Abstract
Aim
To assess patients' satisfaction with the quality of nursing care and the relationship between patients' characteristics and their level of satisfaction.
Design
A descriptive correlational cross‐sectional design was used in this study.
Methods
Convenient sampling was utilized to include 1014 inpatients from six hospitals in Jordan: three private hospitals; two governmental hospitals; and one university‐affiliated hospital. The data collection process occurred from September 2022 to January 2023. The data were collected using the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire. The data were analysed using Pearson correlation, t‐test, one‐way ANOVA and multiple hierarchal regression.
Results
The study included 1014 patients with an average age of 51.3 (SD = 18.6), and 59.9% were females. More than two thirds of the sample reported having health insurance, and 62.7% were unemployed. The mean total score of patients' satisfaction with nursing care quality (NCQ) was 68.2 (SD = 12.9), indicating high satisfaction. Higher‐income levels (p < 0.001), higher education levels (p = 0.003), having health insurance (p < 0.001), being admitted to private hospitals (p < 0.001), being admitted to critical care units (p = 0.002), being in a single room (p = 0.001), excellent perceived health status (p < 0.001) and willingness to recommend the hospital to family and friends (p < 0.001) were significant predictors of patients' satisfaction with NCQ.
Conclusions
Patient and hospital environment characteristics affected patients' satisfaction with NCQ. Hospital management should consider these characteristics to improve patient satisfaction and outcomes.
Implications for the Profession and/or Patient Care
Policymakers and hospital management should consider improving the physical environment of their facilities to improve patients' satisfaction. Continuous professional development should emphasize nurses' communication skills to enhance their abilities to deliver information to their patients.
Impact
This study examined levels and predictors of patients' satisfaction with the quality of nursing care. The results indicated that improving patients' satisfaction can be achieved by focusing on areas of nurses' communication skills and explaining information to patients.
Reporting Method
The study adhered to STORBE guidelines for reporting observational studies.
Patient or Public Contribution
Hospitalized patients contributed to the data of this study. Hospital administrators facilitated its implementation.
Keywords: healthcare, hospitals, Jordan, nursing care, patient satisfaction
1. INTRODUCTION
Quality of care is how healthcare services achieve the desired health outcomes and meet the empirical evidence of practice. Quality of care can be evaluated by assessing the presence of effective, safe, patient‐centred, equitable and efficient services (World Health Organization, 2020). Poor‐quality healthcare has a wide range of negative consequences for the patient and the healthcare system. These can include physical and mental health issues, such as increased pain, suffering and disability, and decreased quality of life (Zimbudzi et al., 2018). Poor quality healthcare also leads to decreased patient trust in the healthcare system, which leads to a decline in both the patient's quality of life and satisfaction with the treatment (Birkhäuer et al., 2017). Poor‐quality healthcare is associated with increased medical errors, resulting in severe injury or death (Rodziewicz et al., 2018), and in developing countries, it has been associated with millions of deaths annually (World Health Organization, 2020).
For the healthcare system, poor quality healthcare can lead to decreased patient satisfaction, which may affect the number of patients seeking healthcare. Patient satisfaction indicates the degree to which a patient is fulfilled with the received healthcare services. Patient satisfaction with nursing care in hospitals is an essential indicator of the quality of care. Hospitals must ensure that their nursing staff provide patients with the highest quality of care (Alharbi et al., 2023; Goh et al., 2016). Nurses compose the largest proportion of the healthcare industry; thus, the quality of nursing care is a significant indicator of patient satisfaction (Butler et al., 2019; Karaca & Durna, 2019). Studies have shown that patients satisfied with nursing care are more likely to have positive outcomes and fewer complications (Baumbach et al., 2023; Kennedy et al., 2014; Papastavrou et al., 2014). Poor‐quality nursing care was associated with medication errors, urinary tract infections, patient falls, pressure ulcers and critical incidents (Recio‐Saucedo et al., 2018). Patient satisfaction with nursing care is also essential in determining a hospital's financial success.
2. BACKGROUND
Studies have shown that hospitals with higher patient satisfaction ratings tend to have higher patient volumes and reimbursement rates (Baumbach et al., 2023; Tevis et al., 2015). Patient satisfaction with nursing care can increase patient loyalty and referrals, leading to increased revenue for the hospital (Chen et al., 2022). In previous studies, patients' satisfaction with nursing care was found to be related to several factors, including educational status and history of admission, overall hospital quality of care, recommending the hospital to families and friends, self‐rated health and frequency of hospitalization (Al‐Awamreh & Suliman, 2019; Sharew et al., 2018) and hospital size (Kennedy et al., 2014). On the other hand, Abdel Maqsood et al. (2012) found no association between patient satisfaction with nursing care and sociodemographic variables, including age, gender, marital status and education.
Studies examining patients' satisfaction with quality nursing care in Middle Eastern and developing countries indicated several important factors that affect satisfaction levels. Alharbi et al. (2023) reported that patients' satisfaction in Saudi Arabian hospitals varied significantly according to patients' characteristics, such as age, education, marital status, employment and urban/suburban residency; younger patients, patients with lower levels of education, divorced/widowed patients, unemployed patients and patients who lived in suburban areas were more satisfied with the quality of nursing care. These findings were consistent with some studies in the Middle East and developing countries, such as Oman, Jordan and Turkey (Al‐Awamreh & Suliman, 2019; Albashayreh et al., 2019; Karaca & Durna, 2019). However, some inconsistencies were indicated in other studies. For example, in Saudi Arabia, Al Qahtani et al. (2015) reported that patients with higher education were more satisfied with nursing care.
On the other hand, two studies in India and Iran reported no significant association between patients' education levels and satisfaction (Parizad et al., 2021; Shinde & Kapurkar, 2014). In Jordan, Abdel Maqsood et al. (2012) assessed patients' satisfaction with nursing care in a convenience sample of 250 patients from different wards in a private hospital in Amman. They found that patients were more satisfied with the technical and ethical aspects of nursing care and less satisfied with the professional information provided by nurses (Abdel Maqsood et al., 2012). Using the Patients' Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), Al‐Awamreh and Suliman (2019) examined patients' satisfaction with nursing care in a sample of 377 thalassemia patients in public hospitals in Jordan. The results showed that patients were more satisfied with nursing skills and competencies, ease of getting information, responses to patients' calls and privacy. On the other hand, these patients were less satisfied with the structure of the units and the method of dispensing medication. A significant association was found between patients' satisfaction with nursing care and overall quality of care at the hospital, recommending the hospital to families and friends, self‐rated health and frequency of hospitalization. Measuring patients' satisfaction with quality nursing care could effectively improve nursing care by facilitating the creation of standards of care. Many Jordanian hospitals have recently undergone quality improvement projects and have been accredited nationally and internationally to improve patient care. The inconsistent findings in the recent literature on patient satisfaction with quality nursing care in the Middle Eastern and developing countries and the need for more recent research in Jordan require further examination of the factors that affect satisfaction levels.
3. STUDY AIMS AND OBJECTIVES
This study aimed to assess patients' satisfaction with quality nursing care and the relationship between patients' characteristics and their level of satisfaction. The study's objectives were to describe patients' satisfaction with the quality of nursing care, examine the differences in patients' satisfaction according to specific characteristics and examine the predictors of patients' satisfaction with nursing care quality (NCQ).
4. METHODS
4.1. Design
A descriptive correlational cross‐sectional design was used to describe Jordanian patients' satisfaction with NCQ.
4.2. Instrument with validity and reliability
The first part of the questionnaire included questions about patients' demographic information and personal characteristics. The questions addressed gender, marital status, level of education, employment status, monthly income, health insurance, type of hospital, chronic disease, type of ward, patient escort, number of patients in the same room, self‐rated health status, recommending the hospital to family and friends, age, days from the last admission and number of admissions in the previous 2 years.
Patient satisfaction with nursing care was measured using the Arabic version of the PSNCQQ (Albashayreh et al., 2019). The original English version of the PSNCQQ is a 19‐item questionnaire measuring patients' satisfaction with NCQ on a 5‐point Likert scale ranging from poor (score = 1) to excellent (score = 5), with a possible range of scores between 19 and 95. It is intended to measure the patients' satisfaction based on the quality of nursing care they received during their hospital stay. A higher score indicates higher levels of patient satisfaction. Two items that asked about patient discharge were not included in the Arabic version since that version applied to inpatients before discharge (Albashayreh et al., 2019). The instrument contains two additional items related to the overall quality of care and hospital recommendation (Laschinger et al., 2005). The questionnaire's items represent two dimensions: items 1–5 represent satisfaction with the provided information, while the remaining items reflect satisfaction with the provided care (Albashayreh et al., 2019). A total mean score of patients' satisfaction with NCQ was calculated for the study sample. The PSNCQQ‐Arabic version was tested previously for content validity. The item content validity index (CVI) ranged from 0.83 to 1, and the scale CVI/ave was 0.94. Also, the Cronbach's alpha was excellent (0.96) (Albashayreh et al., 2019).
4.3. Sampling and recruitment
Jordan has four types of hospitals: 96 private hospitals (36.1% of total bed capacities); 32 governmental hospitals (35%); 15 military hospitals (21%); and two university‐affiliated hospitals (7.9%) (Ministry Of Health, 2020). Three private hospitals (265, 160 and 200 beds), two governmental hospitals (436 and 151 beds) and one university‐affiliated hospital (544 beds) were conveniently selected based on bed capacities and admission rates. The study included these hospitals' medical, surgical, critical care, gynaecological, postpartum and intermediate care units. A convenient sampling design included the participants from the selected hospitals. All eligible patients in the selected hospitals were invited to participate in the study.
4.4. Sample size and power
The sample size was estimated using a survey sample formula (Taherdoost, 2017). The selected confidence interval was 95%, indicating a 5% chance of error. The selected margin of error was three, indicating an accepted precision level. These parameters were selected because this study is social research with an estimated population size of 15,003 (based on the total bed capacities in Jordanian hospitals) (Ministry of Health, 2020). The required sample size was at least 996 patients.
4.5. Inclusion and exclusion criteria
The inclusion criteria for the participants were: having at least 2 days of hospital stay; having a stable condition or planned for discharge; having the cognitive ability to assess the hospital environment and their experience with the hospital; being willing to participate; and being able to read and write Arabic. Exclusion criteria included: patients in unstable conditions or cognitively impaired; and patients in specialized units with less than 2 days of hospital stay.
4.6. Data collection
Data collection began after obtaining Research Ethics Committee approval. Data were collected using a self‐administered questionnaire using Google Forms. Trained data collectors were available at the bedside and provided the patients with tablets connected to the Internet to facilitate questionnaire filling. The questionnaire included a description that provided the participant with information about the study purpose, data collection procedure and the rights of the participants, followed by a consent statement that must be checked for acceptance before answering the instrument questions. The data collectors were available during the data collection process for any inquiries. A total of 1300 patients were invited to participate in the study, and 1014 were included, with a 78% response rate. The data collection was conducted between September 2022 and January 2023.
4.7. Data analysis
Data were analysed using the Statistical Package for the Social Sciences version 22 (IBM Corporation, 2012). Descriptive statistics were calculated to describe patients' characteristics and the questionnaire items. Pearson correlation, t‐test and one‐way ANOVA were used to test the significant correlations and differences in patients' satisfaction scores with patient characteristics. Scheffe post hoc test for one‐way ANOVA was used to identify significant differences between groups. A two‐step multiple hierarchal regression analysis was used to identify the predictors of patient satisfaction with NCQ. The significance level was set at α ≤ 0.05. Test assumptions, including normality, independence, homogeneity of variances and multicollinearity, were checked and met as the following: patient satisfaction was a continuous and normally distributed variable; the study observations were independent; the lack of random sampling was mitigated by including variant types and locations of hospitals; an equal variance was not assumed as Levene's test was not significant; and the VIF values for all the covariates in the regression models were at acceptable levels.
5. RESULTS
5.1. Subjects
A total of 1014 patients participated in the study. The ages of the patients ranged from 18 to 92 years, with a mean of 51.3 (SD = 18.6). Females composed 59.9% of the sample. Most of the sample reported having health insurance (71.4%), and the unemployed composed 62.7% of the sample. The average hospital stay for patients in the study was 4.7 days (SD = 5.2), and 2.7 was the average number of admissions (SD = 3.2). See Table 1.
TABLE 1.
Demographic characteristics of patients (N = 1014).
| Variable | n | % |
|---|---|---|
| Gender | ||
| Male | 407 | 40.1 |
| Female | 607 | 59.9 |
| Marital status | ||
| Single | 170 | 16.8 |
| Married | 712 | 70.2 |
| Divorced | 22 | 2.2 |
| Widowed | 110 | 10.8 |
| Level of education | ||
| Primary education | 270 | 26.6 |
| Secondary school | 277 | 27.3 |
| Diploma | 140 | 13.8 |
| Bachelor | 304 | 30 |
| Higher education | 23 | 2.3 |
| Employment status | ||
| Employed | 378 | 37.3 |
| Not employed | 636 | 62.7 |
| Monthly income in JOD a (n = 912) | ||
| Low income (below 352) | 274 | 27 |
| Middle income (between 352 and 825) | 502 | 49.5 |
| High income (more than 825) | 136 | 13.4 |
| Health insurance | ||
| Yes | 724 | 71.4 |
| No | 290 | 28.6 |
| Type of hospital | ||
| Private | 380 | 37.5 |
| Governmental | 339 | 33.4 |
| University‐affiliated hospital | 295 | 29.1 |
| Chronic disease | ||
| Yes | 664 | 65.5 |
| No | 350 | 34.5 |
| Type of ward | ||
| Medical | 483 | 47.6 |
| Surgical | 313 | 30.9 |
| Gynaecological and postpartum | 118 | 11.6 |
| Critical care | 72 | 7.1 |
| Intermediate care | 28 | 2.8 |
| Patient escort | ||
| Yes | 758 | 74.8 |
| No | 256 | 25.2 |
| Number of patients in the same room | ||
| Alone | 410 | 40.4 |
| With another patient | 282 | 27.8 |
| With many patients | 322 | 31.8 |
| Self‐rated health status | ||
| Excellent | 152 | 15 |
| Very good | 455 | 44.9 |
| Good | 343 | 33.8 |
| Fair | 57 | 5.6 |
| Poor | 7 | 0.7 |
| Recommend the hospital to family and friends | ||
| Strongly agree | 485 | 47.8 |
| Somewhat agree | 209 | 20.9 |
| Agree | 233 | 23 |
| Somewhat disagree | 45 | 4.4 |
| Strongly disagree | 42 | 4.1 |
| Variable | M | SD |
| Age | 51.3 | 18.7 |
| Days from the last admission | 4.7 | 5.2 |
| Number of admissions during the last 2 years | 2.7 | 3.2 |
1 JOD = 1.41 USD.
5.2. Patient satisfaction with nursing care quality
The mean total score of patients' satisfaction with NCQ is 68.2 (SD = 12.9), with scores ranging from 19 to 85. The analysis also showed that 50% of the patients scored 61 to 79. The mean item score was 4.01, ranging from 3.39 to 4.43, indicating that patients' satisfaction with NCQ was excellent. The item that received the highest mean scores was ‘Provisions for your privacy by nurses’ (m = 4.43, SD = 0.88). The item that received the lowest scores was ‘How well the nurses kept them informed about your condition and needs’ (m = 3.39, SD = 1.46).
The mean overall satisfaction with the quality of nursing care was 4.01 (SD = 0.88), while the overall satisfaction with care and services was 3.91 (SD = 1.01). Most patients (91.7%) either agreed, somewhat agreed or strongly agreed that they would recommend the hospital based on the nursing care they received. See Table 2.
TABLE 2.
Patients' satisfaction with nursing care quality items (N = 1014).
| No. | Item | Poor n (%) | Fair n (%) | Good n (%) | Very good n (%) | Excellent n (%) | M (SD) |
|---|---|---|---|---|---|---|---|
| 1 | Information you were given: how clear and complete the nurses' explanations were about tests, treatments and what to expect | 37 (3.6) | 85 (8.4) | 192 (18.9) | 379 (37.4) | 321 (31.7) | 3.85 (1.07) |
| 2 | Instructions: how well nurses explained how to prepare for tests and operations | 47 (4.6) | 86 (8.5) | 189 (18.6) | 375 (37) | 317 31.3 | 3.82 (1.1) |
| 3 | Ease of getting information: willingness of nurses to answer your questions | 17 (1.7) | 52 (5.1) | 157 (15.5) | 351 (34.6) | 437 (43.1) | 4.12 (0.96) |
| 4 | Information given by nurses: how well nurses communicated with patients, families and doctors | 17 (1.7) | 39 (3.8) | 206 (20.3) | 398 (39.3) | 354 (34.9) | 4.02 (0.96) |
| 5 | Informing family or friends: how well the nurses kept them informed about your condition and needs | 191 (85) | 85 (8.4) | 175 (17.3) | 262 (25.8) | 301 (29.7) | 3.39 (1.46) |
| 6 | Involving family or friends in your care: how much they were allowed to help in your care | 26 (2.6) | 26 (2.6) | 228 (22.5) | 391 (38.6) | 343 (33.8) | 3.99 (0.94) |
| 7 | Concern and caring by nurses: courtesy and respect you were given; friendliness and kindness | 10 (1) | 19 (1.9) | 101 (10) | 356 (35.1) | 528 (52.1) | 4.35 (0.81) |
| 8 | Attention of nurses to your condition: how often nurses checked on you and how well they kept track of how you were doing | 16 (1.6) | 43 (4.2) | 176 (17.4) | 381 (37.6) | 398 (39.3) | 4.09 (0.93) |
| 9 | Recognition of your opinions: how much nurses ask you what you think is important and give you choices | 50 (4.9) | 89 (8.8) | 224 (22.1) | 345 (34) | 306 (30.2) | 3.76 (1.12) |
| 10 | Consideration of your needs: willingness of the nurses to be flexible in meeting your needs | 25 (2.5) | 51 (5) | 191 (18.8) | 350 (34.5) | 397 (39.2) | 4.03 (1) |
| 11 | The daily routine of the nurses: how well they adjusted their schedules to your needs | 11 (1.1) | 50 (4.9) | 172 (17) | 408 (40.2) | 373 (36.8) | 4.07 (0.91) |
| 12 | Helpfulness: ability of the nurses to make you comfortable and reassure you | 24 (2.4) | 48 (4.7) | 179 (17.7) | 396 (39.1) | 367 (36.2) | 4.02 (0.97) |
| 13 | Nursing staff response to your calls: how quick they were to help | 35 (3.5) | 119 (11.7) | 163 (16.1) | 305 (30.1) | 392 (38.7) | 3.89 (1.14) |
| 14 | Skill and competence of nurses: how well things were done, like giving medicine and handling IVs | 8 (0.8) | 26 (2.6) | 110 (10.8) | 396 (39.1) | 474 (46.7) | 4.28 (0.81) |
| 15 | Coordination of care: the teamwork between nurses and other hospital staff who took care of you | 19 (1.9) | 35 (3.5) | 183 (18) | 416 (41) | 361 (35.6) | 4.05 (0.91) |
| 16 | Restful atmosphere provided by nurses: amount of peace and quiet | 22 (2.2) | 38 (3.7) | 176 (17.4) | 347 (36.9) | 404 (39.8) | 4.08 (0.95) |
| 17 | Privacy: provisions for your privacy by nurses | 19 (1.9) | 24 (2.4) | 88 (8.7) | 252 (24.9) | 631 (62.2) | 4.43 (0.88) |
| 18 | Overall quality of care and services you received during your hospital stay | 26 (2.6) | 67 (6.6) | 217 (21.4) | 370 (36.5) | 334 (32.9) | 3.91 (1.01) |
| 19 | Overall quality of nursing care you received during your hospital stay | 12 (1.2) | 39 (3.8) | 203 (20) | 433 (42.7) | 327 (32.2) | 4.01 (0.88) |
| Variable | M (SD) | Min–Max | 25th percentile | 50th percentile | 75th percentile | ||
| Patient satisfaction with nursing care quality | 68.2 (12.9) | 19–85 | 61.0 | 68.0 | 79.0 | ||
5.3. Differences in patients' satisfaction with nursing care quality
There was a significant negative relationship between patients' age and their perceived satisfaction with NCQ (r = −0.06, p = 0.046). No significant correlations were found in patients' satisfaction with NCQ based on the number of days from the last admissions and the number of admissions in the last 2 years.
The t‐test results showed that significant differences in patient satisfaction with NCQ were found with the availability of health insurance, the employment status of the patients and patients' level of education. Patients who did not have health insurance reported significantly higher satisfaction levels than patients who had insurance, and employed patients reported significantly higher perceived NCQ than unemployed patients. There were no significant differences in patients' satisfaction with NCQ based on gender, presence of chronic illnesses or patient escort.
ANOVA test results showed statistically significant differences in patients' satisfaction with NCQ in relation to the patient's level of education, monthly income, hospital type, ward type, number of patients in the same room, levels based on self‐rated health status and patient's willingness to recommend the hospital to family and friends. See Table 3.
TABLE 3.
Differences in patients' satisfaction based on selected personal characteristics (N = 1014).
| Patients' satisfaction with nursing care quality | ||||
|---|---|---|---|---|
| Variable | Group | Mean | Test result | p‐value |
| Health insurance | t = −7.60 | <0.001 | ||
| Yes | 66.34 | |||
| No | 72.99 | |||
| Employment status | t = −2.14 | 0.033 | ||
| Employed | 69.37 | |||
| Unemployed | 67.57 | |||
| Monthly income in JOD a (n = 912) | F = 217.20 | <0.001 | ||
| Low income (below 352) | 56.59 | |||
| Middle income (between 352 and 825) | 68.87 | |||
| High income (more than 825) | 77.14 | |||
| Level of education | F = 7.44 | <0.001 | ||
| Primary education | 68.11 | |||
| Secondary school | 66.37 | |||
| Diploma | 65.66 | |||
| Bachelor | 70.71 | |||
| Higher education | 75.17 | |||
| Hospital type | F = 186.36 | <0.001 | ||
| Private | 76.68 | |||
| Governmental | 65.02 | |||
| University‐affiliated hospital | 61.07 | |||
| Wards | F = 5.59 | <0.001 | ||
| Critical care | 74.33 | |||
| Intermediate care | 71.61 | |||
| Surgical | 68.55 | |||
| Gynaecological and postpartum | 67.20 | |||
| Medical | 67.19 | |||
| Number of patients in the same room | F = 139.67 | <0.001 | ||
| Patient alone | 75.38 | |||
| With another patient | 65.17 | |||
| With many patients | 61.84 | |||
| Self‐rated health status | F = 37.36 | <0.001 | ||
| Excellent | 77.32 | |||
| Very good | 69.07 | |||
| Good | 64.65 | |||
| Fair | 59.23 | |||
| Poor | 66.57 | |||
| Recommend the hospital to family and friends | F = 116.78 | <0.001 | ||
| Strongly agree | 74.71 | |||
| Somewhat agree | 65.70 | |||
| Agree | 63.62 | |||
| Somewhat disagree | 51.93 | |||
| Strongly disagree | 49.26 | |||
1 JOD = 1.41 USD.
5.4. Predictors of patients' satisfaction with nursing care quality
A two‐step multiple hierarchal regression analysis was generated to assess predictors of patients' satisfaction with NCQ, controlling for selected demographics of the patients (see Table 4). In Model 1, the patient's satisfaction with NCQ was entered into the model as a dependent variable in addition to selected demographics (i.e. age, gender, marital status, educational level, employment status, monthly income and chronic illnesses). The model was significant (F (7,904) = 63.82, p < 0.001) and explained 32.6% of the variance in the patient's satisfaction with NCQ. Monthly income, educational level and employment status were significant predictors. In Model 2, having health insurance, type of hospital, type of ward, number of patients in the same room, self‐rated health status and recommending the hospital to family and friends entered the model. The model remained significant (F(13,898) = 100.05, p < 0.001) and explained 58.6% of the variance in patients' satisfaction with NCQ. Significant predictors in Model 2 were as follows: monthly income, level of education, having health insurance, type of hospital, type of ward, number of patients in the same room, self‐rated health status and recommending the hospital to family and friends. The amount of variance change was 26.1%.
TABLE 4.
Predictors of patients' satisfaction with nursing care quality (N = 1014).
| Covariate | Model 1 | Model 2 | ||||
|---|---|---|---|---|---|---|
| Beta | T | p | Beta | t | p | |
| Age | −0.05 | −1.11 | 0.266 | −0.04 | −1.09 | 0.227 |
| Gender | 0.02 | 0.62 | 0.538 | 0.02 | 0.93 | 0.355 |
| Monthly income in JOD | 0.56 | 20.04 | <0.001 | 0.31 | 12.60 | <0.001 |
| Marital status | 0.01 | 0.29 | 0.775 | −0.01 | −0.12 | 0.902 |
| Educational level | −0.07 | −2.02 | 0.044 | −0.08 | −2.96 | 0.003 |
| Employment status | 0.11 | 3.16 | 0.002 | 0.04 | 1.38 | 0.169 |
| Having chronic illnesses | 0.04 | 1.23 | 0.220 | −0.01 | −0.19 | 0.849 |
| Having health insurance? | −0.12 | −4.65 | <0.001 | |||
| Type of hospital | −0.32 | −10.16 | <0.001 | |||
| Type of ward | 0.07 | 3.08 | 0.002 | |||
| Number of patients in the same room | −0.10 | −3.31 | 0.001 | |||
| Self‐rated health status | 0.14 | 6.03 | <0.001 | |||
| Recommend the hospital to family and friends | 0.37 | 15.90 | <0.001 | |||
6. DISCUSSION
This study examined the patients' satisfaction with NCQ and identified its predictors. The analysis indicated high overall patient satisfaction with NCQ since all the items were reported above the scale's midpoint. Patients who reported the significantly highest levels of satisfaction with NCQ were as follows: younger patients; patients who reported not having health insurance; employed patients; patients with higher education levels; patients with higher income levels; patients admitted to private hospitals; patients admitted to critical care units; patients who rated their health status as excellent; and patients who were willing to recommend the hospital to family and friends. Significant predictors of patient satisfaction with NCQ were monthly income, level of education, health insurance, type of hospital, type of ward, number of patients in the same room, self‐rated health status and recommendation of the hospital to family and friends.
The analysis of the findings revealed that the mean total score of patients' satisfaction with NCQ was 68.2, and the mean item score was 4.01, indicating a generally positive perception of the care provided by nursing staff. These results highlight the importance of ongoing efforts to improve NCQ while acknowledging the successes already achieved. Similar results were reported in previous studies in Turkey and Saudi Arabia (Alharbi et al., 2023; Karaca & Durna, 2019). In the study conducted by Alharbi et al. (2023), 400 patients were randomly selected to examine their satisfaction with NCQ. The average items score for patient satisfaction with NCQ ranged from 2.31 to 3.9, with an average score of 3.26 (SD 0.64). This indicated that patients in the study reported positive perceptions of NCQ, as did patients in the current study. Also, Karaca and Durna (2019) conducted a cross‐sectional study with a sample of 635 patients discharged from a private hospital. This study revealed that the average item scores for patients' satisfaction with NCQ ranged from 1 to 4.05, with an average score of 1.61, indicating high levels of satisfaction with nursing care, as did the patients in the current study. The authors used different scoring systems for the questionnaire, assigning higher numbers for lower satisfaction levels (i.e. 1 = excellent, 2 = very good, 3 = good, 4 = fair and 5 = poor). In the current study, patients reported the highest satisfaction with nurses' courtesy and respect and how nurses give medicine and handle intravenous fluids. In another study that included 635 patients in a Turkish hospital, patients reported the highest satisfaction with nurses' courtesy, respect and quick response to patient calls (Karaca & Durna, 2019). In another study conducted in Saudi Arabian hospitals and which included 238 patients, Alharbi et al. (2023) found that patients were most satisfied with nurses' courtesy and respect and nurses' explanations regarding patients' treatments and tests.
On the other hand, the findings of this study indicated that patients were least satisfied with how nurses informed patients about their condition and asked them about their views and choices. In the study by Karaca and Durna (2019), the patients were least satisfied with nurses' explanations regarding their treatments and tests and how they asked patients about their views and choices. In the Alharbi et al. (2023) study, patients were least satisfied with how nurses respond to calls for help and how they inform patients about their condition. Patients in all of these studies showed the highest satisfaction with nurses' courtesy and respect, an essential professional interpersonal skill for nurses that affects patient satisfaction. On the other hand, patients were less satisfied with the information provided by nurses about their health condition, test results and prognosis. It is worth mentioning that providing supportive information for the patient is a significant role of nurses (Strini et al., 2021).
In this study, younger patients were more satisfied with the quality of nursing care. Similar findings were reported in a previous study (Karaca & Durna, 2019). However, other studies indicated that older people were more satisfied with healthcare than younger people (Alharbi et al., 2023; Guo et al., 2022). This could be due to nurses' lack of understanding or underestimating older adults' needs, which are usually more demanding than those of younger adults. In addition, the results indicated that patients with higher socioeconomic status were more satisfied with NCQ. These results were similar to previous studies in Saudi Arabia and Oman (Al Qahtani et al., 2015; Albashayreh et al., 2019). On the contrary, patients with lower education levels were more satisfied in other studies conducted in Saudi Arabia (Alhowaymel et al., 2022) and Turkey (Karaca & Durna, 2019). Patients with higher socioeconomic status may have access to more information and a better quality of life, which might increase their satisfaction with nursing care.
A lack of health insurance significantly predicted better patient satisfaction with nursing care. However, this result contradicts previous literature (Wudu, 2021). It is possible that patients without health insurance usually visit private hospitals and pay out of their own pocket, come from high socioeconomic levels and receive exceptional care compared to patients with health insurance. In the current study, patients in private hospitals were more satisfied than those in governmental or university‐affiliated hospitals. This finding was similar to a study in Ethiopia in 2021, where patient satisfaction was relatively higher among private and public hospital patients (Dinsa et al., 2022). Patients in critical care units reported higher satisfaction with nursing care compared to other types of wards. Direct nursing care is a major component that contributes to patient satisfaction with nursing care (Butler et al., 2018; Goodrich & Lazenby, 2023). In the critical care unit, the nurse‐to‐patient ratio is 1:2, allowing nurses to spend more time providing direct patient care and enhancing patient satisfaction (Hong & Cho, 2021). Patients who were admitted to a single patient room were more satisfied with nursing care than patients who were admitted to a room with another patient or those admitted with other patients; this is consistent with the findings of a previous study conducted in public hospitals in Ethiopia (Ahmed et al., 2014). Patients who recommended the hospital to their family and friends and those who perceived their health as excellent were more satisfied than their counterparts. These results are consistent with previous (Alharbi et al., 2023; Alhowaymel et al., 2022).
6.1. Strengths and limitations
This study utilized a cross‐sectional design; thus, no causal relationships can be inferred among study variables. Further, this study examined patients' satisfaction with nursing care from the patient's point of view. As this study included a convenient sampling method, the sample might not be sufficiently varied or represent all patient populations. In addition, this sampling design might affect the study's external validity and limit the findings.
6.2. Recommendations for further research
Future studies that examine patients' family satisfaction and nurse satisfaction with NCQ could be beneficial. Qualitative studies are recommended to understand in‐depth factors that affect patients' satisfaction with NCQ.
7. CONCLUSION
Patients' satisfaction with NCQ is relatively high and is affected by patients' demographic and hospital environment characteristics. Income, educational level, health insurance, type of hospital, admission unit, type of admission room, self‐rated health status and willingness to recommend the hospital to family and friends significantly predicted patient satisfaction with NCQ. This study indicates important implications for practice for healthcare providers, policymakers and researchers. It found that several patient characteristics, including younger age, higher income and higher education, significantly predict higher patient satisfaction with NCQ. This suggests that healthcare providers should consider these demographic factors when designing nursing care plans and interventions to improve patient satisfaction.
Admission to a private hospital, an intensive care unit and a single patient room significantly influenced higher patient satisfaction with NCQ. This highlights the importance of the physical environment in which nursing care is delivered. Healthcare providers should consider the design and layout of their facilities when developing strategies to improve patient satisfaction. Finally, patients who reported a better self‐rated health status were more likely to be satisfied with NCQ. This suggests that healthcare providers should prioritize interventions to improve patients' health and well‐being. Therefore, nurses can then improve the quality of care, leading to better patient outcomes and a more satisfied patient population. Patients in the current study were less satisfied with the nurses' role in providing supportive information for them. Continuous education in hospitals should focus on nurses' communication skills as this affects their vital role in providing their patients with needed information, especially for older patients.
AUTHOR CONTRIBUTIONS
We confirm that all listed authors meet the authorship criteria. All authors have made substantial contributions to all of the following: (i) conception and design or analysis and interpretation of data; (ii) drafting the article or revising it critically for important intellectual content; and (iii) final approval of the version to be published. All authors approved the final version for submission.
FUNDING INFORMATION
This research was funded by The Specialty Hospital, Amman, Jordan.
CONFLICT OF INTEREST STATEMENT
There are no competing interests associated with this study.
ETHICS STATEMENT
Research Ethics Committee approval was obtained from the Scientific and Research Committee at (REDACTED). Also, ethical consent was obtained from the Ministry of Health for Governmental Hospitals (REDACTED) and directly from the selected private (REDACTED) and university‐affiliated hospitals (REDACTED). Participation was voluntary, and patients were informed that their responses would be confidential. The anonymity of the participants was ensured throughout the study. Patients were informed that no identifying data would be requested from them. All submitted questionnaires were stored in the researcher's Google Drive. No one except the researcher has access to the data. The front page of the questionnaire contains the study objectives, confidentiality issues and the guarantee of the respondents' anonymity and privacy, in addition to the consent statement that must be checked for acceptance before filling out the questionnaire. Data were secured in a password‐protected computer.
ACKNOWLEDGEMENTS
Not applicable.
Al‐Hammouri, F. , Hamdan, K. M. , Haymour, A. M. , Ibrahim, M. O. , Malkawi, A. , Al‐Hiary, S. S. , Albqoor, M. A. , & Shaheen, A. M. (2024). Quality of nursing care: Predictors of patient satisfaction in a national sample. Nursing Open, 11, e2252. 10.1002/nop2.2252
DATA AVAILABILITY STATEMENT
The datasets generated during and/or analysed during the current study are available from the corresponding author on request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated during and/or analysed during the current study are available from the corresponding author on request.