ORIGINAL ARTICLE

Surgical patient satisfaction:

nursing care quality index
Georgia Giannakopoulou1, Maria Tsironi2, Panagiotis Prezerakos3,
Theofanis Fotis4, Eleni Giannakopoulou5, Sofia Zyga6

1. Nurse, MSc, General Hospital of Sparta, Sparta, Greece 2. Associate Professor, Faculty of Human
Movement and Quality of Life Sciences, Department of Nursing, University of Peloponnese, Sparta, Greece
3. Assistant Professor, Faculty of Human Movement and Quality of Life Sciences, Department of Nursing,
University of Peloponnese, Sparta, Greece 4. Lecturer, Faculty of Human Movement and Quality of Life
Sciences, Department of Nursing, University of Peloponnese, Sparta, Greece 5. Scientific Collaborator
of Technological Institution of Crete, School of Management & Economics, Department of Accounting,
Crete, Greece 6. Assistant Professor, Faculty of Human Movement and Quality of Life Sciences, Department
of Nursing, University of Peloponnese, Sparta, Greece

Corresponding author
Sofia Zyga, Assistant Professor, University of Peloponnese, Faculty of Human Movement and Quality of
Life Sciences, Department of Nursing, Leonidou 3, Sparta Lakonias, Greece, Tel:+30 2731 089 725,
E-mail:[email protected]

ABSTRACT

Introduction: Patient satisfaction is a quality indicator for the health services provided by a hospital, and
also the principal method for the evaluation and feedback of the system used for measuring quality of
service.
The οbjective of this study was to estimate the level of the services offered by the General Hospital of
Sparta and the investigation of patients' satisfaction before and after their treatment. Moreover, the
current work was intended to investigate whether the specific demographics of respondents, such as
gender, age, place of residence and their level of education affect their satisfaction about the services,
provided by the nursing staff during their stay in the hospital.
Material and Method: The sample of this study was 93 patients, hospitalized in the Surgical Department.
The collection of the questionnaires was conducted by personal interviews. As research tools, the Scale
of measurement of patient satisfaction about nursing care (MPSS) was used in addition with questionnaire
with socio-demographics evidence. In order to perform the statistical analysis, the statistical software
SPSS 14.0 was used.
Results: The majority of patients in the sample were women (51.6%). Their educational level was relatively
low, since approximately 31.5% rate of the participants had only compulsory education. 47.3% of patients
described that their state of health is a small degree of serious while only 7.5% of patients responded
that it is very serious. The effectiveness of public hospitals in Greece was considered as good by the 71%
of the participants and as very good by the 22.6% of them.34,4% of them stated that they were very satisfied
with the assistance given to them by the nursing staff regarding their everyday needs, such as personal
hygiene, dressing and creating a comfortable environment. The 31,2% of patients were very satisfied
about the help, provided by the nursing staff while 28% of patients were extremely satisfied. Five people
(5,4%) replied that stayed in a small extent satisfied, while just one person (1,1%) replied that the help
of nursing personnel for the daily needs was not satisfied at all.

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Conclusions: Although the study has highlighted some problems and some areas needing improvement,
the overall picture is very positive for the General Hospital of Sparta to the extent that the largest percentage
of patients was satisfied with the provided services. The information process seems to be improved, since
it is an important moral and legal right of patients. The measurement of patient satisfaction should be
continued in order to allow comparisons and evaluation of the impact of various interventions in its
modulation.
Keywords: Patient satisfaction, quality, nursing care, health services.

INTRODUCTION The study was an exploratory-descriptive research

I
n the competitive environment of the health care and was conducted between August 2011 and October
system, there is an increasing interest on the 2011. Patient’s population included 93 people hospitalized
assessment and the measurement of the quality of in the surgical wards of the General Hospital of Sparta,
the provided health care services. Despite the fact that, Greece. The collection of data was made by a randomized
in order to measure the quality of the provided health stratified method. For the conduct of the study, the
care services, the health care professionals have used authors used the Munich Patient Satisfaction Scale
many tools, the patient’s satisfaction, remains one of (MPSS) which has been weighed by Associate Professor
the most reliable tools although the fact that some Anastasios Merkouris. The study has been approved
authors have questioned in the past the reliability of by the hospital’s ethical committee (Merkouris 1999).
this tool, due to patient’s lack of technical knowledge, The assessment of the provided health care services
psychological situation at the time of investigation, concerned the nursing personnel and the Likert scale
culture diversions and due to different perspectives was used. The Likert scale included the following levels
between patients and health care professionals of satisfaction: 5: «not at all satisfied», 4; «just satisfied»,
(Donabedian 1980,1982,1988; Walker and Restuccia,1984; 3: «fairly satisfied», 2: «very satisfied» and 1; «totally
Vuori,1987; Hall and Dornan,1988; Waltz et al.,1991; satisfied». At the end there was an open question where
Greeneich et al., 1992). each patient had the opportunity to express his/her own
So a number of authors have agreed in the past, that opinion. Furthermore there was a custom made questionnaire,
patient’s attitudes over their treatment, should be taken specific for this study, for the collection of the demographic
seriously on account when the quality of the provided data by face to face interview, after the patients have read
health care services is being measured and furthermore the information booklet and signed the informed consent.
it has been agreed that one of the most important
indicators for the measurement of the quality, is actually STATISTICAL ANALYSIS
patient’s satisfaction (Schulmeister et al., 2005; Zineldin, Data were analyzed using SPSS 11.0 for Windows (SPSS
2006; Zyga, 2010). These findings have led many hospitals Inc., Chicago, IL). Descriptive statistics, including mean,
to the direction of giving to their patients the opportunity median, ranges, and standard deviation values, were
to decide on their own the way they will be treated in calculated for all the continuous baseline demographic
terms of hospitality and be part of the decision making and clinical characteristics. Statistically significant
process (Cleary and McNeil, 1988; Megivern et al., 1992; correlations of the satisfaction, age, level of education
Greeneich et al., 1992; Sitzia and Wood, 1997; Rao et were evaluated with the chi-square test (Pearson x2)
al., 2006). and the Fisher exact test. A statistically significant
The purpose of the current research was to investigate correlation was demonstrated if the maximum likelihood
the satisfaction of the surgical patients in a specific ratio criterion had a P value less than. 05.
hospital, by answering questions on how much satisfied
the patients are for the nursing care they get and to RESULTS
investigate potential correlations between satisfaction Ninety-three patients with a median of 4.37 (2 to 20)
and other demographic data. days of hospitalization were questioned in order to
measure the level of their satisfaction. The median age
was 49 (12 to 96) years old, where 51.6% were men and
PATIENTS AND METHODS 48.4% were women. As it concerns their level of education,
This publication is a part of a master level dissertation 31.2% were only primary school graduates, 23.7% high
conducted at the University of Peloponnese, Sparta school and only 20.4% of them had graduated from a
Greece. university.

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RELIABILITY OF THE INSTRUMENTS concerning to be asked by the nursing staff for their
Before the statistical analysis of the data, the authors informed consent before any treatment.
checked the reliability of the variables they used, with
the Cronbach alpha (a) indicator, where the results DISCUSSION
showed a 0.964, which meant that the used data were Almost all patients were satisfied with the care they
highly reliable. received. These results correspond to the results of other
studies which show that patients are, in general, satisfied
PATIENT SATISFACTION with nursing care (Johansson, 2002; Alhusban, 2009).
Generally the patients found to be 28% totally satisfied, However, in many cases as in this study also, participants’
31.2% very satisfied, 34.4% fairly satisfied, 5.4% and comments suggest that patients might not be dissatisfied
1.1% just and not at all satisfied respectfully, as it with nursing care and/or nurses per se, but rather with
concerns the care that the nursing staff offered them the circumstances under which care was provided.
for their everyday needs (dressing, personal hygiene). Nursing staff shortage, inappropriate facilities, housekeeping
When the relationships between the patient issues and allocation of nursing time to tasks other than
characteristics (age, sex, length of stay, ward, and patient care appeared to form a suboptimal caring
education) and patient satisfaction (MPSS) were environment, within which care could not always be
examined, it was found that the MPSS score showed sufficient for patients’ needs (Merkouris, 2004).
a correlation with the age (P = 0.029) gender (P = 0.030), When comparing wards, the results showed that
and level of education (P = 0.004). The results of the participants in general surgical wards had higher level
multiple linear regression analyses of the data from of satisfaction with nursing care than participants in
the MPSS are shown in Table 1. orthopaedic wards; such a result is consistent with
It has been found that the MPSS score was affected the findings of similar studies (Phi et al., 2002). A
by the severity of the patient’s condition, where the possible explanation for this result might be because
more serious were the patient’s condition, the more of the fact that orthopaedic operations are more technical
satisfied where from the delivered care services by to be explained by nursing staff. Furthermore the kind
the nurses (P= 0.033). The same results found as it of ward where the patient stays plays also a significant
concerned the skills with which nurses perform all role to the satisfaction. Al-Kandari and Ogundeyin
nursing procedures (P= 0.002) and in correlation with (1998) in a study population of 148 patients, concluded
the food’s quality (P= 0.002). The most severed ill that surgical patients where more satisfied in compare
patients would also prefer to be treated by the same with medical patients as it concerned their information
nurses in compare to lees ill patients (P= 0.011). and the areas of nursing responsibility.
The correlation between the days of hospitalization The received information by the patients, in order
and patient satisfaction, showed also that there was to give their informed consent is a crucial factor for
statistically significant difference, whereas the patients their satisfaction. In a literature review by Riitta Suhonen
who stayed longer, where very satisfied by the nursing and Helena Leino-Kilpi (2004) the conclusion was that
measures against their pain (P= 0.000). in most cases the patients are not satisfied by the load
Furthermore statistically significant correlation of information they get as it concerns their condition
was found, between the ward where the patients were and treatment options, and the suggestion was that
hospitalized and their satisfaction. Patient’s stayed at there is a need to put more emphasis on assessing
general surgical wards were more satisfied concerning and evaluating their individual needs.
the information that their relatives were receiving Since the study was conducted in only one peripheral
(P=0.005), and moreover they were more satisfied, Greek hospital, the limitation that the researchers found

Table 1.
Patient characteristics and satisfaction (N=93)
Parameter Field of interest P
Age Received information 0.005
Showed respect 0.038
Gender Recommend the ward 0.031
Effective services 0.025
Education level Help received 0.029
Food quality 0.006

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 ORIGINAL ARTICLE

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APPENDIX

SCALE MEASUREMENT OF SATISFACTION OF PATIENTS WITH THE NURSING CARE (MPSS)

I would like after you think the care provided (to you and / or other patients) to tell us the answer that
best expresses the degree of your satisfaction using the following scale:

Not at all satisfied just satisfied Fairly satisfied Very satisfied Totally satisfied
1 2 3 4 5

1. Help with everyday needs. Such as: personal hygiene, dressing, toilet, 1 2 3 4 5
change position in bed, walking, eating, when you want water, linen, bed
and break-up of a comfortable environment.
2. Nursing procedures or operations. Such as medication, injections, 1 2 3 4 5
venipuncture, sera change, wounds or wound care, changing dressings,
etc. Rate on:
α. The skill with which nurses perform these procedures or operations.
β. Consistency (in terms of hours to be done) by which nurses perform
these procedures or operations.
3. Relief of pain. Application of measures by nurses to relieve pain (eg 1 2 3 4 5
evaluation of pain, presence next to the patient, repositioning, administering
medication, etc.).
4. Information. Information from the nurse: 1 2 3 4 5
a guide for the unit, the section on the first day the patient comes into
the chamber (space, routine, bell).
β. for diagnostic and therapeutic procedures (preparation, when and
what to do, results).
γ. relatives or other close contacts of the patient (eg for the patient and
what they expect from them).
5. Education - Instructions. Education - instructions from the nursing 1 2 3 4 5
staff for the necessary care, both in hospital and after discharge.
6. Response-speed. 1 2 3 4 5
A. how quickly nurses responded to the call for help (bell - signal).
β. how quickly the nurses do to help.
7. Available time. Time nurses spend on general care, compared to the 1 2 3 4 5
one you think would be enough.

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8. Continuity of nursing care. The nursing staff from day to day and from 1 2 3 4 5
shift to shift the situation and know the specifics of each patient.
9. Time for rest and sleep. 1 2 3 4 5
α. measures implemented by the nursing staff to reduce noise (from
other patients, visitors, staff).
β. selection of nursing staff hours or appropriate selection of the patient
time to wake
10. Cleanliness. 1 2 3 4 5
α. room
β. Public areas
11. Food. 1 2 3 4 5
α. quality
β. Choice of food (meeting of personal needs)
γ. temperature
δ. Way and time of serving
ε. Help from nursing staff
12. Kindness of nursing staff 1 2 3 4 5
13. Respect. Attitude of nursing staff show respect (eg, speech pattern, 1 2 3 4 5
protection of exposure of the body, respect for diversity, etc.)
14. Interested - contact.Time nurses spent with patients to discuss, 1 2 3 4 5
listen, understand their problems and to stand by them in difficult
moments.
15. Personal preferences. Whether the nurse takes into account the 1 2 3 4 5
personal desires (eg hours of food, cleaning, visiting, etc.)
16. Participation in care. 1 2 3 4 5
α. Opportunities it gives you the nursing staff to decide about your care.
β. nurses seek authorization from the patient to perform any procedure
or operation relating to caring
17. Professionalism of the nursing staff. 1 2 3 4 5
18. Effectiveness. Overall, how satisfied are you by the nursing service 1 2 3 4 5
and contribution to the betterment of the situation or not your health.

Please fill in the following information:

Hospital …..............…………….............................................…… Ward: ……….....................................………
Age:...................(years). Days of stay: ….................................……
Gender: male ! female ! Residence: city…............................. village….............................
Level of education: elementary ! high school ! college ! university !
How serious you consider your condition: not at all ! fairly ! very ! too !
I know for my condition: nothing ! little ! enough ! many !
The effectiveness of the Greek hospitals is: very bad ! bad ! good ! very good !

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Please tell us in what grade do you agree with the following:

If I need care in the future I would like to be treated by the same nursing staff:
Totally disagree Disagree Neither disagree, Nor agree Agree Totally agree
1 2 3 4 5

As it concerns the nursing staff, I would recommend the same ward to a relative:
Totally disagree Disagree Neither disagree, Nor agree Agree Totally agree
1 2 3 4 5

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