REVIEW ARTICLE
Patient satisfaction with nursing care in the context of health
care: a literature study
Peter Johansson1,2 RN, MNSc (Student), Magnus Ole

ni1,3 RN, MNSc (Student)
1,4
and Bengt Fridlund RN, RNT, PhD (Professor)
1
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden, Departments of 2Internal Medicine and 3Child Psychiatry,
Central Hospital, Halmstad, Sweden, and 4Department of Medicine and Care, Link€ oping University, Link€
Scand J Caring Sci; 2002; 16; 337–344
Patient satisfaction with nursing care in the context
of health care: a literature study
To evaluate and improve the quality of care provided, it is
of vital importance to investigate the quality of care in the
context of health care. Patient satisfaction is a significant
indicator of the quality of care. Consequently, quality work
includes investigations that map out patient satisfaction
with nursing care. To improve the quality of nursing care,
the nurse needs to know what factors influence patient
satisfaction. The aim of this literature study was to describe
the influences on patient satisfaction with regard to nur-
sing care in the context of health care. In the description of
nursing care, we have used Henderson’s nursing care
model. The results describe eight domains that have an
influence on patient satisfaction with nursing care: the
socio-demographic background of the patients, patients’
Introduction
Over the last two decades there has been an increasing
interest in how patients experience health care (1). It is of
utmost importance to be able to define, measure and
evaluate the quality of the health care provided, in order to
maintain and increase patient satisfaction. This area has
attracted worldwide attention in recent years; in Sweden,
too, its importance has increased significantly over the last
decade.
The reformation currently taking place in the Swedish
health care system has made it difficult to maintain a high
level of the quality of care (2). As a result of the recession
in the early 1990s, fewer resources were allocated to the
Swedish health care system (3, 4). With escalating costs
for treatment and nursing and with health care being
Correspondence to:
Peter Johansson, Hertig Knutsgatan 7, S-302 50 Halmstad, Sweden.
E-mail: peter.x.johansson@lthalland.se

2002 Nordic College of Caring Sciences, Scand J Caring Sci
oping, Sweden
expectations regarding nursing care, the physical envi-
ronment, communication and information, participation
and involvement, interpersonal relations between nurse
and patient, nurses’ medical–technical competence, and
the influence of the health care organization on both
patients and nurses. The bulk of the literature included in
the study came from the UK, Sweden and the USA. This
means that the results should be applicable to health care
in the western world. An important implication for future
research is to continue to elucidate the factors that influ-
ence satisfaction with nursing care, as seen from the
patient’s perspective.
Keywords: patient satisfaction, quality of nursing care,
nursing, health care, literature review.
Submitted 20 April 2001, Accepted 30 May 2002
subjected to competition, new attention is being focused
on achieving patient satisfaction (5). This has resulted in
greater emphasis on improved quality (6). Today, nursing
care is recognized as an area subjected to competition,
where the patient is seen both as a client and as a con-
sumer of health care (7).
High-quality technical care is most often regarded as a
matter of course (8). For this reason, the patient places
high value on the interpersonal care provided by the
nursing staff. Here, our definition of nursing care is ‘to
promote health and to help, support, educate and develop
the patient by liberating his or her own resources. Nursing
care is based on interaction and participation for the pur-
pose of satisfying universal and personal needs in relation
to daily life, needs that have become disrupted because of
ill health. Professional nursing care is based on theoretical
knowledge and systematic scientific methods’ (9, p. 173).
The ability to provide satisfactory nursing care has been
circumscribed concurrently with staff cuts. Thus, demands
are now being raised to extend the duration of nursing care
(2, 10). Otherwise there is a risk that the patient’s per-
ception of care will be negatively affected, which in turn
337
338 P. Johansson et al.
may exert a negative influence on the nurse’s perception
and possibility of providing high-quality nursing care.
There is a strong correlation between the patients’ per-
ception of nursing care and their perception of the quality
of care (2).
The concept of patient satisfaction
Patient satisfaction is defined as the patients’ subjective
evaluation of their cognitive and emotional reaction as a
result of the interaction between their expectations
regarding ideal nursing care and their perceptions of the
actual nursing care (11, 12). No consensus can be found in
the literature regarding the factors that constitute patient
satisfaction (13, 14). Yet, the concept is used as an important
indicator of care quality (6, 7, 10, 15–17). Moreover, it is
frequently included as a variable of interest in health care
planning and evaluation, i.e. in measurements of the
quality of care (11). It is also regarded as a marker, which is
described and evaluated from a professional perspective (6).
In measurements, this indicator has to be used together with
other indicators relevant to the area of the quality of care
(18). Patient satisfaction has become important because of
the increasing practice of applying a consumer policy
viewpoint to health care while also safeguarding patients’
rights and taking their views into account (17). Another
contributory factor is the knowledge that a patient who is
satisfied complies, to a greater extent, with the treatment
and advice he or she receives from health care professionals
(16). A satisfied patient also tends to return more frequently
when in need of health care. Moreover, a satisfied patient is
more willing to recommend the hospital that provided his or
her care to others (19).
It is the patient’s subjective perception of what consti-
tutes patient satisfaction that counts (18). No one other
than the patient can tell the health care professionals what
is important. For this reason, the concept should be
regarded as an adequate indicator of nursing care quality.
Patients can expect and demand satisfaction from nursing
care and be allowed to take an active part in decision-
making regarding their care (7). This contributes to making
nursing care both patient- and result-orientated. Different
health care professionals exert different influences on the
patient’s perception of satisfaction (19). The nursing care
provided by nurses is regarded as the most important factor
in patient assessments of their satisfaction with health care.
In this respect, the nurse is at the forefront of the hospital.
If the nurse is unable to fulfil this role, a high level of
patient satisfaction will not be achieved. It is therefore of
crucial importance that all health care professionals
co-operate to improve care quality, in consultation with
the care-receivers (20).
The factors that influence the concept of patient satis-
faction, as seen from the patient’s perspective, are of
primary importance. Other perspectives, such as those of
the health care professionals, are of lesser value (21). If the
patient is satisfied with the nursing care received, this is
positive not only for the individual but also for the nurse
and the entire health care organization. Although it is an
indisputable fact that the nurse’s care is important for
patient satisfaction, an interesting point is how the nurse
can improve it. Accordingly, the focus of nursing care must
be on factors that influence patient satisfaction. By bearing
this focus in mind, the nurse can enhance the quality of
nursing care. The aim of this literature study was to
describe what influences patient satisfaction regarding
nursing care in the context of health care, based on the
following questions:
• In what way do patients’ social background variables
influence patient satisfaction?
• In what way do patients’ subjective evaluations of health
care influence patient satisfaction?
• In what way does nurses’ care influence patient satis-
faction?
• In what way does the organization of health care
influence patient satisfaction?
The theoretical framework of nursing care based
on Henderson’s nursing model
Henderson’s nursing model has been used for the analysis
of and reflection on the literature (22). This model des-
cribes how nursing care should primarily be individual-
orientated. Important factors for achieving good health
are knowledge, ability and will-power (22, p. 22). The
surrounding physical environment in the form of air,
light, sound and hygiene also impacts on the patient’s
physical and mental health (22, p. 42). Nursing care
should be based on a dynamic relation between patient
and nurse. Furthermore, nursing care should be aimed at
instruction and be built on professional research findings
(22, p. 84).
All human beings have the same basic needs but each
individual has his or her own unique needs as well (22, p.
27). These needs vary from individual to individual and
during different periods in life (22, p. 27). As the patient
knows his or her own needs best and often has distinct
wishes and expectations regarding the performance of the
nursing care (22, p. 23), the patient should be regarded as
an active and responsible participant in nursing care (22, p.
23, 84). The nurse should create a natural and constructive
relationship with the patient for the purpose of achieving
the goal of nursing care, which is to satisfy the patient’s
needs and to help the patient attain the greatest possible
degree of self-efficacy (22, p. 28). In order to do this, the
nurse needs to be responsive, empathetic, provide emo-
tional support, and be able to observe and understand the
patient’s nonverbal expressions (22, p. 28). The patient’s
needs should be satisfied in the way to which the patient is
accustomed, unless this conflicts with the treatment and

2002 Nordic College of Caring Sciences, Scand J Caring Sci

nursing plan (22, p. 23). The nurse should also help the
patient carry out medical prescriptions initiated by the
physician (22, p. 22).
Method
The literature search was carried out using Medline and
CINAHL databases. The search was not restricted with
respect to dates. The following search words were used
separately and in combination with each other: client
satisfaction, customer satisfaction, patient satisfaction,
quality of care, quality indicators and quality of nursing
care. The names of authors from the reference lists in the
scientific articles identified through the data search were
also used in the extended search. To get a comprehensive
outlook, the following inclusion criteria were used: the
articles had to have been peer reviewed and published in
English, Swedish, Danish or Norwegian, and to have a
caring science perspective. The data material was proc-
essed, analysed and reflected through a step-wise proce-
dure, using a theoretical framework based on Henderson’s
model. The first step consisted of reading through the
material to reach an overall impression of the content.
Then attributes included in the aim and the issues raised
therein were searched for. The attributes were grouped
systematically and categorized into so-called domains
according to the content of the subject.
Results
Thirty studies, published between 1987 and 1999, were
found. The majority of the articles were statistically ana-
lysed observation studies, which were carried out in the
UK, Sweden and the USA. From the data material, eight
domains, describing factors that influence patient satis-
faction with nursing care in the context of health care,
were developed.
Socio-demographic background of the patients
The care-receiver’s age was important for his or her per-
ception of satisfaction with the nursing care provided (14,
23–26). The older care-receiver tended to be more satisfied.
Quality measurements focusing on the patient’s perspective
demonstrated that older people rated the quality of care
higher (27). Further, the patient’s gender also influenced
the perception of satisfaction (8, 23–26). Men reported a
higher level of satisfaction compared with women. Patients
with a higher level of education reported less satisfaction
compared with those with less education (27).
Expectations of nursing care
Patients’ satisfaction was determined by their expectations
regarding the health care they were about to receive and

2002 Nordic College of Caring Sciences, Scand J Caring Sci
Patient satisfaction with nursing care 339
by their perception of health care previously received (17).
These two subjective factors were crucial for the patient’s
perception of being satisfied or dissatisfied. Dissatisfaction
arose when their expectations were not fulfilled (28).
Care-receivers who perceived the quality of service and
care to be better than expected reported greater satisfaction
with their hospital stay (19). The patients’ different
expectations fluctuated during the course of the hospital
stay (29). Some expectations were relatively stable and did
not change over time, while others were influenced by the
information given by the nursing staff. Patients had
expectations that the nurse would play a central role in
their care (29) as well as expectations regarding the care to
be provided by the nurse (30). These expectations were not
only related to the nurse’s knowledge and competence but
also to ‘personal’ care. There were also expectations that
the nurse would act as a companion and adviser. Other
expectations were that the nurse would possess an empa-
thetic ability and good communication skills as well as
being able to provide necessary information, while guiding
the patient both emotionally and physically during the
hospital stay. Patients’ expectations regarding nursing care
were important for the outcome of the care provided and
for their perception of satisfaction or dissatisfaction. There
were also expectations that the nurse and the doctor would
co-operate in giving care (29).
Physical environment
The surrounding physical environment had an influence
on patient satisfaction (31). The physical environment
included cleanliness, food, sound level, fellow patients,
and the comfort and aesthetics of the premises. The patient
made suggestions for improvements, such as more single
bedrooms, a maximum of two patients per room and a
special room for postoperative care (14). Clean clothes, a
clean bed and tasty food were considered to be tokens of
good nursing care (32, 33). Further cutbacks in areas not
related to the immediate care, such as cleaning routines,
also had an influence on the patient’s satisfaction with the
hospital stay (19).
Communication and information
Clear communication and information was a prerequisite
for the patient’s perception of satisfaction with the nursing
care (23, 34–36). The patients emphasized the importance
of receiving adequate information and that there was a
need for the information they received to be improved for
their satisfaction to increase (7, 14, 31, 37). It was
important that the nurses’ explanations were clear and
straightforward, so that the patient could understand what
they were talking about (38). The time aspect also had an
influence on patient satisfaction. Patients who had
received information about ward routines at an early stage
340 P. Johansson et al.
rated the quality of care higher (27). It was also considered
important that care-receivers were given information in
such a way that their integrity was not violated (31). The
key factor in involving patients in their own care was the
information and education provided by the nurse (7, 38).
Participation and involvement
The patients’ ability to participate and be actively involved
had an influence on their perception of satisfaction (23,
39). They wished to be able to influence and take
responsibility for the care they received and had expecta-
tions in this respect (29). Thus, they needed to be given the
opportunity to take part in decisions concerning their own
nursing care (7, 23, 32, 34).
Interpersonal relationship
A good relationship between care-receiver and nurse was
found to be important for patient satisfaction (40). The
characteristics of a good relationship were: mutual
understanding, respect, trust, honesty, co-operation (33)
and humour (37). The patient perceived being treated as a
specific individual and being given personal nursing care as
positive (31). Patients who reported a high level of satis-
faction had been influenced, to a significant degree, by
how much attention the nurse paid to them and to what
extent she had shown empathy and patience (41). Care-
receivers regarded consideration and attentiveness on the
part of the nurse as a necessary condition for satisfaction
with nursing care (42). This, in turn, enabled nurses to use
their intuition to understand the patient’s unexpressed
questions and needs.
Patient satisfaction was rated high in an organization
where the nurse was allowed to give more personalized
nursing care (35). Personalized nursing care resulted in
improved communication, increased patient involvement
and a better outcome. There was a positive relationship
between the nurse’s care and patient satisfaction (10). The
more attention the nurse paid to the patient, the greater
the perception of satisfaction. In addition, patient satis-
faction was influenced by the nurse’s behaviour and nur-
sing qualities (31, 38). These should be characterized by a
pleasant and positive interaction between patient and
nurse, which demanded that the nurse was responsive,
kind, attentive, calm and encouraging. Other important
factors were that the nurse took time to listen to the
patient as well as demonstrating an interest and a com-
mitment in contacts with the patient (32, 39). The initial
contact was especially important for the development of
future relations and patients’ level of confidence in the
nursing care, in turn influencing their perception of sat-
isfaction with nursing care. A holistic view of nursing care
was a significant factor in achieving patient satisfaction (2).
Nursing care based on feelings was the best predictor of the
patient’s perception of satisfaction. Nursing care based on
feelings means to be responsive to patients’ feelings and to
care about their needs.
Medical–technical competence
Important factors for patient satisfaction were the advice
the nurse gave and that she performed her work in a
technically correct way (38). Patients felt that nurses
should skilfully assist the doctor in examinations and
treatments and that they should support and show patients
how to carry out the doctor’s orders. Patients expected the
nurse to have a command of specific knowledge about
each patient and his or her treatment (31). Adequate pain
relief influenced patient satisfaction (41). Absence of
physical pain resulted in a higher level of patient satisfac-
tion with nursing care (43). Pain relief was considered
by the patient to be the equivalent of good nursing care
(32).
Health care organization
Organizational changes influence the patient’s perception
of satisfaction with nursing care (23, 44). It has been
shown that the introduction of care provided by staff
members working in teams of two, individual care
planning, nursing documentation and quality assurance
within important nursing areas contributed to increased
patient satisfaction in several nursing areas. Continuity
of the health care organization exerted an influence on
patient satisfaction (31) as did accessibility (39). There
was also a wish to be cared for by as few nurses as
possible (31). Patients considered that this, among other
things, facilitated and improved the communication
between the nurses with respect to their situation,
resulting in fewer misunderstandings when a new shift
took over. Accessibility meant that it should be easy to
get the attention of the nurse (39). The nurse’s job
satisfaction influenced patient satisfaction with nursing
care (45). A nurse who is over-worked or who expresses
dissatisfaction with the workplace has a negative influ-
ence on the patient’s perception of satisfaction. The
nursing staff’s work environment was a factor of
importance for how the patient perceived the quality of
care (25).
Discussion
The results of this literature study are based on peer-
reviewed articles published in scientific journals, the
majority of them having quantitative observation designs.
It would have been desirable however, if more of the
identified articles had had an experimental design, as such
a design is considered to be of greater scientific value (46).
On the other hand, explorative qualitative studies are

2002 Nordic College of Caring Sciences, Scand J Caring Sci

needed to study patients’ views. We chose to describe
patient satisfaction with nursing care from the perspective
of the nurse but other health care professionals may, of
course, also benefit from the results.
In the present study it was found that patients’ expec-
tations of nursing care are of crucial importance for how
they perceive satisfaction in the context of health care. In
addition to age, gender and education, previous experience
of nursing care had a primary influence on expectations.
This previous experience is based on how the patients
perceived communication and information, participation
and involvement, the health care organization, interper-
sonal relation, medical–technical competence and the
physical environment during their last stay in hospital. The
finding of the present study that older patients rated their
satisfaction higher than younger patients can perhaps be
explained by the fact that they grew up in a society where
institutions had great power and were seldom questioned,
which may mean that they are not inclined to criticize
nursing care (47). Despite the fact that the need for nur-
sing care tends to increase with age, elderly people are the
group most satisfied with their care. A likely explanation is
that people place greater value on nursing care when their
own need of care is at its greatest.
Differences in satisfaction ratings between men and
women may be caused by the man–woman relationship or
to behavioural differences between the sexes. It has been
shown that men receive information more spontaneously
from the nursing staff compared with women (23).
Patients’ educational level also influences their level of
satisfaction. Patients with higher levels of education
probably make greater demands on nursing care, which
may lead to expectations of more information and educa-
tion. These patients rated their satisfaction lower if they
perceived that the information and education they had
received was insufficient. A social network of relatives and
friends who support the patient by being the patient’s
spokesperson may increase patient satisfaction. People
from different cultures may have different expectations
regarding nursing care, which means that, as patients, they
perceive satisfaction differently. In line with Henderson,
the need for nursing care can vary during the course of a
person’s life and from individual to individual (22, p. 27).
Further, norms and mores prevailing in different cultures
and social environments may influence this need. This
could explain the influence of age, education and gender
on the degree of satisfaction.
The physical environment has an impact on the patient’s
physical and mental health (22, p. 42). In today’s modern
hospitals, the overall control of many physical aspects,
such as the air, is in the hands of technology, while pro-
fessional groups are responsible for the hospital food.
However, the nurse still has some measure of influence on
factors in the physical environment (31) by, for example,
considering the patient’s need of warmth or quiet (14).

2002 Nordic College of Caring Sciences, Scand J Caring Sci
Patient satisfaction with nursing care 341
Consequently, nurses should take part in the planning
of new care units, thus allowing them to influence the
patient’s physical environment at an early stage.
The literature underlines the importance of providing
adequate communication and information to the patient,
which leads to increased patient satisfaction. Nursing care
should be aimed at instructing patients to increase their
knowledge, thereby helping them to attain good health
(22, p. 85). Despite this, insufficient information has been
shown to be perhaps the most common cause of dissatis-
faction (14, 18). Many factors may contribute to the
patient’s experience of not receiving sufficient information.
However, this is no excuse for the patient’s perception, on
leaving the hospital, of not having received sufficient
information. Other reasons for insufficient information
reaching the patient could be weak pedagogical skills on the
part of the nurse or the nurse’s increased workload. This
could lead to information not being prioritized. Greater
emphasis should be placed on patient education during
nursing education. This would give the nurse increased
knowledge of how to give information, counselling, guid-
ance and support to the patient (48) and would no doubt
lead to increased patient satisfaction. Yet another way of
increasing patient satisfaction is to give the patient infor-
mation regarding ward procedures and what care and
treatment are planned as early as possible after arrival at the
hospital (14). Patients who receive information not only
show greater satisfaction but also take part and become
involved in their own care to a greater extent. The patient
should be regarded as a resource and as an active and
responsible actor with individual wishes and expectations
of nursing care (22, p. 23, 84). Participation and involve-
ment lead to greater patient satisfaction (14). In order to
actively involve patients in their care, its planning and
implementation should be carried out in consultation with
the patients(14, 22, p. 85). Nurse and patient should work
jointly towards an agreed common goal.
Patients have reported that nursing interventions based
on feelings are more important for patient satisfaction than
the medical–technical nursing interventions (38). In order
for nurses to satisfy the patient’s nursing care needs, they
must create a natural and constructive relationship with
the patient (22, p. 28). The nurse should not underesti-
mate the value of physical contact with the patient, espe-
cially if it has a comforting effect. The capacity to feel
kinship with the patient is characteristic of the best nurses.
Within the health care of today, nurses are faced with
great demands regarding their relationship with the care-
receiver, among other things. To ensure patient satisfac-
tion, nurses need to provide personalized care. They need
to be attentive, show empathy and respect as well as caring
about what they are doing. They need to exhibit patience,
consideration, dedication and honesty. In order to create a
pleasant and positive interaction with patients, nurses
need to be responsive, friendly, calm, encouraging, take
342 P. Johansson et al.
the time to listen, show an interest and be able to under-
stand patients’ unexpressed questions and needs. Nurses
are expected to meet these demands while, at the same
time, experiencing increasing time-related pressures and
demands for high quality. If they are unable to cope with
these demands, there is a risk that they will develop feel-
ings of insufficiency. This, in turn, can negatively influence
nursing care, resulting in decreased patient satisfaction.
Despite this, many studies have shown that patients are
very satisfied with nursing care (8, 18, 23, 37). The nurse
must be aware that the patient’s perception of satisfaction
or dissatisfaction is not always a reflection of the nursing
care provided (49). As the present results show, other
factors influence the care-receiver, over which the nurse
has little influence.
Few descriptions were found showing patient satisfaction
to be the result of the nurse’s technical competence. A
possible explanation for this is that patients in general lack
the necessary knowledge to evaluate the technical care (50,
51). What patients can assess, however, is the quality of the
nursing care they receive. This means that the patient is the
optimal judge of the care provided in areas not related to
technology (16, 51). However, the importance of technical
competence should not be underestimated. Nurses need to
feel confident in their technical competence in order to
provide satisfactory nursing care at all levels. The nurse has
a responsibility to assist the patient in performing the
medical actions necessitated by the disease (22, p. 22).
There is a clear relationship between patient satisfaction
and compliance with prescriptions, advice and directions
(52, 53). A patient who is dissatisfied seldom complies with
directions and often does not turn up for revisits. This
indicates that a prerequisite for patient participation in
medical care is that the patient is satisfied with nursing
care. In other words, quality nursing care is a prerequisite
for quality medical care. The increasing costs of health care
in the western world (3–5) will force relatives and friends to
assume greater responsibility for nursing care in the future.
Escalating health care expenditure also increases the pres-
sure on politicians to deliver a more efficient health care
system. Research can establish what good quality nursing
is, thereby making it possible to optimize nursing care
resources. The politicians can then make clear to the
general public the demands and expectations that can be
placed upon the nursing profession, in turn increasing the
possibilities of achieving patient satisfaction.
The nurse is part of a health care team and is expected to
co-operate with the other health care professionals
involved in the care of the patient (22, p. 22). In their role
as supervisors, nurses have an important task to fulfil in
the organizational work of the field of health care. In this
work, the nurse should not only act in the patient’s best
interest but also in the interest of the nursing staff and
their work environment, as this influences patient
satisfaction (45). One way of increasing patient satisfaction
is to provide nursing staff with a positive work environ-
ment in order to prevent burnout. Neglect of the well-
being of the nursing staff results in disregard of patient
satisfaction as well as decreased quality of care in the long
term. By creating an organizational climate that is con-
ducive to further education, the staff is given the possibility
of enhancing their nursing competence, which, in the long
run, may improve patient satisfaction and possibly also the
nursing staff’s job satisfaction.
In investigations of patient satisfaction, care-receivers
with communication and speech difficulties as well as
confused or demented care-receivers are often excluded
(23, 44). However, these groups are the most important to
investigate when it comes to satisfaction with nursing care,
as they are the most dependent on the nurse’s care. It is of
utmost importance to develop measuring instruments that
make it possible to evaluate this patient group’s satisfaction
with the nursing care (24).
Conclusions
Patients’ expectations regarding health care are a key factor
when it comes to satisfaction with nursing care. Several
factors influence patient expectations both before and
during care. The background factors influencing expecta-
tions before the care begins are age, gender and education,
all of which belong to the socio-demographic domain, as
well as experiences from previous occasions on which the
patient received care. While in hospital, the patient has
expectations that can be found within the other domains,
such as the physical environment, communication and in-
formation, participation and involvement, interpersonal
relations between nurse and patient, the nurse’s medical–
technical competence, and influence of the health care or-
ganization on patient and nurse. These are domains where
nursing care may influence the care-receiver’s perception
of satisfaction. However, in some of these, such as physical
environment, medical–technical competence and the
health care organization, the nurse has less opportunity to
exert an influence. Accordingly, the nurse is dependent on
co-operation from other health care professionals to
achieve patient satisfaction. Nurses have a far greater pos-
sibility of influencing the domains of communication and
information, participation and involvement, and interper-
sonal relations, as these are the very foundations of their
profession. The patient makes a continuous subjective
evaluation of these domains, resulting in a perception of
nursing care. This perception is then reflected in new ex-
pectations within the different domains. As Fig. 1 shows, it
is the perception of satisfaction or dissatisfaction with nur-
sing care that forms the basis for the patient’s expectations
prior to the next hospitalization. This literature study pri-
marily illuminates patient satisfaction from a western world
perspective, as the scientific articles studied come from the
UK, Sweden and the USA. The health care in these coun-

2002 Nordic College of Caring Sciences, Scand J Caring Sci

Figure 1 The diagram shows eight domains and their relations that have an influence on patient satisfaction with the nursing care provided by the
health services.
tries can be said to be characterized by an equally high level
of technology. From this follows that the results can be
applied to the Swedish health care system as well as to the
rest of the western world.
Implications
In order to increase patient’s knowledge, greater emphasis
must be placed on patient education within nursing edu-
cation as well as within health care services as a whole.
The patient should expect to receive personal nursing care
based on scientific knowledge and utilization of the
patient’s own resources. Furthermore, in order to satisfy
his or her need of nursing care, the patient also expects the
nursing staff to have a joint strategy and common goals. It
is important to give patients information about what to
expect from nursing care, as it has been shown that their
expectations are of great importance for patient satisfac-
tion. The scientific community should inform hospital
administrators and politicians of what the general public
can expect from care and what demands they can place
upon it so that this can be made known to the public.
What is most important today is to clarify the concept of
patient satisfaction and to make clear what influences
patient satisfaction from the perspective of the patient, i.e.
to explore what it is that makes the patient perceive the
provided nursing care as of good quality.
It is therefore desirable to carry out further experimental
studies that illuminate patient satisfaction. In addition,
more explorative qualitative studies are needed, in order to
study the patient’s perspective. When this has been
achieved, the development of new and/or old instruments

2002 Nordic College of Caring Sciences, Scand J Caring Sci
Patient satisfaction with nursing care 343
can be continued. It is also important to develop an
observation instrument for measuring patient satisfaction
in patients who have communication difficulties or who
suffer from dementia, as no such instrument is available
today. There is also reason to focus further research on a
measurement of patient dissatisfaction, as this may be
another step forward in improving patient satisfaction and
thereby the quality of care.
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