Patient Satisfaction from Nursing Care in Private Tertiary Care Hospital Peshawar

Objective: The objective of this study was to assess patient satisfaction regarding nursing care provided in health care setting. Methodology: Cross-sectional study was conducted in private tertiary care hospital. A well-structured questionnaire was adopted and translated from English into Urdu that covered multiple domains to assess patient satisfaction. Data was collected through convenience sampling technique. Data analysis was done by SPSS version 22. Results: Total participants were 52 in which 59.6% subjects were highly satisfied, 32.6% were partially satisfied and 7.7% were dissatisfied from nursing care. Age, gender, education and hospital stay have no effect on patient satisfaction. Applied Chi-square test that was not significant. Conclusion: Satisfaction level of patient from nursing care was high while few participants were dissatisfied. Type of ward, education, hospital stay and gender were not determined to affect satisfaction level. Moreover Routine greeting, caring time, giving information regarding disease, keeping privacy, medication timing and taking vital signs were appreciated. Few participants were not satisfied with information regarding action, side effect of medication and relaxation therapy.


Introduction
Patients have more expectation from nursing care which has a direct relation to the patient satisfaction. Some factors that influence patient expectations are Age, Gender and education [1]. Researchers observed that patient satisfaction is a good indicator of the quality of nursing care delivery [2]. Different factors can affect patient satisfaction like age, education, sex, income, and hospital stay [3]. Patients will cooperate in achieving of desire goal and will give positive opinion to friend and family members if they are satisfied [4].
Patient satisfaction is the better indicator of measuring nursing care delivery [5]. Patient satisfaction ratio was 23% in obstetrics/ chronology, 19% in medicine and 24% in surgery, whereas moderate satisfaction was observed 65% in obstetric, 64% in surgery and poor satisfaction was observed 12% in obstetric, 16%in medicine and 12% in surgery [4].
The patient satisfaction ratio was very high that means patients were very satisfied with nursing care. Further they stated that patient liked the nursing care because, nurses were competent, polite, friendly and provided detail information regarding disease [5]. Patient satisfaction with nursing care was high but some different things that can effect patient satisfaction were ward, age, sex, income, education and hospital stay. Patient in surgical ward with high stay have more satisfied then short stayed patients [3].
Patient satisfaction in medical and surgical wards was moderate 69.4% and 66.2% respectively but patient's shows high satisfaction in gynecological ward. They further told that patient satisfaction can be enhance by spending more time to talk and explain what nurses do with them according to needs competently [1]. Study was conducted in tertiary care hospital in which 45% patients were satisfied while 55% patients were partially satisfied. The study was conducted in six dimensions of care, nurses practices of keeping privacy, checking of routine vital signs, behavior of nurses, talking to nurses, nursing skills, and attentive to needs of patients [6].
According to [7] patients were very satisfied with administering medication by nurses. They further reported that patient satisfaction can be effected by information provider's interaction during the course of care and the physical environment of patients. According to [8] overall patients were very satisfied. Female were more satisfied than male, uneducated and unemployment patients were more satisfied than educated and employed. Nurses were found competent and nursing care was rated high. Information regarding treatment and surgery were not provided to one third of total patients. There are few studies regarding patient satisfaction in Pakistani context. The purpose of this study was to assess patient satisfaction from nursing care. The outcome of this study will help health care organization to identify patient satisfaction level and to improve care accordingly.

Research Questions
a) Are patients satisfied from nursing care? b) Are patients giving preference to treat their patients in the same hospital?

Research Design
The descriptive cross sectional study was used in this research project. This research design was used because cross-sectional studies provide a 'snapshot' of the outcome at a specific point in time over a short period [9].

Population
Population for this study was admitted patients at tertiary care hospital Peshawar, KP.

Sampling Technique
Convenience sampling technique was used for sample selection.

Sample Size
Sample size was calculated by Rao soft software, with the population size 170 with 5% margin of error and 5% nonresponsive rate. The calculated sample size was 52.

Data Collection Tools
For data collection Questionnaire was adopted, developed and translated from English into Urdu language, so that the participant can easily understand the questions. For data analysis criteria was developed; positive response to questions less than 6 is considered poor satisfaction, positive response to greater than 6 and less than 12 is considered partially satisfaction and greater than 12 positive responses is considered highly satisfaction.

Ethical Consideration
Permission from Chief Nurse Services (CNS) was obtained prior data collection. Informed consent was distributed among all participants. Confidentiality and anonymity was maintained throughout the study.

Inclusion criteria a)
Admitted patients for at least 24 hours b) Subject Age 18 or above.
c) Subject that are Oriented and have the insight.

Data Analysis
Statistical Package for Social Sciences (SPSS) version 22 was used for Statistical analysis. For data analysis in descriptive statistic, percentages and frequencies were calculated for nominal and ordinal data while in inferential statistic Chi-square was applied which was not significant.  This study consisted of 52 participants including 23 (44.2%) males and 29(55.8%) female ( Figure 1). Age of subject's from18 to 38 years =20 (38.5%), from 39 to 59 years =20 (38.5%) and age above 59 years =12 (23.1%) ( Figure 2). 22 (42.3%) subjects were uneducated, 6 (11.5%) had passed primery level while 6 (11.5%) passed secondary and 18 (34.6%) was above secondary ( Figure  3). Same number of patient were selected from medical, surgical, gynecology and others wards ( Figure 4). Hospital stay of participant was;1 to 2 days =12(23.1%), 14(26.9%) were 2 to 3 days and stay more than 3 days was 26(50%) ( Figure 5) (Table 1).    Patient's satisfaction was calculated in percentage where the study showed that 59.6% subjects were highly satisfied, 32.6% were partially satisfied and 7.7% were dissatisfied from nursing care ( Figure 6). To check association between satisfaction and age, gender, education and hospital stay one way ANOVA and chi square test was applied which were not significant ( Table 2).

Discussion
Patient satisfaction is an indicator of measuring nursing care delivery [5]. Current study showed that there was equal percentage of satisfaction in each ward, while a study conducted by [4] revealed that Patient satisfaction ratio was 23% in obstetrics/ chronology, 19% in medicine and 24% in surgery, whereas moderate satisfaction was observed 65% in obstetric, 64% in surgery and poor satisfaction was observed 12% in obstetric, 16% in medicine and 12% in surgery. This study highlighted that patient satisfaction level was high due to the high state of tertiary care hospital.
A study conducted by [5] presented that patient satisfaction ratio was very high that means patients were very satisfied with nursing care. Further they stated that patient liked the nursing care because, nurses were competent, polite, and friendly. They provided detail information regarding disease. Similarly, current study also proposed the same result.
A study conducted by [3] determined that Patient satisfaction with nursing care was high but some different things that can effect patient satisfaction were ward, age, sex, income, education and hospital stay. Patient in surgical ward with longer stay were more satisfied than those who stay shortly. Compared the above study to current study indicated that patient satisfaction was also very high, but there was no such factor observed that effect satisfaction level of patient because every patient is treated the same. Moreover, the participants in current study were selected from private sector hospital, so only those patients came who can afford the treatment cost.
Study conducted in tertiary care hospital by [6] identified that 45% patients were satisfied while 55% patients were dissatisfied. The study was conducted on six dimensions of care that is nurses practices of keeping privacy, checking of routine vital signs, behavior of nurses, talking to nurses, nursing skills, and attentive to needs of patients. This study showed that 59.6% patients were highly satisfied, partially satisfaction ratio was 37.2% and 7.7% were dissatisfied from nursing care. This study presented high satisfaction ratio because current's study setting was private sector hospital while the mentioned study setting was a Government Headquarter hospital.
According to [7] patients were very satisfied with medication administering by nurses. They further reported that patient satisfaction could be affected by information provider's interaction during the course of care and the physical environment of patients. While in current study patients were also very satisfied with all nursing skills while 50% participant were dissatisfied with information provided regarding action and side effect of medication, furthermore, patients stated that nurses only provided information regarding medication when asked by patients.
A study conducted by [2] showed that satisfaction level of patients was moderate regarding nursing care. Further study determined that satisfaction level of female patient was more than male patient, gynecological patient's satisfaction was high than medical and surgical patient. Satisfaction level was less in public hospital than semi private hospital. Current study identified high satisfaction level of patients from nursing care. Each ward has same satisfaction level and there was no significant association identified between gender and satisfaction. Present study exposed high satisfaction because nurses strictly follow evidence based practice and have weekly evaluation rounds of each ward by nursing managers. While above mentioned study was conducted in public and semi-private hospitals.
A study conducted by [8] displayed that overall patients were very satisfied. Female were more satisfied than male and also uneducated and unemployment patients were more satisfied than those of educated and employed. Nurses were found competent and nursing care was rated high. Information regarding treatment and surgery were not provided to one third of total patients. In current study patients were also highly satisfied. There was no significant association between gender, education and employment with satisfaction from nursing care because every patient is treated equally and provide quality of care. Nurses of private sector hospitals were very professional and competent that's why patients were very satisfied from nursing care as compared to above mentioned studies. In current study the satisfaction level was very good but need some recommendation to raise patient satisfaction to the highest possible level. As following: a) Nursing manager should do ongoing monitoring of patient satisfaction specific to nursing services b) Communication skills of nurses should be emphasized particularly interpersonal skills c) Nursing training institutions should strengthen skills of students. This study was certain limitation such as convenient sampling technique was used which may be a source of selection bias. Due to which generalizability of findings is potentially limited, secondly the study was conducted only in medical and surgical wards of the hospital. Finally the study was focused only on patient admitted in ward however not focused on ICU patient.

Conclusion
The study was conducted to assess the satisfaction level of patient in private tertiary care hospital Peshawar KP. In this study, satisfaction level of patient from nursing care was high while few participants were dissatisfied. Type of ward, education, hospital stay and gender were not determined to affect satisfaction level. Routine greeting, caring time, giving information regarding disease, keeping privacy, medication timing and taking vital signs were appreciated. Few participants were not satisfied with information regarding action, side effect of medication and relaxation therapy. Furthermore present study addressed need of some recommendation for nurses to improve patient satisfaction