
tients_ scores in the 19-item satisfaction scale and the
1-item scale on overall patient satisfaction (0.54, P <
.01) reflects the internal consistency of the satisfac-
tion scale and would support the use of the 1-item
scale as a standalone scale of satisfaction. Overall,
Cronbach_s ! for the scale was .92, which is consid-
ered to be reliable in measuring patient satisfaction
and consistent with previously reported reliability co-
efficients for the same scale.
Limitations
Relationship of patient satisfaction with health status
was not examined in this study. Such data would have
been valuable in showing the effect of health status
on satisfaction as a patient outcome. Satisfaction in
this study was examined only during hospitalization
using cross-sectional design; it would be worth know-
ing how patient satisfaction changed after discharge.
In addition, the convenience sampling used in the
study limits its external validity. Also, cultural norms
may influence the outcomes when conducted in 1 site
in the Middle East.
Conclusions
Level of patient satisfaction with nursing care was
high (90.67%) at KAMC-R. Age, level of education,
and place of admission were not found to have sig-
nificant effect of patient satisfaction with care. Female
patients were significantly more satisfied than males.
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Thank you to the deanship of academic research, Uni-
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