QUALITY OF CLINICAL CARE AND COMMUNICATION SKILLS OF NURSES AS

PREDICTORS OF PATIENT SATISFACTION IN SELECTED PRIVATE HOSPITALS

IN DIGOS CITY.

Trisha Mae M. Alalong

INTRODUCTION

Patient satisfaction with nursing care has been considered as the most important predictor
of the overall patient satisfaction with hospital service and quality of health care service at large
(Henok Mulugeta, 2019). With this, it is necessary to examine the various dimensions of
structural, medical, nursing and support services (Aiken et al., 2018). In nursing care, patient-
centered care or person-centered care must acknowledge patients’ experiences, stories, and
knowledge and provide care that focuses on and respects patients’ values, preferences, and needs
by engaging the patient more in the care process. (Johnsson A et al., 2018). However, the
shortage of nursing staff, high workload, burnout, and limited-time constituted one complex
institutional and healthcare system-level barrier to effective care delivery and prevented nurses
from having adequate time with patients [Al-Kalaldeh, 2021].

Communication plays the most important role between the presenter (nurses and other
staff) and the recipient of the services (patients) (Itri, Yacob, & Mithqal, 2017). Research shows
that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational
and cultural factors. Like other health care professionals, nurses may also have difficulties
communicating with patients due to personal fears and shortcomings (Jennifer Bullington et al.,
2019).

However, the reality in many settings is that providing quality care remains a significant
challenge, and inadequate quality results in avoidable mortality, human suffering and significant
economic losses. (WHO, 2021). Moreover, the study of Anita Karaca (2021) in Turkey indicated
that patients were more satisfied with having respectful communication whereas they were less
satisfied with the professional information provided by the nurses about their disease, health
status, investigations and prognosis of their condition. (Abdel Maqsood et al., 2012)

Meanwhile, in the Philippine setting, the Department of Health, through its Health
Facilities and Services Regulatory Bureau, utilized the customer satisfaction survey as an
indicator for improving performance (DOH, 2018). Indeed, in the study of J.C. Salugsugan
(2020), it assessed the level of patient satisfaction on the health services and identified the
challenges encountered by patients. Also, it compared the level of patient satisfaction in terms of
their demographic profile. The study revealed that the overall level of satisfaction was very high.

In the Philippines, nurses are generally underpaid, and overburdened because of the low
nurse and high patient ratio, thus, further limiting the time for quality interaction between the
nurse and patient. Galvez-Tan (2005) revealed that the latest nurse to patient ratio in The
Philippines is 1:50. The international standard for the ideal ratio of nurses to patient in hospitals
is 1:4. Even at the Philippine General Hospital (PGH), a premiere hospital in the country, the
ratio of nurse to patient average from 1:15 up to 1:25. It was also reported that in many hospitals
in the Philippines, the ratio would even reach 1:50 up to 1:100 (Galvez-Tan, 2005).

Several studies highlighted personal factors as important antecedents of quality of care

(Aminder Singh, 2020) and communication skills of nurses. (Maureen Sibiya, 2017). The
perspectives of both patients and nurses showed that they viewed both quality of care as
excellent, with slight differences, indicating a high level of patient satisfaction and competent
healthcare delivery professionals (Fatma Al-Jabri, 2021). While in communication skills of
nurses, Nurses' ability to perform effective communication is the key to creating a therapeutic
relationship between them and patients. It will help nurses in providing excellent service with
regard to increasing patient satisfaction with the health services provided. However, most of the
studies on these factors are focused on its relation with the patient's satisfaction (Mojgan Lotfi,
2019).

In many instances, nurses serve as patients’ advocates, in addition to performing their

primary care duties. Although good nurse-patient relationships positively impact nurse-patient
communication and interaction, studies have shown that several factors impede these
relationships with significant consequences on care outcomes and quality (Madula P., et al.,
2018).

In line with this, the measure of satisfaction with the quality of nursing care received is a
one of the components of hospital quality management system, which is also considered as a
good indicator for measuring the quality of care of hospitalized patients (Alsaqri S., 2016).
Effective communication is an essential factor in nurse-patient interactions and a core component
of nursing care. When communication in the nurse-patient dyad is patient-centered, it becomes
therapeutic.

Considering that the patients' complaints about the weakness of nursing care in wards,
increased readmissions and mortality of patients, and also so far no study has been done on the
satisfaction of patients with the quality of care from nursing services and nurse communication
with these patients , this study aims to describe the quality of nurse–patient communication and
the patient's satisfaction of clinical care from nursing services in women and men.

STATEMENT OF THE PROBLEM

This study will determine the influence of quality of care and communication skills on the
satisfaction of patients.
It specifically aims to answer the following questions:
1. What is the level of the quality of clinical care in terms of:
1.1. Safety
1.2. Effective
1.3. Patient-centered
1.4. Timely
1.5. Efficient
1.6. Equitable
 2. What is the level of communication skills of nurses in terms of:
2.1. Explanation prior to procedure/investigation/medication
2.2. Felt frustration due lack of communication
2.3. Interaction of nurses to patient
2.4. Politeness of Nurse

3. Is there any significant relationship between:

3.1. Quality of Clinical Care and Patient’s Satisfaction
3.2. Communication Skills of Nurses and Patient’s Satisfaction

4. Do the quality of clinical care and communication skills of nurses significantly influence
as the predictors of the patient’s satisfaction in selected Private Hospitals in Digos City?

FRAMEWORK

This research theorized that the interplay of the different aspects of the quality of care
results to the level of patient satisfaction. The level of satisfaction is the patient’s perception of
the quality of clinical care (Gill & White, 2009). For a patient to be satisfied with the health care
services, he should have an optimistic judgment towards every aspect of the quality of care, in
particular, the interpersonal side of health care delivery (Ghaffari, Jahani Shourab, Jafarnejad, &
Esmail, 2012).

The framework was anchored on a client satisfaction theory in the field of health care
referred to as the Health Care Quality theory of Donabedian. In 1966, the Donabedian model was
presented as the primary comprehensive framework used to evaluate health care. It asserts that
the level of patient satisfaction is the perception on the quality of clinical care in all its aspects,
but specifically with regards to the interpersonal component of health care (Gill & White, 2009).
It defined three distinct aspects of health care quality, namely: structure, process, and outcome
(Ghaffari et al., 2012).

The structure refers to the conditions in which the health care service is delivered. It
includes the following: tangible resources and human resources. Tangible resources include
medicines and medical facilities or equipment and human resources are the professional and
support staff with their qualifications and number (Donabedian, 2002). Availability of medicines
has a substantial role in improving patient satisfaction in health facilities (Rao, Peters, &
Bandeen-Roche, 2006). Incompetent health care provider increased the chance of patient
dissatisfaction (Hemadeh, Hammoud, Kdouh, Jaber, & Ammar, 2019). Interpersonal interactions
of the health care provider are the main factors of determining patient satisfaction (Hausman,
2004).
The process refers to the activities that encompass health care, which include prevention
and patient education, diagnosis, treatment, and rehabilitation (Donabedian, 2002). Quality of
health education is one of the main factor in patient satisfaction, thus poor health education,
counseling and promotion likely leads to patient not satisfied with health care service (Hemadeh
et al., 2019). In terms of treatment such undergoing medical procedures it is recommended that
patient’s expectation and pain control are important factors to address to achieve patient
satisfaction (Hamilton, Lane, Gaston, Patton, Macdonald, Simpson, & Howie, 2013). The
promptness of service, quality and professional care and communication are essential elements to
patient satisfaction in emergency cases (Mahmoud, Hou, Chu, Clark, & Eley, 2014).

The outcome is defined as either desirable or undesirable changes in individuals

attributed to health care. This includes health status change, behavioral, and knowledge changes
that influence future care and patient satisfaction (Donabedian, 2002). Satisfied clients are
important aspects in the overall success of health care facility (Joshi, et al., 2013).

In Figure 1, there are two independent variables that include the quality of clinical care and
communication skills of nurses; while the dependent variable is the Satisfaction of Patient in
selected Private Hospitals in Digos City.

Quality of
Clinical Care
Patient’s
Satisfaction
Communication
Skills of Nurses

Figure 1. Conceptual Framework Showing the Relationship between the variables.

METHOD

This section presents the research design, research locale, respondents, research
instruments, data gathering procedure, and statistical tools.

Research Design
This study utilized the quantitative design of research to determine the patient’s
satisfaction in the quality of clinical care and communications skills of nurses in selected Private
Hospitals in Digos City.
The quantitative research design (Tan, 2011) manipulates and control research situations
and verify results, using empirical data gathered through the senses. Quantitative research is
concerned with the objective meaning of experience to an individual. There is a rigid control of
the research situation and generalization of findings. With this design, the researchers will use
the descriptive-comparative research design to compare the relevance of each variable to
another.
In the study, I used quantitative research design to measure the extent of satisfaction of
the clients towards the environmental quality of facility and quality of care provided by staff
nurses in Digos City.

Research Respondents

The patients in hospitals will be the respondents of this study were the 150 ward clients in
selected Private Hospitals in Digos City as stratified random sampling was used and fishbowl
technique to identify the actual respondents.
The respondents of the study are the ward clients admitted in selected Hospital in Digos
City, who experience the quality of clinical care and communication skills from the staff nurses.
Patients are the primary respondents; these clients evaluated their satisfaction in the quality of
clinical care and communications skills of nurses in selected Private Hospitals in Digos City.

Research Instrument

The researcher, employed a self-made questionnaire. The questionnaire gathers

information to determine the Quality of clinical care and communication skills of nurses as
predictors of Patients satisfaction in selected Private Hospitals in Digos City.

Research Procedure

The researcher will obtain a letter to conduct a survey at the selected Hospitals in Digos
City. The researchers will ask permission from the respondents who were able to answer the
survey. Questionnaires will be distributed by the researcher only to the ward clients. To secure a
100% retrieval of the questionnaire, the researchers will personally collect the materials as soon
as all were answered by the respondents. After they will retrieve the data, it will be collated for
the conduct of statistical analysis. Results will be interpreted; thereafter, the conclusions and
recommendations will be drawn.

Statistical Tools
The following statistical tools were used in the study:
Mean and Standard Deviation will be used to determine the levels of satisfaction in the
environmental quality of facility and quality of care provided by the staff nurses.
Pearson Product Moment Correlation will be utilized to determine the relationship
between environmental quality of facility and quality of care provided by staff nurses.
Multiple Regression Analysis will be used to measure the influence in patient’s level of
satisfaction towards environmental quality of facility and quality of care.

REFERENCE
Henok Mulugeta, 2019 Patient satisfaction with nursing care in Ethiopia: a systematic review and
meta-analysis. 18, Article number: 27 https://link.springer.com/article/10.1186/s12912-019-
0348-9
Abukari Kwame et al., 2021 A literature-based study of patient-centered care and communication in
nurse-patient interactions: barriers, facilitators, and the way forward 20: 158. doi:
10.1186/s12912-021-00684-2
Aiken et al., 2018 Patient satisfaction with hospital care and nurses in England: An observational
study. British Medical Journal Open, 8(1), e019189 10.1136/bmjopen-2017-019189
Johnsson A, Wagman P, Boman A, Pennbrant S. What are they talking about? Content of the
communication exchanges between nurses, patients and relatives in a department of medicine for
older people: An ethnographic study. J Clin Nurs. 2018 Apr;27(7–9):e1651-9.
doi:10.1111/jocn.14315.
Al-Kalaldeh M, Amro N, Qtait M. Barriers to effective nurse-patient communication in the
emergency department. Emerg Nurse. 2021 Mar 2;29(2). doi:10.7748/en.2020.e1969
Itri, J. N. , Yacob, S. , & Mithqal, A. (2017). Teaching communication skills to radiology residents.
Current Problems in Diagnostic Radiology, 46(5), 377–381. 10.1067/j.cpradiol.2017.01.005
Jennifer Bullington et al., 2019 Communication skills in nursing: A phenomenologically-based
communication training approach https://doi.org/10.1016/j.nepr.2019.08.011
Anita Karaca et al., 2021 Patient satisfaction with the quality of nursing care Apr; 6(2): 535–545.
Published online 2019 Jan 4. doi: 10.1002/nop2.237
Goh, M. I. et al., (2016). A descriptive quantitative study on multi‐ethnic patient satisfaction with
nursing care measured by the revised humane caring scale. Applied Nursing Researc, 31, 126–
131. 10.1016/j.apnr.2016.02.002
Abdel Maqsood, A. S. , Oweis, A. I. , & Hansa, F. S. (2012). Differences between patients’
expectations and satisfaction with nursing care in a private hospital in Jordan. International
Journal of Nursing Practice, 18, 140–146. 10.1111/j.1440-172X.2012.02008.x
Department Of Health. (2018). Health Facilities and Services Regulatory Bureau, Hospital
Assessment tool.Retrieved from http://caro.doh.gov.ph/wp-content/uploads/2018/11/level-1-
hospital.pdf
John Clifford P. Salugsugan (2020) Patient Satisfaction and Challenges of the Health Care Services
of Negros Occidental Provincial Medical Clinic Vol 3 No 1 (2020): January-June 2020 DOI:
https://doi.org/10.52006/main.v3i1.122
Galvez-Tan, J., 2005, “The Brain Drain Phenomenon and Its Implications to Health”.
www.bulatlat.com, Vol. V, No. 43, December 4-10, 2005.
Aminder A. Singh & Jonathan R. Boyle (2020) Evaluating quality in clinical care 38(10): 632–636.
doi: 10.1016/j.mpsur.2020.07.010
Fatma Al-Jabri, Tarja Kvist, Reijo Sund & Hannele Turunen (2021) Quality of care and patient safety
at healthcare institutions in Oman: quantitative study of the perspectives of patients and
healthcare professionals DOI https://doi.org/10.1186/s12913-021-07152-2
Dwi Ratna Sari, Dhian Kartikasari and Nurnaningsih Herya Ulfah (2021) Impact of Effective
Communication on the Quality of Excellent Service and Patient Satisfaction in the Outpatient
Department DOI: 10.18502/kls.v0i0.8883
Mojgan Lotfi, Vahid Zamanzadeh, Leila Valizadeh,Mohammad Khajehgoodari Assessment of nurse–
patient communication and patient satisfaction from nursing care
https://doi.org/10.1002/nop2.316 Citations: 40
Madula P, Kalembo WF, Yu H, Kaminga CA. Healthcare provider-patient communication: A
qualitative study of women’s perceptions during childbirth. Reprod Health. 2018 Dec;15(135):1–
10. 10.1186/s12978-018-0580-x.
Alsaqri S. (2016) Patient satisfaction with quality of nursing care at governmental hospitals, Ha’il
City, Saudi Arabia. Journal of Biology, Agriculture and Healthcare.;6(10):128 -42.

APPENDIX A

Place a check mark inside the box of your own corresponding answer.
4 – Very satisfied
3 – Satisfied
2 – Moderately satisfied
1 – Unsatisfied

“Patient’s Satisfaction with the Quality of Clinical Care and Communication skills
of Nurses”
4 3 2 1
Attentiveness of the nurses

1. Nurses’ regular checking of your health status

2. Nurses’ willingness to know about your needs & problems

3. The way nurses response for your requests.

4. The amount of time nurses spent with you.

Availability of the nurses

1. Availability of nurses during your needs

2. Quickness of nurses to respond for your requests

3. Timely implementation of routine care

4. Promptness of nurses response to your call

Emotional support by the nurses

1. Nurses’ efforts to make you feel at home.

2. Nurses efforts to allay your fear and anxiety.

3. Reassurance and support offered by nurses during your periods of

distress/ pain

4. Interest of nurses in sharing your doubts & worries

Clinical skills of the nurses

1. Nurses’ pace and smoothness in doing procedures

2. Nurses’ skills in creation of environment for promotion of rest and

sleep

3. Nurses’ competence in medication administration

4. Nurses’ skills in pain management

Interpersonal relationship of the nurses

1. The way nurses shown respect towards you and your family

2. The way nurses listened to your concern

3. The way nurses talked with you

4. Nurses behaviour towards you and your family

Professional knowledge of the nurses

1. Nurses’ knowledge regarding your disease condition

2. Nurses’ knowledge regarding your treatment & drugs

3. Nurses’ knowledge regarding your needs

4. Nurse’ knowledge regarding your progress

Professionalism among nurses

1. The way nurses carried out all the tasks without call and complaining
 2. The way nurses treat you and other patients with equality

3. The way nurses maintained a happy atmosphere in the ward

4. The way nurses considered your choices during your care

Communication provided by the nurses

1. The information given by nurses regarding ward/ ward routines on

admission.

2. The Nurses explanations of your disease condition, treatment & drugs

3. Explanation provided before doing any nursing procedure

4. Explanation provided by nurses to your family members as required