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Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis.

Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital.

Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis.

Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV).

Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2012. , 94 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2012:2
Keyword [en]
emotion, external care conditions, inpatient, patient perspective, patient satisfaction, person-related conditions, quality of care
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-9023ISBN: 978-91-7063-406-2 (print)OAI: oai:DiVA.org:kau-9023DiVA: diva2:471271
Public defence
2012-02-24, Lagerlöfsalen 1A 305, Karlstads universitet, Karlstad, 11:00 (Swedish)
Opponent
Supervisors
Available from: 2012-01-26 Created: 2012-01-02 Last updated: 2016-04-13Bibliographically approved
List of papers
1. Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions
Open this publication in new window or tab >>Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions
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2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17/18, 2540-2551 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions. Background. Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis. Design. A cross-sectional design. Method. A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used ( p < 0·05). Results. The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high. Conclusions. Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice. Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-9305 (URN)10.1111/j.1365-2702.2011.03810.x (DOI)000293748900016 ()
Available from: 2012-01-24 Created: 2012-01-24 Last updated: 2017-12-08Bibliographically approved
2. Exploring patient satisfaction predictors in relation to a theoretical model
Open this publication in new window or tab >>Exploring patient satisfaction predictors in relation to a theoretical model
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2013 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 1, 37-54 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2013
Keyword
Patient satisfaction, Healthcare quality, Public health service, Norway, Service delivery
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-9160 (URN)10.1108/09526861311288631 (DOI)
Available from: 2012-01-11 Created: 2012-01-11 Last updated: 2017-12-08Bibliographically approved
3. A pattern approach to analysing patients’ satisfaction and quality of care perceptions in hospital
Open this publication in new window or tab >>A pattern approach to analysing patients’ satisfaction and quality of care perceptions in hospital
2011 (English)In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 1, no 4, 766-775 p.Article in journal (Refereed) Published
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-9145 (URN)
Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2017-12-08Bibliographically approved
4. Patients' experiences of care quality and satisfaction satisfaction during hospital stay: a qualitative study
Open this publication in new window or tab >>Patients' experiences of care quality and satisfaction satisfaction during hospital stay: a qualitative study
2013 (English)In: European Journal for Person Centered Healthcare, ISSN 2052-5656, Vol. 1, no 1, 185-192 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objectives: Patients experiencing high care quality and satisfied patients are more likely to follow treatments. Patient satisfaction is an important contributor to physical and mental health-related quality of life. Research emphasises the need to further study satisfaction from the patients’ perspective. The aim was to describe patients’ experiences of care quality and the relation to their satisfaction during hospital stay. 

Methods: A qualitative descriptive design was used. Interviews were conducted with 22 patients discharged from hospital. Data was analysed by conventional content analysis.

Results: Four categories and seven subcategories describing patients’ experiences of care quality and the relation to their satisfaction emerged. Desire to regain health comprised waiting for treatment, being cured, having hopes of being cured and described the treatment and health outcome of hospitalisation. Need to be met in a professional way as a unique person comprised receiving personalized knowledge, receiving healthcare by competent healthcare personnel and described the way patients need to be met by healthcare personnel. Need to be involved comprised taking responsibility for own health, leaving responsibility for own health and concerned the patients’ way of handling hospitalisation. Need to have balance between privacy and companionship concerned the relationship to fellow patients.

Conclusions: Health condition is of great importance to patients’ experiences of quality of care and their satisfaction in relation to hospital stay. The healthcare personnel need to be aware that seriously ill patients may never be completely satisfied. Furthermore, healthcare personnel must do their utmost to provide the patients with person-centered care.  Hospital managers must consider the design of wards with respect to such matters as multiple-bed versus single-bed rooms and heads of nursing must carefully plan each patient’s accommodation.

National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-9307 (URN)10.5750/ejpch.v1i1.650 (DOI)
Available from: 2012-01-24 Created: 2012-01-24 Last updated: 2017-12-06Bibliographically approved

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