Journal of Biology, Agriculture and Healthcare ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol 2, No.

6, 2012

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A study to evaluate the level of satisfaction perceived by postnatal mothers following nursing care in postnatal wards as expressed by themselves: pilot study
Jipi Varghese 1 (Corresponding Author), K.Rajagopal 2 1.PhD Researcher in obstetrics and gynecology nursing ,Yenepoya University, University road , Derlakkate 575018, Mangalore Karnnataka India Tel :+91469-2-677180 E-mail(Corresponding Author) :[email protected] 2.HOD and consultant in department of obstetrics and gynecology ,Yenepoya medical college, Yenepoya University, University road , Derlakkate 575018, Mangalore Karnnataka India Abstract A descriptive study was conducted to evaluate the level of satisfaction perceived by postnatal mothers following with nursing care in postnatal wards as expressed by themselves and to determine the association between patient's satisfaction with nursing care and selected sociodemographic variables .Purposive sampling technique was employed to select sample and it consisted of 100 postnatal mothers who met the inclusion criteria .Jipis postnatal satisfaction with nursing care questionnaire (JPSNQ) which contained structured questionnaire schedule and demographic proforma was used to collect data. The questionnaire was classified under six domains namely orientation, information, communication, comfort and care, specific to postnatal care and value and preference of postnatal mothers with the total of 39 . Findings of the study showed that (39%) of postnatal mothers were moderately satisfied and (60%) of postnatal mothers were minimally satisfied and (1 %) of postnatal mothers were satisfied with the care provided by the nursing personnel. They were highly satisfied in the area of value and preference. The least satisfaction was found in the area related to orientation. Patients' opinions regarding their expectations and their satisfaction with nursing care can be considered as an important opportunity for nurses to plan and implement appropriate strategies that improve the quality of nursing care. Keywords: Postnatal mothers, Satisfaction ,Nursing care 1.Introduction Health care providers are expected to be accountable for the quality of their work to clients, institution, profession and to the society as a whole. Patients satisfaction is one of the medical document that medical services at public and private hospital have been under increasing strain to meet the expectation of the patient as consumers, because medical care has come to the ambit of services under consumer protection act. So it is necessary to monitor quality services in the hospital by the management. Assessment of care adequacy must go beyond the usual measures of structure, process and outcome variables to include consumer evaluation of quality, indeed any evaluation of care outcome may be incomplete without including outcomes as perceived by the patients (Kumar R 2003). Patient satisfaction with nursing care is one of the 21 indicators identified by the American Nurses Association as having a strong theoretical link to the availability and quality of professional nursing services in hospital settings(Bolton L.B et al. 2003). As per the regional committee report submitted by government of India, WHO Described various aspect of the maternal care include care during pregnancy, childbirth and care of mother and child after birth .In the current practice of care, consideration is made not only to the physical and physiological needs but also to the emotional and social needs of the women and her unborn baby. Over the past decades health services organization and infrastructure have undergone changes and expansion with a view to improve the maternal and child health services

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(Waldenstrom U, Rudman A, and Hildingsson 2006). A study done by Waldenstrom et al., (2006) revealed that 26% of women were not satisfied with postpartum care .Researchers have developed several indicators to measure quality of health care services based on patients' health outcomes. In maternal-child nursing practice, patient satisfaction has been widely recognized as one of the critical indicators of the quality and the efficiency of the health care systems (Johansson et al., 2002). 2. Objectives of the study The objectives of the study are to: 1) 2) determine the postnatal mothers satisfaction with care provided by nursing personnel as expressed by them. find association between the postnatal mothers satisfaction with selected demographic variables.

3. Hypothesis H1=There will be significant association between postnatal mothers level of selected demographic variables. 3. Methodology A descriptive study was carried out in selected hospitals of dakshina kannada district, Mangalore Karnataka state India. Sample consisted of 100 postnatal mothers admitted in the postnatal unit and they were selected by purposive sampling technique. Inclusion criteria was as following mothers who can speak and write Kannada or English ,postnatal mothers who stay in hospital for 3 or more day ,mother who have undergone full term normal delivery ,and who have received care from diploma nurses(GNM) who have minimum 2 years' experience in postnatal unit. Exclusion criteria were mothers who are not willing to participate, mothers and newborn with medical conditions, those undergone caesarean section and who do not speak or write kannada. Data was collected by administration of Jipis postnatal satisfaction with nursing care questionnaire (JPSNQ) related to postnatal satisfaction with nursing care which included six domains namely orientation ,information, communication ,comfort and care ,specific to postnatal care and value and preference of postnatal mothers with 39 items and 10 items in demographic proforma. 3.1 Data Analysis Data was analyzed using Statistical Package for Social Sciences version (SPSS) 17.0. Descriptive and inferential statistics were used to analyze the demographic data. 4. Results 4.1 Table 1 and 2 shows the distribution of sample according to their demographic data: Most (30 %) of the postnatal mothers belongs to the 22-26 years age group. Most (52%) of the antenatal mothers were Muslims and as (28%) of the postnatal mothers were Hindus. (72 %) belonged to nuclear family. (39 %) of the postnatal mothers completed their high schooling as their educational qualification. Most (94%) of postnatal mother choose the particular hospital because of the availability of good doctors. Where as (33%) of postnatal mothers selected the particular hospital because of quality care by the staff nurses.
4.2 Table 3 describes the distribution of subject according to their overall satisfaction level

satisfaction with nursing care and

The data presented in table 4 shows that (39%) of postnatal mothers were moderately satisfied and (60%) of postnatal mothers were minimally satisfied and (1 %) of postnatal mothers were satisfied with the care received by them.
4.3 Table 4 enumerates the association between postnatal mothers level of satisfaction and selected demographic variables

The data presented in table 4 shows that computed chi-square values of postnatal mothers with selected variables like age,religion ,type of family, occupation ,dietary pattern,obstetrical score were not significant at 0.05 level.

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Therefore, null hypothesis was accepted and research hypothesis was rejected .The data presented in table 4 shows that the computed chi-square values of postnatal mothers with selected variables like educational qualification ,monthly income , reason for previous admision to the hospital were significant at 0.05 level. Therefore null hypothesis was rejected as research hypothesis was accepted. 4.4 table 5 Description of postnatal mothers level of satisfaction in the areas of care in terms of maximum possible score mean, standard deviation and mean percentage. The table presented in table 5 describes the mean percentage scores were calculated as the minimum and maximum possible scores in each of care which ranged from 4 to 68.The data also shows that the mean percentage distribution of scores is highest in area of value and preference (62.25%) and lowest in orientation (48 %).The dispersions of scores in the area of specific to antenatal & postnatal care i.e. (SD=5.353) were more dispersed when compared to other areas of care. 5. Conclusion Findings of the study showed that (39%) of postnatal mothers were moderately satisfied and (60%) of postnatal mothers were minimally satisfied and (1 %) of postnatal mothers were satisfied with the care provided by the nursing personnel. They were highly satisfied in the area of value and preference . The least satisfaction was found in the area related to orientation. Hence the investigator found that there is a need to improve the quality of care provided by the nursing professionals which is only possible through periodic evaluation of the same. 6. Limitation Purposive sampling technique was used to select the samples, which limits generalizability of study findings. Study results are limited to Indian population. 7. Suggestions:1. Attempt can be made to evaluate the services provided by nursing personnel that would serve as an indicator of effectiveness of services in terms of quality of care. 2. A study to evaluate the services of nursing personnel can be conducted in every departments of the hospitals where nurses are indulged in providing care. 7. Recommendation The following recommendations are made based on the present study for future study; The study may be replicated on a larger sample. A comparative study may be undertaken between a hospital catering to rural population and a hospital catering to urban population. Similar study may be conducted to find the level of satisfaction between Primiparae and multiparae mothers in maternity wards.

References Bolton L.B. Aydin CE. Donaldson N.Brown D.S, Nelson MS, Harms D. Nurse staffing and patient perceptions of nursing care. J.Nurs Adm.2003. Nov; 33(11):607-14. Kumar R. Patient satisfaction document .J Acad Hosp Adm 2003; 15(1):54-6. Johansson P., Olni M., and Fridlund B. (2002): Patient satisfaction with nursing care in the context of health care: a literature study. Scandinavian Journal of Caring Sciences, 16,337-344. W H O. Health of the underprivileged reproduction of country information paper submitted by government of India .1990 Waldenstrom U, Rudman A, and Hildingsson,I., (2006): Intrapartum and postpartum care in Sweden: women's opinions and risk factors for not being satisfied.; 85(5):551-60.

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Jipis postnatal satisfaction with nursing care questionnaire (JPSNQ). INSTRUCTION TO THE INTERVIEWER / RESPONDE PLEASE TICK ( ) MARK IN THE APPROPRIATE COLUMN ACCORDING TO THE MOTHERS RESPONSE. TOOL: 1 DEMOGRAPHIC PROFORMA Code No 1.Age in Years. a) 18 -22 b) 22 26 c) 26 30 d) 30 and Above 2.Religion a) Hindu b) Muslim c) Christian d) others 3.Type of Family a) Nuclear b) Extended / Joint 4.Educational Qualification. a) No formal Schooling b) Primary School c) High School d) Collegiate Education e) Any other specify 5.Monthly Income a) Below 2000 b) 2001 to 4000 c) 4001 to 6000 d) 6001 and above 6.Occupation a) Coolie d) Agriculture d) Business d) Employee e) Any other specify 7.Dietary pattern a) Pure vegetarian b) Vegetarian (consumes egg) c) Non vegetarian 8.Obstetrical score. a) Gravida d) Para c) Living d) Abortion e) Still birth :

( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( (

) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) )

( ( ( (

) ) ) )

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9.Previous admission to hospital. a) 0 months - 6 months back b) 7 months 1 year back c) 2 years 5 years back d) 5years 8 years back 10.Reason for choosing this hospital. a)Modern facilities available. b) Quality care by the staff nurses c) Referred from camp/other hospital clinics d) Convenient e) Availability of good doctors f) Any other reasons specify

( ( ( (

) ) ) )

( ( ( ( ( (

) ) ) ) ) )

Tool II BASED ON YOUR EXPERIENCE AS A PATIENT IN THIS HOSPITAL, PLEASE ( MARK WHETHER YOU ARE FULLY SATISFIED ( FS), MODERATELY SATISFIED ( MS), MINIMALLY SATISFIED(MnS),SATISFIED(S) NOT SATISFIED (NS). I. ORIENTATION S.L.NO 1 ITEM I was given a warm welcome and made me comfortable on admission. 2 I was oriented to the health team members and postnatal unit. 3 I was oriented to toilet , bathroom, washing area and availability of safe drinking water. 4 I was oriented about visiting hours for family and doctors. II. INFORMATION 5 6 I was informed about ward routines I was informed regarding rules & regulations of the hospital. 7 Nurses used to convey message, which I hesitated to ask my doctor. 8 I was informed about informed consent before any procedure III. COMMUNICATION: S.L.NO 9 10 11 ITEM All my questions were answered promptly with positive attitude. Nurses maintained a good IPR with myself and my family members. Nurses communicated in my own language and were free to talk. FS MS MnS S

) TICK

NS

FS

MS

MnS

NS

FS

MS

MnS

NS

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12

Nurses answered all doubts asked by me concerning my treatment results and prognosis

V. COMFORT AND CARE S.L.NO 13 14 15 16 ITEM I got help when needed Nurses were calm and approachable. Nurses assisted me in keeping myself clean & groomed I felt safe and secured throughout the day and night during my hospital stay. 17 There was no noise at night in the ward VI. SPECIFIC TO POSTNATAL CARE. S.L.NO 18 19 20 21 22 23 ITEM I was assisted to go to toilet and got information regarding personal hygiene during postnatal period. I was assisted in perineal toilet and informed regarding how to keep my perineum hygienic . I was assisted in early ambulation. The nurses checked my vital signs regularly. I was taught about involution of uterus I was explained how to take care of my breast and minor breast problem in postnatal period & its management. I was informed regarding nutrition, sleep and rest in postnatal period. My medication / treatment was administered at proper time I was told regarding lochial flow and was told how to detect excessive bleeding during puerperal period . I was advised about postnatal exercise. I was assisted with episiotomy care and told how to detect signs and symptoms if infection and how to detect it. I was informed about the methods & importance of family planning and postnatal follow up visits. I was assisted with giving bath and diaper care cord and eye care and detect signs and symptoms of infection in my baby. I was taught about the importance of colostrum and exclusive breast feeding I was assisted to position my baby during and after feeding and was taught to burp my baby after breast feeding. Nurses taught me to detect sign and symptoms of FS MS MnS S NS

FS

MS

MnS

NS

24 25 26 27 28

29 30

31 32

33

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neonatal conditions. 34 I was taught about rooming in ,bonding and attachment 35 I was educated about immunization and weaning of my baby. VII. VALUE & PREFERENCE FOR POSTNATAL MOTHERS S.L.NO 36 37 38 39 ITEM Staff nurse treated me with dignity and respect. Staff nurses talked to me to find my values and preference for care. In future if there is a need for my treatment I would prefer this hospital. Ill recommend this hospital to my friends and relatives. FS MS MnS S NS

Table 1: Frequency and percentage distribution on selected sample characteristics of postnatal mother based on Demographic data N=100
Demographic Variables Sample Characteristics 18-22 22-26 26-30 30 and above Hindu Muslim Christian Nuclear Joint No formal schooling Primary school High school Collegiate Education Below 2000 2001 to 4000 4001 to 6000 6001 and above Pure vegetarian Vegetarian- consumes egg Non vegetarian Coolie Agriculture Business Employee Gravida G1 G2 G3 Para P0 P1 P2 Postnatal mothers F 29 30 28 13 28 52 20 72 28 7 35 39 19 1 14 58 15 8 38 54 10 36 39 15

Age in Years

Religion Type of Family

Educational Qualification Monthly Income

% 29 30 28 13 28 52 20 72 28 7 35 39 19 1 14 58 15 8 38 54 10 36 39 15

Dietary pattern

Occupation

Obstetrical Score

29 54 17 35 84 17

29 54 17 35 84 17

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Demographic Variables

Sample Characteristics Living Lo L1 L2 Abortion A0 Still birth Nil

Postnatal mothers 35 48 17 94 6 100 F 43 29 27 1 35 48 17 94 6 100 % 43 29 27 1

Previous admission to hospital. a) 0 months - 6 months back b) 7 months 1 year back c) 2 years 5 years back d) 5years 8 years back

Table 2: Frequency and percentage distribution on selected sample characteristics of postnatal mother based of their reason for choosing this hospital.
10. reason for choosing this hospital. Modern facilities available. Quality care by the staff nurses Referred from camp/other hospital clinics Convenient Availability of good doctors Any other reasons specify yes f 84 33 84 95 94 9 % 84 33 84 95 94 9 no f 52 67 52 5 6 91 % 52 67 52 5 6 91 total f 100 100 100 100 100 100 % 100 100 100 100 100 100

Table 3 : Distribution of subject according to their overall satisfaction level Group Moderately satisfied Minimally satisfied Satisfied Total Postnatal Mothers Frequency 39 60 1 100 Percent 39.0 60.0 1.0 100 Total 39.0 60.0 1.0 100

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Table 4: Association between postnatal mothers level of satisfaction and selected demographic variables
Overall satisfaction Demographic variables Total Less than median (101) Age 18-22 22-26 26-30 30 and above Total Religion Hindu Muslim Christian Total 16 12 15 6 49 26 15 8 49 More than median (101) df 2

13 18 13 7 51 26 13 12 51

29 30 28 13 100 52 28 20 100

1.691 p=.639

No association 2 0.903 p=.637 No association

Type of family 1. Nuclear 2. Joint Total Educational qualification No formal school Primary school High school Collegiate education Total Monthly Income 1. Below 2000 2. 2001 to 4000 3. 4001 to 6000 Total

37 12 49

35 16 51

72 28 100

0.587 p=.443 No association

10 23 79 7 49

4 12 23 12 51

14 35 32 19 100

*13.435 p=.004

There is association 9.766 p=.008

31 7 11 49

27 20 4 51

58 27 15 100

There is association

Occupation Agriculture Business Employee Others Total

4 15 21 9 49

6 21 18 6 51

10 36 39 15 100

3 2.192 p=0.543 No association

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Dietary Pattern 1.Pure vegetarian 2. Vegetarian (consumers egg) 3. Non vegetarian Total Obstetrical score Gravida Once Twice Thrice Total

4 19 26

4 19 28

8 38 54

0.034 p=.983

49

51

100

No association

12 28 9 49

17 26 8 51

29 54 17 100

0.955 p=.620

No association

Para P0 P1 P2 Total Living L0 L1 L2 Total Abortion Nil Total Previous admission to hospital 0 months - 6 months back More than two years Total Modern facilities Yes No Total Quality care by staff nurses Yes No Total Availability of good doctors Yes No Total

15 25 9 49

20 23 8 51

35 48 17 100

0.817 p=.665 No association

15 25 9 49 46 3 49 19 16 14 49 17 32 49

20 23 8 51 48 3 51 24 13 14 51 31 20 51

35 48 17 100 94 6 100

0.817 p=0.665 No association

0.000 P=1.000 No association

2 43 29 28 100 48 52 100 1

0.852 P=0.653

No association 6.815 p=0.009 There is association 6.890 p=0.009 There is association 6.815 p=0.009 There is association

39 10 49 17 32 49

28 23 51 31 20 51

67 33 100 48 52 100

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Table 5: Description of postnatal mothers level of satisfaction in the areas of care in terms of maximum possible score, mean, standard deviation ,median and mean percentage.
Areas N Minimum Maximum Max possible score 20 20 20 25 90 20 Mean SD Median Standard error Mean %

1.Orientation 2.Information 3.Communication 4.comfort and care 5.postnatal care 6. value and preference

100 100 100 100 100 100

4 7 4 5 39 6

17 16 16 22 68 16

9.78 10.08 9.15 11.97 48.79 12.45

2.048 1.824 1.882 3.413 5.353 2.231

9.50 10.00 9.00 11.00 47.00 13.00

0.205 0.182 0.188 0.341 0.535 0.223

48% 50.40% 56.75% 55.88% 54.21% 62.25%

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