Patient Satisfaction - a Concept Analysis Within Nursing Care

Patient Satisfaction: A Concept Analysis within Nursing Care

Kimberly Koziol

Loyola University Chicago

Abstract

In today’s market, patient satisfaction is critical for a health care system’s success. Patient satisfaction is a significant gage of value of treatment. Consumers have the ability to choose any healthcare system and patient satisfaction is publicly reported. Hospitals must maintain superior levels of patient satisfaction in order to remain viable. Nurses have the most personal contact with patients. Therefore, patient satisfaction largely affects nursing. Defining the meaning of patient satisfaction in relation to nursing will create a foundation for continued nursing research on this concept and increase awareness of nurses’ influence on patient satisfaction. Walker and Avant’s process of concept analysis for nurses provided framework for this paper. Data was retrieved from the Cumulative Index of Nursing and Allied Health Literature, Pub Med and Google Scholar. Most References were limited to those published within the last 5-7 years. Defining attributes discussed are affective support, health information, decisional control and professional competencies. Model, contrary and borderline cases were also used to illustrate the understanding of patient satisfaction. Additionally, temporal variables of the individual, personal and environmental qualities of the patient are reviewed to further define the concept. A great deal of literature and tools are published on the concept of patient satisfaction but few articles are focused on nursing, revealing a need for further studies and instruments linking nursing and patient satisfaction.

        Keywords: Patient satisfaction, nursing care, concept analysis

Introduction

The health care environment is becoming progressively competitive. (Shore, 2007) In the past, health care providers believed they understood the needs of their patients based on professional guidelines and their evaluation. Today, providers place more attention on patient satisfaction due to ever-rising costs and constantly increasing patient demands. Patients are now regarded as healthcare consumers rather than receivers of healthcare. (Wagner & Bear, 2008) In order to be successful, healthcare systems need to recognize and comprehend what influences patients to identify quality healthcare and be satisfied with a health care environment. (Liu & Wang, 2007)

Nursing care gains even more significance with patient satisfaction, because nurses encompass the largest part of hospital staff and are continually positioned at the side of the patient to fulfill their needs (Merkouris, Papathanassouglou & Lemonidou, 2004). The only healthcare service having a direct relationship with overall patient satisfaction is nursing. (Wagner & Bear, 2008) There seems to be an agreement, amongst the literature, concerning the value of nursing services in the shaping of overall patient satisfaction with healthcare services. (Wagner & Bear, 2008)

Patient satisfaction is a major indicator of quality nursing care. (Wagner & Bear, 2008) Surveys rating patient satisfaction are available to all healthcare customers, making research of customer satisfaction with nursing crucial for health care systems. Development of effective and dependable tools to determine patient satisfaction is essential in nursing. (Lynn, McMillan & Sidoni, 2007) Clarifying the definition of this concept is essential to construct these tools and progress nursing knowledge and its influence on healthcare today (Wagner & Bear, 2008).

Definition and Historical Background

Developing a definition for patient satisfaction, particularly in relation to nursing, is a constantly evolving undertaking. In 1957, Abdellah and Levine established the initial instrument to measure customer satisfaction in patients. Although, the tool did not particularly contain satisfaction with nursing care, nursing was incorporated as complete hours of nursing support available (Abdellah and Levine, 1957). Risser first created an instrument to measure patient satisfaction with nursing care in 1975. It included technical and professional behavior of the nurse, interpersonal manifestations of the nurse, trust and education as qualifications to satisfaction with nursing care. Quality and satisfaction became interwoven in the 1980s (Hinshaw & Atwood 1981, Donabedian 1988). In 1981, Hinshaw & Atwood (1981) defined patient satisfaction as “the patient’s opinion of the care received from nursing staff” (p. 170). Donabedian (1988) defined it as “an expression of a patient’s judgment on the quality of care in all its aspects, but particularly as it concerns the interpersonal process” (p. 1746).

Beside patient satisfaction, having a large correlation to nursing care, research also links it to the expectations of the patient. In 1975, Risser explained patient satisfaction as, “the degree of congruency between a patient’s expectations of ideal nursing care and the patient’s perception of the real nursing care the patient receives,” (p. 46).  Patient satisfaction’s working definition, given by Mrayyan (2007) is, “the degree to which nursing care meets patients’ expectations in terms of art of care, technical quality, physical environment, availability and continuity of care, and the outcomes of care,” (p. 226).

In 1996, Mahon wrote a concept analysis of patient satisfaction as it relates to nursing care. Eight attributes were identified: art of care, technical quality of care, convenience, cost, environment, resources, continuity of care and outcomes. This concept analysis was not theorized within nursing structure was therefore, built on by Wagner and Bear in 2008. Wagner and Bear analyzed the concept of patient satisfaction in relation to nursing care in nursing framework to broaden the science of nursing. Cox’s (1982) Interaction Model of Client Health Behavior (IMCHB) was used to guide their analysis. This nursing model presents a structure for evaluating the distinctive combinations of individual characteristics of a patient in order to establish the most favorable nurse interaction with the patient to accomplish positive health results (Wagner & Bear, 2008).

Defining Attributes

Attributes establish a true meaning of a concept by specifying its properties and traits. The IMCHB classifies affective support, health information, decisional control and professional competencies as the attributes of nursing care that guide patient satisfaction (Wagner & Bear, 2008).

Affective support is the capability to soothe anxieties through interventions and aid (Cox, 1982). Interpersonal characteristics of nursing has consistently been emphasized, in recent literature, as an element of patient satisfaction. According to Liu and Wang, satisfaction is reported when the patient perceives personal, pleasant and distinctive care. More developed analysis suggests patients are gratified with experiences of caring, supportive, considerate, compassionate and sympathetic nurses (Liu & Wang, 2007).  

Health information is the data disclosed to the patient about their health condition, its influence on their daily life and management options (Cox, 1982). Information about their health care, treatment and medication is valuable to patients (Eriksson & Svedlund, 2007). Typically, the more a nurse educates a patient, the higher the patient satisfaction. On the other hand, decreased patient satisfaction is noted when a patient perceives inadequate education was given by the nurse (Eriksson & Svedlund, 2007).

Decisional control is the consumer’s expectation to take part in the management of their health care. This includes their objectives, treatment and strategy to reach their goals (Cox, 1982). According to Kremer, Ironson, Schneiderman and Hautzinger (2007), patients have superior outcomes when engaged in determining their treatment. Consumers also report greater patient satisfaction when nurses notify them of what is occurring with their treatment.

Professional competencies characterize the practical skills nurses present to fulfill consumer demands (Cox, 1982). According to Mrayyan (2007), some patients identify nurses as skilled experts. Nurses that display proficiency in professional skills concerning medication administration, procedures and clinical knowledge receive superior patient satisfaction scores then nurses who do not display these characteristics (Liu & Wang, 2007). Patient satisfaction with nursing care directly relates with nursing quality but some patients believe they are incapable of evaluating technical properties of nursing and identify quality nursing in relation to nursing traits like attitude and professional appearance (Lynn, McMillan & Sidoni, 2007).  

Case Studies

Identifying a model case is significant and provides a clear example of the concept. The purpose is to improve the understanding of the concept by demonstrating its characteristics in applicable situations and provide a valuable presentation of the concept (McEwen & Wills, 2011). The intention of a contrary case is to identify a clear example of an instance that is not the concept. The borderline case is an example of the use of the concept in which some of but not all the critical attributes are present. The following cases are derived from actual work experiences. The names of the participants are fictitious to respect the privacy of the patients.