Received date: December 27, 2018; Accepted date: January 09, 2019; Published date: January 16, 2019
Citation: Adane MD, Ereso BM, Debela TF (2019) Patient’s Expectations and Satisfaction with Nursing Care among Admitted Patients in Debra Tabor General Hospital, Northern Ethiopia: A Cross Sectional Study. Health Syst Policy Res Vol.6 No.1:77
Copyright: © 2018 Adane MD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: In the process of improving health care, patient point of view is becoming more important in today’s health system. Ignoring input from the patient or client is not living with reality today. Hence, this study is helpful to identify voice of patients that can be used as a tool for improving the health care delivery in the study area and similar settings.
Methods: Facility based cross sectional study was conducted in Debre-Tabor General Hospital from March 01-April 30/2017. All randomly selected patients admitted in the wards were included into the study. Data were collected by face to face interview using structured questionnaires. Sample was allocated proportionally to all adult wards. Data were entered into EpiData v3.1, exported to SPSS version 21 and cleaned to check for completeness and missing values. Both descriptive and inferential statistics were done. Logistic regression analysis was carried out to identify factors associated with patients’ satisfaction with their nursing care.
Result: A total of 398 respondents were interviewed making the response rate 94.5%. The overall adult inpatient satisfaction with nursing care was 66%. Patient expectation was 78%. Majority (71.6%) of respondents were satisfied with the way of nurses welcomed patients but, almost half (48.1%) of respondents were dissatisfied with the help/assistance given by the nurses. In this study sex of patients (AOR=2.22), residence (AOR=2.01), and duration of stay in the ward (AOR=14.04) as well as frequency of admission (AOR=1.87) were significantly associated with adult inpatient satisfaction.
Conclusion: The patients’ satisfaction with nursing care was found to be moderate. The expectation was good. The satisfaction was influenced by Sex of patients, residence, and duration of stay in the ward as well as frequency of admission. Health administrators should often emphasize on nursing procedural competency throughout patient care.
Satisfaction; Nursing care; Inpatient; Debre Tabor general hospital
Patient satisfaction is defined as the combination of experience, expectations and needs perceived by patients’ and their reaction toward that . Analyzing the satisfaction of patients help the health institution managers to determine the level of health care delivery and identify areas to improve . Patient satisfaction is used as an important indicator of quality of care . It belongs to the service dimension of quality of care; it reports few problems related to technical quality of care in hospitals [4,5].
Patient satisfaction is influenced by patient’s expectations, their Sociomedical condition and health status, psychological variables and characteristics of the treatment . Patients are the best and only source of information about the nurses’ communication, health education, and pain management processes, and about dignity and respect during treatment .
Patient satisfaction studies require continuous analyses in relation to the changing standard of medical services. It allows the integration of the patients’ view into the functioning of the hospitals and identifies difficulties of health services as well as gaps in the quality of care . The interaction of patient and nursing staff is high in the hospital and the illness itself affects the attention of nurses .
Nursing care is one of the major health care services. It contributes a lot to the patient healing process. Even though there are competent physicians present in a given health Nursing care is one of the major health care services. It contributes a lot to the patient healing process. Even though there are competent physicians present in a given health Nursing care is one of the major health care services. It contributes a lot to the patient healing process. Even though there are competent physicians present in a given health Improving communication between admitted patients and nurses can improve the overall satisfaction of patient . In order to build a culture of client service distinction in hospitals and achieve outstanding patient satisfaction, it is necessary to understand the intangible aspects of expectation that contribute to patient satisfaction . Patients there by evaluate the health-care services as well as the providers from their own subjective point of view . Even though patients may not be able to judge specific technical aspects, they are best source of accurate information regarding clarity of explanations, helpfulness of information patients are receiving, barriers to obtaining care or the physician’s interpersonal behavior .
A very important aspect on which patient satisfaction depends is ‘nursing care’ because nurses are involved in almost every aspect of client’s care in hospital, that is nurses interact with patients more often than any other health care personnel in a hospital . Nurses spend much time with the patients than other health care professionals and they have a unique position to influence and promote effective consumer relationships . Nursing care is the major health care service in hospitals. It contributes a lot to the healing process of patients. Nurses have long contact time with patients. As they are frontline service providers, patients expect more from them and also more expected from them to fulfill the expectation of patients . On this line assessing the satisfaction of patient with nursing care is crucial to identify areas of dissatisfaction. A hospital may be soundly organized, beautifully situated and well equipped, but if the health care lacks quality, the hospital will fail in its responsibility of providing care. Ignoring input from the patient or client is not living with reality today . In today’s health systems, patient perspective is becoming more important . Therefore, patient satisfaction and expectations should be assessed continuously at each and every health care institutions to balance expectations and actual service quality.In our study area, there is no study conducted on the subject matter. Hence, this study is helpful to know voice of patients and can be used as a tool for improving the health care delivery in the study area and also in the similar settings.
Study design and setting
Institutional based cross sectional study design was conducted in Debra Tabor General Hospital from March 01 to April 30, 2017. Debra Tabor General Hospital is found South Gondar 666 km from Addis Ababa (capital city of Ethiopia) and 102 km from Bahir Dar (capital of Amhara regional state). Hospital was established by the Italian missionaries in 1941 and providing service for a total of 2.3 million population. There were around 434 workers in the hospital from these 296 were technical staff while 138 were supportive staff. Among technical staff 143 were nurses. The hospital has 120 beds and five admission wards (surgical, Medical, Gynecology & obstetric, pediatric and neonatal).
All randomly selected patients, who were admitted in inpatient wards and stayed for two and more days in the ward, were included in to the study. The data were collected voluntarily and patients who were seriously ill or have mental health problems were excluded from the study.
The required sample size was determined using a single population proportion formula by considering the proportion of patients’ satisfaction 52.8% with the inpatient nursing services, from study done in Dessie Referral Hospital , 95% confidence level and 0.05 margin of error were used. Hence, the calculated sample size was 383. By adding 10% non-respondents, the final sample size became 421.
Proportional allocation of sample was done for each adult wards. To have individual study subjects from each ward, systematic sampling method was employed during data collection with K value of 3 (N=1150 monthly patient load and n=421 that means every 3rd patients from the registration). The first patient was selected by lottery method. For patients who did not fulfill inclusion criteria the next patients were selected.
Data collection procedure
Data were collected by face to face interview using structured questionnaires. Instruments were developed after reviewing related literatures. The questionnaire was first prepared in English and then translated in to Amharic (local language) and re-translated into English by language experts to ensure its consistency. Using the one in Amharic questionnaire, 5% of sample size pretest was conducted in Nifasmewucha hospital outside the study area. The study participants were asked whether they are able to differentiate nursing staff from other health professionals. If not, the data collectors explained the nurses’ uniform and the activities of nursing staffs to the participants, to help them differentiate the nursing staffs before the interview. Five diploma graduated health professionals those speak local language (Amharic) and working outside the study hospital collected the data with one BSc holder supervisor.
The questionnaires had four parts; the first part was about Socio medical demographic characteristics of the participants, the second part was the questions about the satisfaction with nursing care, the third part was about the institution and the fourth part was about the patients’ expectation from care providers as well as from the hospital. Each item was rated using a five-point Likertscale type ranging from (1) very dissatisfied and (5) very satisfied. The prevalence of patient satisfaction was calculated by percent mean (which is the ratio of actual value minus potential minimum with the potential maximum minus potential minimum then multiplied with hundred) . If the prevalence or percent (>80), we affirm that there were good satisfaction on overall aspect of the nursing care. Moderate (not too bad), when equals to 60 to 80 and considered as low satisfaction if less than 60 percent.
Data collectors were trained for one day to be familiar with data collection tool. Pretest was conducted outside the study area. After pretest, the questionnaire was reviewed for appropriateness of wording; clarity of both contents and checked whether instructions elicited be going with responses. Crombach’s alpha was calculated to test internal consistency (reliability) of items. If only Crombach’s alphas>0.7 were incorporated to the main research questionnaire. Editing and sorting of the questionnaires were done to determine the completeness and consistency of data every day during the data collection. The completed questionnaires were cross checked and made correction on daily basis.
Data were entered into EpiData v3.1, exported to SPSS version 21 and cleaned to check for completeness and missing values. Both descriptive and inferential statistics were done. For socio demographic characteristics and patient expectation descriptive statistical analysis was employed. Logistic regression with binary and multiple analyses were done to identify factors associated with dependent variable. Those explanatory variables with a p-value<0.25 in crude analysis were entered into multivariate analysis. A significance level of 0.05 was used in multivariate analysis to identify the predictors of adult inpatients’ satisfaction with nursing care. The final model was checked by hosmerlemeshow goodness of fit test. Confounders and multi co-linearity was checked to reduce bias.
Socio demographic characteristics of the respondents
From a total of 421 sample sizes, only 398 respondents were interviewed; yielding the response rate of 94.5%. Out of the total study participants, about three fourth (75.4%) of the respondents were female. Two hundred seventy four (68.8%) of respondents were rural residents. One hundred forty three (36%) of respondents were farmer in occupation while 108 (27%) and 67 (16.8%) of respondents were housewife and government workers respectively. One hundred ninety one (48%) of respondents can’t read and write. One third (33.4%) of the respondents were in the age group of 25-29 with the mean age of 31.4 ± 11.09. Two hundred eighty five (71.6%) of the respondents earn monthly income greater than 925 Ethiopian birr (27 Ethiopian Birr=1 USD). Majority 331 (83.2%) of respondents were married while two third (66.6%) of respondents were orthodox Christianity in religion (Table 1).
|Unable to read and write||191||48.1|
|Read and write||52||13.0|
|Diploma and above||68||17.2|
|Greater than 49||11||2.7|
|Less than 401||33||8.4|
|Greater than 925||285||71.6|
Table 1: Socio-demographic characteristics of adult patients admitted in Debra Tabor General Hospital, Northwest Ethiopia 2017 (n=398).
Among the respondents included in the study 173 (43.5%) were from gynecology department while 137 (34.4%) were from medical ward. Two hundred thirty six (59.3%) of respondents were admitted for the first time while 162 (40.7%) of them admitter more than two times. Three hundred seventy eight (95.1%) of the respondents were stayed 2-5 days in the ward (Table 2).
|Type of ward||Gynecology||173||43.5|
|Frequency of admission||First time||236||59.3|
|More than two times||162||40.7|
|Duration of stay in the ward||2-5 d ays||378||95.1|
Table 2: Patient admission characteristics of inpatients who were admitted in Debra Tabor General Hospital, Northwest Ethiopia 2017 (n=398).
Satisfaction of patients with hospital structure
Out of the study participants, 209 (52.6%) of respondents were satisfied on the adequacy and maintenance of ward. Two hundred ninety three (73.7%) of the respondents were satisfied on the cleanliness of the admission ward. One hundred ninety five (49.1%) of the study participants were satisfied with the adequacy of ward’s space while 299 (75.1%) were satisfied with ward room light and ventilation system. More than half (54.7%) of the respondents were satisfied with the condition of bed while only 166 (41.8%) of the study participants were satisfied on condition of food. One hundred fifty one (37.9%) of the respondents were dissatisfied on access to water and 179 (44.9%) of them were also dissatisfied on access to latrine and 167 (42.1%) of them were very dissatisfied on access to hand washing facility (Table 3).
|Very dissatisfied n (%)||Dissatisfied
|Neutral n (%)||Satisfied
|Adequacy and maintenance of infrastructures||2 (0.4)||4 (1.1)||99 (24.9)||209 (52.6)||84 (21.1)|
|Cleanliness of ward||0||2 (0.4)||10 (2.5)||293 (73.7)||93 (23.5)|
|Adequacy of ward space||5 (1.1)||14 (3.5)||87 (21.8)||195 (49.1)||98 (24.6)|
|On light and ventilation||0||3 (0.7)||24 (6.0)||299 (75.1)||72 (18.2)|
|Condition of bed||0||5 (1.1)||38 (9.5)||217 (54.7)||138 (34.7)|
|Condition of food||0||3 (0.7)||81 (20.4)||166 (41.8)||148 (37.2)|
|Access to water facility||0||151 (37.9)||100 (25.3)||141 (35.4)||6 (1.4)|
|Access to latrine facility||43 (10.9)||179 (44.9)||0||61 (15.4)||115 (28.8)|
|Access to hand washing facility||167 (42.1)||7 (1.7)||87 (21.8)||137 (34.4)||0|
Table 3: The adult patients’ satisfaction status toward hospital characteristics; at Debra Tabor General Hospital, Northwest Ethiopia 2017.
Patients expectations of nursing care
From all the respondents 370 (93%) were satisfied with empathy of nurses and 362 (91%) of respondents were satisfied with the way of nurses explain and listen the patients. Two hundred seventy three (96%) were satisfied with the way the respectful treat and the behavior of the nurses. The overall patients expectation was 78% i.e. majority of the respondents got the nursing service as they expected (Figure 1).
Patient’ satisfaction with the service given by nursing care providers
From all the respondents 285 (71.6%) of them were satisfied with the way of nurses welcomed patients. Two hundred fifty four (63.9%) of the respondents were satisfied with the approach of nurses and 212 (53.3%) of the respondents were satisfied with the way nurses communicate with them. One hundred ninety one (48.1%) of respondents were dissatisfied with the help/ assistance given by the nurses. Two hundred twenty four (56.5%) of respondents were satisfied with the confidentiality (Table 4).
|Dissatisfied n (%)||Neutral n (%)||Satisfied n (%)
|Very satisfied n (%)|
|The way nurses welcomed me on my admission to this ward.||0||6 (1.4)||63 (15.8)||285 (71.6)||44 (11.2)|
|The nurses’ approach when they were examining me||0||14 (3.5)||50 (12.6)||254 (63.9)||80 (20)|
|The way nurses were talking /communicate with me.||0||22 (5.6)||66 (16.5)||212 (53.3)||98 (24.6)|
|How nurses were willing to respond to my concerns/requests||0||32 (8.1)||126 (31.6)||184 (46.3)||56 (14)|
|How nurses helped me with my pain||0||47 (11.9)||59 (14.7)||144 (36.1)||148 (37.2)|
|How nurses helped/assisted me with bed making||2 (0.4)||191 (48.1)||50 (12.6)||39 (9.8)||116 (29.1)|
|My anxiety and stress was alleviated by nursing care||0||31 (7.7)||47 (11.9)||211 (53)||109 (27.4)|
|The amount of time nurses spent with you||2 (0.4)||43 (10.9)||96 (24.2)||148 (37.2)||109 (27.4)|
|How quickly nurses came when you need them||2 (0.4)||19(4.9)||50 (12.6)||187 (47)||140 (35.1)|
|The way nurses made you feel at home||3 (0.7)||27 (6.7)||53 (13.3)||184 (46.3)||131 (33)|
|The information given to you about your condition and treatment||10 (3.5)||43 (15.1)||76 (26.7)||67 (23.5)||89 (31.2)|
|How often nurses checked to see if you were okay||2 (0.4)||41 (10.2)||65 (16.5)||176 (44.2)||114 (28.8)|
|The amount of privacy nurses gave you||2 (0.4)||24 (6)||70 (17.5)||157 (39.6)||145 (36.5)|
|The confidentiality nurses gave you||2 (0.4)||13 (3.2)||60 (15.1)||224 (56.5)||99 (24.9)|
Table 4: Adult inpatients’ satisfaction with nursing care at Debra Tabor General Hospital, Northwest Ethiopia 2017.
Overall satisfaction of patients
The overall magnitude of patients’ satisfaction towards the nursing care of Debra tabor general hospital was 66% (95% CI: 60.4%. 71.2%). About 34% of them were dissatisfied with the overall service given by nurses at inpatient departments (Figure 2).
Factors associated with patients’ satisfaction
In the bi-variate analysis five variables such as residence, duration of stay, frequency of admission, sex and type of ward were associated.
In this study, admitted patients stayed for two up to five days in the ward were 13 times (AOR=13.13, 95% CI: (2.875, 59.958)) more likely to be satisfied as compared to those who stayed more than five days. In addition the odds of admitted patients from urban area were 1.86 times (AOR=1.86, 95% CI: (1.104, 3.119)) more likely to be satisfied compared to patients admitted from rural area. Patients’ who were admitted for the first time were two times (AOR=2.09, 95% CI: (1.274, 3.456)) more likely to be satisfied compared to patients who were admitted two or more times and male inpatients were two times (AOR=2.47, 95% CI: (1.419, 4.293)) more likely to be satisfied compared to female admitted patients. Similarly, patients admitted in medical and surgical ward were 2.56 (1.363, 4.825) and 2.9 (1.043, 3.826) times more likely to be satisfied with nursing care compared to patients admitted in gynecology ward respectively (Table 5).
|Sex||Male||48 (48.6)||50 (51.4)||2.47 (1.419, 4.293)*||0.01|
|Female||89 (29.3)||211 (70.7)||1|
|Residence||Rural||81 (29.6)||193 (70.4)||1|
|Urban||54 (43.8)||70 (56.2)||1.86 (1.104, 3.119)*||0.02|
|Duration of stay in the ward|
|2-5 days||119 (31.4)||259 (68.6)||13.13 (2.875, 59.958)||0.001|
|>5 days||17 (85.7)||3 (14.3)||1|
|Frequency of admission|
|First time||64 (27.2)||172 (72.8)||2.09 (1.274, 3.456)*||0.004|
|>=2 times||71 (44)||91 (56)||1|
|Types of ward|
|Medical||67 (49.2)||70 (50.8)||2.56 (1.363, 4.825)*||0.004|
|Surgical||29 (32.7)||59 (67.3)||2.9 (1.043, 3.826)||0.037|
|Gynecology||47 (27.2)||126 (72.6)||1|
Table 5: Bivariate analysis of factors associated with adult patient satisfaction with inpatients nursing care in Debre Tabor General Hospital, Northwest Ethiopia 2017.
Predictors of patients’ satisfaction
Out of these five variables identified in the bivariate analysis of logistic regression only duration of stay, frequency of admission, sex and residence were significantly associated with adult inpatients’ nursing care satisfaction in the multivariate analysis. In this study, admitted patients stayed for two to five days in the ward were fourteen times (AOR=14.14, (95% CI: 2.948, 66.816)) more likely to be satisfied as compared to those who stayed more than five days. In addition the odds of admitted patients from urban area were two times (AOR=2.01, (95% CI: 1.144, 3.536)) more likely to be satisfied compared to patients’ admitted from rural areas. Patients’ who were admitted for the first time were 1.87 times (AOR=1.87, (95% CI: 1.090, 3.218)) more likely to be satisfied compared to patients who were admitted two or more times and male inpatients were 2.22 times (AOR=2.22, (95% CI: 1.102, 4.473)) more likely to be satisfied compared to female patients (Table 6).
|Sex||Male||48 (48.6)||50 (51.4)||2.22 (1.102, 4.473)**||0.026|
|Female||89 (29.3)||211 (70.7)||1|
|Residence||Rural||81 (29.6)||193 (70.4)||1|
|Urban||54 (43.8)||70 (56.2)||2.01 (1.144, 3.536)**||0.015|
|Duration of stay in the ward|
|2-5 days||119 (31.4)||259 (68.6)||14.04 (2.948, 66.816)**||0.001|
|>5 days||17 (85.7)||3 (14.3)||1|
|Frequency of admission|
|First time||64 (27.2)||172 (72.8)||1.87 (1.090, 3.218)**||0.023|
|>=2 times||71 (44)||91 (56)||1|
Table 6: Multivariate analysis of factors associated with adult inpatient satisfaction with nursing care Debre Tabor General Hospital, Northwest Ethiopia 2017.
This study clearly demonstrated that, magnitude of patient satisfaction with nursing care was 66% (95% CI: 60.4%, 71.2%). This finding was in line with the study done in the Mizan Aman of Ethiopia which was 61.3%. The finding of this study was lower than study done in Mekelle city which was 79.7% and study done in Black Lion teaching Hospital  which was 90.1%. The difference might be due to most of nurses in Black Lion teaching Hospital were professional expertise and the hospital use adequate technology for the implementation of better nursing care practices. But, the finding was higher than studies done in other part of the country. A cross sectional study done in selected public health institution showed that 52.7% of patients were satisfied with the nursing care . Also, this finding was higher than study done in Dassie  which was 52.5%, study done in Felegehiwot  which was 44.9%, In south nation nationality and people  which was 47% and study done in Amhara region  which was 56.9%. Our finding was also higher than the study conducted in Dil Chora Hospital found in eastern part of Ethiopia, Addis Ababa (which was 48.8%) and Minilik II Hospital (which was 55.8%) . The reason for difference might be the above mentioned hospitals may have high number of patient flow and work overload which leads low percent of adult inpatient satisfaction or might be due to the difference in management system among the hospitals. The finding of this research also, differs from study done in other part of the world. The satisfaction of patient with the nursing care in Kenya was much higher than our finding. In Kenya 87% of patients were satisfied with the nursing care . This difference might be due to the socio economic and technological as well as due to the difference in management system of two countries. But, our finding was higher than study done Risgary of Iraq which was 40.5% .
In this study sex of patients, residence, and duration of stay in the ward as well as frequency of admission were statistically significant.
Male patients who were admitted in the ward were two times (AOR=2.47) more likely to be satisfied compared to female admitted patients. This finding was in line with study done in Dassie in which sex was an associated factor for the satisfaction of patients . Admitted patients from urban areas were two times (AOR=2.01) more likely to be satisfied compared to patients from rural area. This finding appeared to be consistent with studies done in Mizan and Mekelle in which the place of the residence were the associated factor [7,19]. Adult in-patients who were admitted for the first time (AOR=1.87) were 1.87 times more likely to be satisfied compared to those who were admitted more than one. This result was the similar with other studies done in Ethiopia and abroad. In Saud Arabia, patients who had prior history of admission and the satisfaction had significant association . In Ethiopia, study done in Addis Ababa , Dessie , and in selected public hospital  were revealed frequency of admission had significant association with patient satisfaction with nursing care.
Duration of stay in the ward had also a significance association with patient satisfaction with nursing care. In this study, admitted patients who stayed 2-5 days in the ward had (AOR=14.14) 14.14 times more likely to be satisfied compared to those who stayed more than 5 days. This result is consistent with other study done in Ethiopian hospitals and other part of Africa. The study done in Addis Ababa , Mekelle  and Mizan  had clearly showed the length of stay had influence on the satisfaction of patients with the nursing care. In Kenya also patient satisfaction was influenced by the length of stay in the hospital . In other study satisfaction of patients with nursing care was influenced by age of respondents, income, education level, type of wards in which the admitted, marital status and privacy [2,7–9,14]. But, in this study they were not statistically significant.
In conclusion, the level of patients’ satisfaction with inpatient nursing care was found to be moderate or not too bad. The patient expectation was also good since majority of patients got what they expect. Sex of patients, residence, and duration of stay in the ward as well as frequency of admission were significantly associated with adult inpatient satisfaction with nursing care. Since nursing care is determinant of patient outcomes during hospitalization, health administrators should often emphasize on nursing technical competency and interpersonal relationships throughout patient care. Prompt quality nursing care should be prioritized to match with patient expectations in each hospital units and ensure patient satisfaction through reduction of length of stay in hospital and frequency of admission.
Data on patient satisfaction was collected using survey tools, can be considered a valid source for performance indicators from patient perspective. If health policies have to be patient centered, managers and health workers need to monitor patient experience and to consider the results obtained to plan services and to evaluate performance. Promoting surveys regarding patient experience and considering them as a systematic tool to detect patient needs help to give more importance to the role of patient in health care. The service performance improved only if each professional is made accountable for the quality of assistance he delivers.
There is no competing conflict of interest with the presented data as external data collectors collected. We, the researchers, have no any form of competing financial and non-financial interest between ourselves.
We are grateful to acknowledge our study participants for providing the necessary information and the data collectors for collecting the data carefully.
The data collection process of this study was funded by the Jimma University for the support of the data collection. The funding body only followed the process to confirm whether the fund allocated was used for the proposed research.
The data collected for this study can be obtained from the first or last author based on a reasonable request.
All authors involved in the study proposal writing, design, data analysis, write-up, and drafted the first version of the manuscript, and participated in all phases of the project.
Ethical clearance was obtained from institute of health ethical review board of jimma university. Permission letters was obtained from debra tabor general hospital and the letter was presented to selected wards. Oral consent was taken from each participant before start of data collection. Confidentiality was assured by indicating they are not requested tell their name and by assuring that their responses not in any way be linked to them. In addition, they were told that they have the right not to participate or withdraw from the study any time during data collection.
There is no competing conflict of interest with the presented data as external data collectors collected it. There was no financial interest between the funder and the research area community and the authors. We, the researchers, have no any form of competing for financial and non-financial interest between ourselves.